Carlos H. Ramírez-Ronda

Increased pharyngeal bacterial colonization during viral illness.

The oropharyngeal colonization by Staphylococcus aureus and Gram-negative bacilli (GNB) and its duration were studied in 89 house staff officers, with biweekly quantitative cultures for 11 months. Eighty-two episodes of upper respiratory tract infection were documented during the study period. The oropharyngeal colonization during illness-free periods ranged from 12% to 18% for GNB and from 5% to 14% for S aureus. During an episode of upper respiratory tract infection, the oropharyngeal colonization of GNB increased to 60%; S aureus colonization increased to 43%. The colonization with both GNB and S aureus was transient and lasted for approximately two weeks. The increased colonization by S aureus and GNB during a viral respiratory tract infection may be a factor contributing to the increased risk of pneumonia in patients with this condition.

Dengue and hepatic failure

Dengue hemorrhagic fever/dengue shock syndrome is a serious manifestation of dengue fever, which is observed predominantly in the tropical regions of the West Pacific and in Southeast Asia and is associated with secondary infections, mainly in children under age 15. A concomitant microangiopathic coagulopathy has been described; moreover, encephalopathy and even Reyes syndrome have been rarely reported. This report describes a 51-year-old man with secondary dengue infection who presented with clinical evidence of severe hepatitis, encephalopathy, cranial nerve palsy, and microangiopathic coagulopathy and who had a favorable outcome. A careful surveillance for the occurrence of secondary dengue in the Western Hemisphere is proposed, and dengue is suggested as a diagnostic possibility in obscure febrile illnesses presenting as either hepatitis, encephalopathy, or coagulopathy in places in which the mosquito vector, Aedes aegypti, is present.

Ciprofloxacin in the treatment of urinary tract infections caused byPseudomonas aeruginosa and multiresistant bacteria

Ciprofloxacin is a new quinoline carboxylic acid derivative demonstrating better activity than other antimicrobial agents of this class (1–5). The compound is active against both gram-positive and gram-negative bacteria, particularly Enterobacteriaceae and Pseudomonas aeruginosa (6). In addition, microorganisms resistant to penicillins, cephalosporins or aminoglycosides are generally sensitive to ciprofloxacin (7). Penetration into body fluids and tissue is good after both intravenous and oral administration (8).

Treatment of urinary tract infection with norfloxacin: Analysis of cost

Twenty-five patients with urinary tract infection were treated with norfloxacin, a fluoroquinolone antibacterial with a wide spectrum of activity for an oral agent. Of 22 patients who were evaluable, 20 had complicated urinary tract infection; infection was cured in 19 patients at one week after treatment. Optimal alternative treatments were also selected in norfloxacins stead, based on each patients characteristics and the results of susceptibility testing for each isolated pathogen. Direct costs for alternative treatment ranged from

Efficacy and safety of aztreonam versus tobramycin for aerobic gram-negative bacilli lower respiratory tract infections

7 to

A Comparative Analysis of Aztreonam + Clindamycin versus Tobramycin + Clindamycin or Amikacin + Mezlocillin in the Treatment of Gram-Negative Lower Respiratory Tract Infections

970. The results indicated that for those patients with suspected or proven urinary tract infection caused by multiresistant bacteria, therapy with norfloxacin may represent a cost-effective choice.

Oral Ciprofloxacin vs Parenteral Cefotaxime in the Treatment of Difficult Skin and Skin Structure Infections: A Multicenter Trial

Aztreonam therapy was evaluated for the management of 80 patients with gram-negative bacilli lower respiratory tract infections. Study results confirmed its efficacy and safety for this indication.

Comparative, double-blind study of oral ciprofloxacin and intravenous cefotaxime in skin and skin structure infections.

One hundred ten patients were randomized to receive one of the following antibiotic combinations: aztreonam + clindamycin, tobramycin + clindamycin, or amikacin + mezlocillin for the treatment of lower respiratory tract infections (LRTI) caused by gram-negative bacilli. Of the 68 patients who received aztreonam + clindamycin, 60 were clinically evaluable and 50 were bacteriologically evaluable. Of the 60 clinically evaluable patients, 54 were cured and 5 were treatment failures or died during the study period. Of the 50 bacteriologically evaluable patients, 46 were cured and 3 failed to respond to therapy. Of the 26 clinically evaluable patients in the tobramycin + clindamycin group, 22 were cured and 4 either failed to respond or died during the study period. Of 18 bacteriologically evaluable patients in this group, 16 were cured and 2 failed to respond. In the amikacin + mezlocillin group, 14 of the 15 clinically and bacteriologically evaluable patients were cured, and 1 failed to respond. The most commonly isolated pathogens were Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. The very few adverse drug reactions that were seen were transient and comparable in all three groups except for renal function parameters, which deteriorated in 6-8% of patients receiving the aminoglycoside combination. All three antibiotic combinations were similar in effectiveness and safety.