Sickle hemoglobinopathy and Edwardsiella tarda meningitis.
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Biomedical subjects
Publications and source records attributed to G W Counts.
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Ampicillin and tetracycline, in doses of 2 g a day, were compared in the treatment of acute exacerbations of chronic bronchitis. Seventy-nine patients were followed for 3 to 29 months and were treated for 118 exacerbations. Clinical improvement occurred after 10 days of treatment with either drug in over 80% of the cases. Haemophilus influenzae and Diplococcus pneumoniae were eradicated from the sputum more than 60% of the time, but in general there was a poor correlation between bacteriological clearing and clinical response. The effect of chemoprophylaxis with ampicillin and tetracycline in doses of 1 g a day on the frequency of acute exacerbations of bronchitis was compared with that of a placebo. Seven hundred eighty prophylactic regimens, consisting of one capsule every 12 hr for 5 days beginning with the first sign of a cold, were prescribed for 76 patients. Irrespective of the regimen, an acute exacerbation of bronchitis was encountered at approximately 13% of the follow-up visits to the clinic.
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Explore the source record for details and available documents.
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122 patients with hematologic malignancies underwent allogeneic marrow transplantation from HLA-matched sibling donors and received one of two forms of infection prophylaxis while granulocytopenic: 1) decontamination and laminar air flow isolation (LAF, 68 patients), and 2) LAF plus prophylactic systemic antibiotics (LAF + PSA, 54 patients). Patients were evaluated for infection acquisition while in isolation. Septicemia occurred in 11 (16%) of the patients in the LAF group and in three (6%) patients in the LAF + PSA group. Fourteen (21%) of the patients in the LAF group and four (7%) patients in the LAF + PSA group had a major local infection. There was no difference in the incidence and severity of graft-versus-host disease or incidence and duration of fever. The addition of prophylactic intravenous broad-spectrum antibiotics for patients isolated in LAF rooms significantly decreased infection acquisition.
Cefoxitin has become one of the most used parenteral antibiotics in the United States, perhaps because of a broad spectrum of activity, including activity against Bacteroides fragilis, which makes the drug suitable for prevention and treatment of intraabdominal and pelvic infections. This review focuses on the use of cefoxitin in obstetric and gynecologic infections, with comparisons to older and newer antibiotics. Numerous studies have shown that cefoxitin is clearly effective; in most of these studies, however, either the initial infection rates were low or the sample sizes were small--circumstances making it difficult to establish the superiority of any one agent. Thus, the necessity of using a drug with activity against B. fragilis for prevention and treatment of pelvic infections has not been proven. Several antibiotics without such activity have been equally effective. Cefoxitin may be of particular value when combined with surgical drainage of pelvic abscesses, infections in which control of B. fragilis may be especially important to outcome.
Low-dose trimethoprim (TMP), trimethoprim-sulfamethoxazole (TMP-SMZ), and nitrofurantoin macrocrystals were found to be safe and effective as prophylaxis against recurrent urinary tract infections. Women given placebo had 2.8 infections per patient-year during the six-month study period, while women given TMP, TMP-SMZ, or nitrofurantoin had significantly lower infection rates (0.015 per patient-year). The effect of prophylaxis appeared to be limited to the period when the agents were taken. Only one patient had a TMP-resistant coliform isolated from cultures obtained during prophylaxis and six months afterwards. The sole factor associated with the recurrence of infection after prophylaxis was a history of three or more infections in the year preceding prophylaxis. Thirty-one of the 60 women in the trial were monitored for a mean of 6.1 years before and 3.2 years after they entered the study. Analysis of infection rates indicated that about half these women were experiencing an infection cluster when they entered the study and that the prestudy baseline infection rate correlated with the poststudy rate. Thus, prophylaxis did not appear to exert a long-term effect on the baseline infection rate. Urinary prophylaxis generally appears to become cost-effective when the baseline infection rate exceeds two per patient-year.
The efficacy of a single dose (four tablets) and of 10-day courses of trimethoprim-sulfamethoxazole (TMP-SMZ) was studied in 77 women with symptomatic cystitis and negative tests for antibody-coated bacteria. Cure rates after six weeks were 76% for single-dose therapy and 87% for 10 days of treatment. For Escherichia coli infections, cure rates after six weeks were 80% and 86%, respectively. However, 10-day treatment eliminated enteric bacilli from urethral and vaginal sites more often than did single-dose therapy. Two weeks after completion of treatment, perineal colonization was observed more often in the women who developed recurrent infections than in those who did not (P = 0.01). During these two weeks, recurrent infections were found somewhat more often in the women who had received single-dose therapy than in those who had undergone 10-day treatment (5 of 38 vs. 2 of 39; P = 0.07). With conventional courses of antibiotics, retreatment of all recurrent infections was less successful in women previously given single-dose therapy. Recurrent infections were also more frequent in women infected with bacteria other than E. coli. Both drug regimens were well tolerated. However, serious adverse reactions were fewer in patients treated with a single dose (8.5%) than in patients treated for 10 days (15%). Single-dose therapy with TMP-SMZ appears as effective as 10-day therapy in acute uncomplicated cystitis caused by E. coli.
In 1975 an outbreak of group A meningococcal disease began in Seattle, Washington, and cases subsequently were recognized throughout the Pacific Northwest. Nearly one-half of the affected persons were Native Americans; two-thirds were alcohol abusers and/or habitués of skid road communities. In Seattle, group A meningococci colonized asymptomatic persons only if these individuals had contact with skid road (P = .006). The epidemic strain may have spread from American Indians in Manitoba, Canada. Traditional migration routes connect the two populations; asymptomatic American Indians on reservations in Washington carried group A meningococci. Vaccination programs were undertaken in four cities but only after cases occurred. In Seattle, vaccination reached 80% of the target population and was associated with a significant decrease in incidence of the disease, but cases recurred after the program ended. The social habits of skid road communities, combined with the "case-triggering" approach to, and premature termination of, vaccination programs, may have resulted in 56% of regional cases occurring after the start of the vaccination program in Seattle.
Cefoxitin is active in vitro against beta-lactamase-producing strains of Neisseria gonorrhoeae; therefore, its efficacy in the treatment of uncomplicated genital gonorrhea was evaluated in a study of ten men and 15 women. Cefoxitin was administered in two intramuscular doses given 5 hr apart, patients alternately receiving either 1 g or 2 g of cefoxitin in each injection. Probenecid (1 g) was administered orally with both injections to five women, and with the first injection only in the remaining patients. All cases of gonococcal cervicitis or urethritis were cured, and all rectal carriage was eliminated. Four of seven patients had persistent oropharyngeal carriage after treatment. There was no discernible difference between the efficacies of the 1-g and 2-g regimens. It was concluded that the cefoxitin regimens used are effective for therapy of uncomplicated genital or anorectal gonorrhea, but not for eradication of oropharyngeal carriage of N. gonorrhoeae.