The published experience with trimethoprim-sulfamethoxazole (TMP-SMZ) for treatment of infective endocarditis was reviewed. Among 62 cases, a high proportion had unusual causative organisms: 60% of cases were due to Coxiella burnetii or Pseudomonas species. Only 17% of patients had previously normal cardiac valves. Patients often had complicated courses in which TMP-SMZ was tried only after other treatment regimens had failed, yet a successful outcome was achieved in 61% of cases. Thirty-five patients were treated with antibiotics alone, while the other 27 patients required combined medical and surgical management. TMP-SMZ has a limited role in the management of infective endocarditis; specific guidelines for its use, including proper laboratory control, have been delineated.

Anti-Infective Agents↗

PubMedDate not supplied

Trimethoprim-sulfamethoxazole vs. ampicillin in the treatment of experimental meningitis due to Streptococcus pneumoniae.

When given in combination, both trimethoprim and sulfamethoxazole penetrated well into the cerebrospinal fluid of rabbits with experimental pneumococcal meningitis, reaching concentrations that should have been adequate for synergistic killing of Streptococcus pneumoniae. However, trimethoprim-sulfamethoxazole was less effective than ampicillin in the treatment of this experimental infection. The effect of the combination on pneumococci in vivo was bacteriostatic rather than bactericidal, possibly because the number of pneumococci in the cerebrospinal fluid of the rabbits at the start of treatment was larger than that in the inoculum used for in vitro sensitivity tests.

Ampicillin↗

PubMedDate not supplied

Combined therapy with amphotericin B and 5-fluorocytosine for Candida meningitis.

The course and outcome of combined treatment with amphotericin B and 5-fluorocytosine were analyzed in 17 patients with candida meningitis. Eleven patients were twelve months of age or younger; seven of these were neonates. All but two patients had underlying conditions or therapy that could predispose them to systemic candidiasis. The median duration of concurrent dual therapy was 26 days; in ten cases, therapy with either drug alone was continued longer. Fifteen patients improved; 14 were cured of their infection. Cultures of cerebrospinal fluid became sterile a median of seven days after the start of therapy. Primary resistance to 5-fluorocytosine was found in four of the Candida isolates, and acquired resistance, in one. Serious adverse drug reactions were uncommon. The two patients who died had received intrathecal rather than systemic amphotericin B. One of eight infants who survived had psychomotor retardation; three of eleven infants developed hydrocephalus. Although experience with candida meningitis is limited, the combination of amphotericin B and 5-fluorocytosine is effective and offers potential advantages over amphotericin B alone.

Adult↗

PubMedDate not supplied

Computed tomographic evaluation of an experimental model for pyogenic liver abscesses.

Computed tomography (CT) was used to evaluate 15 rabbits with experimentally induced liver abscesses. The animals were examined both before and after intravenous contrast injection. After sacrificing the animals, postfreeze CT scans were made to mark the abdomen for 1-cm thick whole body sections for correlating the gross pathology with the results of the CT scans. CT detected 15 abscesses in 13 of the 14 rabbits with true positive lesions. Ten abscesses less than 1.4 cm in diameter were not detected by CT. Contrast agent enhancement was helpful in 70% of the studies. These abscesses have characteristics similar to human liver abscesses, but there was more gas and calcium in the experimentally induced abscesses than is encountered in humans with hepatic abscesses. The model and its CT characteristics appear well suited for future studies in the diagnosis and treatment of liver abscesses.

Animals↗

PubMedDate not supplied

The 1976 Paul B. Beeson lecture. Some observations on experimental endocarditis.

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Animals↗