Combination Of Ciprofloxacin Research Articles

105 The success of the early eradication therapy regimens for Pseudomonas aeruginosa in cystic fibrosis

Objectives Pseudomonas aeruginosa (Pa) is the predominant pathogen affecting patients with cystic fibrosis(CF). Antibiotic therapy aimed at eradicating Pa after early lung infection have played a major role in the increasing median survival of CF patients. Method We examined the demographic, clinical and microbiological data of 146 CF patients with firstly Pa isolation from all 630 CF patients following at Hacettepe University Department of Pediatric Pulmonology and evaluated eradication protocols. Results The mean age of the patients was 71.5 months(2–348 months) at first isolation; and 133 patients had symptoms. S. aureus was the most common co-pathogen(n = 64) and malnutrition was the most common comorbid condition(n = 44). The most common treatment choices are two weeks of intravenous ceftazidim-amikacin in severe exacerbation or 3 months of inhaled gentamycin with 3 weeks of oral ciprofloxacin combination in mild exacerbation and asymptomatic patients. We noticed eradication in 47 patients(32%), intermittan colonization in 42 patients(28%) and chronic colonization in 57 patients(40%). FEV1 decline was statistically significant in intermittan colonization and chronic colonization (p = 0.006). The patient's age of older than two years or having symptoms at the first isolation negatively affects the success of treatment. Conclusion It is now generally accepted that early antibiotic treatment of the initial growth of Pa can eradicate the organism, prevent or delay the development of chronic colonization. Relative low success rate of the eradication may be explained because of no reimbursement of inhaled tobramycin and colistin for eradication therapy in our country.

Effect of combination therapy between thyme oil and ciprofloxacin on ulcer-forming Shigella flexneri.

Shigella flexneri is a Gram-negative bacteria that has the ability to invade the epithelium of the colon and cause colon ulcers. The ability of isolated Shigella flexneri from bloody diarrhea to cause colon ulcers was investigated by histopathological examination via oral administration of the bacteria to adult male albino Sprague-Dawley rats. The antibacterial activity of thyme oil, ciprofloxacin, and their combination were evaluated in vitro and in vivo. Oral administration of 12×108 CFU/mL of S. flexneri was able to cause colon ulcers. Thyme oil had the highest antibacterial activity among other investigated oils (minimum inhibitory concentration [MIC] 150µL/L). Ciprofloxacin had the highest antimicrobial activity against S. flexneri (MIC 0.4mg/L). The synergism between thyme oil and ciprofloxacin showed the maximum growth inhibition of S. flexneri. The synergistic activity of thyme oil and ciprofloxacin succeeded in healing the epithelial surface of the colon and decreased the inflammation of the lamina propria; it also decreased the bacterial load in the infected colon, while the commercial drug failed to heal the colon ulcer. Thyme oil, ciprofloxacin, and their combination showed different degrees of effects on the bacterial cell structure by transmission and scanning electron microscopes. The combination of thyme oil and ciprofloxacin gave synergistic activity, which proved to be more effective in inhibiting the growth of ulcer-forming S. flexneri, healing the colon ulcer, and decreasing infiltration of the lamina propria with inflammatory cells.

Therapeutic effect of post-exposure treatment with antiserum on severe fever with thrombocytopenia syndrome (SFTS) in a mouse model of SFTS virus infection

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging viral disease that is endemic in China, Korea and Japan. No effective vaccine or specific treatment for SFTS is currently available. Here, we used a mouse model to examine the effects of ribavirin, site-1 protease inhibitor PF-429242, steroids, and combination of minocycline and ciprofloxacin (MC) on SFTS infection. The antiserum from a patient who recovered from SFTS was also examined for its effect on mice. Administration of antiserum completely protected mice against lethal infection with SFTSV. It could also protect mice from showing clinical signs of the disease due to non-lethal infection. MC-treatment resulted in prolonged survival times during lethal infection. Although other agents had no significant protective effects, they did not provide detrimental effects that could lead to progression of the disease in mice. Our results suggest that antiserum treatment may be clinically useful for post-exposure prophylaxis against SFTSV infection.

Amodiaquine-Ciprofloxacin: a potential combination therapy against drug resistant malaria.

Emergence of malaria parasites resistant to artemisinin necessitates the need for development of new antimalarial therapies. Ciprofloxacin (CFX) a second generation quinolone antibiotic possesses some antimalarial activities. We investigated the in vivo antimalarial activities of CFX in combination with amodiaquine in mice infected with chloroquine-resistant Plasmodium berghei ANKA. Animals were treated orally with 80 or 160 mg kg-1 body weight of CFX alone given twice daily or in combination with amodiaquine (AQ) 10 mg kg-1 body weight. Parasitological activity and survival of the animals were assessed over 21 days. Peak parasitaemia in the untreated control group was 72.51%. Treatment with AQ alone resulted in clearance of parasitaemia by day 4 while treatment with CFX 80 and 160 mg kg-1 alone suppressed parasitaemia by 13.94-54.64% and 35.6-92.7%, respectively. However, the combination of CFX with AQ significantly enhanced response of infection in the animals to treatment (P < 0.05) resulting in complete resolution of parasitaemia throughout follow up period with CFX 160 mg kg-1, delayed recrudescence time with CFX 80 mg kg-1 and significant increase in survival rate of the animals. The results demonstrate beneficial interaction between AQ and CFX which may provide a clinically relevant antimalarial/antibiotic therapeutic option in the management of malaria.

항생제 내성 Enterococcus faecalis에 대한 감태(Ecklonia cava) 추출물의 항균 시너지 효과

【With continuing demand for the development of new, effective and safe therapies, an investigation was carried out to test the efficacy of an antibacterial agent derived from marine edible seaweed. The methanolic extract of Ecklonia cava from marine edible seaweed evinced potential antibacterial activity against Enterococcus faecalis. Among five solvent-soluble fractions of E. cava methanolic extract, the ethyl acetate soluble extract (EtOAc) exhibited the strongest antibacterial activity, with a MIC value of $128{\mu}g/mL $ against E. faecalis strains. Furthermore, a synergistic antibacterial effect between an antibiotic and the EtOAc fraction was assessed using fractional inhibitory concentration (FIC) indices. A combination of ciprofloxacin and the EtOAc fraction resulted in a ${\sum}FIC_{min}$ range of 0.188 and ${\sum}FIC_{max}$ of 0.508 to 563, suggesting that the ciprofloxacin-EtOAc fraction of E. cava combination resulted in an antibacterial synergy effect against E. faecalis.】

Bacteriologic Profile, Antibiotic Regimen and Clinical Outcome of Neonatal Sepsis in a University Teaching Hospital in North Central Nigeria

Background and Aims: Neonatal sepsis is an important cause of morbidity and mortality in Nigeria and in most parts of the world. Consequently, we determined the prevalence of the common bacterial pathogens of neonatal sepsis, their antibiotic susceptibility profiles, antibiotic regimen used in treatment and their clinical outcomes in a resource limited environment. Study Design: This was a prospective cross sectional study. Place and Duration of Study: Study was conducted in the Special Care Baby Unit (SCBU), Original Research Article Onyedibe et al.; BJMMR, 7(7): 567-579, 2015; Article no.BJMMR.2015.363 568 Department of Paediatrics and the Department of Medical Microbiology of Jos University Teaching Hospital (JUTH), Jos, Nigeria between May to December 2011. Methodology: Biological samples were collected from 218 neonates suspected of sepsis (119 male, 99 female). The WHO and the Integrated Management of Childhood Illnesses (IMCI) criteria for suspicion of sepsis were used to select subjects into the study. Samples were processed and analyzed by standard methods in the microbiology laboratory. Antibiotic susceptibility testing was done. The antibiotic regimen used for therapy and subsequent clinical outcomes were documented. Results: Prevalence of culture proven sepsis was 34.4% (75/218). The common isolates were Klebsiella pneumoniae (32%), Staphylococcus aureus (30.7%) and Escherichia coli (10.7%). More than 60% of the K. pneumoniae isolates were resistant to the antibiotics tested. The E. coli and Enterobacter isolates were 100% sensitive to meropenem. The Gram positive isolates were most sensitive to ciprofloxacin (85%). Resistance of S. aureus was 6% to cefotaxime and 61% to ampicillin. A total of 173 (79.4%) neonates were discharged home, 15 (6.8%) were discharged against medical advice and 30 (13.8%) died on admission. The antibiotic regimen with the least mortality was a combination of ciprofloxacin and gentamicin. Conclusion: The cultures in this study showed variable antibiogram with complicated patterns of resistance. In all cases of suspected neonatal sepsis, we recommend culture and sensitivity tests to identify the causative pathogen and initiate specific antibiotic therapy. However, cefotaxime in combination with gentamicin is recommended as first line empirical therapy.

Assessment of the Potential of CFC (Calcium hydroxide Flagyl Ciprofloxacin) for the Rapid Disinfection of Resilon and Gutta-Percha.

Obturating materials exposed to the dental operating environment has been shown to be contaminated, making rapid chair side disinfection mandatory to ensure the sterility of the root canals. The purpose of this study was to investigate the effectiveness of CFC (combination of Calcium hydroxide, Flagyl and Ciprofloxacin) for the rapid disinfection of Gutta-percha and Resilon cones. Seventy new Gutta-percha and Resilon cones were randomly selected, contaminated with Enterococcus faecalis and divided into 4 group according to the irrigant used for disinfection {Group I: 5.25% Sodium Hypochlorite (NaOCl), Group II: MTAD, Group III: 2% Chlorhexidine (CHX), Group IV: CFC (a combination of Calcium hydroxide, Flagyl and Ciprofloxacin)}. All the samples were placed in a centrifuge tube with BHI broth after being washed with sterile water. The samples were then incubated for 7 days at 37(o)C. Samples were randomly plated on Mac Conkey agar plate and the colony count was recorded and the observations were drawn. A 5.25% NaOCl required 1 minute exposure for effective disinfection of all the samples. MTAD could eliminate E.faecalis from gutta-percha samples in 30 seconds whereas it required 1 minute of exposure for Resilon cones. Both 2% CHX and CFC could not disinfect the samples with 1 minute exposure and a minimum of 5 minute exposure was required. A 5.25% NaOCl and Biopure MTAD required less chair side time to disinfect all the samples effectively when compared with 2% CHX and CFC.

Retrieval of Smiley Ball through Gastrotomy in a Saint Bernard Dog - A Case Report

Gastrointestinal foreign bodies are very often seen in pet animals either while playing or due to nutritional deficiencies like pica. A smiley ball was accidentally ingested by a Saint Bernard pup which was retrieved by gastrotomy. The fluid and electrolyte deficits were rectified through preoperative crystalloid infusions. The post operative treatment comprised a combination of ciprofloxacin and metronidazole.

Amodiaquine and Ciprofloxacin Combination in Plasmodiasis Therapy.

Objective. The study was designed to determine the efficacy of combined Amodiaquine and Ciprofloxacin in plasmodiasis therapy. Method. The in vivo antiplasmodial effect of different dosage levels of Amodiaquine, Ciprofloxacin, and their combinations against Plasmodium berghei berghei was evaluated using Swiss albino mice. Results. Amodiaquine (a known antiplasmodial agent) had a fairly significant antiplasmodial effect reducing the parasites for every 100 red blood cells (RBC) from 66 to 16 (75.75%) at the tolerable dosage level of 7.5 mg/kg body weight while Ciprofloxacin (an antibiotic known to have antimalarial effect) showed an insignificant antiplasmodial effect reducing the parasites for every 100 RBC from 65 to 64 (1.53%) at the tolerable dosage level of 10.7 mg/kg body weight. Conversely, the combination therapy of Amodiaquine and Ciprofloxacin had a significant antiplasmodial effect at all the doses administered. The combination of 7.5 mg/kg of Amodiaquine and 12.8 mg/kg of Ciprofloxacin, however, showed the most significant antiplasmodial effect of the doses used reducing the number of parasites per 100 RBC from 60 to 10 (83.33%). Conclusions. Appropriate Amodiaquine and Ciprofloxacin combination will be effective for the treatment of malaria and better than either Amodiaquine or Ciprofloxacin singly at their recommended dosage levels.

Ciprofloxacin-Induced Antibacterial Activity Is Attenuated by Phosphodiesterase Inhibitors

BackgroundCiprofloxacin is a commonly used antibiotic for urinary tract infection that interacts with bacterial topoisomerases leading to oxidative radicals generation and bacterial cell death. Phosphodiesterase inhibitors (PDEis), on the other hand, are commonly used drugs for the management of erectile dysfunction. The group includes agents such as sildenafil, vardenafil, and tadalafil. ObjectivesWe investigated whether PDEi could interfere with the antibacterial activity of ciprofloxacin. MethodsPDEis were tested in several reference bacteria, including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus epidermidis, Acinetobacter baumannii, Proteus mirabilis, and Klebsiella pneumoniae utilizing a standard disc diffusion method and measuring both zones of inhibition and MIC. ResultsResults from both assays indicated that ciprofloxacin demonstrates potent activity against the tested reference bacteria. Additionally, when bacteria were treated with a combination of ciprofloxacin and sildenafil, tadalafil, or vardenafil, the zones of the combination inhibition were significantly reduced, whereas the MIC values were significantly greater than those of ciprofloxacin alone for all tested bacterial strains. In an attempt to examine the mechanism by which PDEis interfere with the action of ciprofloxacin, we utilized the in vitro E coli DNA gyrase cleavage assay. The results showed that PDEi drugs had no effect on ciprofloxacin’s inhibition of E coli gyrase activity. ConclusionsPretreatment of various reference bacterial cells with PDEis largely inhibited the antibacterial activity of ciprofloxacin.

Autoinflammatory Disorder-Associated Pouchitis

Introduction: The autoinflammatory diseases (AInD) have features of systemic inflammation that commonly manifest as fever, rash, arthritis, or serositis of multiple organ systems. The role of autoinflammation in the pathogenesis of pouchitis and its contribution to chronic antibiotic-refractory pouchitis (CARP) are unknown. We describe a 52-year-old woman with UC who underwent proctocolectomy and a 2-stage J pouch surgery at the age of 40 for the treatment of toxic megacolon. The surgery was complicated by anastomotic leak and pelvic abscess that was surgically drained. After surgery, she had symptoms and pouch endoscopy findings consistent with pouchitis that were persistent for years, despite a combination of oral ciprofloxacin 500 mg twice a day and rifaximin 200 mg every day, consistent with CARP. She developed recurrent abscesses in the perianal region on the fourchette of the vagina and was diagnosed with ano-vaginal fistula treated with seton placement. Four years after the pouch surgery, the patient presented with fever, left-sided chest heaviness, and abdominal pain. An echocardiogram showed a moderate pericardial effusion without tamponade, for which she was treated with indomethacin and colchicine. She also had intermittent episodes of fever and arthralgia involving the shoulder, low back, and lower extremities. Genetic testing for nucleotide-binding oligomerization domain-containing protein 2/caspase recruitment domain-containing protein 15 (NOD2/CARD15) revealed 2 mutations: 3020insC and IVS8+158 (Figure 1). She was started on 6-mercaptopurine and celecoxib for the treatment of an AInD, with resolution of the symptoms of fever and arthralgia. This case introduces the concept of “pouchitis with AInD features.” An autoinflammatory etiology should be suspected, and appropriate genetic testing pursued in patients with chronic pouchitis and a spectrum of systemic manifestations that include periodic fevers, arthritis, rash, and serositis. Anti-inflammatory and/or immunosuppressive medications, including colchicine, would be treatment considerations.Figure 1: Structure of the NOD2/CARD15 gene and location of mutations detected in this case (bold). The IVS8+158 variant is rare in Crohn’s disease but characteristic of NOD2-associated autoinflammatory disorder (NAID).

Combining Artesunate-Amodiaquine and Ciprofloxacin Improves Serum Lipid Profile of Mice Exposed to Plasmodium Berghei Berghei

We investigated the effects of combining artesunate-amodiaquine and ciprofloxacin on the serum lipid profile of mice exposed to Plasmodium berghei berghei . The use of this combination for the treatment of febrile illness, suspected malaria and malaria-typhoid coinfection is very common in Nigeria. 60 adult mice and Plasmodium berghei berghei were used in this study. Calculated amount of the drugs was administered orally based on dosages of 4mg/kg body weight of Artesunate, 10mg/kg body weight of amodiaquine and 9mg/Kg body weight of ciprofloxacin. The drugs were administered in two divided doses for 3 and 5 days for ACT and ciprofloxacin respectively. The result of our study showed that treatment with the combination of ACT and ciprofloxacin improved serum TG levels better than groups treated with either ACT or ciprofloxacin alone. There were significant (p 0.05) increases in the HDL-chol and insignificant (p&gt;0.05) changes in VLDL-chol and LDL-chol of groups treated with ACT and ciprofloxacin only in comparison with the normal control. Animals treated with ACT plus ciprofloxacin showed insignificant (p&gt;0.05) increases in all fractions of cholesterol tested in comparison to the normal control. All parameters in treated groups tested showed significant increases when compared to the parasitized untreated animals. The result of our study showed that the use of this triple regimen in management of malaria restored the lipid profile deranged by the disease better than either ACT or ciprofloxacin alone. Although synergism in the drugs action may be considered, the actual mechanism is a matter of further research.

Efficacy of purified lactonase and ciprofloxacin in preventing systemic spread of Pseudomonas aeruginosa in murine burn wound model

Pseudomonas aeruginosa is an important etiological agent associated with systemic infection in burn patients. Quorum sensing (QS) mechanism of P. aeruginosa contributes to its virulence. Inhibition of QS signals can serve as an effective anti-virulence strategy. Aim of the present study was to evaluate the efficacy of lactonase alone and in combination with ciprofloxacin in treating P. aeruginosa murine burn wound infection. Topical application of lactonase alone and ciprofloxacin alone prevented systemic spread of P. aeruginosa through burned skin and also reduced the mortality. When lactonase (topical) and ciprofloxacin (I/P) were used in combination, zero mortality was observed. It not only significantly reduced systemic dissemination and severity of histopathologic lesions but also resulted in skin regeneration. Decreased production of pathologic index factors (malondialdehyde and reactive nitrogen intermediates) and interleukins (IL-10, IL-6 and MIP-2) was also observed in comparison to control. The results of present study suggest that combination of lactonase and ciprofloxacin can potentially attenuate the virulence of P. aeruginosa. This is the first report of topical administration of lactonase along with antibiotic for the efficient control of burn wound infection.

Ciprofloxacin plus fluocinolone acetonide versus ciprofloxacin alone in the treatment of diffuse otitis externa.

We aimed to evaluate the clinical efficacy of ciprofloxacin plus fluocinolone acetonide (antibiotic plus corticosteroid) ear drops compared to ciprofloxacin (antibiotic) ear drops in diffuse otitis externa. This was a multicentre, randomised, parallel-group, double-blind study involving 590 patients of both sexes aged 7years or older. The rate of clinical cure was higher (p=0.01) with ciprofloxacin plus fluocinolone acetonide than with ciprofloxacin alone. The mean total symptom score was lower with ciprofloxacin plus fluocinolone acetonide (p=0.005). No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving ciprofloxacin plus fluocinolone acetonide and patients receiving only ciprofloxacin. Resolution of oedema and otorrhoea (p=0.003 and p=0.002, respectively) was higher with ciprofloxacin plus fluocinolone acetonide, as was eradication or presumed eradication (p=0.003). There were eight mild adverse events, three with the ciprofloxacin plus fluocinolone acetonide combination (not related to the treatment) and five when ciprofloxacin was administered alone (directly related to the treatment). Ciprofloxacin plus fluocinolone acetonide is a more effective treatment for diffuse otitis externa than ciprofloxacin alone. The ciprofloxacin plus fluocinolone acetonide combination also has an excellent safety profile.

In vivo efficacy of the combination of ciprofloxacin and cefotaxime against Vibrio vulnificus sepsis.

ObjectivesThe in vivo efficacy of a cefotaxime-ciprofloxacin combination against Vibrio vulnificus and the effects on rtxA1 expression of commonly used antibiotics are unknown.Methods In vitro time-kill studies were performed to evaluate synergism. Female BALB/c mice were injected subcutaneously with 1×107 or 1×108 cfu of V. vulnificus. Antibiotic therapy was initiated at 2 h after inoculation in the following four therapy groups: cefotaxime; ciprofloxacin; cefotaxime-plus-ciprofloxacin; and cefotaxime-plus-minocycline. The cytotoxicity of V. vulnificus for HeLa cells was measured using the lactate dehydrogenase assay; rtxA1 transcription was measured in a transcriptional reporter strain using a β-galactosidase assay.Results In vitro time-kill assays exhibited synergism between cefotaxime and ciprofloxacin. In the animal experiments, the 96-h survival rate for the cefotaxime-plus-ciprofloxacin group (85%; 17/20) was significantly higher than that of the cefotaxime-plus-minocycline (35%; 7/20) and cefotaxime alone (0%; 0/20) groups (P<0.05 for both). Bacterial counts in the liver and spleen were significantly lower in the cefotaxime-plus-ciprofloxacin group 24 and 48 h after treatment, relative to the other groups. At sub-inhibitory concentrations, ciprofloxacin inhibited more effectively rtxA1 transcription and mammalian cell cytotoxicity than either minocycline or cefotaxime (P<0.05 for both).ConclusionsCiprofloxacin is more effective at reducing rtxA1 transcription and subsequent cytotoxicity than either minocycline or cefotaxime, and the combination of ciprofloxacin and cefotaxime was more effective in clearing V. vulnificus in vivo than previously used regimens. These data suggest that the combination of ciprofloxacin and cefotaxime is an effective option for the treatment of V. vulnificus sepsis in humans.

EFFECT OF CARROT AND GINGER EXTRACTS (ALONE AND IN COMBINATION WITH CIPROFLOXACIN) ON MULTIDRUG RESISTANT PSEUDOMONAS AERUGINOSA

Antibacterial activity of ginger ( Zingiber officinale ) and carrot ( Daucus carota ) watery extracts (cold a nd hot) with or without ciprofloxacin against 53 isolates of multidrug - resistant Pseudomonas aeruginosa was screene d by agar well diffusion method . The results showed that the hot watery extracts were more active than cold watery extracts . The combination of ciprofloxacin and hot watery extracts of ginger or carrot was most effective than ciprofloxacin alone or plant extracts alone, also the results showed that the mixture of ciprofloxacin and ginger extract was the best for inhibition growth of P. aerugin osa . These results indicate that the plant extracts contain natural inhibitors and the combination between them and ciprofloxacin could be useful in fighting emerging drug - resistance P. aeruginosa .

Evaluation of Double- and Triple-Antibiotic Combinations for VIM- and NDM-Producing Klebsiella pneumoniae by In Vitro Time-Kill Experiments

Combination therapy is recommended for infections with carbapenemase-producing Klebsiella pneumoniae. However, limited data exist on which antibiotic combinations are the most effective. The aim of this study was to find effective antibiotic combinations against metallo-beta-lactamase-producing K. pneumoniae (MBL-KP). Two VIM- and two NDM-producing K. pneumoniae strains, all susceptible to colistin, were exposed to antibiotics at clinically relevant static concentrations during 24-h time-kill experiments. Double- and triple-antibiotic combinations of aztreonam, ciprofloxacin, colistin, daptomycin, fosfomycin, meropenem, rifampin, telavancin, tigecycline, and vancomycin were used. Synergy was defined as a ≥2 log10 decrease in CFU/ml between the combination and its most active drug after 24 h, and bactericidal effect was defined as a ≥3 log10 decrease in CFU/ml after 24 h compared with the starting inoculum. Synergistic or bactericidal activity was demonstrated for aztreonam, fosfomycin, meropenem, and rifampin in double-antibiotic combinations with colistin and also for aztreonam, fosfomycin, and rifampin in triple-antibiotic combinations with meropenem and colistin. Overall, the combination of rifampin-meropenem-colistin was the most effective regimen, demonstrating synergistic and bactericidal effects against all four strains. Meropenem-colistin, meropenem-fosfomycin, and tigecycline-colistin combinations were not bactericidal against the strains used. The findings of this and other studies indicate that there is great potential of antibiotic combinations against carbapenemase-producing K. pneumoniae. However, our results deviate to some extent from those of previous studies, which might be because most studies to date have included KPC-producing rather than MBL-producing strains. More studies addressing MBL-KP are needed.

Isolation of Mycobacterium branderi, an unusual species from an acute myelogenous leukemia patient

We report a case of pulmonary infection caused by Mycobacterium branderi, a slow growing non-tuberculosis mycobacteria, in a patient with acute myelogenous leukemia. The pulmonary disease was treated successfully with the combination of Ciprofloxacin, Doxycycline and Clarithromycin. M. branderi may be considered as an opportunistic pathogen, especially among immunologically compromised patients.

Oral Antibiotic Therapy

Oral Antibiotic Therapy

Irrigation and Debridement

Irrigation and Debridement