Yonsei Med J. 2002 Oct;43(5):644-51.
Treatment of female urethral syndrome refractory to antibiotics.

Yoon SM, Jung JK, Lee SB, Lee T.

Department of Urology, Inha University College of Medicine, Incheon, Korea.

Various methods of treatment, other than antibiotic therapy, have been proposed for the treatment of female urethral syndrome; however, the results of these treatment methods are disappointing, due perhaps to the use of the wrong treatment approach. The aim of this study was to evaluate the effectiveness of external sphincter relaxant and biofeedback (BFB) with electrical stimulation therapy (EST) in patients who do not respond well to antibiotics. One hundred and five patients with a diagnosis of female urethral syndrome were entered into this study. Antibiotics were given as a first-line therapy for about 3 months. In cases of recurrent or incurable urethral syndrome, antibiotic therapy combined with external sphincter relaxant or BFB with EST were performed. External sphincter relaxant group was composed of 31 patients (29.5%) who showed functional urethral obstruction. Biofeedback group was composed of 41 patients (39.0%) who had severe pain or discomfort with irritative voiding symptoms. Subjective symptom was measured before and after therapy using the Bristol Female Lower Urinary Tract Symptoms questionnaire. Thirty-three patients (31.4%) were treated with antibiotic therapy alone and 7 (21.2%) of these patients recurred. The symptom score of this group changed from 10.51 to 2.85. In the antibiotics plus external sphincter relaxant group (N=31), the symptom score changed from 12.39 to 3.96. Five (16.1%) of these patients recurred and 3 of these 5 underwent urethral dilatation. In the antibiotics plus biofeedback group (N=41), the average urinary frequency changed from 12.2 to 7.7 times a day and nocturia changed from 2.4 to 0.6 times a night. The symptom score improved from 15.22 to 4.69 and the overall satisfaction rate was 87.8% (41.5%: very satisfied, 46.3%: satisfied, 12.2%: no response). Female urethral syndrome is not due to a single factor but is a complex disease due to various combined symptoms and mechanisms. This condition needs to be treated with an appropriate treatment protocol. We believe that satisfactory results could be obtained in female urethral syndrome, which has shown poor prognosis until now, by appropriately combining treatment methods, which include the use of external sphincter relaxants, biofeedback therapy and bladder training, according to indication, and depending on whether symptoms continue after initial antibiotic therapy.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12402379&dopt=Abstract antibiotic, antibiotics



J Infect Dis. 2002 Nov 15;186(10):1430-7. Epub 2002 Oct 23.
Detection of attenuated, noninfectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment.

Bockenstedt LK, Mao J, Hodzic E, Barthold SW, Fish D.

Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8031, USA. linda.bockenstedale.edu

Xenodiagnosis by ticks was used to determine whether spirochetes persist in mice after 1 month of antibiotic therapy for vectorborne Borrelia burgdorferi infection. Immunofluorescence and polymerase chain reaction (PCR) were used to show that spirochetes could be found in Ixodes scapularis ticks feeding on 4 of 10 antibiotic-treated mice up to 3 months after therapy. These spirochetes could not be transmitted to naive mice, and some lacked genes on plasmids correlating with infectivity. By 6 months, antibiotic-treated mice no longer tested positive by xenodiagnosis, and cortisone immunosuppression did not alter this result. Nine months after treatment, low levels of spirochete DNA could be detected by real-time PCR in a subset of antibiotic-treated mice. In contrast to sham-treated mice, antibiotic-treated mice did not have culture or histopathologic evidence of persistent infection. These results provide evidence that noninfectious spirochetes can persist for a limited duration after antibiotics but are not associated with disease in mice.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12404158&dopt=Abstract antibiotic, antibiotics



Med J Aust. 2002 Nov 4;177(9):512-5.
Treatment of sore throat in light of the Cochrane verdict: is the jury still out?

Danchin MH, Curtis N, Nolan TM, Carapetis JR.

Clinical Research Fellow, University Department of General Paediatrics/Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia. danchinryptic.rch.unimelb.edu.au

There are few good-quality studies of the effectiveness of antibiotic treatment of proven group A streptococcal (GAS) pharyngitis in children; available data suggest that antibiotics may reduce symptom duration. While there is limited justification for antibiotic treatment of GAS pharyngitis to prevent acute rheumatic fever in non-Indigenous Australians, there is no justification for routine antibiotic treatment of all patients with sore throat. Two strategies are open to clinicians: not to treat GAS pharyngitis with antibiotics, in which case no investigations should be done; or to treat cases of sore throat with clinical features that suggest GAS, in which case diagnosis should be confirmed with a throat swab, and penicillin started while awaiting the result. Penicillin should be discontinued if the swab is negative, or continued for 10 days if it is positive for GAS. Surveillance of GAS infections and acute rheumatic fever is needed in Australia, as are further studies of effectiveness (including cost-effectiveness) of antibiotic treatment of proven GAS pharyngitis.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12405896&dopt=Abstract antibiotic, antibiotics



Curr Treat Options Gastroenterol. 2002 Dec;5(6):479-489.
Spontaneous Bacterial Peritonitis.

Hillebrand DJ.

Loma Linda University Medical Center, 11234 Anderson Street, Room 1432, Loma Linda, CA 92354, USA. dhillebranhs.llumc.edu

Spontaneous bacterial peritonitis (SBP) is the prototypical ascitic fluid infection occurring in patients with advanced liver disease and ascites. The key to successful treatment of SBP is a knowledge of appropriate antibiotic regimens and an understanding of the setting in which infection develops, particularly those individuals at high risk for infection. A high index of suspicion should lead to early diagnostic paracentesis and ascitic fluid analysis. Treatment of SBP involves the use of non-nephrotoxic broad-spectrum antibiotics expected to cover the typical bacterial flora associated with SBP. SBP typically involves infection with a single organism, with Escherichia coli, Klebsiella spp, and Streptococcus spp responsible for nearly three fourths of cases. The treatment of choice is cefotaxime 2 g given intravenously every 8 hours for a total of 5 days. The antibiotic regimen is adjusted based on the results of ascitic fluid cultures. Other antibiotic regimens for SBP are less well studied. Given the significant morbidity and mortality rates associated with SBP, efforts to prevent its development and recurrence with antibiotic prophylaxis are warranted. The most extensively studied form of prophylaxis involves selective intestinal decontamination (SID) with the oral fluoroquinolone norfloxacin. Individuals with low-protein ascites (ascitic fluid total protein < 1g/dL) benefit from SID with norfloxacin 400 mg daily during times of hospitalization. Long-term primary prophylaxis during outpatient management of individuals awaiting liver transplantation with severe ascites and advanced liver failure should also be considered. Patients with cirrhosis and upper gastrointestinal bleeding should receive norfloxacin 400 mg twice daily for 1 week following their bleed. Those individuals surviving an episode of SBP should be treated with norfloxacin 400 mg daily until the risk of SBP is removed by definitive resolution of the ascites or liver transplantation surgery. Although the infection-related mortality associated with SBP has decreased to less than 10%, hospitalization-related mortality remains as high as 30% as a result of the severe underlying liver disease in which the infection arises and the marked generation of cytokines and nitric oxide resulting from the infection. Recently, the simultaneous administration of intravenous albumin and antibiotics for SBP has been shown to result in the decreased development of azotemia and hospitalization-related mortality. Further improvement in the outcomes of SBP will require treatments targeting this cytokine cascade rather than the development of more potent antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12408785&dopt=Abstract antibiotic, antibiotics [PubMed - as supplied by publisher]



Med Microbiol Immunol (Berl). 2002 Oct;191(2):107-14. Epub 2002 Jun 29.
Minimal attachment killing (MAK): a versatile method for susceptibility testing of attached biofilm-positive and -negative Staphylococcus epidermidis.

Knobloch JK, Von Osten H, Horstkotte MA, Rohde H, Mack D.

Institut fur Medizinische Mikrobiologie und Immunologie, Universitatsklinikum Hamburg-Eppendorf, Martinistr. 52, Germany. knoblocke.uni-hamburg.de

Due to its ability to attach to polymeric surfaces Staphylococcus epidermidis is a common pathogen in chronic, medical device-associated infections. Attached S. epidermidis displays reduced susceptibility against a variety of antimicrobial substances, and little correlation between standard susceptibility test results and clinical outcome of antibiotic treatment is observed. In this study we established a new, versatile, and easy method of antimicrobial susceptibility testing for attached Staphylococcus epidermidis, suitable for both biofilm-negative and biofilm-positive attached bacteria using readily available equipment. For three biofilm-positive wild-type strains and their biofilm-negative mutants minimal attachment killing concentrations (MAK) of penicillin, oxacillin, vancomycin, and gentamicin were determined. Depending on strain and investigated antibiotics, a heterogeneous MAK (MAK(hetero)) could be differentiated from a homogeneous resistance (MAK(homo)), favoring a model of few persisters within attached cells under antibiotic treatment. For the biofilm-negative mutants, a lower MAK(homo) was detected than for the corresponding wild types for some of the tested antibiotics, which probably resulted from higher bacterial inocula of wild-type strains, whereas the MAK(hetero) were comparable for mutants and wild types for most of the tested antibiotics and strains. These data indicate that biofilm formation is not a necessary prerequisite for persistence of attached S. epidermidis cells under antibiotic treatment, which could explain therapeutic failure in foreign body-associated infections due to biofilm-negative S. epidermidis isolates. The highly individual resistance phenotypes of the investigated strains with different antibiotics suggests that MAK determination could help to predict the therapeutic outcome of foreign body-associated infections with both biofilm-positive and biofilm-negative S. epidermidis.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12410350&dopt=Abstract antibiotic, antibiotics



Poult Sci. 2002 Oct;81(10):1496-500.
Screening of Salmonella isolates from a turkey production facility for antibiotic resistance.

Nayak R, Kenney PB.

US Food and Drug Administration, National Center for Toxicological Research, Division of Microbiology, Jefferson, Arkansas 72079, USA.

An ecological survey was conducted from April 1997 to June 1999 on four turkey flocks (F1 to F4). Turkey cecal contents, litter, waterers, feed, feeders, and environmental swabs were analyzed. Presence of Salmonella was determined using conventional microbiological screening techniques and confirmed by serology. Positive isolates were serotyped and screened for antibiotic resistance. From a total of 69 Salmonella isolates 25% were resistant to one or more antibiotics including gentamicin (G), spectinomycin (SP), streptomycin (S), tetracycline (T), tobramycin (TO), and trimethoprim/sulfamethoxazole. Isolates included 45 S. heidelberg, 13 S. senftenberg, 7 S. muenster, 2 S. anatum, and 2 S. worthington. Resistance to antibiotic(s) was highest among waterer isolates (55%) followed by environmental swabs (43%), feeder content samples (33%), turkey cecal contents (26%), and litter samples (5%). Frequencies of antibiotic-resistant Salmonella in F1, F2, and F4 were 27, 13, and 40%, respectively. Salmonella was undetected in F3. In F1, S. heidelberg from cecal content and waterer samples was resistant to G, SP, S, and T, whereas S. anatum from waterer samples was resistant to T and S. In F2, S. worthington from litter and feeder content samples was resistant to T, and in F4, S. muenster from environmental swabs was resistant to TO, S, SP, and G. Identifying preharvest sources and characterizing serotype and antibiotic-resistance profile can assist poultry producers and integrators in tracking movement of Salmonella on turkey farms.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12412915&dopt=Abstract antibiotic, antibiotics



Arch Pediatr Adolesc Med. 2002 Nov;156(11):1114-9.
Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections.

Nash DR, Harman J, Wald ER, Kelleher KJ.

Department of Pediatrics, University of Pittsburgh School of Medicine, PA 15213, USA. david.nashp.edu

OBJECTIVES: To determine if the rate of appropriate antibiotic use in the treatment of children with bronchitis, viral upper respiratory tract infections, sinusitis, otitis media, and pharyngitis has changed in recent years and to identify factors that are associated with the use of inappropriate antibiotic therapy. DESIGN: The National Ambulatory Medical Care Survey was used to examine the antimicrobial prescribing habits of physicians who provide primary care for children. Data were analyzed from 1995-1998. SETTING: Office-based physician practices. PARTICIPANTS: Pediatricians, family physicians, and generalists completing survey forms for patients younger than 18 years. MAIN OUTCOME MEASURE: The appropriate use of antibiotics for upper respiratory tract infections. RESULTS: Multivariate analyses were used to examine factors associated with the use of inappropriate antibiotics to treat either upper respiratory tract infections or bronchitis. Patients seen in 1998 and diagnosed as having upper respiratory tract infections were 0.69 (95% confidence interval, 0.59-0.81) times less likely to be treated with antibiotics compared with patients seen in 1995. Multivariate analyses were also used to assess factors associated with the use of antibiotics with a suboptimal therapeutic profile for the treatment of either sinusitis or otitis media. Children diagnosed as having either sinusitis or otitis media were 0.3 (95% confidence interval [CI], 0.16-0.48) times less likely to receive antibiotics with a suboptimal therapeutic effect in 1998 compared with 1995. CONCLUSIONS: Physicians are slowly improving their antibiotic prescribing patterns but the use of inappropriate antibiotics is still common. Almost half of patients with upper respiratory tract infections receive antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12413339&dopt=Abstract antibiotic, antibiotics