Nancy Mummaw

Comparative study of clarithromycin and penicillin V in the treatment of streptococcal pharyngitis

This study evaluated the safety and efficacy of clarithromycin in the treatment of patients with Group A beta-hemolytic streptococcal pharyngitis. Subjects were treated with either 250 mg clarithromycin twice daily or 250 mg penicillin V four times a day for 10 days and followed for approximately three weeks post-treatment. At the completion of therapy, 96 % (45/47) of patients treated with clarithromycin and 89 % (43/48) of patients treated with penicillin V were clinically cured or improved. Recurrence of symptoms occurred in 7 and 5 patients who were treated with clarithromycin and penicillin V respectively. Initial bacteriologic eradication was observed in all but one patient. Recurrence ofStreptococcus pyogenes occurred in 5 (11 %) patients who received clarithromycin and 7 (15 %) patients who received penicillin V. The majority of adverse events reported during this study were mild and involved the gastrointestinal tract. Diarrhea was more frequent in patients who received clarithromycin. In this multicenter, randomized, double-blind trial, clarithromycin was as safe and effective as penicillin V in the treatment ofStreptococcus pyogenes throat infections.

Comparative Study of Fluconazole and Clotrimazole in the Treatment of Vulvovaginal Candidiasis

Fluconazole is a new oral triazole antifungal with good activity against Candida spp. In this study, we investigated the effectiveness and tolerability of a three-day course of treatment with fluconazole compared with clotrimazole vaginal tablets in nonpregnant women with acute Candida vaginitis. Of the 90 evaluable patients who received fluconazole, 76 (84 percent) were asymptomatic seven to ten days after treatment compared with 84 of 95 (88 percent) treated with clotrimazole. An additional ten patients in the fluconazole group (11 percent) and seven in the clotrimazole group (7 percent) had improvement in their signs and symptoms. Only four patients in each group (4 percent) were considered treatment failures. Mycological cures were obtained in 89 and 93 percent of patients treated with fluconazole and clotrimazole, respectively, seven to ten days posttreatment. Clinical cure rates remained high one month posttreatment: 79 percent in the fluconazole group and 83 percent in the clotrimazole group. Both therapies were well tolerated. One patient discontinued treatment after she developed diarrhea while receiving fluconazole. The most common adverse effects associated with fluconazole use were nausea (six percent) and diarrhea (three percent). No clinically significant laboratory abnormalities were observed. In this investigation, oral fluconazole therapy was found to be as safe and effective as clotrimazole vaginal tablets in women with acute vulvovaginal candidiasis.

The Effect of Hormones on Trichomonas vaginalis

The hormonal milieu can alter susceptibility to infection. The effect of hormones on Trichomonas vaginalis was studied utilizing axenically cultured clinical isolates. Oestrogens, in physiological concentrations, decreased the growth of the organisms and their attachment to mammalian cells in vitro, and acted as a chemorepellent. The specificity of these effects was verified by their being blocked with anti-oestrogens, by the dose- and time-dependency of the responses, and by the lack of effect with other hormones. These results suggest that oestrogens may decrease the virulence of T. vaginalis; however, interactions between oestrogens and mammalian cells may promote the development of infection. Thus complicated interactions between hormones, micro-organisms and mammalian cells must determine whether exposure to oestrogens predisposes to or prevents the development of infection.

Prevention of Recurrent Vaginal Candidiasis with Weekly Terconazole Cream

OBJECTIVE: To investigate the prophylactic use of weekly terconazole 0.8% cream to prevent recurrent episodes of candidal vaginitis. DESIGN: Women with a documented history of recurrent candidal vaginitis (≥4 recurrences/y) were enrolled into a secondary prevention trial. None of these women were HIV positive, pregnant, diabetic, or immunosuppressed. Patients were initially treated for a symptomatic episode of candidal vaginitis and then started on weekly applications of terconazole 0.8% cream for 26 weeks. These women were then followed for an additional 26 weeks after therapy. SETTING: A university-affiliated medical school. PARTICIPANTS: The study population consisted of 22 healthy women aged 19–41 years. MAIN OUTCOME MEASURES: Patients were interviewed by phone each week concerning symptoms and compliance. They were also reminded to notify the study investigators any time vaginal symptoms of candidiasis occurred. Patients were examined whenever they developed vaginal symptoms and were treated on the basis of microscopic and culture results. RESULTS: Ten patients had 14 symptomatic cases of vaginitis during the prophylactic phase of the study, but Candida spp. were isolated during only 4 of these episodes. One episode was due to bacterial vaginosis and no pathogenic organisms were found in 9 of these cases. Eighteen of the 20 patients who completed the prophylactic phase were followed after therapy and 14 (78%) of these patients had a current case of candidal vaginitis. This incidence of infection was statistically higher than that observed during the treatment period (p < 0.001). CONCLUSIONS: Weekly applications of terconazole 0.8% cream were effective in preventing recurrent episodes of candidal vaginitis and were well tolerated.

Treatment of acute uncomplicated urinary tract infection with ceftibuten.

SummaryCeftibuten is an orally active third generation cephalosporin with increased potency against members of theEnterobacteriaceae. In this study, 74 women with acute uncomplicated urinary tract infection (UTI) were enrolled in an open study to evaluate the safety and efficacy of this new antibiotic. Patients were treated with 400 mg ceftibuten once daily for seven days and followed for four to six weeks after cessation of therapy. All pathogens were eradicated during treatment, including five coagulase-negative staphylococci that were resistant to ceftibuten. At five to nine days posttreatment, 93% of patients were cured. Of the five recurrent infections, four patients had a relapse and one had a reinfection. By four to six weeks post-treatment, five additional patients had recurrent infections. The overall cure rate was 85% in this study. Most ceftibuten-associated adverse effects were mild and involved the gastrointestinal tract. Diarrhea was the most commonly reported side effect. Of the eight (11%) patients who developed diarrhea, three had a positive latex agglutination test forClostridium difficile. The diarrhea resolved in all patients without sequelae. Ceftibuten was effective and generally safe in the treatment of women with acute uncomplicated UTI. The high incidence of diarrhea observed in this study is a concern.ZusammenfassungCeftibuten ist ein Oralcephalosporin der dritten Generation mit erhöhter Aktivität gegenEnterobacteriaceae-Arten. Die Wirksamkeit und Sicherheit dieses neuen Antibiotikums wurden in einer offenen Studie bei 74 Frauen mit akuter, unkomplizierter Harnwegsinfektion geprüft. Die Patientinnen erhielten sieben Tage lang eine einmal tägliche Dosis von 400 mg Ceftibuten oral. Nach Ende der Therapie wurden vier bis sechs Wochen lang Nachuntersuchungen vorgenommen. In allen Fällen war eine Erregereradikation nachzuweisen, darunter waren auch fünf Fälle, bei denen koagulase-negative Staphylokokken mit Resistenz gegen Ceftibuten aus dem Urin isoliert worden waren. Eine Heilung war fünf bis neun Tage nach Behandlungsende bei 93% der Patientinnen eingetreten. Rezidive wurden in einem von fünf Fällen auf eine Reinfektion zurückgeführt, in vier Fällen durch den ursprünglichen Keim. Vier bis sechs Wochen nach Therapie hatten weitere fünf Patientinnen erneut Infektionsschübe entwickelt. Insgesamt kam es in dieser Studie zu einer Heilungsrate von 85%. Nebenwirkungen, die unter der Therapie mit Ceftibuten auftraten, waren meistens leicht und betrafen den Gastrointestinaltrakt. Die häufigste Nebenwirkung war Diarrhoe. Der Latex-Agglutinationstest fürClostridium difficile war in drei von acht Fällen mit Diarrhoe (11% des Gesamtkollektivs) positiv. Bei Frauen mit akuter, unkomplizierter Harnwegsinfektion erwies sich die Therapie mit Ceftibuten als wirksam und im allgemeinen sicher. Bedenken ergeben sich aus der hohen Diarrhoerate in dieser Studie.

Placebo-Controlled Trial of Intravaginal Clindamycin 2% Cream for the Treatment of Bacterial Vaginosis

OBJECTIVE: To compare the safety and efficacy of intravaginal clindamycin 2% cream with placebo in nonpregnant women with bacterial vaginosis. DESIGN: A randomized, double-blind, placebo-controlled clinical trial. SETTING: Ambulatory patients in the general community. PATIENTS: Two hundred fifteen nonpregnant outpatients with a diagnosis of bacterial vaginosis were entered into this study. Of the 134 evaluable patients, 65 received clindamycin and 69 placebo. Demographic parameters were comparable between the two treatment groups. INTERVENTION: Study subjects were equally randomized to receive either 5 g of clindamycin 2% vaginal cream or placebo cream for seven nights. MAIN OUTCOME MEASURES: Clinical and microbiologic follow-up evaluations were scheduled for 5–10 days and 25–39 days posttreatment. Patients were interviewed about signs and symptoms, adverse events, and compliance. Diagnostic examinations were performed. RESULTS: Clinical success rates (cure and improvement) occurred in 50 of 65 patients who received clindamycin (77 percent) and 17 of 69 patients who received placebo (25 percent) by the first posttreatment visit (p<0.001). Microbiologic cures or improvement were observed in 59 of the 65 patients treated with clindamycin (91 percent) compared with 20 of 69 placebo-treated patients (29 percent) (p<0.001). At the end of the study, clinical and microbiologic cures or improvement were evident in 45 of 57 (79 percent) and 37 of 57 clindamycin-treated patients (65 percent), respectively, and 18 of 51 (35 percent) and 14 of 51 (28 percent) of the placebo-treated patients, respectively. The success rates with clindamycin 2% cream were statistically higher than those with placebo. The adverse-effect profiles in the two groups were similar and no serious adverse effects were reported. Patients who received clindamycin had a statistically higher incidence of nonbacterial vaginitis/cervicitis (18.5 vs. 7.5 percent, p=0.003). CONCLUSIONS: Intravaginal clindamycin 2% cream appears to be an effective and safe treatment of symptomatic bacterial vaginosis in nonpregnant women.

Comparison of chlamydial culture with Chlamydiazyme assay during erythromycin PCE treatment of Chlamydia genital infections.

&NA; We compared chlamydial culture with the chlamydial antigen detection enzyme immunoassay system (Chlamydiazyme®, Abbott Diagnostic Products; Abbott Park, IL) during treatment of Chlamydia genital infections. Participants received 333 mg of erythromycin PCE® (Abbott Laboratories; Abbott Park, IL) 3 times per day for 7 days. On days 0, 3, 7, and 14, chlamydial cultures were positive in 30/30 (100%), 5/29 (17.2%), 0/27, and 0/25 participants, respectively. Concurrent Chlamydiazyme® assays were positive in 30/30 (100%), 11/30 (37%), 1/28 (4%), and 0/25 participants. Twenty‐eight of 28 persons who received erythromycin PCE® for at least 3 days had negative test results for both chlamydial culture and Chlamydiazyme® at their last clinic visit. Chlamydiazyme® assay tended to remain positive longer than chlamydial culture during treatment, but 7 days after therapy was completed, no Chlamydia trachomatis antigens were detectable by this assay. Erythromycin PCE® was well tolerated and rapidly eliminated Chlamydia genital infections in 83% of persons showing negative cultures by the third day of therapy.