Penicillin Treatment Research Articles

Fecal microbiota of horses in the clinical setting: Potential effects of penicillin and general anesthesia

Antimicrobial treatment is associated with the spread of antimicrobial resistance and disturbances in the ecological balance of intestinal microbiota. In horses, the main adverse effect of antimicrobial treatment is colitis. We used culture and 16S rRNA gene based molecular methods to monitor the prevalence of antimicrobial resistance and changes in predominant fecal populations during penicillin treatment and general anesthesia of horses in the clinical setting. After 5 days of parenteral administration of penicillin, fecal Escherichia coli were resistant to multiple unrelated antimicrobial agents when compared to the pre-exposure situation. Denaturing gradient gel electrophoresis (DGGE) profiles indicated that horses have an extremely diverse fecal microbiota, with marked differences between individual horses. Most of the variation in DGGE profiles could be attributed to horse-specific factors, and penicillin, general anesthesia or both could not explain the remaining variation. Within-animal variation remained less than between-animal variation despite treatment. However, real-time PCR quantification (qPCR) indicated subclinical changes in selected bacterial groups of the penicillin treated horses.

Drug allergy

Drug allergy is one type of adverse reaction to drugs and encompasses a spectrum of hypersensitivity reactions with heterogeneous mechanisms and clinical presentations. A thorough history is essential to the management of drug allergy. Laboratory testing has a very limited role in the management of drug allergy. Graded dose challenges and procedures to induce drug tolerance might be required in patients with drug allergy when there is a definite need for a particular agent. Management of reactions to specific agents, including beta-lactam antibiotics, sulfonamides, local anesthetics, radiocontrast media, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, and biologic modifiers, will be discussed in further detail.

Once-Daily Amoxicillin for Pharyngitis

A once-daily antibiotic regimen for group A β-hemolytic streptococcal pharyngitis (GABHS) could improve compliance and be effective in the prevention of rheumatic fever, a dangerous complication of untreated or poorly treated GABHS. Amoxicillin is ideal for once-daily dosing due to its low cost. Azithromycin, cefadroxil, ceftibuten, cefixime and extended release amoxicillin are also FDA approved to treat GABHS once daily; however, even when taken for short courses, these antibiotics are more expensive compared with a oncedaily dosing of conventional amoxicillin for 10 days. The American Heart Association recently recommended once-daily amoxicillin dosing when treating GABHS, and amoxicillin has been proven to be effective when dosed once daily, with no obvious disadvantage compared with twice-daily dosing or with conventional penicillin treatment 3 to 4 times daily.

Requirement of de novo synthesis of the OdhI protein in penicillin-induced glutamate production by Corynebacterium glutamicum

We found that penicillin-induced glutamate production by Corynebacterium glutamicum is inhibited when a de novo protein synthesis inhibitor, chloramphenicol, is added simultaneously with penicillin. When chloramphenicol was added 4 h after penicillin addition, glutamate production was essentially unaffected. (3)H-Leucine incorporation experiments revealed that protein synthesis continued for 1 h after penicillin addition and then gradually decreased. These results suggest that de novo protein synthesis within 4 h of penicillin treatment is required for the induction of glutamate production. To identify the protein(s) necessary for penicillin-induced glutamate production, proteome analysis of penicillin-treated C. glutamicum cells was performed with two-dimensional gel electrophoresis. Of more than 500 proteins detected, the amount of 13 proteins, including OdhI (an inhibitory protein for 2-oxoglutarate dehydrogenase complex), significantly increased upon penicillin treatment. Artificial overexpression of the odhI gene resulted in the decreased specific activity of the 2-oxoglutarate dehydrogenase complex and increased glutamate production without any triggers. These results suggest that the de novo synthesis of OdhI is the necessary factor for penicillin-induced glutamate overproduction by C. glutamicum. Moreover, continuous glutamate production was achieved by overexpression of odhI without any triggers. Thus, the odhI-overexpressing strain of C. glutamicum can be useful for efficient glutamate production.

Isolated fever in horses: a new case of equine anaplasmosis in France

Anaplasma phagocytophilum is an obligate intracellular bacterium that invades neutrophils, creating intravacuolar aggregates called morulae. It is transmitted to humans and horses through Ixodes tick bites and induces a febrile disease. This research note describes the second equine case confirmed in France. A 14-year-old French saddle horse from an area where Ixodes ricinus ticks are endemic (Ecole Polytechnique, Paris) was referred in May 2007 to the military veterinary clinic for fever and depression. The horse was presented after having received a single-dose penicillin treatment 24 h before because of hyperthermia. The horse underwent thorough clinical examination and blood was collected for analysis, haematology and PCR. Blood was stained with Hemacolor 61650 (Merck, Darmstadt, Germany). DNA was extracted using the QIAamp Tissue Kit and amplified and sequenced by PCR using primers targeting the citrate synthase (gltA) gene and 16S rRNA gene [1]. Clinical signs included fever (39.5 C), depression, anorexia, lethargy, mild icterus and reluctance to move. No limb oedema was noted. The blood count revealed a lymphopenia (745 ⁄mm), an anaemia and a thrombocytopenia (67000 ⁄mm). The horse received prior to other examinations and analyses a single intramuscular dose of 1.2 g of imidocarb dipropionate. An attentive examination of the blood smears showed later basophilic morulae inclusions in the neutrophils, which was suggestive of Anaplasma phagocytophilum infection (Fig. 1). The PCR on blood was positive for both genes and sequencing analysis identified A. phagocytophilum (similarity 100%). The horse recovered within 5 days without any treatment and fever disappeared within 48 h. The first case of European equine anaplasmosis was confirmed in 1998, by PCR and sequencing, in a 12-year-old Arabian mare from an area where ticks were endemic in Switzerland. The first case of Ehrlichia equi infection in an adult horse in France was reported in 2002 [2]. The diagnosis was confirmed by PCR of a blood product and serology (IFA). In France, many cases of fever of unknown origin (FUO) in horses are treated successfully with tetracycline by veterinary practitioners. This led to the hypothesis that A. phagocytophilum incidence might be underestimated and responsible for a part of these cases as suggested by previous epidemiological and molecular studies [3]. The diagnosis of equine anaplasmosis is a challenge if limb oedema and ataxia are lacking, as other clinical signs are not specific. Consequently, this diagnosis should be investigated systematically when facing ‘fever of unknown origin’, which is a frequent syndrome in horses. Horses, indeed, are not well protected from tick bites by ectoparasiticides because of their weak remanency due to equine sudation. This may explain the sporadic cases of ‘subclinical babesiosis’ and even unrecognised cases of mild anaplasmosis. In a case series of horses with FUO, 43% had a well-defined infectious disease, 22% had neoplasia, 6.5% had immune-mediated disease, 19% had miscellaneous causes, and in 9.5% the cause was not determined [4]. Consequently, diagnosis by both PCR and serology appears to be the most appropriate method to confirm a case. In an experimental infection of six horses in Sweden, PCR signal was consistently detected 2–3 days before appearance of clinical signs and persisted 4–9 days after the clinical signs cleared. Antibody response appeared 12–16 days after inoculation and rapidly increased within 3–7 days of clinical illness [5]. For an isolated fever in horses in endemic Corresponding author and reprint requests: P. Brouqui, URMITE, CNRS-IRD UMR 6236, Faculte de medecine et de pharmacie, Universite de la Mediterranee, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France E-mail: philippe.brouqui@medecine.univ-mrs.fr

Penicillin Induced Persistence in Chlamydia trachomatis: High Quality Time Lapse Video Analysis of the Developmental Cycle

Background Chlamydia trachomatis is a major human pathogen with a unique obligate intracellular developmental cycle that takes place inside a modified cytoplasmic structure known as an inclusion. Following entry into a cell, the infectious elementary body (EB) differentiates into a non - infectious replicative form known as a reticulate body (RB). RBs divide by binary fission and at the end of the cycle they redifferentiate into EBs. Treatment of C.trachomatis with penicillin prevents maturation of RBs which survive and enlarge to become aberrant RBs within the inclusion in a non - infective persistent state. Persistently infected individuals may be a reservoir for chlamydial infection. The C.trachomatis genome encodes the enzymes for peptidoglycan (PG) biosynthesis but a PG sacculus has never been detected. This coupled to the action of penicillin is known as the chlamydial anomaly. We have applied video microscopy and quantitative DNA assays to the chlamydial developmental cycle to assess the effects of penicillin treatment and establish a framework for investigating penicillin induced chlamydial persistence.Principal FindingsAddition of penicillin at the time of cell infection does not prevent uptake and the establishment of an inclusion. EB to RB transition occurs but bacterial cytokinesis is arrested by the second binary fission. RBs continue to enlarge but not divide in the presence of penicillin. The normal developmental cycle can be recovered by the removal of penicillin although the large, aberrant RBs do not revert to the normal smaller size but remain present to the completion of the developmental cycle. Chromosomal and plasmid DNA replication is unaffected by the addition of penicillin but the arrest of bacterial cytokinesis under these conditions results in RBs accumulating multiple copies of the genome.ConclusionsWe have applied video time lapse microscopy to the study of the chlamydial developmental cycle. Linked with accurate measures of genome replication this provides a defined framework to analyse the developmental cycle and to investigate and provide new insights into the effects of antibiotic treatments. Removal of penicillin allows recovery of the normal developmental cycle by 10–20 hrs and the process occurs by budding from aberrant RBs.

Treatment of Persistent Vaginal Erosion due to Actinomyces Infection in a Penicillin-Allergic Patient

In Brief Previous reports in the literature have identified Actinomyces sp. as a complication associated with vaginal mesh erosion following pelvic floor reconstruction. Several of these cases have reported success with long-term penicillin treatment in conjunction with vaginal mesh excision. We report a case of vaginal mesh erosion linked to Actinomyces following abdominal sacrocolpopexy in a penicillin-allergic patient. A 68-year-old postmenopausal woman underwent an abdominal sacrocolpopexy with polypropylene mesh and a midurethral sling for recurrent vaginal vault prolapse and stress-urinary incontinence. Three months postoperatively, she was found to have 0.5-cm graft erosion at the anterior vaginal cuff. Pathology of the exposed mesh revealed Actinomyces. Due to a penicillin allergy, a 9-month course of doxycycline was initiated with subsequent successful removal of the remaining mesh with no residual infection. To our knowledge, this is the first report using doxycycline as adjunctive treatment for Actinomyces complicating vaginal mesh erosion. This case report describes the successful treatment of recurrent mesh erosion complicated by Actinomyces in a penicillin-allergic patient using prolonged treatment with doxycycline in conjunction with delayed surgical resection.

A Single Mutation in Enzyme I of the Sugar Phosphotransferase System Confers Penicillin Tolerance to Streptococcus gordonii

Tolerance is a poorly understood phenomenon that allows bacteria exposed to a bactericidal antibiotic to stop their growth and withstand drug-induced killing. This survival ability has been implicated in antibiotic treatment failures. Here, we describe a single nucleotide mutation (tol1) in a tolerant Streptococcus gordonii strain (Tol1) that is sufficient to provide tolerance in vitro and in vivo. It induces a proline-to-arginine substitution (P483R) in the homodimerization interface of enzyme I of the sugar phosphotransferase system, resulting in diminished sugar uptake. In vitro, the susceptible wild-type (WT) and Tol1 cultures lost 4.5 and 0.6 log(10) CFU/ml, respectively, after 24 h of penicillin exposure. The introduction of tol1 into the WT (WT P483R) conferred tolerance (a loss of 0.7 log(10) CFU/ml/24 h), whereas restitution of the parent sequence in Tol1 (Tol1 R483P) restored antibiotic susceptibility. Moreover, penicillin treatment of rats in an experimental model of endocarditis showed a complete inversion in the outcome, with a failure of therapy in rats infected with WT P483R and the complete disappearance of bacteria in animals infected with Tol1 R483P.

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.

School-Based Prevention of Acute Rheumatic Fever

Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease is the commonest cause of childhood cardiac morbidity globally. The current approach to the prevention of a primary attack of rheumatic fever in children using oral medication for streptococcal pharyngitis is poorly supported. The efficacy of injectable penicillin, in high rheumatic fever incidence military environments is indisputable. To evaluate school-based control of rheumatic fever in an endemic area. Fifty-three schools ( approximately 22,000 students) from a rheumatic fever high incidence setting ( approximately 60/100,000) in Auckland, New Zealand were randomized. The control group received routine general practice care. The intervention was a school-based sore throat clinic program with free nurse-observed oral penicillin treatment of group A streptococcal pharyngitis. The outcome measure was ARF in any child attending a study school. Analysis A defined ARF cases using criteria derived from Jones Criteria 1965 (definite) and 1956 (probable) with more precise definitions. Analysis B was based on 1992 Jones criteria but also included echocardiography to determine definite cases. In Analysis A, 24 (55/100,000) cases occurred in clinic schools and 29 (67/100,000) in nonclinic schools, a 21% reduction when adjusted for demography and study design (P = 0.47). Analysis B revealed a 28% reduction 26 (59/100,000) and 33 (77/100,000) cases, respectively (P = 0.27). This study involving 86,874 person-years showed a nonsignificant reduction in the school-based sore throat clinic programs.

Screening for Syphilis Infection in Pregnant Women: Evidence for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

In 2004, the U.S. Preventive Services Task Force strongly recommended that clinicians screen all pregnant women for syphilis infection. To update the evidence on screening pregnant women for syphilis infection. MEDLINE searches from 1 January 2003 through 31 July 2008, recent systematic reviews, reference lists of retrieved articles, and expert suggestions. English-language studies were selected to answer the following 2 questions: Does screening for syphilis in pregnancy reduce the prevalence of congenital syphilis in neonates? Are there harms of screening for syphilis or harms of treatment with penicillin in pregnancy to women or neonates? Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; and ecologic studies were selected for the potential benefits question. Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; case-control studies; and large case series were selected for the potential harms question. Information on the study design, selection criteria, demographic characteristics, and clinical outcomes was extracted from each study. One study on benefits evaluated the effect before and after the implementation of a universal syphilis screening program for pregnant women and found reductions in rates of congenital syphilis. Two studies on screening accuracy for syphilis reported false-positive rates of less than 1%. One study that used a large insurance claims database reported an incidence of anaphylaxis after oral penicillin of 0.1 per 10,000 dispensings. In a study from Hungary, oral penicillin in pregnancy was not associated with orofacial clefts. This was a targeted literature search and could have missed small studies on the benefits and harms of screening for syphilis in pregnancy. We did not review evidence on interventions to improve rates of prenatal screening. New evidence from a study of universal screening supports previous evidence on the effectiveness of screening for syphilis in pregnancy to prevent congenital syphilis. Harms include testing and follow-up for false-positive test results and adverse effects from penicillin treatment.

Cutaneous actinomycosis presenting as chronic mastitis

Actinomycosis is a chronic granulomatous suppurative infection caused by anaerobic actinomyces. Primary cutaneous involvement is uncommon because of the exclusively endogenous habitat of the organism. We describe a very unusual presentation mimicking chronic mastitis. A 35-year-old woman presented 7 months post-partum with tenderness and induration in the right breast. She was pyrexial and felt systemically unwell. An initial diagnosis of mastitis was made. Treatment with penicillin, imipenem, co-amoxiclav and metronidazole had no effect. Skin biopsy revealed the characteristic 'sulphur granules' of actinomycoses in the deep dermis. Long term oral clindamycin (> 12 months) has produced a very good response clinically, with a concomitant decrease in inflammatory markers. Cutaneous actinomycosis has been described by haematogenous spread from visceral organs or after trauma. The organism is difficult to culture and is often diagnosed histologically by the presence of 'sulphur granules'. It is very sensitive to penicillin but prolonged treatment is needed.

Evaluation of meropenem alone and combined with rifampin in the guinea pig model of pneumococcal meningitis

Meropenem is a broad-spectrum carbapenem antibiotic that is highly active against the pathogens causing meningitis. The aims of this study was to determine the efficacies of meropenem alone and combined with rifampin against two Streptococcus pneumoniae strains with different susceptibility to beta-lactams using the guinea pig meningitis model and compare them with the standard ceftriaxone plus vancomycin therapy. All treatments except rifampin were bactericidal from 6 h. The addition of rifampin did not improve the activity of meropenem alone. Our results provide good evidence of the efficacy of meropenem in the treatment of penicillin- and cephalosporin-susceptible and -resistant pneumococcal meningitis similar to that of ceftriaxone plus vancomycin, suggesting that meropenem might be a good option in the management of this infection.

Epidural Extension Of Actinomycosis- Correct Diagnosis Can Avoid Surgical Intervention: A Case Report

Vertebral involvement in actinomycosis is very uncommon and epidural extension rare. We report a case of thirty years old HIV infected immunocompromised man who presented with cervical actinomycosis involving cervicodorsal vertebrae with epidural extension causing paraparesis. Patient recovered on long term penicillin treatment without any surgical intervention. Though actinomycosis is uncommon in this era, when present, it poses a diagnostic challenge. Hence it is worthwhile to consider this possibility in any soft tissue tumoral formation on the face and neck, especially in presence of discharging sinuses. Appropriate use of imaging and laboratory investigations aids in prompt and accurate diagnosis of this difficult condition and obviates surgical treatment. Tuberculosis is the closest differential diagnosis in such cases. Differentiating features from tuberculosis are also considered. Vertebral involvement in actinomycosis is very uncommon. We report a case of cervical actinomycosis involving cervical vertebrae with epidural extension leading to paraparesis. Less than 20 cases of actinomycosis-related spinal neurological deficit have been documented [12345]. Actinomycosis is usually mistaken for tuberculosis.

50 Years Ago in The Journal of Pediatrics: Pediatric empyema: a second look at its incidence and importance

In 1957 and 1958 there was an abrupt increase in the number of children presenting to the Children’s Hospital of Pittsburgh with empyema, a condition which had been steadily declining since the introduction of penicillin. To further examine this surprising upsurge in cases, these investigators retrospectively compared the incidence, etiology, treatment and outcomes of pediatric empyema in the “pre-penicillin era” from 1940–1945 with the “antibiotic era” of 1952–57. They found staphylococcus to be the primary bacteria cultured in the 1957 cases, in contrast to pneumococcus which was the predominate organism in previous years. This increasing prevalence of staphylococcus in association with the initiation and widespread availability of penicillin treatment illustrates how broad changes in pediatric medical practice can effect the etiology of empyema. Subsequent studies through the 1980s reported Staphylococcus aureus and Haemophilus influenzae as predominant pathogens in pediatric empyema. In the early 1990s, following adoption of universal conjugated Haemophilus influenzae vaccination, a number of centers in North America and Europe reported significant increases in empyema cases with the resurgence of Streptococcus pneumoniae as the foremost pathogen. Recent investigations covering the period after the introduction of conjugated pneumococcal vaccine now report a rising prevalence of S aureus and the emergence of MRSA as causative organisms. The Pittsburgh data also reveals the improved outcomes penicillin therapy provided for pediatric empyema. Duration of hospitalization and mortality fell from 34 days and 16% in the pre-antibiotic era to 23 days and 8% in the 1952–1957 period. Pediatric studies from the past decade generally report duration of hospitalization of approximately 14 days with mortality rates less than 1% demonstrating the continued advances in treatment of the ensuing 5 decades. Apparently even 50 years ago one could not write a pediatric empyema paper without addressing controversies in medical versus surgical management. The authors advocate aggressive surgical evacuation of pleural exudate either by repeated thoracentesis or tube drainage over “conservatively handled cases”. Unlike current retrospective empyema studies, however, the readers are spared the common concluding cliche of: “future prospective studies are needed”!

The Clinical Analysis of General Paresis With 5 Cases

The Clinical Analysis of General Paresis With 5 Cases

Why epidemiological and clinical intervention studies often give different or diverging results?

In this response, we will interpret ‘‘epidemiological’’ as ‘‘observational studies’’, and ‘‘clinical intervention’’ studies as ‘‘randomised studies’’. A prototype epidemiological study would be a cohort study, and a prototype clinical intervention study

Comparison between some medicinal plants and Pira cream in clinical Staphylococcus and E. coli mastitis in dairy cattle

The aim of this study was carried out to compare of medicinal plants and pira cream as localized anti-inflammatory drug to treatment of Staphylococcus and E.Coli mastitis in the dairy cattle. In this study which has done in semi-industrial husbandry shahr-e-kord province on 20 infected dairy cattle that have clinical Staphylococcus and E.Coli mastitis. Detection of microorganism confirmed via milk culture in the laboratory. The dairy cattle were randomly allocated in 2 groups with 10 members. One group called control (treated with Pira cream) and the other group called treatment (treated with medicinal plants). The systemic treatment was done via injection of Penicillin, Gentamicin and local treatment via penestroson ointment intra mammary glands. The systemic treatment confirmed by Antibiogram test. On the other, Ointments including Pira cream and medicinal plants used superficially on mammary gland as well as the same time and used twin per day after milking. The medicinal plant compounds were Plantago Psyllium, Aithaea Officinalis, Viola odorata, Malva sylvestris, Flaxseed and flour of Vicia Fava that offered by powder form with equal amount of each element and used from Vaseline (Eucerin) as a basic material of cream. However, for improve progress were done Clinical examination and California mastitis test (CMT) on every day. The result shown the usage of medicinal plants affected on improving Staphylococcus and E.Coli mastitis process better than Pira cream in infected cattle and treatment done in shorter time ( Medicinal plants 4 days VS Pira cream 5 days ). The cost of treatment with medicinal plants is cheaper than Pira cream. On the other, using of medicinal plants better than synthetic, chemical drugs and industrial medicine has better performance in more disease.

Penicillin treatment for early syphilis in the presence of HIV-1 infection: the long or the short of it?

Penicillin treatment for early syphilis in the presence of HIV-1 infection: the long or the short of it?

Randomized, Comparative Efficacy Trial of Oral Penicillin Versus Cefuroxime for Perianal Streptococcal Dermatitis in Children

To investigate the efficacy of penicillin compared with cefuroxime for group A beta-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis. Children 1 to 16 years of age with signs and symptoms of perianal dermatitis and a positive anal swab were randomized to penicillin or cefuroxime treatment and were clinically re-evaluated on day 3 and at the end of treatment (cefuroxime, day 7; penicillin, day 10). An anal swab was obtained to document eradication of GABHS at the end of treatment. Severity of disease was assessed with a clinical score (perianal erythema, 5 points; perianal itch, 3 points; painful defecation, 3 points; constipation, 2 points). Patients were enrolled and randomly assigned to penicillin (n = 18) or cefuroxime (n = 17) treatment. Treatment with penicillin was inferior to cefuroxime, which led to premature study termination after consultation with the ethics committee. Clinical improvement was more rapid in the cefuroxime group (P = .028) and GAHBS was not isolated from the anus the last day of therapy in 13 of 14 patients treated with cefuroxime compared with 7 of 15 patients treated with penicillin (P < .01). Cefuroxime was more effective than penicillin and therefore should be considered as the treatment of choice for perianal dermatitis due to GABHS.