Role Of Antibiotic Therapy Research Articles

Treatment of psoriasis in children: is there a role for antibiotic therapy and tonsillectomy?

Numerous studies implicate subclinical or recurrent streptococcal infection as a trigger or maintenance factor in the pathogenesis of psoriasis in children. The purpose of this article is to review the efficacy of antibiotic therapy and tonsillectomy as treatments for childhood psoriasis. Clinical trials assessing the efficacy of antibiotics or tonsillectomy as treatments for childhood psoriasis were identified with a search of the medical literature and the results were compared. Only one controlled clinical trial was identified and it did not find a significant effect of antibiotic treatment on psoriasis. In other studies, the percentage of psoriasis patients who experienced disease clearance with antibiotic therapy ranged from 0% to 55%, with no patients experiencing disease worsening during treatment. No controlled trials of tonsillectomy for psoriasis were identified. The percentage of patients who experienced disease clearance after tonsillectomy in uncontrolled trials ranged from 32% to 53% and a similar percentage reported significant improvement in their psoriasis, with a maximum of 7% noting worsening of the disease after the operation. The available evidence does not demonstrate the efficacy of either antibiotic therapy or tonsillectomy in the treatment of childhood psoriasis. Because these treatments are relatively benign compared to other treatments for severe psoriasis, the use of antibiotic therapy or tonsillectomy may still be worth considering, especially for those patients with recurrent streptococcal infections that seem to trigger or maintain their skin disease.

The role of infection in the pathogenesis of cardiovascular disease.

Atherosclerosis is a complex, multifactorial disease. Recently, research has intensified to identify the role of various infections in the pathogenesis of atherosclerosis. Specific agents have been proposed as direct initiators or accelerators of atherosclerosis, while other infectious agents have been proposed as accelerators of atherosclerosis through nonspecific stimulation of the inflammatory cascade. Recently, the total pathogen burden concept has suggested that while each specific infection contributes only slightly to the pathogenesis of atherosclerosis, the cumulative effects of infectious agents contribute greatly. Several randomized trials evaluating antibiotic therapy in the prevention of cardiovascular events have now been completed, although results have been conflicting. This manuscript summarizes current understanding of the role of infectious agents as a trigger of inflammation, as a contributor to atherosclerosis, and the potential role of antibiotic therapy in the treatment of atherosclerosis.

Role of antibiotic therapy on long-term germ excretion in faeces and digestive symptoms after Salmonella infection.

The role of antibiotic therapy on Salmonella faecal excretion is controversial. Acute Salmonella gastroenteritis induces long-lasting digestive symptoms in up to one-third of subjects. The role of antimicrobial therapy on persistent post-infectious symptoms is unknown. To investigate the role of antibiotic therapy on long-term germ faecal excretion and digestive symptoms after Salmonella infection. 1543 subjects [518 aged between 3 and 5 years (35.3%); 950 between 6 and 10 years (64.7%) and 75 adults (4.9%)] involved in a single outbreak of Salmonella enteritis fulfilled the study criteria by repeating stool cultures and answering a symptom questionnaire 3 months post-infection. 327 subjects (21.2%) were treated with antibiotics during the acute infection [121 children aged 3-5 years (23.4%), 175 children aged 6-10 years (18.4%) and 31 adults (41.3%)]. Antibiotic treatment did not affect Salmonella excretion at any of the time points studied up to three months post-infection in any age group as compared to age-matched untreated controls. Persistent digestive symptoms were more common among the patients treated with antibiotics (9.5% vs. 2.9%; P=0.003). Antibiotic therapy does not affect Salmonella enteritis excretion. Digestive symptoms after clearance of the infectious agent are significantly higher in patients treated with antibiotics during acute gastroenteritis.

Reactive arthritis.

Reactive arthritis is one of the spondyloarthropathy family of clinical syndromes. The clinical features are those shared by other members of the spondyloarthritis family, though it is distinguished by a clear relationship with a precipitating infection. Susceptibility to reactive arthritis is closely linked with the class 1 HLA allele B27; it is likely that all sub-types pre-dispose to this condition. The link between HLA B27 and infection is mirrored by the development of arthritis in HLA B27-transgenic rats. In this model, arthritis does not develop in animals maintained in a germ-free environment. Infections of the gastrointestinal, genitourinary and respiratory tract appear to provoke reactive arthritis and a wide range of pathogens has now been implicated. Although mechanistic parallels may exist, reactive arthritis is distinguished from Lyme disease, rheumatic fever and Whipple's disease by virtue of the distinct clinical features and the link with HLA B27. As in these conditions both antigens and DNA of several micro-organisms have been detected in joint material from patients with reactive arthritis. The role of such disseminated microbial elements in the provocation or maintenance of arthritis remains unclear. HLA B27-restricted T-cell responses to microbial antigens have been demonstrated and these may be important in disease pathogenesis. The importance of dissemination of bacteria from sites of mucosal infection and their deposition in joints has yet to be fully understood. The role of antibiotic therapy in the treatment of reactive arthritis is being explored; in some circumstances, both the anti-inflammatory and anti-microbial effects of certain antibiotics appear to be valuable. The term reactive arthritis should be seen as a transitory one, reflecting a concept which may itself be on the verge of replacement, as our understanding of the condition develops. Nevertheless it appropriately describes arthritis that is associated with demonstrable infection at a distant site without traditional evidence of sepsis at the affected joint(s). Although several forms of disease could be described as "reactive", particularly acute rheumatic fever, post-meningococcal septicaemia arthritis and Lyme disease, in clinical practice the term is restricted to an acute spondyloarthritis, usually, but not exclusively, linked to acute genitourinary or gastrointestinal infection. A proportion of patients fulfil criteria for Reiter's Syndrome [1].

The Role of Antibiotic Therapy in the Prevention of Prematurity

Prematurity is the leading cause of perinatal morbidity and mortality in the industrial world, occurring in 4% to 9% of all deliveries, a rate that has remained unchanged during the past decades. Despite the relative minority of obstetric patients affected by this problem, prematurity is responsible for approximately 70% to 80% of perinatal morbidity and mortality corrected for congenital anomalies. To date, treatment modalities (tocolysis) that have been applied to patients who have preterm labor (PTL) and preterm premature rupture of membranes have been found to be of limited value in reducing both the rate of prematurity and of perinatal mortality and morbidity. A possible explanation for this failure in prevention of prematurity can be attributed to the poor understanding of the mechanisms of parturition in general and the pathophysiology of PTL in particular.

The Role of Antibiotic Therapy in the Prevention of Empyema in Patients with an Isolated Chest Injury (ISS 9–10)

The purpose of this study was to determine the impact of an antibiotic regimen on the incidence of empyema in patients admitted with isolated chest trauma (ISS 9/10) and hemopneumothorax requiring tube thoracostomy. All patients with isolated chest trauma and hemopneumothorax (estimated ISS 9 or 10) seen in our trauma center were considered eligible for this study. Patients were excluded for the following reasons: age less than 18 years, presence of shock at the time of initial resuscitation, ongoing antibiotic therapy for unrelated disease, documented pre-existing infection or documented abnormal immune status. Ninety patients were randomized to two treatment limbs: antibiotics and tube thoracostomy or tube thoracostomy alone. All patients had the procedure performed in the trauma center in a standard fashion. Wound care and tube care were identical. Antibiotic therapy consisted of a first-generation cephalosporin (cefazolin), one dose given just before the procedure and then q 6 h into the tube removal. Injury Severity Scores were established as described by Schwab after the manner of Baker. Statistical analysis was performed using Fisher's exact test of binary outcome. In this study, antibiotics were able to reduce the incidence of empyema in patients with isolated chest trauma and for such patients antibiotic treatment appears justified. Further work is required to determine the effect on patients with more severe injury and multisystem involvement.

Salmonella enteritis in children in Libya: role of antibiotic therapy

In vivo sensitivity of salmonella has been studied in 38 children with acute gastroenteritis. They were treated for 7 days with gentamicin, to which the organisms were sensitive in vitro. Stool culture remained positive in 30 of the 38 cases. The children improved on supportive and symptomatic therapy. This study shows that antibiotics have no role to play in the management of acute salmonella gastro-enteritis in children.

Acute hematogenous staphylococcal osteomyelitis: evaluation of cloxacillin therapy in an animal model

A reproducible avian model of acute hematogenous staphylococcal osteomyelitis was used to investigate various aspects of antibiotic therapy using a single antibiotic, cloxacillin. The effects of both delaying antibiotic administration and increasing the frequency of antibiotic administration on the outcome of the disease were evaluated. Following bacterial inoculation, a delay in commencing therapy for 4 d in comparison to 1 d significantly reduced the likelihood of a favourable outcome. An increase in the frequency of antibiotic administration from once to 4 times daily resulted in significant improvement in the recovery rate of chickens. Whilst repeated antibiotic administration controlled the systemic effects of the disease and improved the clinical status of chickens, the local bone lesion was not always sterilized. The role of antibiotic therapy in acute hematogenous osteomyelitis is discussed in relation to these findings.

Campylobacter: common cause of enteritis in an infectious diseases hospital.

Eleven patients were referred to the infectious diseases wards of the Prince Henry Hospital, Sydney, between August and December, 1979, with acute infectious diarrhoea acquired within Australia. Nine of the 11 had infection with Campylobacter species as the sole pathogens. In contrast, a variety of pathogens was isolated from the stools of 13 patients referred to the hospital with enteritis acquired during overseas travel, including three Shigella species, but only one Campylobacter species. The patients with campylobacter enteritis suffered fever, abdominal discomfort and diarrhoea, often with some blood. Complications of campylobacter enteritis included colitis, severe abdominal pain, renal failure, severe muscle cramps, headache with meningism, myalgias and arthralgias. Campylobacter enteritis resolved with cessation of solid food intake, together with intravenous or oral fluid therapy. Some patients were treated with erythromycin, with prompt improvement, though a role for antibiotic therapy has not yet been established.

A review of positive blood cultures: identification and source of microorganisms and patterns of sensitivity to antibiotics.

All strains of bacteria and fungi isolated from blood cultures of patients hospitalized in a large primary and tertiary care center were studied prospectively for determination of their clinical significance and probable source. In some instances the immediate mortality rate was also determined. The sensitivity patterns of all aerobic organisms to antibiotics were studied in relation to the role of antibiotic therapy. A positive culture was obtained from 6.8% of all blood specimens cultured and these positive cultures represented 639 episodes of bacteremia or fungemia. The organism isolated most of ten was Escherichia coli, and the most common known source was the urinary tract. Anaerobic organisms were isolated from 9.2% of the episodes of bacteremia, with the bowel being the most common probable source of infection. Antibiotic sensitivity testing revealed that all staphylococci were sensitive to methicillin, but only 22% were sensitive to penicillin. No penicillin-resistant pneumococci were encountered. The Enterobacteriaceae exhibited such a high sensitivity to gentamicin that comparison of its activity with that of other, newer aminoglycosides was impossible.

Use of Antimicrobials in the Management of Open Fractures

The role of antibiotic therapy in open fractures is secondary to adequate debridement, irrigation, and definitive wound care. Experimental and clinical studies indicate that parenteral administration of appropriate antibiotics within three hours after injury helps to prevent wound sepsis. Intial wound cultures of 158 open fracture wounds revealed bacterial growth in 70.3%. Eighty-six were Gram-positive, 57 were Gram-negative, and 32 yielded mixed bacterial growth. Sensitivity studies of these organisms suggest that cephalothin sodium is the most effective antibiotic for prophylaxis. In a prospective study from 1969 to 1975, treatment of 520 patients was as follows: debridement, copious irrigation, and primary closure for types 1 and 2 fractures and secondary closure for type 3 fractures. No primary internal fixation was done except in vascular injuries. Cultures were taken of all wounds and antibiotics were given before surgery and for three days postoperatively. In type 3 open fractures, severe soft tissue injury, and segmental or traumatic amputation, the infection rate was 9%, compared to a 44% infection rate in the retrospective study from 1955 to 1968.

Clinical importance of infections due to Bacteroides fragilis and role of antibiotic therapy.

Out of 200 infections due to Bacteroides fragilis occurring over a period of three years 133 were related to the intestinal tract, 55 to the genitourinary tract, and the remainder were in bedsores and ulcers; 56% occurred in patients undergoing major intestinal surgery.B. fragilis was isolated in pure culture from 56% of the infections. In mixed culture it was most commonly associated with Klebsiella and Enterobacter species. Other anaerobic bacteria were isolated in 9% of the mixed cultures.Altogether 131 (65.5%) of the patients recovered without antibiotic therapy or further surgery, but 59 (29.5%) developed complications and 10 (5%) died. The commonest complication was abscess formation, and the incidence was highest with infections associated with malignancy (44%) and lowest with obstetric infections (5%). The mortality was 5% overall but in the presence of bacteraemia it rose to 33%.Only 43 patients received appropriate chemotherapy. Clindamycin was the most effective antibiotic, having a recovery rate of 78%, but this rate was little better than in untreated patients (65%). The role of prophylactic antibiotic therapy in preventing bacteroides infection remains to be studied.The incidence of the isolation of bacteroides from wound infections after major intestinal surgery rose from 13% in 1970 to 81% in 1973. This increase was due to both the accurate collection and care of specimens while in transit to the laboratory and the use of selective media for the isolation of bacteroides in laboratory culture. The importance of these precautions is emphasized.

Abscess of the spleen

1. 1. A case of splenic abscess due to hematogenous spread of infection from a deltoid abscess in the postoperative period, following total colectomy for idiopathic ulcerative colitis, is presented. Successful result with splenectomy and erythromycin therapy was obtained. 2. 2. The choice of operation, splenotomy vs. splenectomy, and the indications for each procedure are discussed. 3. 3. The role of antibiotic therapy as an adjunct to, but not as a substitute for, surgery in treatment of this condition is emphasized.

Mucormycosis of the central nervous system associatedwith thrombosis of the internal carotid artery

The first reported case of mucormycosisof the central nervous system in infancy has been presented. The mucor organism is believed to have produced the third recorded case of infantile carotid artery thrombosis. The unusual ability of this fungus to invade blood vessels and to occlude their lumina has been pointed out. The role of antibiotic therapy in mycotic infection is discussed. No effective therapy is known for this condition. The first reported case of mucormycosisof the central nervous system in infancy has been presented. The mucor organism is believed to have produced the third recorded case of infantile carotid artery thrombosis. The unusual ability of this fungus to invade blood vessels and to occlude their lumina has been pointed out. The role of antibiotic therapy in mycotic infection is discussed. No effective therapy is known for this condition.