Short Oral Antibiotic Treatment of Osteomyelitis Questioned

1980 ◽  
Vol 2 (1) ◽  
pp. 18-18
Keyword(s):  
Antimicrobial Therapy ◽  
Oral Therapy ◽  
Initial Period ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Oral Route ◽  
Antimicrobial Treatment ◽  
Blood Levels ◽  
Oral Antibiotic ◽  
Cortical Destruction

Dr. Rothman of Haverhill, MA questioned the short duration of antimicrobial treatment and use of oral route for the patient with osteomyelitis presented by Bennett in PIR 1:153, November 1979. He noted that the traditional regimen for osteomyelitis calls for six weeks of intravenous antimicrobial therapy. Dr. Bennett quotes from Telzlaff et al (J Pediatr 92:485, 1978). In this report good results were found when antimicrobial regimens for patients with osteomyelitis and suppurative arthritis consisted of a brief initial period of parenteral therapy of only one to seven days followed by oral antimicrobial therapy begun when there was a definitive decrease in clinical signs of inflammation and continued for three weeks or longer. It is important to note that surgical drainage of pus was carried out, that antimicrobial blood levels were obtained after initiation of oral therapy to ensure adequate levels, that therapy was continued until all signs and symptoms had subsided, that there was no evidence of cortical destruction or sequestrum formation on roentgenogram, and the erythrocyte sedimentation rate was less than 20 mg/hr. When these conditions are met it is clear that oral therapy can be an adequate substitute for prolonged intravenous therapy for osteomyelitis in children.

Lyme borreliosis: diagnosis and management

BMJ ◽  
2020 ◽  
pp. m1041 ◽  
Author(s):  
Bart Jan Kullberg ◽  
Hedwig D Vrijmoeth ◽  
Freek van de Schoor ◽  
Joppe W Hovius
Keyword(s):  
Lyme Borreliosis ◽  
Erythema Migrans ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Antimicrobial Treatment ◽  
Post Exposure Prophylaxis ◽  
Acrodermatitis Chronica Atrophicans ◽  
Persistent Symptoms ◽  
Clinical Signs And Symptoms ◽  
Exposure Prophylaxis

Abstract Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.

The Common Cold—Principles of Judicious Use of Antimicrobial Agents

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_1) ◽  
pp. 181-184 ◽  
Author(s):  
Nancy Rosenstein ◽  
William R. Phillips ◽  
Michael A. Gerber ◽  
S. Michael Marcy ◽  
Benjamin Schwartz ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Common Cold ◽  
Antimicrobial Agents ◽  
Signs And Symptoms ◽  
Antimicrobial Treatment ◽  
Controlled Trials ◽  
Nasal Discharge ◽  
Treatment Changes ◽  
The Common ◽  
Antimicrobial Prescription

Most children will suffer between 3 and 8 colds per year, and over half of patients seen for the common cold are given an antimicrobial prescription. Unnecessary antimicrobial therapy can be avoided by recognizing the signs and symptoms that are part of the usual course of these diseases. Controlled trials of antimicrobial treatment of the common cold are reviewed. These trials consistently fail to show that treatment changes the course or outcome. Furthermore, antimicrobial therapy for patients with viral rhinosinusitis is not an effective way to prevent bacterial complications. Mucopurulent rhinitis (thick, opaque, or discolored nasal discharge) frequently accompanies the common cold and is part of the natural course of viral rhinosinusitis. It is not an indication for antimicrobial treatment unless it persists without improvement for >10 to 14 days.

scholarly journals Case reports of invasive mucormycosis associated neutropenic enterocolitis in leukemic children: diagnostic and treatment challenges and review of literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Amanati ◽  
Omid Reza Zekavat ◽  
Hamidreza Foroutan ◽  
Omidreza Azh ◽  
Ali Tadayon ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Fungal Infections ◽  
Case Reports ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Salvage Chemotherapy ◽  
Antimicrobial Treatment ◽  
High Morbidity ◽  
Disease Relapse ◽  
Neutropenic Enterocolitis

Abstract Background Bacterial enterocolitis is one of the most common neutropenic fever complications during intensive chemotherapy. Despite aggressive antibacterial treatments, this complication usually imposes high morbidity and mortality in cancer patients. Management of bacterial neutropenic enterocolitis are well known; however, management of fungal neutropenic enterocolitis may be more challenging and needs to be investigated. Prompt diagnosis and treatment may be life-saving, especially in patients at risk of mucormycosis-associated neutropenic enterocolitis. Case presentation We report two mucormycosis-associated neutropenic enterocolitis cases in pediatric leukemic patients receiving salvage chemotherapy for disease relapse. Both patients' clinical signs and symptoms differ from classical bacterial neutropenic enterocolitis. They were empirically treated as bacterial neutropenic enterocolitis with anti-gram-negative combination therapy. Despite broad-spectrum antimicrobial treatment, no clinical improvement was achieved, and both of them were complicated with severe abdominal pain necessitating surgical intervention. Mucormycosis is diagnosed by immunohistopathologic examination in multiple intraoperative intestinal tissue biopsies. Both patients died despite antifungal treatment with liposomal amphotericin-B and surgical intervention. Conclusion Mucormycosis-associated neutropenic enterocolitis is one of the most unfavorable and untreatable side effects of salvage chemotherapy in leukemic children with disease relapse. This report could be of considerable insight to the clinicians and scientists who counter the enigma of fungal infections during febrile neutropenia and help to understand better diagnosis and management.

scholarly journals Acute ischaemic stroke in Listeria monocytogenes meningoencephalitis

2020 ◽  
Vol 6 (1) ◽  
pp. 20190068
Author(s):  
Surrin S. Deen ◽  
Jennifer Boyes ◽  
Bankole Oyewole ◽  
Anna Bahk ◽  
George Thomas ◽  
...  
Keyword(s):  
Listeria Monocytogenes ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Mass Effect ◽  
Antimicrobial Treatment ◽  
Neurological Deficits ◽  
Limb Weakness ◽  
Number Of Patients ◽  
Clinical Signs And Symptoms ◽  
Stroke Mimic

Listeria monocytogenes is the third most frequent cause of bacterial meningitis and has a predilection for elderly patients and the immunosuppressed. A small number of patients with Listeria monocytogenes meningoencephalitis have previously been reported to experience stroke-like symptoms that were attributed to microabscess formation and the mass effect of collections of infection in the brain. These infections led to temporary neurological deficits that resolved with antimicrobial treatment, rather than to true strokes with permanent neurological deficits. This report discusses the case of an 80- year-old male, who was immunosuppressed with mesalazine for the treatment of Crohn’s disease, and who went on to develop Listeria monocytogenes meningoencephalitis. 1 week into his admission, for antibiotic therapy, the patient began to experience new onset right upper limb weakness, nystagmus and past pointing. These symptoms were initially thought to be a complication of the infection. However, subsequent diffusion-weighted MRI revealed that the patient had more likely suffered an acute ischaemic event and a contrast-enhanced MRI performed later could not detect any abscess or large infective focus in a region that could explain the symptoms. This case report highlights the fact that ischaemic and infective pathologists may coexist in immunosuppressed Listeria patients and that clinical signs and symptoms should guide the use of appropriate imaging modalities such as MRI to clarify differentials so that ischaemia is not mistaken for the more common stroke mimic caused by infection in these patients.

scholarly journals ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients

2016 ◽  
Vol 71 (9) ◽  
pp. 2405-2413 ◽  
Author(s):  
Georg Maschmeyer ◽  
Jannik Helweg-Larsen ◽  
Livio Pagano ◽  
Christine Robin ◽  
Catherine Cordonnier ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Treatment Success ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Antimicrobial Treatment ◽  
Pneumocystis Jirovecii ◽  
High Dose ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Laboratory Findings ◽  
Patients At Risk

Abstract The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.

Bacterial Endocarditis of the Pulmonic Valve in a Dog

2018 ◽  
Vol 54 (5) ◽  
Author(s):  
Grace K. Clark ◽  
Alan Spier ◽  
Derek Nestor ◽  
Scott Rizzo
Keyword(s):  
Oral Therapy ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Bacterial Endocarditis ◽  
Blood Cultures ◽  
Oral Antibiotic ◽  
Pulmonic Valve ◽  
Intravenous Antibiotics ◽  
Pulmonic Regurgitation

ABSTRACT An 11 yr old female spayed golden retriever weighing 30.3 kg presented for evaluation of progressive lethargy, anorexia, tachypnea, stiff gait, and nonlocalized pain. On physical exam, the patient was febrile and tachycardic, and an arrhythmia with pulse deficits was noted. Clinicopathological abnormalities included thrombocytopenia, leukocytosis, nonregenerative anemia, and mild hypoalbuminemia. The patient progressed overnight to develop a productive cough, and an echocardiogram performed the next morning revealed irregular proliferative lesions of the pulmonic valve with moderate pulmonic regurgitation. Subsequent blood cultures grew two organisms: alpha-hemolytic streptococci spp. and Empedobacter brevis. The dog was treated with appropriate intravenous antibiotics for 2 wk and then switched to oral therapy. The clinicopathologic abnormalities, fever, and clinical signs resolved with oral antibiotic treatment. To the authors' knowledge, this case report represents the first detailed published case of bacterial endocarditis with E brevis bacteremia involving the pulmonic valve. The clinical presentation, diagnosis, treatment, and follow-up are discussed.

Infection surveillance in nursing homes in Stockholm County, Sweden, 2005 - 2014

2016 ◽  
Vol 12 (3) ◽  
Author(s):  
Ann Tammelin
Keyword(s):  
Nursing Homes ◽  
Infection Control ◽  
Urinary Catheter ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
County Council ◽  
Antibiotic Prescribing ◽  
Viral Gastroenteritis ◽  
Stockholm County ◽  
Infection Surveillance

Swedish nursing homes are obliged to have a management system for systematic quality work including self-monitoring of which surveillance of infections is one part. The Department of Infection Control in Stockholm County Council has provided a simple system for infection surveillance to the nursing homes in Stockholm County since 2002. A form is filled in by registered nurses in the nursing homes at each episode of infection among the residents. A bacterial infection is defined by antibiotic prescribing and a viral infection by clinical signs and symptoms. Yearly reports of numbers of infections in each nursing home and calculated normalized figures for incidence, i.e. infections per 100 residents per year, as well as proportion of residents with urinary catheter are delivered to the medically responsible nurses in each municipality by the Department of Infection Control. Number of included residents has varied from 4,531 in 2005 to 8,157 in 2014 with a peak of 10,051 in 2009. The yearly incidences during 2005 - 2014 (cases per 100 residents) were: Urinary tract infection (UTI) 7.9-16.0, Pneumonia 3.7-5.3, Infection of chronic ulcer 3.4–6.8, Other infection in skin or soft tissue 1.4–2.9, Clostridium difficile-infection 0.2–0.7, Influenza 0–0.4 and Viral gastroenteritis 1.2–3.7. About 1 % of the residents have a suprapubic urinary catheter, 6–7 % have an indwelling urinary catheter. Knowledge about the incidence of UTI has contributed to the decrease of this infection both in residents with and without urinary catheter.

scholarly journals 284. Evaluation of Oral Step-Down Therapy for Enterobacteriaceae Bloodstream Infection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Sara Utley ◽  
Dawn Bouknight ◽  
Radha Patel ◽  
Kent Stock
Keyword(s):  
Bloodstream Infection ◽  
Oral Therapy ◽  
Common Source ◽  
Oral Antibiotic ◽  
Beta Lactam ◽  
Hospital System ◽  
Source Of Infection ◽  
Complete Treatment ◽  
Antibiotic Duration ◽  
Alternate Source

Abstract Background Oral antibiotic stepdown therapy for Gram-negative (GN) bloodstream infection (BSI) appears to be a safe option, though high bioavailability drugs like fluoroquinolones (FQ) and trimethoprim-sulfamethoxazole are often recommended without clear evidence demonstrating superiority. Due to increasing concerns of FQ resistance and collateral damage with an increasing community C. difficile rate, our organization sought to reduce overall FQ use and a shift toward oral beta-lactams (BL) was observed. A review was conducted to assess the outcomes of this shift. Methods This retrospective cohort included all patients within our 3-hospital system who had a positive GN blood culture and were transitioned to oral therapy to complete treatment outpatient for bacteremia between Jan 2017-Sept 2019. The primary outcome was recurrent BSI within 30 days of completing initial treatment. Secondary outcomes included 30-day mortality, 30-day recurrence of organism at an alternate source, 30-day readmission, and 90-day BSI relapse. Results Of 191 GN BSIs, 77 patients were transitioned to oral therapy. The mean age was 68 years, 60% were female. The most common source of infection was described as urine (39/77), intra-abdominal (16/77), unknown (13/77). Mean total antibiotic duration (IV plus PO) was 14 days (range 7–33). Patients received an average of 5 days IV prior to transitioning to PO therapy. The most common PO class was a 1st gen cephalosporin (29/77), followed by BL/BL inhibitor (16/77), and a FQ (13/77). There were no 30-day relapse BSIs observed in this cohort. There was 1 patient discharged to inpatient hospice, and no other 30-day mortality observed. There were 4 recurrent UTIs observed within 30 days, none of which required readmission. Of the twelve 30-day readmissions, 1 was considered by the investigators to be related to the initial infection. Conclusion An opportunity for education regarding duration of therapy was identified. Oral beta lactam use in our limited population appears to be a reasonable option to facilitate discharge. Results should be confirmed in additional, larger studies. Disclosures All Authors: No reported disclosures

scholarly journals Prevalence and Course of IgA and IgG Antibodies against SARS-CoV-2 in Healthcare Workers during the First Wave of the COVID-19 Outbreak in Germany: Interim Results from an Ongoing Observational Cohort Study

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 498
Author(s):  
Mark Reinwald ◽  
Peter Markus Deckert ◽  
Oliver Ritter ◽  
Henrike Andresen ◽  
Andreas G. Schreyer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Significant Proportion ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Observational Cohort Study ◽  
Igg Antibodies ◽  
University Hospitals ◽  
Observational Cohort

(1) Background: Healthcare workers (HCWs) are prone to intensified exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the ongoing pandemic. We prospectively analyzed the prevalence of antibodies against SARS-CoV-2 in HCWs at baseline and follow up with regard to clinical signs and symptoms in two university hospitals in Brandenburg, Germany. (2) Methods: Screening for anti-SARS-CoV-2 IgA and IgG antibodies was offered to HCWs at baseline and follow up two months thereafter in two hospitals of Brandenburg Medical School during the first wave of the COVID-19 pandemic in Germany in an ongoing observational cohort study. Medical history and signs and symptoms were recorded by questionnaires and analyzed. (3) Results: Baseline seroprevalence of anti-SARS-CoV-2 IgA was 11.7% and increased to 15% at follow up, whereas IgG seropositivity was 2.1% at baseline and 2.2% at follow up. The rate of asymptomatic seropositive cases was 39.5%. Symptoms were not associated with general seropositivity for anti-SARS-CoV-2; however, class switch from IgA to IgG was associated with increased symptom burden. (4) Conclusions: The seroprevalence of antibodies against SARS-CoV-2 was low in HCWs but higher compared to population data and increased over time. Screening for antibodies detected a significant proportion of seropositive participants cases without symptoms.

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