AIM: To describe leprosy characteristics, ocular features, and type of organisms that produce infective corneal ulcers in leprosy patients. METHOD: The records of all leprosy patients admitted for treatment of corneal ulcers between 1992 and 1997 were reviewed. RESULTS: 63 leprosy patients, 53 males and 10 females, are described. 16 were tuberculoid and 47 lepromatous. 25 patients had completed multidrug therapy. 10 patients had face patches, eight had type I reaction, and 10 had type II reaction. 43 (68%) patients had hand deformities. In 54% of patients pain was absent as a presenting symptom. 19 patients gave a history of trauma. In 15 patients ulcers had also occurred on the other eye, five of them having occurred during the study period and the rest before 1992. Of the 68 eyes with corneal ulcers, 28 had madarosis, 34 had lagophthalmos, nine had ectropion, three had trichiasis, six had blocked nasolacrimal ducts, and 39 decreased corneal sensation. In 14 eyes, a previous lagophthalmos surgery had been done. 16 patients were blind at presentation. 32% of ulcers were located centrally. After treatment only 18% of the eyes showed visual improvement. Five types of fungus were cultured, two of them rare ocular pathogens. CONCLUSIONS: Corneal ulcers occur more in males and in the lepromatous group of patients. Decreased corneal sensation, lagophthalmos and hand deformity are closely associated. Indigenous treatment and late presentations were notable in many patients. Visual outcome is not good. There is increased risk of developing an ulcer in the other eye. Fungal corneal ulcers are not uncommon. (+info)
No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: a three-month, multicenter, double-blind, randomized, placebo-controlled study.
(58/2353)
OBJECTIVE: To investigate the effect of long-term antibiotic treatment in patients with reactive arthritis (ReA) and undifferentiated oligoarthritis. METHODS: One hundred twenty-six patients were treated with ciprofloxacin (500 mg twice a day) or placebo for 3 months, in a double-blind, randomized study. Of these patients, 104 (48 treated with ciprofloxacin and 56 treated with placebo) were valid for clinical evaluation: 55 were diagnosed as having ReA with a preceding symptomatic urogenic or enteric infection and 49 as having undifferentiated oligoarthritis. These 2 groups were randomized separately. The triggering bacterium was sought by serology and/or culture. The percentage of patients in remission after 3 months of treatment was chosen as the primary efficacy parameter. RESULTS: A triggering bacterium could be identified in 52 patients (50%): Chlamydia trachomatis in 13, Yersinia in 14, and Salmonella in 25. No patient was positive for Campylobacter jejuni or for Shigella. No difference in outcome was found between treatment with ciprofloxacin or placebo in the whole group or in subgroups of patients with ReA or undifferentiated oligoarthritis. No difference was seen in patients with a disease duration <3 months. Ciprofloxacin was not effective in Yersinia- or Salmonella-induced arthritis but seemed to be better than placebo in Chlamydia-induced arthritis. This difference was not significant, however, which might be due to the small sample size. CONCLUSION: Long-term treatment of ReA with ciprofloxacin is not effective; however, it might be useful in the subgroup of patients who have Chlamydia-induced arthritis. This has to be proven in a bigger study focusing on patients with Chlamydia-induced arthritis. (+info)
Use of a low nutrient culture medium for the identification of bacteria causing severe ocular infection.
(59/2353)
A low nutrient culture medium was used to identify the pathogens in four cases of persisting ocular infection. Bacto R2A agar was used in addition to conventional liquid- and solid-phase media to culture pathogenic bacteria from one case of recurrent keratitis, one case of suture-related keratitis with endophthalmitis and two eyes (two patients) with post-operative endophthalmitis. In each case, a pathogen was identified solely with R2A agar after culture for 6 days. Species isolated were Pseudomonas aeruginosa (one), Propionibacterium acnes (two) and Staphylococcus aureus (one). Antibiotic therapy was tailored to conform to the sensitivity of the cultured organism in each case. The use of Bacto R2A low nutrient agar should be considered in culture negative eyes not showing clinical improvement, or for chronic cases where bacteria may have become adapted to more stringent ocular environments. (+info)
Comparative in-vitro activity of moxifloxacin, penicillin, ceftriaxone and ciprofloxacin against pneumococci isolated from meningitis.
(60/2353)
Minimum inhibitory concentrations of penicillin, ceftriaxone, ciprofloxacin, and moxifloxacin (BAY 12-8039), a new 8-methoxyquinolone, were determined for 60 cerebrospinal fluid isolates of Streptococcus pneumoniae collected during January 1997-April 1998 at Italian medical centres. Three reference isolates with predetermined MIC values (two penicillin- and multidrug-resistant isolates, one uniformly susceptible to all antibiotics) were also tested with the same antibiotics. The MIC90 of penicillin was < or = 0.03 mg/L (range < or = 0.03-2 mg/L), of ceftriaxone 0.06 mg/L (range < or = 0.03-0.5 mg/L), of ciprofloxacin 2 mg/L (range 0.5-8 mg/L) and of moxifloxacin 0.06 mg/L (range 0.03-0.12 mg/L). Moxifloxacin was effective against all the penicillin-resistant isolates tested, with an MIC of 0.06 mg/L. Moxifloxacin was 32-fold more active than ciprofloxacin and was not affected by penicillin and cephalosporin resistance. These results indicate that moxifloxacin could be useful for the treatment of both penicillin-sensitive and -resistant S. pneumoniae meningitis. (+info)
In-vitro bacteriostatic activity of levofloxacin and three other fluoroquinolones against penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae.
(61/2353)
The purpose of this study was to investigate the in-vitro bacteriostatic activity of levofloxacin in comparison with that of ofloxacin, sparfloxacin and ciprofloxacin against 205 strains of Streptococcus pneumoniae (101 penicillin-susceptible, 51 penicillin-intermediate and 53 penicillin-resistant). The isolates were provided between September 1996 and October 1996 by French hospitals participating in the National Co-operative Survey of Pneumococcal Infections. The determination of MICs (mg/L) was made by the agar dilution method. The MIC50 and MIC90 values of the four fluoroquinolones for the three classes of S. pneumoniae (penicillin-susceptible, penicillin-intermediate and penicillin-resistant) were not significantly different. In contrast, the differences in in-vitro activity observed among the four fluoroquinolones against the 205 strains allowed them to be separated into three groups: sparfloxacin (MIC50/90 0.25 mg/L); ciprofloxacin and levofloxacin (MIC50 0.5 and 1 mg/L respectively, MIC90 1 mg/L); and ofloxacin (MIC50 1 mg/L, MIC90 2 mg/L). A total of 204 of the strains had a levofloxacin MIC between 0.25 mg/L and 1 mg/L, and only one of the 205 strains was highly resistant (MIC 16 mg/L). Whatever the level of susceptibility to penicillin, the relative bacteriostatic activity was, in descending order of activity, sparfloxacin, levofloxacin/ciprofloxacin and ofloxacin. These results suggest levofloxacin has potential for the treatment of pneumococcal infections. (+info)
In-vitro activity of levofloxacin, a new fluoroquinolone: evaluation against Haemophilus influenzae and Moraxella catarrhalis.
(62/2353)
The in-vitro activity of levofloxacin was studied against 10 beta-lactamase-negative and 93 beta-lactamase-positive Moraxella catarrhalis isolates, and 65 beta-lactamase-negative and 35 beta-lactamase-positive Haemophilus influenzae isolates. The MICs of levofloxacin were determined by agar dilution on Mueller-Hinton agar (with the addition of 5% horse blood for M. catarrhalis) or on Haemophilus Test Medium for H. influenzae, and were compared with those of ofloxacin, ciprofloxacin and sparfloxacin, as well as pefloxacin and D-ofloxacin for M. catarrhalis. The fluoroquinolones showed similar activity against isolates of H. influenzae and M. catarrhalis, irrespective of beta-lactamase production. Levofloxacin (MIC50/90 0.06 mg/L) was 64 times more active against M. catarrhalis than D-ofloxacin (MIC50/90 4/8 mg/L) and twice as active as ofloxacin (MIC50/90 0.125 mg/L). Ciprofloxacin had an MIC50/90 of 0.03/0.06 mg/L and sparfloxacin showed an MIC50/90 of 0.015 mg/L against M. catarrhalis irrespective of the resistance phenotype of the isolates. Against H. influenzae, levofloxacin was twice as active as ofloxacin (MIC90 values 0.03 mg/L versus 0.06 mg/L), while the MIC90s of ciprofloxacin and sparfloxacin were both 0.015 mg/L. Our results therefore suggest that levofloxacin has potential for treating respiratory tract infections caused by H. influenzae and M. catarrhalis. (+info)
Relative potential for selection of fluoroquinolone-resistant Streptococcus pneumoniae strains by levofloxacin: comparison with ciprofloxacin, sparfloxacin and ofloxacin.
(63/2353)
The aim of this study was to evaluate the relative potential of levofloxacin to select for resistance in Streptococcus pneumoniae in comparison with ciprofloxacin, sparfloxacin and ofloxacin. Two S. pneumoniae strains were studied; HBD 153 (parental strain, serotype 3) and HBD 964 (selected from the parental strain in an experimental mouse peritonitis infection model). MICs for the two strains were, respectively: 2 and 2 mg/L for ciprofloxacin; 2 and 4 mg/L for ofloxacin; 0.5 and 1 mg/L for sparfloxacin; 2 and 2 mg/L for levofloxacin. In-vitro, with 4 x MIC as the selection concentration, no mutant was obtained with strain HBD 153 (mutation frequency < 10(-8). With HBD 964, the mutation frequency was 9 x 10(-7) for ofloxacin, 10(-7) for ciprofloxacin, 4 x 10(-5) for sparfloxacin and < 10(-8) for levofloxacin. In an immunosuppressed mouse peritonitis model (20 mice per dose), the S. pneumoniae strains were studied with sc doses of ciprofloxacin, sparfloxacin and ofloxacin at 50 mg/kg od, and with sc levofloxacin at a dose of 10 and 50 mg/kg od, or 10 and 50 mg/kg bid. The MICs for strains isolated after antibiotic treatment and the mutation frequencies at 4 x MIC were determined. Against HBD 153, sparfloxacin was the most active treatment, followed by levofloxacin 10 mg/kg and 50 mg/kg bid, but strains identical to HBD 964 (showing a resistant variant at 4 x MIC) were selected by sparfloxacin. Against HBD 964, levofloxacin (10 mg/kg and 50 mg/kg) was the most active drug. Highly resistant mutants were selected by ofloxacin and ciprofloxacin, but not by sparfloxacin and levofloxacin. In conclusion, the relative potential of levofloxacin to select for fluoroquinolone-resistant S. pneumoniae is lower than that of ciprofloxacin, ofloxacin and sparfloxacin both in vitro and in vivo. (+info)
A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy.
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BACKGROUND: Among patients with fever and neutropenia during chemotherapy for cancer who have a low risk of complications, oral administration of empirical broad-spectrum antibiotics may be an acceptable alternative to intravenous treatment. METHODS: We conducted a randomized, double-blind, placebo-controlled study of patients (age, 5 to 74 years) who had fever and neutropenia during chemotherapy for cancer. Neutropenia was expected to be present for no more than 10 days in these patients, and they had to have no other underlying conditions. Patients were assigned to receive either oral ciprofloxacin plus amoxicillin-clavulanate or intravenous ceftazidime. They were hospitalized until fever and neutropenia resolved. RESULTS: A total of 116 episodes were included in each group (84 patients in the oral-therapy group and 79 patients in the intravenous-therapy group). The mean neutrophil counts at admission were 81 per cubic millimeter and 84 per cubic millimeter, respectively; the mean duration of neutropenia was 3.4 and 3.8 days, respectively. Treatment was successful without the need for modifications in 71 percent of episodes in the oral-therapy group and 67 percent of episodes in the intravenous-therapy group (difference between groups, 3 percent; 95 percent confidence interval, -8 percent to 15 percent; P=0.48). Treatment was considered to have failed because of the need for modifications in the regimen in 13 percent and 32 percent of episodes, respectively (P<0.001) and because of the patient's inability to tolerate the regimen in 16 percent and 1 percent of episodes, respectively (P<0.001). There were no deaths. The incidence of intolerance of the oral antibiotics was 16 percent, as compared with 8 percent for placebo (P=0.07). CONCLUSIONS: In hospitalized low-risk patients who have fever and neutropenia during cancer chemotherapy, empirical therapy with oral ciprofloxacin and amoxicillin-clavulanate is safe and effective. (+info)