Standard Antibacterial Therapy Research Articles

Clinical case of tuberculous otitis media in early childhood

Nowadays, the incidence of tuberculosis remains high all over the world, despite the vaccination, medical support, social policy. The main reasons for this are the high level of migration, the prevalence of bad habits, the prevalence of immunodeficiency conditions, the formation of resistance to antimicrobial drugs, the tendency to refuse vaccination. At the same time, great difficulties arise in the diagnosis of extrapulmonary forms of infection. The purpose of this publication is to remind about the peculiarities of the course and diagnosis of tuberculous otitis media. According to the literature, the main characteristic features of tuberculous of the middle ear are prolonged suppuration without pronounced pain syndrome, inefficiency of standard antibacterial therapy, the anamnestic data about contacts or violation of the vaccination schedule, multiple perforations and a pronounced granulation process during otoscopy, a pronounced destructive process in the temporal bone during X-ray examination. The article presents a clinical case of the development of tuberculous otitis media in a young child with delayed diagnostics and the development of mastoiditis with required emergency surgical treatment. Verification of the etiology of the disease and the specific treatment carried out made it possible to achieve complete relief of ear symptoms, restoration of the tympanic membrane and ventilation of the middle ear.

MarR-Dependent Transcriptional Regulation of mmpSL5 Induces Ethionamide Resistance in Mycobacterium abscessus.

Mycobacterium abscessus (Mabs) is an emerging nontuberculosis mycobacterial (NTM) pathogen responsible for a wide variety of respiratory and cutaneous infections that are difficult to treat with standard antibacterial therapy. Mabs has a high degree of both innate and acquired antibiotic resistance to most clinically relevant drugs, including standard anti-mycobacterial agents. Ethionamide (ETH), an inhibitor of mycolic acid biosynthesis, is currently utilized as a second-line agent for treating multidrug-resistant tuberculosis infections. Here, we show that ETH displays activity against clinical strains of Mabs in vitro at concentrations that are >100× lower than other mycolic acid targeting drugs. Using transposon mutagenesis followed by transposon sequencing (Tn-Seq) and whole-genome sequencing of spontaneous ETH-resistant mutants, we identified MAB_2648c as a genetic determinant of ETH sensitivity in Mabs. MAB_2648c encodes a MarR family transcriptional regulator of the TetR class of regulators. We show that MAB_2648c represses expression of MAB_2649 (mmpS5) and MAB_2650 (mmpL5). Further, we show that derepression of these genes in MAB_2648c mutants confers resistance to ETH, but not other antibiotics. To identify determinants of resistance that may be shared across antibiotics with distinct mechanisms of action, we also performed Tn-Seq during treatment with amikacin and clarithromycin, drugs currently used clinically to treat Mabs. We found very little overlap in genes that modulate the sensitivity of Mabs to all three antibiotics, suggesting a high degree of specificity for resistance mechanisms in this emerging pathogen.

Efficacy of lymphotropic parenteral antibacterial therapy in patients with an acute pancreatitis

Objective.To compare clinical results of application of lymphotropic antibacterial therapy (LATH) versus standard method of parenteral administration of antibiotics in patients, suffering an acute pancreatitis.
 Materials and methods. Clinical data, the values of the leucocyte and hematological intoxication indices, and some other indices of immunity, occurring on background of lymphotropic and standard antibacterial therapy, were studied. The patients were distributed into two groups: Group I (the main) - to whom lymphotropic antibioticotherapy was conducted, and Group II (a control one) - to whom a standard antibioticotherapy was applied.
 Results. In patients of the main group the pain syndrome, belching and regurgitation have had regressed during 2 days of treatment. During 5 days of treatment the intoxication signs have been eliminated. In the patients, admitted to hospital in the first day of an acute pancreatitis manifestation, the values of the intoxication leucocytes index after 5 days of the LATH conduction were on the level of corresponding index of practically healthy people, the CD3 and CD4 quantity raised statistically significantly, and the dimensions of the inflammatory changed pancreatic gland reduced.
 Conclusion. Lymphotropic injection of antibiotics and anti-inflammatory medicines promotes inhibition of inflammatory process in pancreatic gland. On background of adverse development of inflammation, a more rapid improvement of clinical symptoms of an acute pancreatitis, as well as in the indices of the common markers of inflammatory process and cellular immune defense, are observed. The data obtained witness the advantage of LATH over a standard (parenteral) one in the treatment of an acute pancreatitis.

JUSTIFICATION OF LYMPHOTROPIC ANTIBACTERIAL THERAPY BENEFITS BASED ON THE CHANGES IN SPECIFIC IMMUNITY PARAMETERS IN ACUTE PANCREATITIS

Introduction. The incidence and features of acute pancreatitis stimulate the scientific community and clinicians to look for new antibiotics and new algorithms for their use in treating this disease, which is the world's third most frequent acute surgical disease. Despite this, acute pancreatitis mortality indicates the need for better approaches, especially in conditions of microbial resistance to antibiotics, which determines the urgency of the problem. The objective of the paper was to justify lymphotropic antibacterial therapy as an alternative method of treatment of acute pancreatitis based on the changes in specific immunity parameters, which will make it possible to increase the effectiveness of treatment of the disease and potential complications. Materials and methods were based on the study of the leukocyte index of intoxication, the hematological index of intoxication, and some other parameters of immunity on lymphotropic and standard antibacterial therapy. With this in mind, patients were divided into two groups. Results. It was established that under the influence of lymphotropic antibacterial therapy, the leukocyte index of intoxication decreased by 0.3392 units on early admission and by 0.4128 units on late admission compared to standard antibacterial therapy. LAT appeared to be more effective in terms of the effect on HII – by 1.1214 units on early admission and by 1.0537 units on late admission. The effect on cellular immunity with LAT was more pronounced than that with standard antibacterial therapy. Discussion. Purulent-infectious foci in acute pancreatitis lead to profound disturbances in the immune system as they develop intensively and quickly, and already after 24 hours of manifestation, they significantly exceed those that develop within 24 hours. Lymphotropic antibacterial therapy adjusts these changes bringing them closer to the control ones, while standard antibacterial therapy fails to do so. Conclusions. Changes in the immune system parameters, which tend towards the control ones, suggest that lymphotropic antibacterial therapy is an alternative to standard therapy.

Применение комбинированного назального спрея, содержащего туаминогептан, ацетилцистеин и гиалуроновую кислоту, в комплексной терапии острого риносинусита

Aim: to assess the effect of hyaluronic acid on the clinical efficacy of a combination of tuaminoheptane and N-acetylcysteine and the functional activity of the nasal mucociliary apparatus in acute rhinosinusitis (ARS). Patients and Methods: 60 adults aged 17–65 and 60 children aged 6–16 diagnosed with moderate ARS were enrolled. The study group received Drug 1 (a dosed spray for topical use containing tuaminoheptane, acetylcysteine, and sodium hyaluronate). The comparison group received Drug 2 containing tuaminoheptane and acetylcysteine. In addition, all patients received standard antibacterial therapy. Patients were examined at three control points. Visit 1 is an initial referral for subjective assessment of the severity of complaints using a 10-point visual analogue scale/VAS), assessment of symptoms by a specialist (0-3 points), and evaluation of the morphological structure of the mucosa and functional activity of the nasal mucociliary apparatus using video histomorphometry. Visit 2 occurred 5–7 days after starting treatment with a similar set of examinations. Visit 3 occurred on days 10–14 after treatment, and examinations included assessment of the severity of complaints and ARS symptoms. Results: comparative analysis of changes in the severity of complaints and objective ARS signs in both age groups demonstrated that both drugs significantly reduced the severity of subjective complaints and ARS symptoms. However, Drug 1 demonstrated greater clinical efficacy. Both drugs were safe in both adults and children. Drug 1 containing hyaluronic acid had a positive effect on cell morphology and survival and on the activity of the nasal mucociliary apparatus. Conclusions: a combined nasal spray containing sodium hyaluronate, tuaminoheptane, and N-acetylcysteine demonstrated higher clinical efficacy because of a positive effect on the nasal mucociliary apparatus and morphological characteristics of the nasal ciliated epithelium. Therefore, this preparation is recommended for practical use in adults and children. KEYWORDS: acute rhinosinusitis, hyaluronic acid, tuaminoheptane, acetylcysteine, mucociliary clearance, ciliated epithelium, decongestants, mucoactive therapy. FOR CITATION: Ryazantsev S.V., Krivopalov A.A., Dvoryanchikov V.V., Alekseenko S., Kuzovkov V.E., Barashkova S.V., Tikhomirova E.K. Combined nasal spray containing tuaminoheptane, acetylcysteine, and hyaluronic acid in the complex therapy for acute rhinosinusitis. Russian Medical Inquiry. 2023;7(8):498–510 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-5.

Эффективность применения пробиотиков в профилактике рецидивирующих инфекций нижних мочевыводящих путей и бактериального вагиноза

Introduction The literature data indicate that bacterial vaginosis (BV) increases the risk of development of lower urinary tract infections (LUTI). Thus, it is reasonable to assume that the use of probiotics, in particular Lactoginal, can be effective in preventing relapses of LUTI. Aim To study the efficiency of probiotics, particularly Lactoginal, for the prevention of recurrent LUTI and BV. Materials and methods A total of 120 women with chronic recurrent bacterial cystitis in the acute stage and concomitant bacterial vaginosis were randomized into two groups of 60 patients. In group 1, standard antibacterial therapy was used according to guidelines of professional societies. In group 2, vaginal probiotic Lactoginal was prescribed after standard treatment. Results The results obtained in this study correspond to the literature data. The additional use of probiotics in the complex therapy of chronic lower urinary tract inflammation contributed to the normalization of the lactobacilli concentration in 93% of cases, in contrast to standard antibacterial therapy, after which the normal flora was preserved only in 40% of cases. In addition, a reduction in the number of relapses of BV was seen. Moreover, it was found that in the group of patients treated with Lactoginal, there was 18.3% less recurrence of cystitis within 6 months than in the control group (p Conclusion The use of probiotics, in particular, Lactoginal vaginal capsules, in women with BV after antibacterial therapy contributes to a faster recovery and longer preservation of the normal vaginal flora, which allows to the prolongate the relapse-free period of both chronic bacterial cystitis and BV.

Features of the immune status in patients with chronic and complicated pyodermas: choice of a therapeutic correction method


 
 Introduction: To compare the features of the immune status in patients with chronic and complicated pyoderma in the course of complex pharmacotherapy using immunomodulators based on transfer factors and glucosaminylmuramyldipeptide.
 Materials and methods: A clinical examination of 107 patients with pyoderma, divided into three groups, was carried out. All individuals underwent immunological examination before and after etiopathogenetic treatment. The patients of the first group were additionally treated with a drug containing signaling immunoactive molecules (transfer factor) as an immunomodulator; the patients of the second group received glucosaminylmuramyldipeptide; and the patients of the third group received standard antibacterial therapy.
 Results and discussion: Prior to the beginning of pathogenetic therapy, the patients were found to lack non-specific mechanisms of antimicrobial protection; there was a decrease in the activity and intensity of phagocytosis: phagocytic index and phagocytic number of neutrophils by 1.2 and 1.3 times; the production of proinflammatory cytokines IL-6 increased by 2.3 times, IL-8 –by 2.1 times, and TNFa – by 2.4 times. The study of immunological parameters after the inclusion of immunomodulators into the therapy revealed an increase in the phagocytic activity of neutrophils, and the indicators of the NST test were close to the control ones. The production of proinflammatory cytokines in the blood serum was restored to the level of the healthy individuals. Normalization of the number of CD4+-, CD8+-, CD19+-cells was observed in 86.0 ± 3% of the patients. At the same time, against the background of the use of glucosaminylmuramyldipeptide, a more intensive recovery of all links of anti-infectious immunity was recorded in comparison with the group where transfer factor molecules were used.
 Conclusion: A drug based on glucosaminylmuramyldipeptide can be recommended as the drug of choice in non-specific immunocorrection for complex pharmacotherapy of pyoderma accompanied by secondary immune insufficiency, in comparison with a drug containing transfer factors.
 
 

Use of Nordic walking in the complex treatment of lower urinary tract symptoms in chronic prostatitis

Lower urinary tract symptoms (LUTS) caused by chronic prostatitis (CP) are a common condition. Standard antibiotic therapy is often not justified, since bacterial prostatitis is presented in up to 10% of the cases, while there is no effect on the risk factors for the development and relapse of the disease. This study is aimed at one of the main risk factors for LUTS - a sedentary lifestyle. To increase the effectiveness of treatment for LUTS in men using the Nordic Walking technique. 84 patients with CP were examined, which were divided into 3 groups. The 1st group (control) included 32 patients who received standard antibacterial therapy. In the 2nd group (primary) - 32 patients who received complex therapy (antibiotic therapy + 4-week course of Nordic walking). The third group (comparison) included 20 patients who were prescribed monotherapy - Nordic walking for 4 weeks. The dynamics of clinical manifestations was assessed using CP Symptom Scale (NIH-CPSI) and the international symptom index for diseases of the prostate IPSS; the volume of residual urine, uroflowmetric data, and the level of leukocytes in the secretion of the prostate gland were estimated. Laboratory studies showed a significantly faster decrease in the number of leukocytes in the secretion of the prostate gland on the 7th and 14th day in the primary (2nd) group (p<0.001). Clinical symptoms according to the NIH-CPSI and IPSS scales significantly regressed in the primary group on the 14th and 28th days of therapy. Uroflowmetric data and the volume of residual urine improved more significantly in the primary group by the 14th and 28th days. Patients receiving combined therapy showed significantly better treatment results in the form of faster normalization of prostate secretion, regression of clinical symptoms, improved urine flow rate and a decrease in residual urine volume after 4 weeks of therapy. When choosing management algorithm for patients with LUTS, it is advisable to use an integrated approach: in addition to antibiotic therapy, Nordic walking is recommended 3 times a week for at least 4 weeks.

EVALUATION OF TOPICAL APPLICATION OF BACTERIOPHAGES IN THE TREATMENT OF ERYSIPELAS

Erysipelas is known as a human infectious disease, which, unfortunately, in recent years has not reduced its incidence rate in spite of all the advances of medicine. There is a tendency to an increase in the incidence of complicated forms of erysipelas, the consequences of which require prolonged conservative treatment and expenses. Moreover, there is a transition to recurrent forms often associated with large-scale surgical interventions and sometimes plastic surgeries to close skin defects. Thus, the search for best options for treating erysipelas, preventing its recurrence or transition to more severe clinical forms is an urgent issue that requires research aimed at improving the integrated treatment of this pathology. One of the solutions to this problem is the use of bacteriophages in combination with the standard treatment of erysipelas. The aim of the study was to improve the clinical results of erysipelas complex treatment by adding local bacteriophage therapy. Our clinical study included 28 patients with erythematous and erythematous-bullous forms of erysipelas. Two groups of patients were made up to compare the efficacy of the combined use of bacteriophages and standard antibacterial therapy. Evaluation of the efficacy was performed by clinical and microbiological methods. Based on the results of clinical study, we have found out that topical use of bacteriophages incorporated into dressing material in the course of erysipelas treatment, in addition to standard antibacterial therapy and detoxification leads to a statistically significant decrease in the duration of hyperthermic reactions in patients by 0.6 ± 0.13 days, lowering in intensity and the duration of pain syndrome by 0.9 ± 0.21 days, a more rapid local swelling fading by 0.5 ± 0.3 days, enhanced decrease in local skin hyperemia by 27% and accelerated microbial decontamination in the lesion areas by 21%. The results obtained allow us to recommend applying local bacteriophage treatment as a part of the standard management of erysipelas to promote the healing period and to improve the clinical condition of patients.

Dynamics of symptoms of genitourinary menopausal syndrome and the frequency of recurrence of lower urinary tract infection in women in periand postmenopausal patients with combined therapy with Trioginal®

Material and methods. The study included patients (n=164) in peri- and postmenopause, having a laboratory-confirmed picture of the genitourinary menopausal syndrome - atrophic vulvovaginitis and suffering from recurrent lower urinary tract infections (UTI) - cystitis and urethritis. All patients underwent standard antibacterial therapy (ABT) UTI in accordance with the results of bacteriological urine culture according to Russian clinical guidelines on urology. Against the background of ABT, 164 patients received additional therapy with Trioginal® (the study group - SG) containing estriol, micronized progesterone and Lactobacillus casei rhamnosus Doderleini 35 (LCR 35) lactobacillus strain. Trioginal® was administered intravaginally in two stages: for 20 days, 2 capsules per day, then for 10 days, 1 capsule per day. In the comparison group - CG (n=67) with ABT, Ovipol Klio® (estriol monopreparation) was additionally intravaginally used in two stages: for 14 days, 1 suppository per day, then for 2 weeks, 1 suppository 2 times a week. The control group consisted of 30 patients receiving only standard ABT UTI, local hormone therapy for vulvovaginal atrophy (VVA) was not performed. The observation period was 12 months after the end of the course of therapy. At all stages of treatment, a subjective and objective assessment of the severity of urination disorders and urogenital atrophy (UDI-6 questionnaire), their impact on the quality of life of patients (questionnaire IIQ-7), indicators of bacteriuria, bacterial urine culture and vaginal biocenosis, frequency of undesirable phenomena were carried out. According to the initial characteristics of the group of patients were comparable. Results. At all stages of the study, in the group of patients who received therapy with the use of the Trioginal® drug, there was a significant improvement in the clinical picture of urination disorders compared to the CG and the control (main) group - MG (in SG - 18% at the end of therapy versus 100% before the start of therapy; CG - 26 % versus 100% respectively; Ledger - 58% versus 100% respectively; p

Реабилитация пациентов после выполнения современных эндоурологических операций по поводу мочекаменной болезни

Numerous publications on the successful use of NefraDoz (Stada, Germany) in the metaphylaxis of urolithiasis after extracorporeal lithotripsy, and the prevention and treatment of infectious inflammatory diseases of the lower and upper urinary tracts, served as the rationale for a study aimed to evaluate the effectiveness and safety of long-term use of NefraDoz in patients after transurethral and percutaneous interventions performed for urological diseases. The study analyzed results of 116 transurethral and percutaneous endoscopic operations for urolithiasis performed in 62 men and 54 women aged 21 to 84 years from November to December 2017 at the D.D. Pletnev City Clinical Hospital. Depending on the localization of the stones, all patients were divided into three groups: kidney stones (n=68), ureteral stones (n=28), and bladder stones (n=21). In each group, patients were assigned either to receive (study group, n=50) or not to receive (control group, n=66) postoperative NefraDoz, which was administered at a dose of 1 capsule three times daily for one month. Patients in the control group (n=66) received standard antibacterial therapy for one month. The analysis included leukocyturia, 24-hour diuresis, the severity of the symptoms of the disease and the patients quality of life. The use of NefraDoz after transurethral lower urinary tract procedures, reduced the severity of irritative symptoms, improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis. The use of NefraDoz after upper urinary tract procedures improved the patients quality of life, reduced the number of patients with leukocyturia and increased 24-hour diuresis, and improved the clearance of residual fragments. There were no adverse events associated with NefraDoz. We have proved the advantage of using the NefraDoz complex in the rehabilitation of patients after endourologic procedures.

Does Photodynamic Therapy Enhance Standard Antibacterial Therapy in Dentistry?

The aim of this study was to assess whether or not photodynamic therapy enhanced standard antibacterial therapy in dentistry. Photodynamic therapy when used as an adjunct to conventional periodontal therapy kills more bacteria than when conventional periodontal therapy is used alone. To address the focused question, "Does photodynamic therapy enhance killing of oral bacteria?" PubMed/MEDLINE(®) and Google Scholar databases were explored. Original human and experimental studies and studies using photodynamic therapy for killing oral bacteria were included. Letters to the Editor, historic reviews, and unpublished data were excluded. Photodynamic therapy significantly reduces periodontopathogenic bacteria including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Photodynamic therapy kills cariogenic bacteria (such as Streptococcus mutans and Streptococcus sanguis), bacteria associated with infected root canals, and those associated with periimplantitis. Photodynamic therapy, when used as an adjunct to conventional oral disinfection protocols, enhances standard antibacterial therapy in dentistry.

Cryptococcosis presenting as upper limb cellulitis and ulceration: A case series

We report four cases of cryptococcosis presenting as upper limb cellulitis or ulceration, or both. Three of the four patients were on long-term prednisolone therapy at the time of presentation. In each case, the diagnosis of cryptococcosis was established by a biopsy of the skin. Only one of the four patients had conclusive evidence of disseminated disease. Our cases highlight the importance of skin biopsy in immunosuppressed individuals presenting with cellulitis, particularly when the cellulitis occurs in an atypical location and when the clinical condition fails to respond to standard antibacterial therapy.

Bacteraemic Pneumococcal Pneumonia

Streptococcus pneumoniae is the major bacterial cause of pneumonia, meningitis and otitis media, and continues to be associated with significant morbidity and mortality in individuals both in the developed and developing world. Management of these infections is potentially complicated by the emergence of resistance of this pathogen to many of the commonly used first-line antimicrobial agents. A number of significant risk factors exist that predispose to the occurrence of pneumococcal pneumonia, including lifestyle factors, such as exposure to cigarette smoke, as well as underlying medical conditions, such as HIV infection. Several of these predisposing factors also enhance the risk of bacteraemia. The initial step in the pathogenesis of pneumococcal infections is the occurrence of nasopharyngeal colonization, which may be followed by invasive disease. The pneumococcus has a myriad of virulence factors that contribute to these processes, including a polysaccharide capsule, various cell surface structures, toxins and adhesins, and the microorganism is also an effective producer of biofilm. Antibacterial resistance is emerging in this microorganism and affects all the various classes of drugs, including the β-lactams, the macrolides and the fluoroquinolones. Even multidrug resistance is occurring. Pharmacokinetic/pharmacodynamic parameters allow us to understand the relationship between the presence of antibacterial resistance in the pneumococcus and the outcome of pneumococcal infections treated with the different antibacterial classes. Furthermore, these parameters also allow us to predict which antibacterials are most likely to be effective in the management of pneumococcal infections and the correct dosages to use. Most guidelines for the management of community-acquired pneumonia recommend the use of either a β-lactam/macrolide combination or fluoroquinolone monotherapy for the empirical therapy of more severe hospitalized cases with pneumonia, including the subset of cases with pneumococcal bacteraemia. There are a number of adjunctive therapies that have been studied for use in combination with standard antibacterial therapy, in an attempt to decrease the high mortality, of which macrolides in particular, corticosteroids and cyclic adenosine monophosphate-elevating agents appear potentially most useful.

Systematic Review of Clinical Data with BNO-101 (Sinupret?) in the Treatment of Sinusitis

Background: The herbal formula BNO-101 (containing Gentianaeradix, Primulae flos, Rumicis herba, Sambuci flos andVerbenae herba; ratio 1:3:3:3:3) has been widely employedas a ‘mucoactive’ agent in Germany for 70 years for thesymptoms of respiratory infections. This paper reviews theclinical evidence of BNO-101 in sinusitis. Methods: The systematicsearch identified 22 studies with BNO-101. Out ofthese, 6 controlled trials on sinusitis were reassessed accordingto predefined criteria. 4 trials had almost identicaldesigns and could be examined by meta-analysis. Results:The database comprised approximately 900 patients, mostlyyoung adult males. After 2 weeks of treatment, verum wassignificantly superior to placebo (2 RCTs, 159 vs. 160 patients,both add-on to antibacterial treatment). The benefitregards the patients’ assessment (‘cured’: verum = 61.1%,placebo = 34.5%), reduction of drain obstruction, headacheand radiological signs (all p < 0.05). Comparing BNO-101 toambroxol (2 RCTs, 151 vs. 150 patients, add-on to antibacterialsin 13% of the cases) the patients’ assessmentafter 2 weeks showed no difference, although it favouredBNO-101 in chronic cases (‘cured’ BNO-101 = 37.1%, ambroxol= 12.5%; p < 0.05). It also favoured BNO-101 concerningpyorrhoea and headache (p < 0.05). No significantdifferences were reported in 2 open randomised trials vs.N-acetyl-cysteine and vs. the herbal product Myrtol std.Conclusions: BNO-101, combined with standard antibacterialtherapy, significantly reduces the acute symptoms andsigns of sinusitis. The effects are of the same order ofmagnitude as observed with other mucoactive agents. Inthe trials investigated BNO-101 had a favourable risk/benefitratio, with an incidence of adverse events similar to placebo.

Sparfloxacin as alternative treatment to standard therapy for community-acquired bacteremic pneumococcal pneumonia

OBJECTIVE: To assess the effectiveness of a single daily dose of sparfloxacin in comparison with standard antibacterial therapy for the treatment of pneumococcal bacteremic community-acquired pneumonia (CAP). METHODS: The results were analyzed of four comparative trials in CAP, in which 107 adult patients with CAP confirmed by blood cultures positive for Streptococcus pneumoniae were included. Sparfloxacin was given at a loading dose of 400 mg followed by 200 mg daily. Comparator drugs included amoxycillin 3 g/day, amoxycillin/clavulanate 1.5/0.375 g/day and erythromycin 2 g/day. Dosing was for 7--14 days (mean 10 days). Success was determined by a combination of clinical and microbiological assessment and radiologic changes. RESULTS: Sparfloxacin was as effective as the comparator drugs, with an overall success rate of 80% at the end of treatment (comparators 78%), and a 79% success rate at follow-up (76% for comparators). There were no pneumococcal isolates resistant to sparfloxacin, but eight of 56 were either resistant (four) or had reduced susceptibility to penicillin G, and two strains were resistant to erythromycin. Tolerance to sparfloxacin was good, with fewer patients reporting drug-related adverse events (15.8%) than with the comparator drugs (33.3%). CONCLUSIONS: This analysis suggests that sparfloxacin would be an alternative candidate for empirical therapy in moderately severe CAP.