Combination Of Cotrimoxazole Research Articles

Sulfamethoxazole-Trimethoprim-Induced Hyperkalemia in Hospitalized Patients Using Potassium-Sparing Drugs: An Observational Study.

The objective of this analysis is to investigate the risk of hyperkalemia in hospitalized patients using sulfamethoxazole-trimethoprim (Co-trimoxazole) and a potassium-sparing drug (potassium-sparing diuretic or renin-angiotensin system [RAS]-inhibitor). Researchers conducted a nested case control study within a cohort of hospitalized patients using a potassium-sparing diuretic and/or a RAS-inhibitor from the PHARMO Database Network. Researchers estimated the odds ratios (ORs) and 95% confidence intervals (CI) for the risk of hyperkalemia in patients receiving both Co-trimoxazole and a potassium-sparing drug compared with patients only receiving a potassium-sparing drug. Among a cohort of 25,849 patients, researchers identified 2054 cases of hyperkalemia during hospitalization in patients also using a potassium-sparing drug. Using Co-trimoxazole in addition to a potassium-sparing drug was associated with an increased risk of hyperkalemia in hospitalized patients (ORadj = 1.65, 95% CI 1.26-2.16) compared with using only a potassium-sparing drug. There was a trend of a more pronounced association between hyperkalemia and the co-use of Co-trimoxazole and potassium-sparing drugs in patients with an estimated GFR of 15-29 mL/min (ORadj = 3.15, 95% CI 1.29-7.70). The number needed to harm for hyperkalemia induced by adding Co-trimoxazole to patients receiving a potassium-sparing drug is 19.5. Using the combination of Co-trimoxazole with a potassium-sparing drug in hospitalized patients increases the risk of hyperkalemia compared with using only a potassium-sparing drug. Physicians and other prescribers should be aware of hyperkalemia and routinely monitor serum potassium levels in hospitalized patients using this combination of drugs.

Effect of co-trimoxazole and N-acetylcysteine alone and in combination on bacterial adherence on ureteral stent surface

To assess the effect of co-trimoxazole and N-acetylcysteine (NAC), alone and in combination, on bacterial adherence to biofilm formed on ureteral stent surfaces. This prospective randomized study was conducted on 636 patients who underwent double J ureteral stent insertion after variable urological procedures. Patients were randomized into four groups: A (n = 165), no antibiotics or mucolytics during stent indwelling; B (n = 153), oral NAC (200 mg/day for children aged < 12 years old and 600 mg/day for adults) during stent indwelling; C (n = 162), oral co-trimoxazole (2 mg TMP/kg/day) during stent indwelling; and D (n = 156), both oral NAC and co-trimoxazole during stent indwelling. Two weeks following double J stent (JJ stent) insertion, urinalysis was performed on all patients and urine culture was done for all the patients at the day of double J stent removal. The stent was removed 2 weeks postoperatively, and a stent segment sized 3–5 cm from the bladder segment of the stent was sent for culture. Positive stent cultures were found in 63.6% (105/165), 43.1% (66/153), 37% (60/162), and 19.2% (30/156) patients of groups A, B, C, and D, respectively. E. coli was the organism most commonly isolated from the stent culture in all groups. The combination of co-trimoxazole and NAC was more effective in reducing bacterial adherence on ureteral stent surfaces than either alone.

Developing an antibiogram for empiric antibiotic prescribing for adult non-spinal orthopaedic infections in a developing world setting

PurposeEmpiric antibiotic strategies in the treatment of fracture-related infections, chronic osteomyelitis, prosthetic joint infection, and septic arthritis should be based on local microbiological antibiograms. This study aims to describe the microbiology and review the antibiogram profiles of bacterial isolates from patients undergoing surgical treatment for non-spinal orthopaedic infections, to identify the most appropriate empiric antibiotic strategy.MethodsA retrospective review was performed of all cases of non-spinal orthopaedic infections treated surgically from 1 January 2018 to 31 December 2018. The National Health Laboratory Service microbiology database was used to identify all intra-operative microbiological specimens obtained from orthopaedic patients, and data were correlated with the orthopaedic surgical database. Cases were divided into fracture-related infections, chronic osteomyelitis, prosthetic joint infection, and septic arthritis. Antibiotic susceptibility data were used to predict the efficacy of different empiric antibiotic regimens.ResultsA total of 107 cases were included in the study; 184 organisms were cultured. Overall, the most common organism cultured was Staphylococcus aureus (25%) followed by Acinetobacter baumannii (9%), Enterococcus faecalis (7%) and Enterobacter cloacae (5%). Across all categories the oral antibiotic combination with the highest effectiveness (81%) would have been a combination of co-trimoxazole, ciprofloxacin and amoxicillin. The most effective intravenous antibiotic combination would have been either piperacillin–tazobactam, amikacin and vancomycin or meropenem and vancomycin; 90% of tested isolates were susceptible to either of these combinations.ConclusionAntibiogram profiles can serve to guide to empiric antibiotic choice in the management of different categories of non-spinal orthopaedic infections.

Repurpose of Mefloquine-Cotrimoxazole Combination as Anti-Plasmodial Agents in Mice Infected with Pasmodium Berghei

The keystone for the treatment of malaria is artemisininbased combination therapy (ACT). The vulnerability of parasites to ACT has, regrettably, declined. Determining new medications or drug combinations that would mitigate parasite resistance is therefore pertinent. Thisstudy assessed the antimalarial property of mefloquinecotrimoxazole in parasitized mice. Thirty adult Swiss albino mice of (18-30g) were grouped into five of 6 mice each. All the mice were inoculated with Plasmodium berghei and orally treated. Group 1 was not treated while groups 2,3, 4 and 5 were treated with chloroquine (10mg/ kg), mefloquine (10mg/kg), cotrimoxazole (10mg/kg) and a combination of mefloquine/cotrimoxazole (10mg/ kg) respectively for five (5) days. The mean survival timewas determined and blood samples were collected and evaluated for percentage parasitemia, hematological and biochemical markers. The results showed that mefloquine/cotrimoxazole combination significantly (p&lt;0.05) reduced percentage parasitemia when compared with single doses of cotrimoxazole and mefloquine. Curatively, cotrimoxazole, mefloquine and mefloquine /cotrimoxazole combination produced 84.90%, 98.95% and 96.96% respectively, whencontrasted with the 90.84% delivered by chloroquine. Suppressively, cotrimoxazole, mefloquine, mefloquine /cotrimoxazole combination, delivered 84.62%, 90.20% and 97.55% respectively. The prophylactic test delivered cotrimoxazole (61.04%), mefloquine (75.23%), mefloquine /cotrimoxazole combination (89.94%) parasitamia inhibition for day 4. When compared to the individual doses of cotrimoxazole and mefloquine,the mefloquine/cotrimoxazole combo significantly (p&lt;0.05) prolonged the mean survival time in the curative,prophylactic, and suppressive tests. The combination also produced significant (p&lt;0.05) reduction in anemia characterized by increased packed cell volume, hemoglobin,red blood cells and decrease in white blood cells, neutrophils lymphocytes and monocytes when compared with single doses of cotrimoxazole and mefloquine respectively. Theresult showed that the levels of aspertate transferase,alanine alanine transferase, alkaline phosphate total protein, total bilirubin, urea, creatinine and uric acid that were slightly altered was curtailed by mefloquine/cotrimoxazole. The study showed that cotrimoxazole can be utilized as an accomplice drug with mefloquine for the management of malaria.

Brucellosis in pyrexia of unknown origin: Reminiscing the forgotten entity

PurposeBrucellosis is one of the substantial yet forgotten entity of pyrexia of unknown origin, transmitted via contact with animals or animal products. Despite being an important etiological agent of PUO, it is under-reported owing to its non-specific and protean clinical presentations. Thereby, the present study intended to describe clinical profile and outcome of patients of brucellosis from a tertiary care center in North India. MethodsThis was a retrospective study and included all the patients that were reported positive for Brucella in automated blood culture system (BACTEC) and identified using MALDI-TOF MS over a period of 6 years (2014–2020). ResultsA total of nine cases were reported positive for Brucella during the study period. Fever was noted to be the most common symptom present in all the patients (PUO), followed by fatigue. The patients were managed with monotherapy using doxycycline or combination of cotrimoxazole, rifampicin and doxycycline. All the patients responded well to treatment. ConclusionThe present study highlights the significance of automated blood culture system in conjunction with MALDI-TOF MS for early and reliable identification of Brucella. In the present study, all cultures were reported positive within five days of incubation in automated blood culture system, underlining the significance of using the same which lessens the turnaround time and increases the sensitivity. Owing to the protean manifestations and low sensitivity of the available tests, the clinician needs to have a high level of suspicion to precisely diagnose the illness to prevent undue delay in management.

Mycetoma management and clinical outcomes: the Mycetoma Research Center experience.

Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines. This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan. In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009). Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.

Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018.

Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.

Serological and molecular evaluation of Crimean-Congo Haemorrhagic Fever in Iranian probable patients

Background: Neurological manifestations of Brucellosis are rare. We came across nine children with predominant symptomatology of neurological involvement amongst 68 patients of active brucellosis seen in last three years. Methods: The study is related to patients of brucellosis whose principal presenting features were related to neurological symptom (headache, seizure, altered sensorium and encepalopathy) along with fever and other constitutional symptoms. It included nine patients amongst 68 patients of active brucellosis seen during January2009 toDecember2011at SardarPatelMedical collegehospital, Bikaner. The diagnosis of active brucellosis was confirmed by demonstration of the raised brucella agglutination titre of 1:320 or more in the serum and confirmation of neurobrucellosis was done by demonstration of the raised brucella agglutination titre of 1:640 or more in the cerebrospinal fluid. All children were treated with combination of cotrimoxazole, rifampicin and doxycyclin accordingly to age for six week duration. The treatment was extended for another fourweeks in two children because of persistence of raised brucella agglutination titre of 1:640 or more in the cerebrospinal fluid. Results: Fever with seizures was the most common presentation (100%). Other associated manifestations included irritability (88.9%), hepatosplenomegaly (88.9%), vomiting (88.9%) and impaired consciousness (33.3%). CSF lymphocytosis was observed in 77.8% cases. MRI showed encephalomyelitis in 22.2% children and normal changes in remaining. CSF Culture was negative in all cases to rule out the possibilities of associated comorbid illness. The response of treatment started with 10-15 days and all the children became symptom-free at the end of six weeks except two, in them treatment was extended for further four weeks. Follow up brucella agglutination titre in serumand cerebrospinal fluid at the end of six months and twelve months was normal in all children. There was no evidence of relapse in any patient at the end of one year follow up. Liver function tests remained within normal range and no drug toxicity was observed. Conclusion:Neurologicalmanifestations of brucellosis are rare. Treatment of cotrimoxazole, rifampicin and doxycyclin showed marked clinical and radiological improvement. All children were completely disease-free at the end of one year follow up.

Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report

IntroductionMelioidosis, endemic in Thailand and in the Northern Territory of Australia is an emerging infectious disease in India which can present with varied forms. A case of melioidosis, presenting as a rare anterior mediastinal mass which can masquerade as malignancy or tuberculosis, is described here. With treatment, our patient initially showed an increase in the size of mediastinal node and development of new submandibular node.. To the best of our knowledge, this phenomenon has not been documented in the literature and the same is highlighted in this case report. Case PresentationA 43-year-old Asian man with diabetes presented with fever, loss of appetite, weight loss for one month and painful swelling below his left mandible for five days. An examination revealed an enlarged left submandibular lymph node and bilateral axillary lymph nodes. A chest X-ray showed mediastinal widening. Computed tomography of his thorax showed a lobulated heterogeneously enhancing anterior mediastinal mass encasing the superior vena cava suggestive of malignancy. An excision biopsy of the lymph node showed granulomas suggestive of tuberculosis but bone marrow culture and lymph node aspirate culture grew Burkholderia pseudomallei. He was treated with parenteral ceftazidime and amoxicillin-clavulanic acid. During the course of treatment, he developed an enlargement of the submandibular lymph node on the opposite side. It gradually subsided with the continuation of therapy orally with a combination of cotrimoxazole and doxycycline for six months. A repeat computed tomography chest scan showed resolution of the mediastinal mass.ConclusionMelioidosis can present as a mediastinal mass that mimics tuberculosis or malignancy. During the initial phase of treatment of melioidosis, the appearance of new lymph nodes or an increase in the size of the existing lymph nodes does not mean treatment failure. Inexperienced clinicians may consider this as treatment failure and may switch treatment. To the best of our knowledge, this is the first report documenting this phenomenon in melioidosis cases.

A 12-year retrospective study of non-burn skin loss (burn-like syndromes) at a tertiary burns unit in a developing country

Background A retrospective study of the presentation, etiology, and prognosis of non-burn epidermal loss managed at the Lagos University Teaching Hospital Nigeria over a 12-year period. Materials and methods Admission records of patients managed for non-burn skin loss were retrieved from the medical records. Demographic details of the patients, the initial diagnosis, final diagnosis, treatment and outcome of treatment was noted. Results A total of 23 patients were identified, 17 (74%) had idiosyncratic drug reactions. Of this 17, 6 (26%) had Steven Johnson Syndrome, 6 (26%) had Steven Johnson Syndrome/toxic epidermal necrolysis while 5 (22%) presented with toxic epidermal necrolysis. Three of the five patients with toxic epidermal necrolysis died. The age range of patients with idiosyncratic adverse drug reactions was 2–28 years, mean, 10.18 ± 1.44 years and male to female ratio of 1:1.83. The body surface area involved ranged from 8 to 78%; mean 26.65 ± 6.08%. The agents suspected for the reactions were Co-trimoxazole (41.2%) and combination of Co-trimoxazole, and Fansidar ® (17.6%). Other conditions seen were two (9%) Staphylococcal Scalded Skin Syndrome, three (13%) had Necrotizing Faciitis, one of whom was HIV positive and died. One (4%) patient presented with pemphigus vulgaris. The presentation and management of the patients was discussed.

Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-treated bednets on the frequency of malaria in HIV-1-infected adults in Uganda: a prospective cohort study

HIV-1 and malaria are common infections in Africa, and cause substantial morbidity and mortality. HIV infection has been associated with an increased incidence of malaria, and more severe disease. Our aim was to assess the effect of antiretroviral treatment (ART) on the frequency of clinical malaria in people with HIV, and to measure the additive effects of co-trimoxazole (trimethoprim and sulfamethoxazole) prophylaxis, ART, and insecticide-treated bednets. In 2001, we enrolled 466 HIV-infected individuals aged 18 years or older in Uganda in a prospective cohort study that provided co-trimoxazole prophylaxis to 399 participants after 5 months of no intervention. In 2003, we enrolled 138 survivors from the initial study, and 897 new participants from the same community, to take antiretroviral therapy (ART) in addition to co-trimoxazole prophylaxis. The ART was in most cases a combination of stavudine, lamivudine, and nevirapine or efavirenz. In 2004, we also gave participants insecticide-treated bednets. Households were visited weekly by study staff to record fever, illness, or death in the preceding 7 days. In cases of reported fever in the previous 2 days, we took blood to test for malaria parasites. We compared the frequency of clinical malaria, adjusting for CD4-cell count, age, sex, and season. 1035 individuals were given co-trimoxazole and ART (median age 38 years, 74% female, and median CD4-cell count 124 cells/microL); 985 of these, plus four new participants, received co-trimoxazole, ART, and bednets. There were 166 cases of clinical malaria in the study. Compared with a baseline malaria incidence of 50.8 episodes per 100 person-years, co-trimoxazole prophylaxis was associated with 9.0 episodes per 100 person-years (adjusted incidence rate ratio [IRR] 0.24, 95% CI 0.15-0.38); ART and co-trimoxazole with 3.5 episodes per 100 person-years (0.08, 0.04-0.17); and co-trimoxazole, ART, and bednets with 2.1 episodes per 100 person-years (0.05, 0.03-0.08). Malaria incidence was significantly lower during ART and co-trimoxazole than during co-trimoxazole alone (IRR 0.36 [95% CI 0.18-0.74], p=0.0056). A combination of co-trimoxazole, antiretroviral therapy, and insecticide-treated bednets substantially reduced the frequency of malaria in adults with HIV.

Acral necrosis by Stenotrophomonas maltophilia

Stenotrophomonas maltophilia (SM) has been considered a nosocomial pathogen. Nevertheless, community acquired infection may occur more frequently than usually recognized. We describe distal necrosis of the fingers by SM in a farmer, contracted in the community and successfully treated with a combination of cotrimoxazole and ciprofloxacin. The patient was diagnosed with chronic lymphocytic leukaemia 6 months later. This unusual presentation shows that infection with SM should be included in the differential diagnosis of the skin and soft tissue infection, even in apparently healthy patients.

Imipenem for the treatment of melioidosis

Melioidosis is a protean disease caused by Burkholderia pseudomallei. It is rare in the UK and is generally only seen in patients with a travel history to endemic areas such as Thailand, Singapore and Malaysia. Cases may present with disseminated bacteraemic, non-disseminated bacteraemic, multi-focal bacteraemic or localized disease. Subclinical infections also occur. Following acquisition of the organism a patient may remain asymptomatic for several years before infection becomes clinically apparent. Factors such as diabetes, renal failure or other causes for a decrease in host immunity may precipitate the appearance of overt disease. The current treatment choice for severe melioidosis is parenteral ceftazidime followed by oral amoxycillin–clavulanic acid or a combination of co-trimoxazole, doxycycline and chloramphenicol. We report a case of melioidosis in a 59-year-old male diabetic from Bangladesh who initially responded to piperacillin–tazobactam but was changed to ceftazidime when a definitive diagnosis was made. His condition deteriorated on the latter antibiotic. He subsequently responded to imipenem. The patient’s long-term outcome is still not known.

Salmonella meningitis in Thai infants: clinical case reports

Between June 1988 and September 1996 12 of 65 infants (18%) admitted to the Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand with purulent meningitis were infected with Salmonella spp. Their ages ranged from 1.5 to 6 months. Six of the infants had diarrhoea, 9 had seizures, and 11 had subdural effusion or empyema. Six infants required surgical treatment; 2 had brain abscesses. Salmonella was recovered from the cerebrospinal fluid of 11 infants and from the subdural fluid of 10. Eight infants were successfully treated with cefotaxime alone or in combination with co-trimoxazole, one with co-trimoxazole, and one with the combination of co-trimoxazole and ampicillin. The duration of treatment was 6 weeks, except for one patient who had a large brain abscess and was treated for 8 weeks. The last 2 patients, despite the fact that the organisms were susceptible to cefotaxime, failed to respond clinically to appropriate doses of it. Both were cured after ciprofloxacin was added to the therapy. Ciprofloxacin is probably the drug of choice to be used in addition to the previously used antibiotics for severe cases of Salmonella meningitis in infants.

Nephrotoxicity of gentamicin and co-trimoxazole combination in rats

1. The nephrotoxicity of gentamicin is well known. However, little information is available regarding the combined effects of gentamicin plus co-trimoxazole (sulfamethoxazole-trimethoprim). Therefore, Wistar rats were treated daily with 100 mg/kg gentamicin or 100 mg/kg gentamicin plus 30 mg/kg trimethoprim-150 mg/kg sulfamethoxazole for 14 days. 2. Serum biochemical parameters were measured on days 0, 8 and 15, and histopathological examinations of kidneys were performed on day 15, one day following end of treatment. Gentamicin treated rats exhibited a 63% increase in blood urea nitrogen (BUN), a 124% increase in uric acid, and a 63% decrease in serum potassium levels on day 15. 3. The combination of gentamicin plus co-trimoxazole partially ameliorated these effects. With the three drug combination no change occurred in BUN, and only a 30% decrease occurred in serum potassium levels. 4. While serum creatinine levels significantly increased following gentamicin, the co-administration of co-trimoxazole resulted in a significant decrease (30%) in creatinine. Histopathological examinations of kidneys suggested a lower degree of nephrotoxicity in rats treated with gentamicin plus co-trimoxazole as compared to animals treated with gentamicin alone. 5. The results support the importance of monitoring serum biochemical parameters when treating with gentamicin or gentamicin plus co-trimoxazole.