Archive for April 9, 2015

Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy.

Cochrane Database Syst Rev. 2010 Sep 8;(9):CD007855.

Guinto VT1, De Guia B, Festin MR, Dowswell T.

1Department of Obstetrics and Gynecology, University of the Philippines College of Medicine-Philippine General Hospital, Taft Avenue, Manila, Philippines, 1000.

Abstract

BACKGROUND:

Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications.

OBJECTIVES:

To assess which antibiotic is most effective and least harmful as initial treatment for asymptomatic bacteriuria in pregnancy.

SEARCH STRATEGY:

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2010) and reference lists of retrieved studies.

SELECTION CRITERIA:

Randomized controlled trials comparing two antibiotic regimens for treating asymptomatic bacteriuria.

DATA COLLECTION AND ANALYSIS:

Review authors independently screened the studies for inclusion and extracted data.

MAIN RESULTS:

We included five studies involving 1140 women with asymptomatic bacteriuria. We did not perform meta-analysis; each trial examined different antibiotic regimens and so we were not able to pool results. In a study comparing a single dose of fosfomycin trometamol 3 g with a five-day course of cefuroxime, there was no significant difference in persistent infection (risk ratio (RR) 1.36, 95% confidence interval (CI) 0.24 to 7.75), shift to other antibiotics (RR 0.08, 95% CI 0.00 to 1.45), or in allergy or pruritus (RR 2.73, 95% CI 0.11 to 65.24). A comparison of seven-day courses of 400 mg pivmecillinam versus 500 mg ampicillin, both given four times daily, showed no significant difference in persistent infection at two weeks or recurrent infection, but there was an increase in vomiting (RR 4.57, 95% CI 1.40 to 14.90) and women were more likely to stop treatment early with pivmecillinam (RR 8.82, 95% CI 1.16 to 66.95). When cephalexin 1 g versus Miraxid(R) (pivmecillinam 200 mg and pivampicillin 250 mg) were given twice-daily for three days, there was no significant difference in persistent or recurrent infection. A one- versus seven-day course of nitrofurantoin resulted in more persistent infection with the shorter course (RR 1.76, 95% CI 1.29 to 2.40), but no significant difference in symptomatic infection at two weeks, nausea, or preterm birth. Comparing cycloserine with sulphadimidine, no significant differences in symptomatic, persistent, or recurrent infections were noted.

AUTHORS’ CONCLUSIONS:

We cannot draw any definite conclusion on the most effective and safest antibiotic regimen for the initial treatment of asymptomatic bacteriuria in pregnancy. One study showed advantages with a longer course of nitrofurantoin, and another showed better tolerability with ampicillin compared with pivmecillinam; otherwise, there was no significant difference demonstrated between groups treated with different antibiotics. Given this lack of conclusive evidence, it may be useful for clinicians to consider factors such as cost, local availability and side effects in the selection of the best treatment option.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033758/pdf/emss-58193.pdf

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April 9, 2015 at 3:25 pm

Salmonella blood stream infections in a tertiary care setting in Ghana.

BMC Infect Dis. 2014 Dec 21;14:3857.

Labi AK, Obeng-Nkrumah N, Addison NO, Donkor ES.

Abstract

BACKGROUND:

Despite the clinical significance of Salmonella infections, surveillance data worldwide remains limited and is more so exemplified by the lack of reports from Africa especially in eastern, central and western Africa. This study reports on Salmonella serotypes as significant causes of blood stream infections (BSI) and multidrug antibiotic resistance at Korle-Bu Teaching Hospital in Accra, Ghana.

METHODS:

Antibiogram patterns, seasonal variations in disease incidence and predisposing factors for infection with Salmonella serotypes were analyzed retrospectively over a 4-year period from January 2010 to December 2013. Blood cultures were processed with BACTEC 9240 blood culture system. Speciation was done with BBL Crystal Enteric/Nonfermenter identification system®, and with slide agglutination using specific antisera. Antimicrobial susceptibility testing was carried out by the Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standard Institute guidelines.

RESULTS:

We report a 6.5% (n=181/2768) prevalence of Salmonella bacteraemia at the Korle-Bu Teaching Hospital; with a preponderance of non-typhoidal salmonellae (NTS) over typhoidal salmonella (TS) (n=115/181, 63.5% versus n=66/181, 36.5%; P-value <0.002). Children under 5 years bore the brunt of the disease (n=93/174, 53.4%). Resistance to ciprofloxacin (n=1/127, 0.7%), amikacin (n=3/81, 3.7%), and cefotaxime (n=6/99, 6.1%) remained low, despite high levels of multidrug resistant Salmonella phenotypes (n=81/181, 44.2%). In multivariate analysis, and among patients with Salmonella BSI, those <1 year old had reduced risk of non-typhoidal infections [Odds ratio, 0.51; 95% confidence interval (95% CI), 0.16-0.92, P-value 0.021]. Similarly, patients with cefuroxime resistant strans were at increased risk of having multidrug resistant Salmonella BSI (OR, 8.97; 95% CI, 3.62-24.15; P-value, 0.001).

CONCLUSIONS:

Salmonellae, predominantly NTS, account for a reasonable low proportion of positive blood cultures in our tertiary care setting; but with significant multidrug resistant phenotypes and low ciprofloxacin and cefotaxime resistance.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297363/pdf/12879_2014_Article_697.pdf

 

April 9, 2015 at 3:20 pm

Treatment of rectal chlamydia infection may be more complicated than we originally thought

Journal of Antimicrobial Chemotherapy April 2015 V.70 N.4 P.961-964

Jane S. Hocking, Fabian Y. S. Kong, Peter Timms, Wilhelmina M. Huston, and Sepehr N. Tabrizi

1Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton, Victoria 3053, Australia

2University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia

3Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia

4Murdoch Children’s Research Institute, Flemington Road, Parkville, Victoria 3052, Australia

5Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia

*Corresponding author. Tel: +61-3-8344-0762; Fax: +61-3-9347-9824; E-mail: jhocking@unimelb.edu.au

Rectal chlamydia diagnoses have been increasing among MSM and may also rise among women as anal sex rates increase among heterosexuals.

However, there is growing concern about treatment for rectal chlamydia with treatment failures of up to 22% being reported.

This article addresses factors that may be contributing to treatment failure for rectal chlamydia, including the pharmacokinetic properties of azithromycin and doxycycline in rectal tissue, the ability of chlamydia to transform into a persistent state that is less responsive to antimicrobial therapy, the impact of the rectal microbiome on chlamydia, heterotypic resistance, failure to detect cases of lymphogranuloma venereum and the performance of screening tests.

If we are to reduce the burden of genital chlamydia, treatment for rectal chlamydia must be efficacious.

This highlights the need for randomized controlled trial evidence comparing azithromycin with doxycycline for the treatment of rectal chlamydia.

PDF

http://jac.oxfordjournals.org/content/70/4/961.full.pdf+html

April 9, 2015 at 3:16 pm

Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices

MMWR Weekly March 27, 2015 V.64  N.11 P.300-304

Emiko Petrosky, MD, Joseph A. Bocchini Jr, MD, Susan Hariri, PhD, et al.

1Epidemic Intelligence Service, CDC; 2National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, CDC; 3Louisiana State University Health Sciences Center, Shreveport, Louisiana; 4National Center for Immunization and Respiratory Diseases, CDC; 5National Center for Chronic Disease Prevention and Health Promotion, CDC; 6National Center for Emerging and Zoonotic Infectious Diseases, CDC (Corresponding author: Emiko Petrosky, xfq7@cdc.gov, 404-639-1817)

During its February 2015 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended 9-valent human papillomavirus (HPV) vaccine (9vHPV) (Gardasil 9, Merck and Co., Inc.) as one of three HPV vaccines that can be used for routine vaccination (Table 1).

HPV vaccine is recommended for routine vaccination at age 11 or 12 years (1). ACIP also recommends vaccination for females aged 13 through 26 years and males aged 13 through 21 years not vaccinated previously.

Vaccination is also recommended through age 26 years for men who have sex with men and for immunocompromised persons (including those with HIV infection) if not vaccinated previously (1). 9vHPV is a noninfectious, virus-like particle (VLP) vaccine.

Similar to quadrivalent HPV vaccine (4vHPV), 9vHPV contains HPV 6, 11, 16, and 18 VLPs. In addition, 9vHPV contains HPV 31, 33, 45, 52, and 58 VLPs (2). 9vHPV was approved by the Food and Drug Administration (FDA) on December 10, 2014, for use in females aged 9 through 26 years and males aged 9 through 15 years (3).

For these recommendations, ACIP reviewed additional data on 9vHPV in males aged 16 through 26 years (4). 9vHPV and 4vHPV are licensed for use in females and males. Bivalent HPV vaccine (2vHPV), which contains HPV 16, 18 VLPs, is licensed for use in females (1).

This report summarizes evidence considered by ACIP in recommending 9vHPV as one of three HPV vaccines that can be used for vaccination and provides recommendations for vaccine use….

FULL TEXT

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a3.htm?s_cid=mm6411a3_e

PDF See P.300-304

http://www.cdc.gov/mmwr/pdf/wk/mm6411.pdf

April 9, 2015 at 3:12 pm


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