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Abstract Objective To assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat. Design Randomised, double […]

ABSTRACT: The morbidity and mortality associated with community-acquired pneumonia (CAP) can be minimized by treating patients according to validated guidelines. Antibiotic resistance and the role of atypical pathogens are important [...]

A higher dose of amoxicillin appears to be more effective than the standard dose of penicillin in children with group A streptococcal throat infections. Researchers randomly assigned 113 children to receive 40 milligrams per kilogram per day (mg/kg/day) of amoxicillin or the standard penicillin dose, which is approximately 18 mg/kg/day. After 10 days of treatment, 80% of the children on amoxicillin had been cured, compared to 55% of those on penicillin. Only 10% were still colonized by the bacterium, compared to 24% of those on penicillin.

Introduction Acute sinusitis, an inflammation in the paranasal sinuses lasting no longer than one month, is a common clinical problem in general practice.[1-3] Acute sinusitis is a common reason for [...]

Objective: To compare bacteriologic and clinical efficacy and safety of 10 vs 5 days of cefpodoxime proxetil vs 10 days of penicillin V potassium for the treatment of acute group A B-hemolytic streptococcal tonsillopharyngitis in children. Design: Prospective, randomized, observer-blind, multicenter study. Patients/Interventions: Four hundred eighty-four children (age range, 2 to 17 years) with signs and symptoms of acute tonsillopharyngitis were enrolled; 377 had a positive throat culture for group A B-hemolytic streptococci and were fully evaluable. One hundred twenty-one patients received cefpodoxime once a day for 10 days, 126 received cefpodoxime twice a day for 5 days, and 130 received penicillin V three times a day for 10 days. Results: Cefpodoxime for 10 days vs cefpodoxime for 5 days vs penicillin V for 10 days produced bacteriologic eradication at the end of therapy in 95%, 90%, and 78% of the patients, respectively. The 10- and 5-day cefpodoxime treatment regimens were more efficacious than penicillin V (P=.003 and P=.02, respectively). The cumulative bacteriologic failure rate among assessable patients by the 32- to 38-day posttreatment visit was 20 (17%) of 121 patients who were treated with cefpodoxime for 10 days, 24 (19%) of 125 patients who were treated with cefpodoxime for 5 days, and 45 (35%) of 130 patients who were treated with penicillin V for 10 days (P=.001 and P=.005, respectively). Clinical cure or improvement was observed at the end of therapy in 96%, 94%, and 91% of the patients, respectively (P=not significant). Adverse events were infrequent and similar in all three treatment groups, with minor gastrointestinal side effects predominating. Conclusions: Five days of treatment with cefpodoxime is as efficacious in bacteriologic eradication and clinical response (cure plus improvement) as 10 days of cefpodoxime therapy, and both cefpodoxime regimens produced superior bacteriologic efficacy compared with a 10-day regimen of penicillin V in the treatment of group A B-hemolytic streptococcal tonsillopharyngitis in children. (Arch Pediatr Adoles Med. 1994;148:1053-1060), Cefpodoxime seems to be at least as effective as penicillin for the treatment of tonsillopharyngitis in children. Tonsillopharyngitis is a throat infection. Researchers studied 377 children between the ages of two and 17 who had tonsillopharyngitis caused by the group A beta-hemolytic streptococcus bacterium. Of these, 121 children received 10 milligrams per kilogram of body weight(mg/kg) of cefpodoxime once a day for 10 days; 126 received 10 mg/kg of cefpodoxime divided into two doses per day for five days, and 130 received 40 mg/kg penicillin V divided into three doses per day for 10 days. The disease was cured in 89% of the patients who took cefpodoxime for ten days, 75% of those taking cefpodoxime for five days, and 76% of patients treated with penicillin. Both regimens of cefpodoxime eradicated streptococcal bacteria more efficiently than penicillin. There were no significant differences in the rate of adverse affects or infection recurrence among patients in all treatment groups.

Penicillin therapy may not effectively prevent congenital syphilis in infants born to mothers with syphilis. Syphilis is a chronic infectious disease characterized by lesions, lymph node involvement and organ destruction in the late stages of disease. Congenital syphilis is transmitted to the infant during pregnancy. Researchers reviewed the medical records of 253 pregnant women with syphilis and their infants. Laboratory evidence of syphilis at the time of diagnosis and an unknown duration of disease were risk factors for congenital syphilis. For unknown disease duration, 28 women received one dose of penicillin and 35 women received three doses. However, a 68% incidence of congenital syphilis was associated with one dose and a 49% incidence rate was associated with three dose therapy. About 28% of infants with congenital syphilis were premature.

Pregnant women with premature rupture of the membranes may be treated with penicillin to avoid infections. Premature rupture of the membranes is the separation of the membranes that support the fetus from those of the mother before labor and is often associated with premature birth. Researchers evaluated 77 women receiving penicillin and 67 women receiving a placebo. Though not statistically significant, the interval between the rupture of membranes and delivery was 102 hours among women taking penicillin and 79.5 hours among women taking a placebo. Patients receiving penicillin had fewer infections within the amniotic fluid than did those receiving a placebo. Nine patients taking a placebo and only three patients taking penicillin required antibiotics for an infection. Inflammation of the lining of the uterus occurred after childbirth in two patients taking placebo and one patient taking penicillin.

Fleroxacin, 400 mg, was compared with amoxicillin, 3,000 mg, each administered orally in a single- dose, for the treatment of women with acute uncomplicated symptomatic urinary tract infections. A total of 142 patients were randomized to receive fleroxacin, and 147 patients to receive amoxicillin. Of these, 33 in the fleroxacin group and 39 in the amoxicillin group were considered bacteriologically evaluable. Cure at 5-9 days after treatment was achieved in 32 (97%) of the fleroxacin-treated patients and in 22 (56%) of the amoxicillin-treated patients (p

Loracarbef, a member of the carbacephem class of [Beta]-lactam antibiotics, is a potent anti-bacterial agent. In a double-blind, randomized clinical trial to assess efficacy and safety of loracarbef in the treatment of streptococcal pharyngitis and tonsillitis, 107 adult patients were treated with loracarbef (200 mg capsules twice a day or 15 mg/kg/day suspension) and 111 patients were treated with penicillin VK (250 mg capsules four times a day or 20 mg/kg/day suspension) for 10 days. In the loracarbef treatment group, 96.6% of the evaluable patients had a favorable clinical response 3-5 days after therapy, a result that compared favorably with the 93.9% response rate achieved in the penicillin group. The clinical failure/relapse rates were 3.4% for loracarbef-treated patients and 6.1% for patients receiving penicillin. Bacteriologic response data approximated the clinical result, with a successful response in 89.9% of the loracarbef-treated patients and 91.5% of the penicillin recipients. Two (1.9%) loracarbef-treated patients with rash and one (0.9%) penicillin-treated patient with diarrhea discontinued the study early because of these adverse events. The incidence of adverse events was comparable in the two treatment groups except for increased cough, which was reported by 3.7% of the loracarbef-treated patients and none of the penicillin recipients. These data support the conclusion that loracarbef is comparable to penicillin VK in the treatment of streptococcal pharyngitis and tonsillitis in adults.

Syphilis is a sexually-transmitted disease that is caused by infection with the microorganism known as Treponema pallidum. The first symptoms usually appear within 30 days and include fever and chancroid skin lesions, or ulcers, on the genital organs. During the early stages of disease, the infection can be treated with penicillin. In rare cases, syphilis can reappear and, in the later stages of disease, can spread to the central nervous system. This condition is called neurosyphilis. It can damage the brain and cause loss of memory and the inability to think clearly. Neurosyphilis was very rare in the United States until recently when it began to occur in patients with AIDS. Infection with the human immunodeficiency virus (HIV) causes AIDS. This virus attacks the immune system (the body's natural defense system for fighting infection) and increases the risk for developing life-threatening infections. There have been many reports of neurosyphilis in patients with AIDS; meningitis (inflammation of the brain and spinal cord membranes), nerve abnormalities and strokes have resulted. One study reported that approximately half of the AIDS patients who developed neurosyphilis had been treated with penicillin during the early stages of syphilis. This indicates that penicillin is not effective in preventing neurosyphilis in all patients with AIDS. New methods of preventing and treating neurosyphilis are needed for AIDS patients who develop syphilis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pharyngitis, or inflammation of the mucous membranes and underlying areas of the throat, can be caused by bacteria infection of group A beta-hemolytic streptococcus (GABHS). One effective treatment for this form of pharyngitis has been penicillin, which is effective in 75 to 94 percent of cases. However, there is also evidence that beta-lactamase, an enzyme, may inactivate some of the penicillin. An alternative treatment is cefaclor, another antibiotic that may not be as susceptible to the effects of beta-lactamase. To evaluate the efficacy of cefaclor in treating pharyngitis compared with penicillin, 46 patients received cefaclor and 47 were treated with penicillin for 10 days. Eighty-seven percent of the patients treated with cefaclor were cured of pharyngitis within 10 days, and 91 percent of the patients treated with penicillin were cured. The difference was not statistically significant. It was also found that patients treated with penicillin were more likely to have organisms in their systems that produce beta-lactamase. A similar increase was not found in patients treated with cefaclor. It appears that there is no significant difference between the usefulness of penicillin and cefaclor in treating GABHS. The significance of the influence of organisms producing beta-lactamase and their effect on drug therapy need further study. (Consumer Summary produced by Reliance Medical Information, Inc.), The importance of adequate treatment of pharyngitis caused by group A [Beta]-hemolytic streptococcus (GABHS) continues to be stressed in the medical literature as a result of recent articles documenting the [...]

Infection with group A beta-hemolytic streptococcal pharyngitis (GABHS) - pharyngitis is a sore throat - is effectively treated with antibiotics, but one belief that has persisted is that treatment immediately after diagnosis is less effective than treatment started 48 hours later. This is thought to be a consequence of the prevention of one kind of immune response (type-specific immunity) if antibiotics are given too soon. However, not all researchers agree on this point. To compare the effects of penicillin V treatment started immediately after diagnosis with the effects of treatment started 48 hours later, 113 patients (age 2 to 22 years) were randomly assigned to one of the two groups. All had positive results from a throat culture test and a rapid antigen detection test. To evaluate the effectiveness of treatment, patients were followed-up a few days later, as well as two and four months later. Results showed that 39 percent of the whole group had GABHS in throat culture specimens at a follow-up visit. However, no differences were seen at any follow-up point between the two treatment groups with respect to positive throat cultures, recurrences of infection, recurrences of symptoms, or new infections. A review of the medical literature on this topic, which also discusses the role of type-specific antibodies in light of recent immunological research findings, is presented. In summary, immediate treatment of GABHS pharyngitis with penicillin appears as effective as delayed treatment. Since immediate treatment provides faster relief of symptoms and reduces the risk of disease transmission, delaying treatment cannot be recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

One reason for the failure of penicillin to eradicate acute streptococcal pharyngitis (sore throat due to infection with group A beta-hemolytic streptococci, or GABHS) could be the presence in the throat of other microorganisms that render penicillin ineffective. This could occur as a result of the production by bacteria of beta-lactamase, an enzyme that interferes with penicillin's antimicrobial effect. To evaluate this possibility, patients with acute pharyngitis were treated either with an antibiotic used against both GABHS and beta-lactamase-producing bacteria (amoxicillin-clavulanic acid), or an antibiotic against GABHS only (phenoxymethyl penicillin, also called penicillin V). Forty-three penicillin patients and 46 amoxicillin-clavulanic acid patients completed the study: patients were 7 years old, on average. Effective treatment was defined as elimination of the original streptococcal organism at a follow-up visit within several days of their last use of medication. Results showed that throat culture results remained positive for the same GABHS strain in 6.5 percent of the patients treated with amoxicillin-clavulanic acid and in 2.3 percent of those treated with penicillin; these rates were not significantly different. Moreover, two of the three treatment failures in the amoxicillin-clavulanic acid group were in children who had not produced beta-lactamase at the start of the study, so failure could not be said to be a result of the enzyme. The findings of this admittedly small study indicate that treatment failure against GABHS pharyngitis cannot be corrected by adding an agent against beta-lactamase-producing bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Anaerobic infections are caused by bacteria which either do not need oxygen, or live best in the absence of oxygen. Such infections in the lungs are responsible for anaerobic lung abscesses and necrotizing (cell-killing) pneumonia. Until recently, penicillin and clindamycin were thought to be equally effective in treating such infections, but clindamycin has lately been suggested to be more effective. The effectiveness of penicillin and clindamycin in treating such infections in 37 patients was evaluated. Bacteria responsible for infections were identified by sampling tissue or fluids from the lower respiratory tract. Initially, facultative (preferring oxygen but able to survive without it) bacteria from two patients were resistant to clindamycin, while one was resistant to penicillin. Ten strains of bacteria which were obligate anaerobes (i.e. can thrive only in the absence of oxygen) were found in 42 percent of all cases and were penicillin-resistant. None were clindamycin-resistant. Ten of 18 patients treated with penicillin and 18 of 19 patients treated with clindamycin responded well. Five of the patients who worsened had penicillin-resistant bacteria, while two others became infected with additional bacteria and the final two did poorly for other reasons. The study suggests that penicillin-resistant bacteria may be a common cause of failure of penicillin therapy of lung abscesses and necrotizing pneumonia. Clindamycin generally provides a good response, but research on the cost-effectiveness of such treatment is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

The incidence of gonorrhea in which Neisseria gonorrhoeae, the bacteria causing the infection, has become penicillin-resistant has increased on the coasts of the US and in large cities. Rural regions are apparently less affected by this problem. Two measures to deal with this have been recommended. One, all isolated gonorrhea samples should be tested for penicillin resistance, and two, penicillin should be given only to sexual contacts of patients infected with penicillin-sensitive gonorrheal strains. However, the effectiveness and cost of these policies in rural, low prevalence areas is not established. The cost-effectiveness of bacterial screening and penicillin alternatives was studied in a rural Iowa county following an outbreak of penicillin-resistant gonorrhea. Assumptions about medical outcomes were derived from the literature. The outbreak was abrupt and infection extended rapidly, factors that supported the need to identify best strategies for antibiotic choice and use of bacterial testing. Five strategies, which differed in bacterial screening and antibiotic usage for cases of varying risks and presumed or known infections, were identified. Without bacterial screening, ciprofloxacin, an alternative to penicillin, as the only therapy for presumed and known infections (unless medically inappropriate), was the most cost-effective strategy. Ciprofloxacin should not be used by patients 16 years old or younger or by pregnant women, and the most cost-effective alternative for these patients is to treat them initially with penicillin-like antibiotics, test isolated bacteria for penicillin resistance, and then recall those patients with resistant infections for alternative treatment. The study suggests that patients with known or presumed gonorrhea infections should be routinely treated with an inexpensive drug which is effective against penicillin-resistant gonorrhea, such as ciprofloxacin. In addition, bacterial screening should also be performed routinely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bacterial meningitis, the infection or inflammation of the membranes covering the spinal cord and brain, causes considerable sickness and death, even though antibiotics capable of destroying the bacteria are widely available. Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae are the bacteria which most commonly cause death from meningitis. The mortality caused by these bacteria has not changed in 30 years. Recent advances in the understanding of these organisms and how they cause disease have opened up new developments in the treatment of meningitis. Studies published from the years 1975 to 1989 were reviewed. Penicillin and ampicillin were still the drugs most often chosen to treat meningitis caused by Streptococcus pneumoniae, Neisseria meningitis and certain types of Haemophilus influenzae. Meningitis-causing bacteria that have the characteristic of being gram-negative, such as Pseudomonas aeruginosa, are now being treated with cephalosporin antibiotics, such as ceftazidime. Antibiotics do not get into the cerebral spinal fluid easily, and the environment of the cerebral spinal fluid is such the activities of antibiotics are inhibited. Other drugs and products are used to treat various pathological effects of bacterial meningitis. The use of anti-inflammatory agents has reduced inflammation of the subarachnoid space of the brain, which is caused by bacterial infection. Infants and children who were treated with antibiotics and the corticosteroid dexamethasone had a lower incidence of long-term neurologic damage. Other experimental studies include immunotherapy, or using monoclonal antibodies, which could neutralize bacterial factors that cause meningitis. Another investigation may use the factors produced by cells, such as interferon, which are involved in the inflammatory response (cytokine production) against the bacterial products. It is hoped that with greater understanding of the characteristics of the bacteria that cause meningitis, more can be done to treat this disease and reduce the sickness, mortality and neurologic damage that have been associated with it. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective - To examine whether simple interventions in a sickle cell clinic improve survival in sickle cell disease. Design - Survival curve analysis and hazard ratios in a cohort study [...]

Pill comes out top in live debate to celebrate C+D's 150th birthday Chris Chapman The contraceptive pill is the greatest pharmacy innovation of the past 150 years, leading figures from [...]

In recent years there has been an increase in the number of different strains of Neisseria gonorrhoeae (N. gonorrhoeae, the organism that causes gonorrhea) that are resistant to treatment with antibiotics, meaning they are not killed by these drugs. Different strains have been identified that are resistant to penicillin and tetracycline, two commonly used antibiotics. Ofloxacin is a relatively new antibiotic that has been shown to be a potent killer of several different strains of N. gonorrhoeae. To determine the effectiveness of ofloxacin, 40 men and 20 women with N. gonorrhoeae infections were treated with a single oral dose (400 milligrams) of ofloxacin (36 men and 13 women were followed up). Ofloxacin was effective in treating all the cases of infection, which were all located in the urethra or cervix. Also, ofloxacin was effective at killing strains of N. gonorrhoeae that were resistant to penicillin and tetracycline. When the dose of ofloxacin required to kill 50 percent of the bacteria was compared with the required doses of penicillin and tetracycline, it was found that ofloxacin was 100 and 450 times more potent than tetracycline or penicillin, respectively. It is concluded that ofloxacin is an effective treatment for N. gonorrhoeae infections. The advantages of ofloxacin are that it can be given in a single oral dose, it has few side effects, and it is effective against strains of N. gonorrhoeae that are resistant to treatment with penicillin and tetracycline. The effectiveness of ofloxacin is similar to that of ceftriaxone and ciprofloxacin, two other antibiotics used for treating gonorrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

SERENDIPITY has long been one of medicine's most steadfast collaborators. Arguably, the most potent example of an influential accident was when Dr. Alexander Fleming returned to his London laboratory after [...]

ATLANTA -- The juggernaut of penicillin-resistant Streptococcus pneumoniae rolls on. "The trend of increasing penicillin and erythromycin resistance suggests that recommendations for the treatment of pneumonia should be reevaluated in [...]

The United States Food and Drug Administration (FDA) has approved Levaquin(r) (levofloxacin tablets/injection; Ortho-McNeil Pharmaceutical, Inc.) for the treatment of penicillin-resistant Streptococcus pneumoniae in community-acquired pneumonia (CAP) This new indication [...]

Increasingly, Streptococcus pneumoniae with reduced susceptibility to penicillin is becoming a healthcare concern, not only because of the high prevalence of infections caused by this pathogen but also because of the rate at which resistance has progressed. The incidence of penicillin resistance in strains of S. pneumoniae approaches 40% in some areas of the United States, and the incidence of high-level resistance has increased by 60-fold during the past 10 years. With the exception of meningitis and otitis media, there is no conclusive evidence that the acquisition of resistance by S. pneumoniae to [Beta]-lactam antibiotics incurs greater morbidity and mortality in infections caused by this pathogen. However, if the current trends of resistance patterns continue, one can expect the morbidity and mortality to increase. The mechanism of [Beta]-lactam resistance of S. pneumoniae involves genetic mutations which alter penicillin-binding protein structure, resulting in a decreased affinity for all [Beta]-lactam antibiotics. In the treatment of infections caused by S. pneurnoniae, it should not be assumed that nonsusceptibility to [Beta]-lactam antibiotics correlates with clinical ineffectiveness of these agents. On the contrary, the recommended therapy for nonmeningeal pneumococcal infections (e.g., pneumonia, sepsis, acute otitis media) includes a [Beta]-lactam antibiotic: penicillin G, amoxicillin, amoxicillin/clavulanate, cefuroxime, cefotaxime, or ceftriaxone. Recommended therapy for meningitis is cefotaxime or ceftriaxone, with the addition of vancomycin until susceptibility is known. These agents are recommended because of their ability to achieve serum/tissue concentrations greater than the minimum inhibitory concentrations (MICs) of these agents against penicillin-susceptible, penicillin-intermediate, and most penicillin-resistant strains (e.g., penicillin G, cefotaxime, ceftriaxone, amoxicillin, amoxicillin/clavulanate, and cefuroxime), or their ability to provide adequate concentrations in cerebrospinal fluid (e.g., cefotaxime, ceftriaxone). Am J Med. 1999;106(5A):19S-25S. [C] 1999 by Excerpta Medica, Inc.