Broad-spectrum Oral Antibiotics Research Articles

Gill disease in marine farmed Atlantic salmon at four farms in Ireland

A study of four marine salmon farms was undertaken in Ireland in 2008, with a focus on gill health and disease. All four farms suffered severe gill disease resulting in...

A female presenting with prolonged fever, weakness, and pain in the bilateral pelvic region: a case report

IntroductionPsoas abscess, a collection of pus in the iliopsoas compartment that has traditionally been classified as primary and secondary according to its origin.Case presentation48-year-old Turkish female presented to the department with fever, weakness and pain in the bilateral pelvic region. In contrast abdominal magnetic resonance, a collection compatible with the hyperintense abscess was observed in the right and left ilipsoas muscles. It was decided to simultaneously drain both abscesses of the case who had been using oral and intravenous broad-spectrum antibiotics for two months. No factors were detected in the microbiological reviews made on the abscess fluid of the operated case. The case was also examined in terms of tuberculosis and Crohn's disease and no findings were encountered to rise suspicions of such diseases.ConclusionAn abscess of the psoas muscle was a rare entity. However, with the increased use of computed tomography scans to evaluate patients with unknown foci of sepsis, psoas abscesses now are diagnosed and reported more frequently. What should be done after diagnosis are, if possible, defining the infection factor, selecting the appropriate antibiotics and draining the abscess openly or percutaneously.

Survey of pharmacists and physicians on drug interactions between combined oral contraceptives and broad-spectrum antibiotics.

To evaluate physician and pharmacist knowledge on potential drug interactions between combined oral contraceptives (COC) and broad-spectrum antibiotics and determine if any difference exists between responses. Two hundred licensed retail pharmacists and 200 licensed family practice physicians in the states of Virginia, West Virginia, and Maryland were mailed an anonymous survey between August 2007 and November 2007. The survey consisted of 3 short questions asking practitioners about their current opinion on drug interactions with COCs and whether an alternative form of contraception is needed for patients taking COC and concomitant broad-spectrum antibiotics. The main outcome measure of the survey included: identifying how physicians and pharmacists handle prescribing or dispensing COCs along with broad-spectrum antibiotics. Gender, educational degree, and years in practice were also collected. A total of 182 participants returned the surveys (57% were physicians and 43% were pharmacists). When asked if broad-spectrum antibiotics have a clinically significant interaction with COCs, 82.7% of physicians and 88.5% of pharmacists answered, "yes". Of the respondents, 84.6% stated that the drug interaction warrants the patient to be advised to use back-up contraception. A total of 90.1% stated that they currently instruct patients to use back-up contraception when prescribing or dispensing antibiotics to a patient who is on COC, with no statistically significant difference existing between the responses of the pharmacists and the physicians. Physicians and pharmacists believe that broad-spectrum antibiotics decrease the effectiveness of COCs. These practitioners warn their patients of this interaction and advise the use of back-up contraception. More education should be provided to practitioners regarding the data concerning COCs and broad spectrum antibiotics and lack of a proven interaction.

Changes in Mucosal Homeostasis Predispose NHE3 Knockout Mice to Increased Susceptibility to DSS-Induced Epithelial Injury

NHE3 is a target of inhibition by proinflammatory cytokines and pathogenic bacteria, an event contributing to diarrhea in infectious and idiopathic colitis. In mice, NHE3 deficiency leads to mild diarrhea, increased intestinal expression of interferon (IFN)-gamma, and distal colitis, suggesting its role in epithelial barrier homeostasis. Our aim was to investigate the role of NHE3 in maintaining mucosal integrity. Control or dextran sulfate sodium (DSS)-treated, 6- to 8-week-old wild-type (WT) and NHE3(-/-) mice were used for the experiments. Small intestines were dissected for further analysis. NHE3(-/-) mice have elevated numbers of CD8alpha(+) T and natural killer cells in the intraepithelial lymphocytes and lamina propria lymphocytes compartments, representing the source of IFN-gamma. NHE3(-/-) mice display alterations in epithelial gene and protein expression patterns that predispose them to a high susceptibility to DSS, with accelerated mortality resulting from intestinal bleeding, hypovolemic shock, and sepsis, even at a very low DSS concentration. Microarray analysis and intestinal hemorrhage indicate that NHE3 deficiency predisposes mice to DSS-induced small intestinal injury, a segment never reported as affected by DSS, and demonstrate major differences in the colonic response to DSS challenge in WT and NHE3(-/-) mice. In NHE3(-/-) mice, broad-spectrum oral antibiotics or anti-asialo GM1 antibodies reduce the expression of IFN-gamma and iNOS to basal levels and delay but do not prevent severe mortality in response to DSS treatment. These results suggest that NHE3 participates in mucosal responses to epithelial damage, acting as a modifier gene determining the extent of the gut inflammatory responses in the face of intestinal injury.

Recovery from DSS‐induced intestinal colitis is mediated by MIP2‐dependent neutrophil recruitment

Conventionally raised mice successfully recover from the injury caused by DSS‐induced colitis. In contrast, bacteria‐depleted mice (BD mice), generated by treatment with broad‐spectrum oral antibiotics for two weeks, failed to recover from subsequent DSS‐induced injury, suggesting interactions between components of the normal gut microbiota of the host are required for recovery. Monocolonization by Bacteroides fragilis or commensal E. coli strain was able to prevent DSS‐induced mortality in BD mice. Since LPS is one component that is common to both these bacteria, we then determined if LPS alone would be sufficient to rescue BD mice from DSS‐induced mortality. Oral treatment with LPS with continuous antibiotic treatment was sufficient to reduce DSS‐induced mucosal injury and mortality in the wild type BD mice, but not in bacteria‐depleted TLR4−/− mice or MyD88−/− mice. The data suggest activation of TLR4‐dependent signals that enhance the recovery from DSS‐induced colitis in BD mice. We investigated the mechanistic basis for these observations and found that DSS treatment resulted in lower intestinal expression of MIP2 and correspondingly lower levels of neutrophil recruitment to the damaged mucosa. Administration of exogenous MIP2 eliminated DSS‐induced mortality in BD mice with a corresponding increase of neutrophils in the inflamed mucosa strongly suggesting a specific role for MIP2‐dependent neutrophil recruitment. These results support the idea that Gram‐negative commensal gut flora is necessary for the recovery from DSS‐induced colitis. The LPS‐mediated activation of TLR4‐MyD88 dependent signaling leads to up‐regulation of chemoattractants that recruit neutrophils, thereby enhancing the recovery from intestinal injury.

The Toll-Like Receptor Signaling Molecule Myd88 Contributes to Pancreatic Beta-Cell Homeostasis in Response to Injury

Commensal flora and pathogenic microbes influence the incidence of diabetes in animal models yet little is known about the mechanistic basis of these interactions. We hypothesized that Myd88, an adaptor molecule in the Toll-like-receptor (TLR) pathway, regulates pancreatic β-cell function and homeostasis. We first examined β-cells histologically and found that Myd88−/− mice have smaller islets in comparison to C57Bl/6 controls. Myd88−/− mice were nonetheless normoglycemic both at rest and after an intra-peritoneal glucose tolerance test (IPGTT). In contrast, after low-dose streptozotocin (STZ) challenge, Myd88−/−mice had an abnormal IPGTT relative to WT controls. Furthermore, Myd88−/− mice suffer enhanced β-cell apoptosis and have enhanced hepatic damage with delayed recovery upon low-dose STZ treatment. Finally, we treated WT mice with broad-spectrum oral antibiotics to deplete their commensal flora. In WT mice, low dose oral lipopolysaccharide, but not lipotichoic acid or antibiotics alone, strongly promoted enhanced glycemic control. These data suggest that Myd88 signaling and certain TLR ligands mediate a homeostatic effect on β-cells primarily in the setting of injury.

Bilateral brucellar breast abscess in a 48-year-old woman

Bilateral brucellar breast abscess in a 48-year-old woman

Treatment of large vascular lesions in the orofacial region with the Nd:YAG laser

Large vascular lesions in the orofacial region are often very difficult to remove. In the 1990s, the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser emerged as a new and effective mode of treatment for vascular lesions. The purpose of this paper was to determine its effectiveness and safety for the treatment of large vascular lesions in the orofacial region. A prospective study was conducted in which 28 patients with large vascular lesions (their surface diameters being more than 3 x 3 cm) in the orofacial region were treated with the Nd:YAG laser by photocoagulation (PhC). Four different modalities of treatment were used: simple transmucosal PhC, transmucosal PhC with the use of compression, simple intralesional PhC, and ultrasound guided intralesional PhC. Follow up was conducted in all of the cases, time until complete healing was recorded, as were postoperative complications. In all of the patients undergoing transmucosal PhC (simple or with the use of compression), tissue sloughing occured within 1-3 days, and the time until complete healing was 3-5 weeks. In patients undergoing intralesional PhC (simple or ultrasound guided), swelling was present for 1 week. There were no cases of inadvertent bleeding. Nine patients required two or more sessions of PhC. Three patients required a corrective surgical procedure as the final step. Two patients required prolonged intubation and one patient a temporary tracheostomy, all due to oedema. Two patients developed a local intraoral infection, which was controlled with broad-spectrum oral antibiotics. If used properly, the Nd:YAG laser is a safe and effective tool for the treatment of large vascular lesions.

Index of Suspicion

Index of Suspicion

Deep neck infections: a retrospective review of 112 cases

The purpose of this study was to review our recent experience with deep neck infections and compare it to the experiences in the available literature. A total number of 112 charts of patients treated for deep neck infections at the department of otolaryngology of our hospital between August 1996 and September 2007 were retrospectively reviewed. All the relevant clinical charts including presentation, origin and site of deep neck infection, radiological, and bacteriological studies and interventions along with demographic profile, details of hospital stay, and outcomes were evaluated. The findings were compared to those in the available literature. Until 2002, we had nearly constant number of patients annually but since then we have found an increasing number of them. The most common presenting symptom was neck swelling (88.4%). Fever was present in 63.4 and 78% had leukocytosis. The most common known cause was dental infection (31.3%) and in 32.1% of them origin remained unknown. The most commonly encountered site was the submandibular space and 23.2% of patients had two or more involved spaces. Exactly 20.5% were treated with intravenous antibiotic therapy alone whereas 79.5% had surgical procedures with successful results in 98.2% of them. Diabetes mellitus was diagnosed in 20.5% of cases. There was no case of known primary or acquired immunodeficiency. We had two deaths from septic shock but there was not any other complication. Mean hospitalization time was 7 days. Deep neck infections remain potentially lethal infections if they are not diagnosed early and treated promptly. Widespread diffusion of empirical broad-spectrum oral antibiotic and anti-inflammatory treatments may cause masked presentations of deep neck infections without swelling, fever, or leukocytosis. Our tailored approach (medical or medical and surgical) based on clinical and radiological evidence was successful in 98.2% of the patients with a short mean hospitalization time.

Deficiency of Indoleamine 2,3-Dioxygenase Enhances Commensal-Induced Antibody Responses and Protects against Citrobacter rodentium -Induced Colitis

Indoleamine 2,3-dioxygenase (IDO) is a negative regulator of lymphocyte responses that is expressed predominantly in macrophages and dendritic cells. We detected it at high levels in the small intestine and mesenteric lymph node of young adult mice, suggesting a role in intestinal immunity. Consistent with this idea, we found that IDO-deficient mice had elevated baseline levels of immunoglobulin A (IgA) and IgG in the serum and increased IgA in intestinal secretions. These abnormalities were corrected by a course of broad-spectrum oral antibiotics started at weaning, indicating that they were dependent on the intestinal microbiota. Kynurenine and picolinic acid, two IDO-generated metabolites of tryptophan, were able to inhibit lipopolysaccharide-induced antibody production by splenocytes in vitro, and kynurenine also induced B-cell apoptosis, findings that provide an explanation for the elevated Ig levels in animals lacking IDO. The intestinal secretions of IDO-deficient mice had elevated levels of IgA antibodies that cross-reacted with the gram-negative enteric bacterial pathogen Citrobacter rodentium. In keeping with the functional importance of this natural secretory IgA, the mutant animals were more resistant to intestinal colonization by Citrobacter, developed lower levels of serum Citrobacter-specific IgM and IgG antibodies following oral infection, and had significantly attenuated Citrobacter-induced colitis. Our observations point to an important role for IDO in the regulation of immunity to the gut commensal microbiota that has a significant impact on the response to intestinal pathogens.

Cutaneous antimicrobial gene therapy: engineering human skin replacements to combat wound infection

Skin substitutes have been developed as adjunctive treatments for massive burns and chronic wounds. However, compared with native skin autograft, skin substitutes display increased susceptibility to microbial contamination. Wound infection increases the likelihood of amputation in patients with lower extremity chronic wounds and can lead to life-threatening complications in burn patients. Infections in these populations are currently treated with topical antimicrobial agents in addition to broad-spectrum oral or intravenous antibiotics, but this may facilitate development of resistant organisms. Skin replacements with innate resistance to infection could reduce or eliminate the requirement for exogenous antibiotics. Gene-encoded antimicrobial peptides have demonstrated activity against a variety of pathogens and expression of these peptides can be increased in skin cells using gene transfer. Theoretically, skin replacements engineered to overexpress antimicrobial peptides may represent a novel approach for treatment or prevention of wound infection.

Dynamic long distance management of patient variables: Application in ameliorating chemotherapy-associated side effects

Dynamic long distance management of patient variables: Application in ameliorating chemotherapy-associated side effects

Chlamydial conjunctivitis presenting as pre septal cellulitis

Chlamydia conjuctivitis results from infection by chlamydia trachomatis, the commonest treatable sexually transmitted infection in Europe. Its clinical manifestations involve the conjunctiva and the cornea. The inflammation under the upper eyelid may be sufficient to present as ptosis, however previously it has not been documented to cause a preseptal cellulitis. We present such a case.A 15-year-old girl was diagnosed with a left viral conjunctivitis. Five days later, she returned with marked oedema of the left upper and lower lids accompanied by erythema. The tarsal conjunctiva revealed follicles and large papillae and extra ocular movements revealed discomfort on elevation. A secondary diagnosis of bacterial pre septal cellulitis was made and the treatment was changed a broad spectrum oral antibiotic. On review at two days, the patient now complained of a large amount of purulent discharge in association with the marked pre septal swelling. As previous bacteriology and virology had been negative, the patient was re swabbed for chlamydia. This proved positive and her symptoms completely resolved following administration of Azithromycin.In this particular case recognition of the pathogen is important to alert the patient to the likelihood of unknown genital infestation. In all cases of positive culture, the patient should be counselled to attend a genitourinary clinic and to alert any sexual partners to the need to do likewise.

Rejection of injectable silicone “Bioplastique” used for vocal fold augmentation

A rare case of repeated granulomatous inflammation after silicone injection laryngoplasty for vocal fold immobility as well as its treatment by endoscopic approach is reported. The patient presented a right-sided vocal fold immobility after laryngeal trauma and remained dysphonic despite of logopedic voice therapy because of severe glottal insufficiency. An endoscopic transoral intrafold silicone injection was applied to improve the vocal function. Silicone granuloma inflammation was observed 8 days after the vocal fold augmentation. Oral broad-spectrum antibiotics and corticosteroids did not improve the inflammation. A cordotomy was performed to remove the silicone implant. After 3 months, a second endoscopic surgical intervention was necessary to remove a recurrent silicone granuloma. Eight months after the second surgical intervention, the inflammation had disappeared. An autologous fat injection to restore the glottal closure was performed successfully. Type IV contact allergy was excluded with an epicutaneous patch and scratch test with components of the silicone implant. Clinical and treatment observations are reported and the literature on complications of intrafold injected silicone for vocal fold augmentation is reviewed.

Management of Complications after Insertion of the SmartPlug Punctal Plug: A Study of 28 Patients

To characterize and describe the management of complications seen in patients who have undergone insertion of the SmartPlug permanent punctal plug. Retrospective case series. Patients who experienced complications after SmartPlug insertion and were treated by 1 of 18 ophthalmic plastic and reconstructive surgeons between January 2004 and October 2005. Presenting symptoms and signs and the management of complications were analyzed. Prevalences of canaliculitis and dacryocystitis, tearing at presentation, and outcome of conservative and/or surgical management of the SmartPlug complications. Twenty-eight patients were included in the study; 13 had bilateral involvement. On initial presentation, 18 patients had inflammation, including 17 with canaliculitis and 1 with recurrent acute dacryocystitis. Ten patients had little or no inflammation; all 10 had tearing of the involved eye(s). In 5 patients, complications resolved after office irrigation of the lacrimal drainage system; in a sixth patient, silicone intubation was performed as well. Canaliculotomy was performed in 13 patients (bilateral in 3) and combined with silicone intubation (3 patients). Canaliculotomy was planned in an additional 2 patients. Canaliculitis in 1 patient responded to a course of oral antibiotics; the plug was massaged out of the punctum in a retrograde fashion in another patient. In still another patient, the plugs expressed themselves at the time of planned canaliculotomy. In 4 patients, dacryocystorhinostomy (DCR) with silicone intubation was necessary. Two additional patients refused further treatment including DCR and canaliculotomy; both were lost to follow-up. Canaliculitis, acute dacryocystitis, and tearing may be seen in patients who have had SmartPlugs and may be managed by removal of the plug. A trial of topical and oral broad-spectrum antibiotics followed by retrograde massage of the plug through the canaliculus may be helpful should plug removal be deemed appropriate. If conservative measures fail, canaliculotomy with removal of the plug may be considered; DCR may be necessary. Although lacrimal irrigation may resolve the problem, irrigation also may dislodge the plug from its canalicular position and cause permanent obstruction of the lacrimal drainage system.

Outpatient Gatifloxacin Therapy and Dysglycemia in Older Adults

Gatifloxacin has been associated with both hypoglycemia and hyperglycemia. We examined dysglycemia-related health outcomes associated with various antibiotics in a population of approximately 1.4 million Ontario, Canada, residents 66 years of age or older. We conducted two population-based, nested case-control studies. In the first, case patients were persons treated in the hospital for hypoglycemia after outpatient treatment with a macrolide, a second-generation cephalosporin, or a respiratory fluoroquinolone (gatifloxacin, levofloxacin, moxifloxacin, or ciprofloxacin). In the second, case patients were persons who received hospital care for hyperglycemia. For each case patient, we identified up to five controls matched according to age, sex, the presence or absence of diabetes, and the timing of antibiotic therapy. Between April 2002 and March 2004, we identified 788 patients treated for hypoglycemia within 30 days after antibiotic therapy. As compared with macrolide antibiotics, gatifloxacin was associated with an increased risk of hypoglycemia (adjusted odds ratio, 4.3; 95 percent confidence interval, 2.9 to 6.3). Levofloxacin was also associated with a slightly increased risk (adjusted odds ratio, 1.5; 95 percent confidence interval, 1.2 to 2.0), but no such risk was seen with moxifloxacin, ciprofloxacin, or cephalosporins. We then identified 470 patients treated for hyperglycemia within 30 days after antibiotic therapy. As compared with macrolides, gatifloxacin was associated with a considerably increased risk of hyperglycemia (adjusted odds ratio, 16.7; 95 percent confidence interval, 10.4 to 26.8), but no risk was noted with the other antibiotics. Risks were similar in the two studies regardless of the presence or absence of diabetes. As compared with the use of other broad-spectrum oral antibiotics, including other fluoroquinolones, the use of gatifloxacin among outpatients is associated with an increased risk of in-hospital treatment for both hypoglycemia and hyperglycemia.

Rosacea

Rosacea is a common, inflammatory facial dermatosis that affects predominantly middle-aged patients. The cause is unclear, but dermal damage from ultraviolet rays may be important in fair-skinned individuals. It is characterized by a mixture of inflammatory papules and pustules along with varying degrees of flushing, vasodilatation and telangiectasia. These features are seen on the convexities of the face such as the forehead, cheeks and nose. Occasionally, other sites such as the scalp and the V of the neck are involved. Symptoms are aggravated by heat, emotion, vasodilator drugs and potent topical corticosteroids. Treatment is with topical metronidazole or oral broad-spectrum antibiotics, usually tetracyclines. The condition is chronic, and treatment is therefore often required long term. Differential diagnoses includes acne vulgaris, facial eczema and lupus erythematosus. Complications include ocular involvement, rhinophyma and lymphoedema. Ocular disease necessitates oral antibiotic treatment, while rhinophyma usually requires surgical correction.

Bacteriology in Patients with Chronic Sinusitis who have been Medically and Surgically Treated

Chronic sinusitis is a disease that afflicts a significant percentage of the population and causes considerable long-term morbidity. The common use of multiple broad-spectrum oral antibiotics and endoscopic sinus surgery to treat this condition may alter the pathogenes that promote persistence of chronic sinusitis. Forty-eight culture-positive patients with chronic sinusitis who had been medically treated for at least 3 months and had undergone sinus surgery were bacteriologically evaluated. Swab specimens of the middle meatus and sphenoethmoid recess were aseptically obtained endoscopically and cultured for aerobes. Coagulase-negative staphylococci were the most common isolates (45.8%), followed by Streptococcus pneumoniae (16.7%), Enterobacteriaceae (16.7%), Staphylococcus aureus (10.4%), and Pseudomonas aeruginosa (10.4%). Coagulase-negative staphylococci were the most frequently isolated organisms in our study, as in many other studies. Despite the significant predominance of these organisms, they have always been assumed to be contaminants, and their presence in culture has been discounted. Coagulase-negative S aureus may be a pathogen in the chronic sinusitis process, and sensitivities of this isolate should be obtained for evaluation and possible treatment of the disease.

Acute necrotizing esophagitis: a large retrospective case series.

Acute necrotizing esophagitis is a rarely described entity. Its incidence has not yet been established, and its multifactorial etiology remains unknown. The aim of the present study was to establish the incidence, clinical presentation, endoscopic course, accompanying factors, and pathogenesis of the condition. A retrospective analysis of clinical, laboratory, endoscopic and histological data and the clinical course in 29 patients with acute necrotizing esophagitis was carried out over a 5-year period. Acute necrotizing esophagitis was observed in 29 of 10 295 upper gastrointestinal endoscopies (0.28 %) carried out during the 5-year period. The average age of the patients was 75.24 years (range 40 - 91), and they were predominantly male. Eighty-three percent of the patients had comorbid conditions. In all cases, acute necrotizing esophagitis became evident with upper gastrointestinal bleeding, without hemodynamic stabilization in the majority of cases (75.9 %). The lesions predominantly affected the lower two-thirds of the esophagus (59 %), and there were coexisting abnormal endoscopic findings in 83 % of cases. Empirical supportive therapy, including oral nutritional rest, omeprazole, sucralfate (15 cases) and broad-spectrum antibiotics (7 cases) was provided. The condition resolved in all patients. Ten patients in the group died of other causes (coexisting illnesses). Acute necrotizing esophagitis was more commonly recognized than has previously been reported. It is a serious clinical entity that should be considered in the differential diagnosis of upper gastrointestinal bleeding, particularly in elderly patients. The prognosis depends more on the patient's advanced age and on comorbid illnesses than on the course of the esophageal lesions, which resolved in all patients in this series.