Role Of Antibiotics In Treatment Research Articles

Psychiatric Manifestations in a Patient with Neurosyphilis – The Role of Antibiotic Treatment by Benzathine Penicillin G

Psychiatric Manifestations in a Patient with Neurosyphilis – The Role of Antibiotic Treatment by Benzathine Penicillin G

Caregiver knowledge and attitudes relating to paediatric pneumonia and antimicrobial stewardship: a qualitative study

ObjectiveThe objective of this study was to understand caregiver perspectives and experiences relating to the treatment of paediatric community-acquired pneumonia (CAP).Design, setting and patientsThis was a phenomenological qualitative study involving...

Association Between Antibiotic Treatment of Leptospirosis Infections and Reduced Risk of Dementia: A Nationwide, Cohort Study in Taiwan.

BackgroundTo explore the association between leptospirosis, the risk of dementia, and the potential protective role of antibiotic treatment.MethodsWe conducted a retrospective cohort nationwide, population-based study, from Taiwan’s National Health Insurance Research Database (NHIRD). We enrolled 1,428 subjects aged 50 years or above, in the index year of 2000, which included those retrieved from the NHIRD record. Dementia diagnosis and incidence over 16 years follow-up was retrieved from the NHIRD records. The Fine and Gray survival analysis was used to determine the risk of dementia, and the results were presented as a sub-distribution hazard ratio (SHR) with a 95% confidence interval.ResultsIn the study period, 43 of the 357 leptospirosis patients developed dementia, as compared to 103 of the control group (930.90 vs. 732.49 per 105 person-years). By the Fine and Gray survival analysis, the leptospirosis was associated with the risk of dementia, and the adjusted SHR was 1.357 (95% confidence interval [CI]: 1.213–1.519, P < 0.001), across 16-year of the follow-up period. To exclude the protopathic bias, the sensitivity analysis was conducted. This analysis revealed that the leptospirosis was associated with the increased risk of dementia, even after excluding the dementia diagnosis within the first year (adjusted SHR = 1.246, 95%CI: 1.114–1.395, P < 0.001) or within the first 5 years (adjusted SHR = 1.079, 95%CI: 1.023–1.152, P = 0.028), antibiotic treatment for leptospirosis was associated with the reduced risk of dementia (P = 0.001).ConclusionLeptospirosis was associated with an increased risk for dementia, and antibiotic treatment was associated with a reduced risk. Further research will be necessary to explore the underlying mechanisms of this association.

Role of antibiotic treatment after surgical debridement of superficial hand infections in 180 patients

Considering the rising prevalence of antimicrobial resistance and the lack of recommendations on antibiotic treatment, the present study evaluated the necessity of local and systemic antibiotic therapy in addition to surgical debridement in superficial hand infections. Superficial hand infections were defined as not involving tendons, joints or bone. Data were analyzed for 180 patients, assigned to three study groups according to postoperative antimicrobial treatment. Patients in group I were treated with both systemic and local antibiotics; in group II antimicrobial therapy was limited to local antibiotics in the form of subcutaneous gentamicin bead chains; group III did not receive any antibiotic treatment after surgical debridement. Patients were followed up at two weeks and at three months. Immobilization time and length of stay were longer in group I, but there were no significant differences between the groups in terms of revision rate or recovery of hand function assessed by measurement of finger mobility, grip strength and the Disabilities of the Arm, Shoulder and Hand score at follow-up. Antibiotic treatment of hand infections should be considered carefully and reserved for specific indications: e.g., severe infections and selected patients such as those with diabetes or immunocompromising diseases.

Kikuchi-Fujimoto Disease Associated With Mycoplasma Pneumoniae Infection.

Kikuchi-Fujimoto disease (KFD) is a self-limited disease that is more common in young Asian women. Typical presentations included fever and cervical lymphadenopathy. The etiology of KFD is unknown, and diagnosis is based mainly on lymph node biopsy. KFD has been reported to be associated with Mycoplasma pneumoniae infection. However, the role of antibiotic treatment is unclear. We reported 2 cases of KFD associated with Mycoplasma pneumoniae infection and were successfully treated with a macrolide.

Clinical use of linezolid in periprosthetic joint infections - a systematic review.

Introduction: The most common causative organism in periprosthetic joint infections (PJIs) is Gram-positive bacteria that are increasingly drug resistant. In these cases the use of linezolid may be warranted. However, there are conflicting reports regarding its role in antibiotic treatment of PJIs. The aim of this review is to gather and analyze clinical results and treatment details on linezolid in patients with PJIs. Methods: In August 2019, a comprehensive literature search using MEDLINE (Pubmed and Ovid) and Cochrane Library was performed. A total of 504 records were screened, and a total of 16 studies including 372 patients treated with linezolid for a PJI were included in this review based on the PRISMA criteria and after quality analysis using the MINOR score and Newcastle–Ottawa scale, as well as assessing level of evidence. Pooling analysis as well as descriptive analysis was performed. Results: Based on the results from the studies included, infection control was achieved in 80 % (range 30 %–100 %) of patients after a mean follow-up period of 25 (range 2–66) months. The mean duration of treatment was 58 d intravenous and orally at a median dose of 600 mg bis in die (b.i.d.) (range 400–900 b.i.d.). A combination therapy with rifampicin was used in 53 % of patients. MRSA (methicillin-resistant Staphylococcus aureus) infections were present in 29 % and resistant CoNS (coagulase-negative Staphylococcus) in 46 %. Adverse effects occurred in 33 % of cases, mostly anemia, thrombocytopenia and gastrointestinal complaints leading to treatment discontinuation in 9 %. However, great heterogeneity was found with respect to surgical treatment, diagnosis of infection and indication for linezolid. Discussion: Linezolid is an appropriate option for treatment of resistant Gram-positive organisms in PJIs. Most commonly 600 mg b.i.d. is used, and a combination with rifampicin appears feasible although one must consider individual increases in doses in these cases. However, adverse effects are common and there are limited data for long-term use and optimal antibiotic combinations or individual doses.

The Novel Role of Antibiotic Treatment in the Management of Cutaneous T-Cell Lymphoma (CTCL) Patients

The Novel Role of Antibiotic Treatment in the Management of Cutaneous T-Cell Lymphoma (CTCL) Patients

Role of antibiotics in treatment of diarrhea in school going children

To assess the efficacy of different antibiotic regime in treatment of diarrhoea of paediatric patients. Total of 40 paediatric patients with present of diarrhoea were included in the present study. All the patients were divided into two study groups with 20 patients in each group. Group 1 included subjects who were treated with ceftriaxone therapy while group2 included subjects who were treated with ciprofloxacin therapy. Microbial stool cultures were used as a standard for assessing the efficacy of both the antibiotic regimens. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Results: Mean age of the patients of group 1 and group 2 was 15.8 years and 14.9 years respectively. There were 12 males and 8 females in group 1 while there were 11 males and 9 females in group 2. Success rate among both the study groups was found to be 95 percent. Non- significant results were obtained while comparing the success rate of both the antibiotic treatment therapies. Conclusion: Both ceftriaxone and ciprofloxacin therapy are equally effective in treating diarrhoea in paediatric patients.

412. Host Response Biomarkers Predict Clinical Failure in Patients with Staphylococcus aureus Bacteremia (SAB) Treated with Flucloxacillin (FLU) or Vancomycin (VAN)

BackgroundImbalance among innate mediators such as IL-1β, IL-10, and TNF-α portends poor outcomes of persistence and death in patients with SAB. Previous studies did not consider the role of antibiotic treatment in this important host–pathogen relationship. In this study of SAB, we determined cytokine signatures that correlate with the composite endpoint of clinical failure (bacteremia duration >4 days or 30-day mortality) in Australian patients treated with FLU or VAN.MethodsSera from 86 patients with SAB (24.4% MRSA) were obtained from a clinical study of patients treated with FLU or VAN. All of the patient samples were collected at clinical presentation (day 0 or day 1 of infection) and were treated with FLU or VAN throughout. Patients were classified into either clinical success (CS = 68) or clinical failure (CF = 18), defined as death or prolonged bacteremia >4 days. Patient demographic and infection characteristics were collected. A 10-multiplex TH1/TH2 cytokine analysis was performed using electrochemoluminescence with the Meso-Scale Discovery platform analyzed by Mann–Whitney U.ResultsPatients’ median values were significantly elevated and above the normal range in CF for IL-1β (P = 0.029), IL-10 (P = 0.018), TNF-α (P = 0.042), and IL-6 (P = 0.006) (figure). Epidural abscess source was associated with CF, but no other host or pathogen characteristics correlated to outcome. Patients infected with isolates with VAN MIC = 2 mg/L (by Etest and broth dilution) had lower concentrations of IL-1β and IL-10 (P = 1.5 mg/L. In ROC analysis, IL-1β, IL-10, TNF, and IL-6 were higher sensitivity and specificity predictors of CF (AUC 0.65–0.71; P = 0.05).ConclusionA suboptimal host immune response to SAB at presentation predicts adverse clinical outcomes. IL-10, TNF-α, and IL-6 serum concentrations appear to reflect immunopathology in patients with SAB. These predictive markers may be considered in therapeutic clinical decision-making, such as escalation of alternative therapies in high-risk patients and/or de-escalation treatment in low-risk patients. These data offer steps toward further refining therapeutic precision for patients with SAB beyond the standard clinical or microbiological metrics that are employed in current practice. Disclosures All authors: No reported disclosures.

Conservative Treatment in Diverticulitis Patients with Pericolic Extraluminal Air and the Role of Antibiotic Treatment

BackgroundRecently published studies advocate a conservative approach with observation and antibiotic treatment in diverticulitis patients with pericolic air on computed tomography (CT). The primary aim of this study was to assess the clinical course of initially conservatively treated diverticulitis patients with isolated pericolic air and to identify risk factors for conservative treatment failure. The secondary aim was to assess the outcome of non-antibiotic treatment. MethodsPatient data from a retrospective cohort study on risk factors for complicated diverticulitis were combined with data from the DIABOLO trial, a randomised controlled trial comparing non-antibiotic with antibiotic treatment in patients with uncomplicated diverticulitis. The present study identified all patients with Hinchey 1A diverticulitis with isolated pericolic air on CT. Pericolic air was defined as air located < 5 cm from the affected segment of colon. The primary outcome was failure of conservative management which was defined as need for percutaneous abscess drainage or emergency surgery within 30 days after presentation. A multivariable logistic regression of clinical, radiological and laboratorial parameters with respect to treatment failure was performed. ResultsA total of 109 patients were included in the study. Fifty-two (48%) patients were treated with antibiotics. Nine (8%) patients failed conservative management, seven (13%) in the antibiotic treatment group and two (4%) in the non-antibiotic group (p = 0.083). Only (increased) CRP level at presentation was an independent predictor for treatment failure. ConclusionsConservative treatment in diverticulitis patients with isolated pericolic air is a suitable treatment strategy. Moreover, non-antibiotic treatment might be reasonable in selected patients.

Publication status of completed registered studies in paediatric appendicitis: a cross-sectional analysis

ObjectiveAppendicitis is considered the most frequent surgical emergency in children. While the management of paediatric appendicitis is evolving, the precise amount of unpublished completed trials, potentially introducing bias into meta-analyses,...

Risk factors for recurrent carbapenem resistant Klebsiella pneumoniae bloodstream infection: a prospective cohort study.

To assess risk factors for recurrent carbapenem-resistant Klebsiella pneumoniae bloodstream-infection (CR-KP BSI), we performed a prospective observational cohort study of all consecutive adult patients cured of a CR-KP BSI at our hospital over a six-year period (June 2010 to June 2016). Maximum follow-up per patient was 180days from the index blood cultures (BCs). Recurrent CR-KP BSI was defined as new evidence of positive BCs in patients with documented clinical response after completing a course of anti-CR-KP therapy. Univariate and multivariate cause-specific Cox proportional hazards analysis were performed. During the study period 249 patients were diagnosed with a CR-KP BSI, 193 were deemed as cured within 14days after index BCs and were analysed. Recurrence occurred in 32/193 patients (16.6%) within a median of 35 (IQR 25-45) days after index BCs. All but one of the recurrences occurred within 60days after the index BCs. Comparison of recurrent and non-recurrent cases showed significant differences for colistin use (84.4% vs. 62.2%, p=0.01), meropenem-colistin-tigecycline regimen (43.8% vs. 24.8%, p=0.03) and length of therapy for the index BSI episode (median 18 vs. 14days, p=0.004). All-cause 180-day mortality (34.4% vs. 16.1%, p=0.02) was higher in recurrent cases. In the multivariate analysis, the only independent variable was source control as a protective factor for recurrence. Recurrence is frequent among patients cured of a CR-KP BSI and is associated with higher long-term mortality. When feasible, source control is mandatory to avoid recurrence. The role of antibiotic treatment should be further investigated in large multicentre studies.

Probiotics for Irritable Bowel Syndrome

ABSTRACTPurpose of review:The purpose of this review was to summarize the evidence regarding probiotics treatment for pediatric IBS.Recent findings:The overall management of children with IBS should be tailored to the patient's specific symptoms and identifiable triggers. The four major therapeutic approaches include: pharmacologic, dietary, psychosocial, and complementary/alternative medicine interventions.Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and anti‐diarrheals, these may have a role in severe cases. A Cochrane review concluded that only weak evidence exists regarding beneficial effects of pharmacological agents in providing relief from symptoms in functional abdominal pain (AP) in children. Role of antibiotics in treatment of children with IBS remains controversial. Various non‐pharmacologic treatments are available for pediatric IBS. In a recent systematic review including 24 studies some evidence was found indicating beneficial effects of partially hydrolyzed guar gum (PHGG), cognitive behavioral therapy, hypnotherapy, and probiotics (LGG and VSL#3).Few randomized clinical trials (RCTs) are available in children. A meta‐analysis including 9 trials which tested different probiotics as a treatment for Functional Gastrointestinal Disorders (FGIDs) in children and adolescents concluded that Lactobacillus GG, Lactobacillus reuteri DSM 17938 and VSL#3 significantly increased treatment success. We recently showed that, in children with IBS, a mixture of Bifidobacterium infantis M‐63®, breve M‐16V® and longum BB536® is safe and is associated with better AP control and improved quality of life when compared to placebo.Summary:Probiotics are emerging as new therapeutic tools in FGIDs, due to the recognition of the importance of gut microbiota in influencing brain‐gut interactions, and of the role played by intestinal infections in the genesis of AP‐FGIDs. Preclinical data suggest that changes in the gut microbiota can affect brain signaling systems related to pain and associated emotional behavior. Therefore, probiotics could play a relevant role in the management of FGIDs, by affecting the gut microbiota or by altering brain function and pain perception centrally.

Role of antibiotics for treatment of inflammatory bowel disease.

Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of the two main inflammatory bowel diseases: Crohn's disease (CD) and ulcerative colitis. Alterations in gut microbiota, and specifically reduced intestinal microbial diversity, have been found to be associated with chronic gut inflammation in these disorders. Specific bacterial pathogens, such as virulent Escherichia coli strains, Bacteroides spp, and Mycobacterium avium subspecies paratuberculosis, have been linked to the pathogenesis of inflammatory bowel disease. Antibiotics may influence the course of these diseases by decreasing concentrations of bacteria in the gut lumen and altering the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole, the combination of both, rifaximin, and anti-tuberculous regimens have been evaluated in clinical trials for the treatment of inflammatory bowel disease. For the treatment of active luminal CD, antibiotics may have a modest effect in decreasing disease activity and achieving remission, and are more effective in patients with disease involving the colon. Rifamixin, a non absorbable rifamycin has shown promising results. Treatment of suppurative complications of CD such as abscesses and fistulas, includes drainage and antibiotic therapy, most often ciprofloxacin, metronidazole, or a combination of both. Antibiotics might also play a role in maintenance of remission and prevention of post operative recurrence of CD. Data is more sparse for ulcerative colitis, and mostly consists of small trials evaluating ciprofloxacin, metronidazole and rifaximin. Most trials did not show a benefit for the treatment of active ulcerative colitis with antibiotics, though 2 meta-analyses concluded that antibiotic therapy is associated with a modest improvement in clinical symptoms. Antibiotics show a clinical benefit when used for the treatment of pouchitis. The downsides of antibiotic treatment, especially with recurrent or prolonged courses such as used in inflammatory bowel disease, are significant side effects that often cause intolerance to treatment, Clostridium dificile infection, and increasing antibiotic resistance. More studies are needed to define the exact role of antibiotics in inflammatory bowel diseases.

The Role of Antibiotics in Treatment of Chronic Periodontitis

Systemic antibiotics may be a necessary adjunct in controlling bacterial infection because bacteria can invade periodontal tissues, making mechanical therapy alone sometimes ineffective. An ideal antibiotic for use in prevention and treatment of periodontal diseases should be specific for periodontal pathogens, allogenic and nontoxic, substantive, not in general use for treatment of other diseases, and inexpensive . Combination of antibiotics may be necessary to eliminate all putative pathogens from some periodontal pockets. The guidelines for use, structure and origin, mechanisms of action of antibiotics are discussed in this paper. Also the recommended antibiotic dosages in Periodontal therapy is reviewed in this paper.

Rethinking the Composition of a Rational Antibiotic Arsenal for the 21St Century

The importance of the human microbiome in health may be the single most valuable development in our conception of the microbial world since Pasteur's germ theory of the 1860s. Its implications for our understanding of health and pathogenesis are profound. Coupled with the revolution in diagnostics that we are now witnessing - a revolution that changes medicine from a science of symptoms to a science of causes - we cannot continue to develop antibiotics as we have for the past 80 years. Instead, we need to usher in a new conception of the role of antibiotics in treatment: away from single molecules that target broad phylogenetic spectra and towards targeted molecules that cripple the pathogen while leaving the rest of the microbiome largely intact.

Effects of Antibiotics on Shiga Toxin 2 Production and Bacteriophage Induction by Epidemic Escherichia coli O104:H4 Strain

The role of antibiotics in treatment of enterohemorrhagic Escherichia coli (EHEC) infections is controversial because of concerns about triggering hemolytic-uremic syndrome (HUS) by increasing Shiga toxin (Stx) production. During the recent large EHEC O104:H4 outbreak, antibiotic therapy was indicated for some patients. We tested a diverse panel of antibiotics to which the outbreak strain is susceptible to interrogate the effects of subinhibitory antibiotic concentrations on induction of stx(2)-harboring bacteriophages, stx(2) transcription, and Stx2 production in this emerging pathogen. Ciprofloxacin significantly increased stx(2)-harboring phage induction and Stx2 production in outbreak isolates (P values of <0.001 to <0.05), while fosfomycin, gentamicin, and kanamycin insignificantly influenced them (P > 0.1) and chloramphenicol, meropenem, azithromycin, rifaximin, and tigecycline significantly decreased them (P ≤ 0.05). Ciprofloxacin and chloramphenicol significantly upregulated and downregulated stx(2) transcription, respectively (P < 0.01); the other antibiotics had insignificant effects (P > 0.1). Meropenem, azithromycin, and rifaximin, which were used for necessary therapeutic or prophylactic interventions during the EHEC O104:H4 outbreak, as well as tigecycline, neither induced stx(2)-harboring phages nor increased stx(2) transcription or Stx2 production in the outbreak strain. These antibiotics might represent therapeutic options for patients with EHEC O104:H4 infection if antibiotic treatment is inevitable. We await further analysis of the epidemic to determine if usage of these agents was associated with an altered risk of developing HUS.

Links Between Infectious Diseases and Cardiovascular Disease: A Growing Body of Evidence

It is widely acknowledged that a systemic inflammatory process is involved in atherogenesis leading to subsequent cardiovascular disease (CVD). Several types of microbes have been implicated as possible causative agents in acquired CVD. This article reviews current and emerging links established between specific microorganisms and cardiac vessel and other vascular damage. Studies are reviewed that have investigated a possible role for antibiotics in treatment and prevention; other potential primary and secondary preventive measures are then explored. Nurse practitioners have an important role in recognizing and effectively managing the multiple complex processes involved in the development of CVD.

Risk factors for early sepsis in very low birth weight neonates with respiratory distress syndrome

To identify maternal and neonatal factors that increase suspicion of early sepsis in Very Low Birth Weight neonates with respiratory distress syndrome. The cohort included 282 neonates born at Soroka Medical Centre 1996-2000. Definitions of 'high' and 'low'-suspicion groups for early sepsis were based on comparison between neonates with early sepsis and the remaining cohort. Univariate analysis and logistic regression were used to compare between groups. The incidence of early sepsis in the cohort was 1.8%, and 94% received antibiotics following delivery. Comparing with the remaining cohort, the five neonates with early sepsis had increased incidence of positive maternal cultures, use of antenatal antibiotics, lower 1 min Apgar scores and tendency to leucopenia. A 'low-suspicion' group comprised 38% of the cohort and did not include any neonates with early sepsis. This group were more frequently treated with antenatal steroids and delivered by Caesarean section compared to the 'high-suspicion' group, but otherwise there were no clinical and laboratory differences. Although the incidence of early sepsis is low almost all neonates received antibiotics. A 'low-suspicion' group was defined and the role of antibiotic treatment in this group needs to be determined.

Treatment and Outcomes of Community-Acquired MRSA Infection

The rate of infections caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has been increasing dramatically, but the role of antibiotics for treatment remains ill-defined. In this retrospective study, investigators identified all patients with a positive culture for S. aureus (SA) between 1998 and 2005 at a Boston clinic. To be included in the analysis, patients had to have SA isolated from a nonwound site or clinical evidence of a skin or soft-tissue infection (SSTI) with SA isolated from a wound culture. A total of 164 patients were found to be infected with MRSA and 160 …