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An internet-based survey was conducted to determine common strategies for control of feline upper respiratory infections (URI) in animal shelters. Two hundred and fifty-eight North American shelters responded, representing a spectrum of 57% private non-profit, 27% municipal and 16% combined private non-profit-municipal shelters. All but nine shelters reported having a regular relationship with a veterinarian, 53% had full-time veterinarians and 62% indicated full-time (non-veterinarian) medical staff. However, in 35% of facilities, non-medical shelter management staff determined what medication an individual cat could receive, with 5% of facilities making that decision without indicating the involvement of a veterinarian or technician. Ninety-one percent of shelters had an isolation area for clinically ill cats. The most commonly used antimicrobial was doxycycline (52%), followed by amoxicillin/clavulanic acid (33%). Shelters are using a wide range of prevention measures and therapeutics, leaving room for studying URI in different settings to improve understanding of optimal protocols.
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The aim of the present study was to evaluate the clinical effect of non-surgical periodontal therapy with the adjunct of a selected antibiotic in subjects with refractory periodontitis. 10 subjects were selected for the study; all had a history of periodontal surgery, tetracycline therapy, and regular maintenance by a periodontist. Clinical registrations including gingival index, plaque index, presence of bleeding and suppuration, pocket depth, and duplicate measurements of attachment level were performed at baseline and at monthly intervals. When disease activity was detected based on the tolerance method, a bacterial sample was taken from the active site and its susceptibilities to a number of antibiotics were determined. For the selected 10 subjects, Augmentin was the antibiotic of choice. Each subject received 750 mg/day for 2 weeks, during which time a full-month scaling and root planing was performed under local anesthesia. Clinical re-evaluation was performed after 3, 6, 9 and 12 months. At the time disease activity was detected, the average loss of attachment at all active sites was 2.2 mm, and the increase in pocket depth 1.5 mm. At 3 months post-therapy, these sites had regained 2 mm of attachment which remained stable through the 12-month examination. Pocket depths decreased 2.5 mm over the first 6 months and then stabilized. The frequency of all sites that gained 1 mm or more of attachment increased by approximately 10% over the first 9 months following therapy. The frequency of all sites that decreased 1 mm or more in pocket depth increased approximately 15% over the same period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Amoxicillin and amoxicillin-clavulanic acid have superior in vitro activity and longer T > MIC for penicillin-intermediate isolates than the other oral beta-lactams.
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A total of 36 out of 765 patients operated at our institute between 2003 and 2011 had concomitant procedures. Eleven patients had Roux en Y gastric bypass (group I) and remaining 25 had sleeve gastrectomy (group II) performed on them. The operating times were 149 min(120-210 min) in group I and 122 min (90-220min) in group II. No immediate complications or any incidence of mesh infection or recurrence in either of the groups.
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The gastrointestinal tract is a complex ecosystem. Recent studies have shown that the human fecal microbiota is composed of a consortium of microorganism. It is known that antibiotic treatment alters the microbiota, facilitating the proliferation of opportunists that may occupy ecological niches previously unavailable to them. It is therefore important to characterize resident microbiota to evaluate its latent ability to permit the development of pathogens such as Clostridium difficile. Using samples from 260 subjects enrolled in a previously published clinical study on antibiotic-associated diarrhea, we investigated the possible relationship between the fecal dominant resident microbiota and the subsequent development of C. difficile. We used molecular profiling of bacterial 16S rDNA coupled with partial least square (PLS) regression analysis. Fecal samples were collected on day 0 (D0) before antibiotic treatment and on day 14 (D14) after the beginning of the treatment. Fecal DNA was isolated, and V6-to-V8 regions of the 16S rDNA were amplified by polymerase chain reaction with general primers and analyzed by temporal temperature gradient gel electrophoresis (TTGE). Main bacteria profiles were compared on the basis of similarity (Pearson correlation coefficient). The characteristics of the microbiota were determined using PLS discriminant analysis model. Eighty-seven TTGE profiles on D0 have been analyzed. The banding pattern was complex in all cases. The subsequent onset of C. difficile was not revealed by any clustering of TTGE profiles, but was explained up to 46% by the corresponding PLS model. Furthermore, 6 zones out of the 438 dispatched from the TTGE profiles by the software happened to be specific for the group of patients who acquired C. difficile. The first approach in the molecular phylogenetic analysis showed related sequences to uncultured clones. As for the 87 TTGE profiles on D14, no clustering could be found either, but the subsequent onset of C. difficile was explained up to 74.5% by the corresponding PLS model, thus corroborating the results found on D0. The non exhaustive data of the microbiota we found should be taken as the first step to assess the hypothesis of permissive microbiota. The PLS model was used successfully to predict C. difficile development. We found that important criteria in terms of main bacteria could be markedly considered as predisposing factors for C. difficile development. Yet, the resident microbiota in case of antibiotic-associated diarrhea has still to be analyzed. Furthermore, these findings suggest that strategies reinforcing the ability of the fecal microbiota to resist to modifications would be of clinical relevance.
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We investigated the efficacies of cefotaxime (CTX) and amoxicillin (AMX)-clavulanate (CLA) (AMC) against extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli in vitro and in a murine model of urinary tract infection (UTI). MICs, the checkerboard dilution method, and time-kill curves were used to explore the in vitro synergism between cefotaxime and amoxicillin-clavulanate against two isogenic E. coli strains-CFT073-RR and its transconjugant, CFT073-RR Tc bla(CTX-M-15)-harboring a bla(CTX-M-15) plasmid and a bla(OXA-1) plasmid. For in vivo experiments, mice were separately infected with each strain and treated with cefotaxime, amoxicillin, and clavulanate, alone or in combination, or imipenem, using therapeutic regimens reproducing time of free-drug concentrations above the MIC (fT≥MIC) values close to that obtained in humans. MICs of amoxicillin, cefotaxime, and imipenem were 4/>1,024, 0.125/1,024, and 0.5/0.5 mg/liter, for CFT073-RR and CFT073-RR Tc bla(CTX-M-15), respectively. The addition of 2 mg/liter of clavulanate (CLA) restored the susceptibility of CFT073-RR Tc bla(CTX-M-15) to CTX (MICs of the CTX-CLA combination, 0.125 mg/liter). The checkerboard dilution method and time-kill curves confirmed an in vitro synergy between amoxicillin-clavulanate and cefotaxime against CFT073-RR Tc bla(CTX-M-15). In vivo, this antibiotic combination was similarly active against both strains and as effective as imipenem. In conclusion, the cefotaxime and amoxicillin-clavulanate combination appear to be an effective, easy, and already available alternative to carbapenems for the treatment of UTI due to CTX-M-producing E. coli strains.
The median duration of tube otorrhea was significantly shorter in amoxicillin-clavulanate than in the placebo group (3 vs 8 days). At the end of the 7-day medication period, tube otorrhea was resolved in 28 of 34 children receiving amoxicillin-clavulanate compared with 13 of 32 children on placebo (treatment-control difference 41%; 95% confidence interval, 20%-63%; number needed to treat, 2.4). The median duration of bacterial growth in middle-ear fluid was shorter in amoxicillin-clavulanate than in the placebo group (1 vs 8 days).
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This prospective, randomized, open, international, multicenter study of adults with complicated intra-abdominal infections (cIAI) compared the efficacy and safety of sequential intravenous (i.v.) to oral (p.o.) moxifloxacin 400 mg once daily, with that of i.v. ceftriaxone 2 g once daily, plus metronidazole 500 mg three times daily, followed by p.o. amoxicillin/clavulanate 625 mg three times daily. The primary efficacy variable was clinical cure at test of cure (TOC) (day 28-42 after study entry) in the per protocol (PP) population. Of 595 patients in the study, 511 patients were valid for PP analysis (246 moxifloxacin, 265 ceftriaxone/metronidazole). Sequential moxifloxacin was noninferior to the comparator regimen--clinical cure rates at TOC were 80.9% versus 82.3% (moxifloxacin versus ceftriaxone/metronidazole; 95% CI -8.9, 4.2%). The incidence of adverse events was comparable between the two treatment groups. Therefore, sequential moxifloxacin monotherapy is as effective and safe as combination therapy with i.v. ceftriaxone plus i.v. metronidazole followed by oral amoxicillin/clavulanate for the treatment of cIAI.
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To determine trends in ciprofloxacin resistance and co-resistance to other antibiotic classes in blood isolates of Escherichia coli, and to investigate if there is an ecological relationship to the community use of fluoroquinolones and other antibiotics.
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This pilot study examines whether single-dose intravenous metronidazole preoperatively is at least as effective as a broad-spectrum multi-drug regimen in preventing infection-related wound complications following excision of pilonidal sinuses with primary closure.
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A descriptive cross sectional study on bacteriology and sensitivity patterns of laboratory-proven pyogenic meningitis was carried out over a six month period. A total of 92 patients (52 adults, 40 children) were studied. In 75 (82%) of the cases, the cerebrospinal fluid cultures were bacteriologically positive. Common isolates included Streptococcus pneumoniae (45%), Neisseria meningitidis (14%) and Haemophilus influenzae (12%). Other isolates included Cryptococcus neoformans from four (4.3%) adults who were also HIV-l positive. Sensitivity to antibiotics was determined using the disk diffusion method. There was no resistance to chloramphenicol among the three most common bacterial isolates. However, 7% and 15% of Streptococcus pneumoniae and N. meningitidis isolates, respectively, were resistant to crystalline penicillin. Twenty seven percent of Haemophilus influenzae was resistant to ampicillin. Sensitivity of the three organisms to the third generation cephalosporin (ceftazidime, cefotaxime, ceftriaxone) a second generation cephalosporin (cefuroxime) and augmentin was almost 100%. We recommend that chloramphenicol and crystalline penicillin or ampicillin be initial blind therapy for adults and older children with pyogenic meningitis and ampicillin and chloramphenicol for pre-school children. The above cephalosporins and augmentin are alternative therapy but their use will be limited by cost.
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Actinomycosis should be discussed as a possible diagnosis for all cerebral lesions, particularly in patients with a potential dental infection. Histology is required for positive diagnosis. Antibiotic therapy alone is generally sufficient; surgery is often performed for diagnostic purposes.
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Amoxicillin/clavulanic acid (Augmentin), Augmentin ES-600 is a well established, orally administered combination of amoxicillin (a semisynthetic antibacterial agent) and clavulanic acid (a beta-lactamase inhibitor). Amoxicillin/clavulanic acid shows good activity against the main pathogens associated with acute otitis media (AOM), including penicillin-susceptible and -intermediate strains of Streptococcus pneumoniae, and beta-lactamase producing strains of Haemophilus influenzae and Moraxella catarrhalis. It has moderate activity against penicillin-resistant S. pneumoniae; a high-dose formulation has been developed with the aim of providing better coverage for penicillin-resistant strains. Amoxicillin/clavulanic acid (conventional formulations, mostly 40/10 mg/kg/day in three divided doses) produced clinical response rates similar to those of oral cephalosporin comparators and similar to or significantly greater than those for intramuscular ceftriaxone in randomised trials in paediatric patients with AOM (mean age approximately 2 to 5 years). Clinical response rates were generally similar for amoxicillin/clavulanic acid and macrolide comparators (mean patient age approximately 1 to 6 years), although significantly better clinical and bacteriological responses were seen versus azithromycin in one randomised trial (mean patient age approximately 1 year). The high-dose formulation of amoxicillin/clavulanic acid (90/6.4 mg/kg/day in two divided doses) eradicated a high proportion of penicillin-resistant S. pneumoniae (penicillin MICs 2 or 4 mg/L) in a large noncomparative trial in children with AOM (upper limit of the US indication for S. pneumoniae is 2 mg/L). Amoxicillin/clavulanic acid is generally well tolerated. A low total incidence of adverse events (3.6%) and no serious events were reported from a large paediatric postmarketing study. The most frequently reported adverse events in children are mild gastrointestinal disturbances. Diarrhoea is generally less frequent with twice-daily than with three-times-daily treatment. The new high-dose formulation showed similar tolerability to a conventional twice-daily formulation (45/6.4 mg/kg/day) in a well controlled trial.
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The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.
We conducted an open randomized trial to compare the efficacy of parenteral and oral ofloxacin with that of amoxycillin/clavulanate. A total of 121 patients was studied; 92 were clinically evaluable. Of these, 59 patients were treated with ofloxacin and 33 with the comparator drug. Patients were given the drugs intravenously for a minimum of three days followed by oral preparations for the next seven to ten days. Ofloxacin was usually administered as a 200 mg dose bd. In the ofloxacin treated group all patients showed clinical improvement. In the comparator group 94% improved clinically (either a complete or partial response), while 6% were clinical failures. Of the bacteriologically evaluable patients 19 of 20 showed a satisfactory bacteriological response in the ofloxacin treated group, while in the comparator group the bacteriological response was judged satisfactory in 14 of 17 patients. A small proportion of patients (7%) treated with ofloxacin suffered mild adverse effects (nausea, vomiting, headache, hypotension and rash). On the whole, ofloxacin was well tolerated by our patients. The two deaths that occurred were in the comparator group. We conclude that ofloxacin in both oral and parenteral forms is an effective and safe drug in the treatment of lower respiratory tract infections.
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The in-vitro activity of nisin, a 34-residue peptide produced by several Lactococcus lactis strains, and ranalexin, a 20-residue peptide isolated from the skin of the bullfrog Rana catesbeiana, alone and in combination with amoxycillin, amoxycillin-clavulanate, imipenem, clarithromycin, ciprofloxacin, rifampin and vancomycin was investigated against 40 nosocomial isolates of methicillin-resistant Staphylococcus aureus (MRSA). All isolates were inhibited at concentrations of 1 to 32 microg/ml. Synergy was observed when the peptides were combined with other agents, with the exception of the beta-lactams. Finally, the consecutive exposures to each peptide did not result in selection of stable mutants with decreased susceptibility. Our finding show that nisin and ranalexin are active against MRSA, and that their activity is enhanced when they are combined with several antimicrobial agents.
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Oral Fusobacterium nucleatum populations from 20 young, healthy children were examined for beta-lactamase production. Ten children (50%) harbored, altogether, 25 beta-lactamase-positive F. nucleatum isolates that were identified as F. nucleatum subsp. polymorphum, F. nucleatum subsp. nucleatum, and F. nucleatum subsp. vincentii (J. L. Dzink, M. T. Sheenan, and S. S. Socransky, Int. J. Syst. Bacteriol. 40:74-78, 1990). In vitro susceptibility of these beta-lactamase-producing and 26 non-beta-lactamase-producing F. nucleatum isolates was tested with penicillin G, amoxicillin-clavulanic acid, tetracycline hydrochloride, metronidazole, trovafloxacin, and azithromycin. Except for penicillin G, the antimicrobials exhibited good activity against all F. nucleatum isolates.
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A preliminary randomized placebo-controlled double-blind study was conduced in 7 centers. Patients under 80 years of age of both sexes were included. All patients had COPD and presented a bronchial infection defined as the presence of at least 2 of the 3 criteria defined by Anthonisen. Patients were randomly assigned to group F or group P. Group F received an antibiotic therapy from day 1 to day 11 plus fenspiride (3 x 80mg/d from day 0 to day 30). Group P received the same antibiotic therapy plus placebo. Amoxicillin 500mg plus clavulanic acid 125, 3 tablets/day, was administered in both groups.
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Of the 123 enrolled children, 112 were included in analysis and 48% of the 118 samples were positive for S. pneumoniae (23% (27/118)), H. influenzae (18% (21/118)), Moraxella catarrhalis (6% (7/118)) or Streptococcus pyogenes (3% (4/118)). The most common pneumococcal serotypes were 19F (26%) and 14 (22%). The majority of H. influenzae isolates were encapsulated (18/21), with 13 type b (Hib) representing 62% of all H. influenzae isolate or 11% of all samples (13/118), and there were only 3 non-typeable isolates. Despite high antibiotic resistance, amoxicillin/clavulanate susceptibility was high. No pneumococcal vaccine use was reported.
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Our findings indicate that amoxicillin/clavulanate has superior bacteriologic and clinical efficacy compared with azithromycin in children with AOM.
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A simple, rapid and accurate method for simultaneous determination of amoxycillin and clavulanic acid using HPLC with beta-cyclodextrin stationary phase was developed. It involves the use of tetraethylammonium acetate (TEAA) as an additive reagent, methanol-buffer solution (pH 4.5) (35:65; v/v) as the mobile phase, detection at 225 mm and chromatogram within 12 min. Linearity and precision of the internal standard method have been obtained. Recoveries ranged from 99.25 to 105.63% for amoxycillin in the synthetic mixture. For clavulanic acid it was from 99.50 to 101.64%. This method is convenient and reproducible for analyses of these two components in different dosage forms.