1/5. lamivudine treatment failure in preventing fatal outcome of de novo severe acute hepatitis B in patients with haematological diseases.BACKGROUND: patients with malignant haematological diseases administered or no longer receiving immunosuppressive therapy are at high risk of reactivation or de novo hepatitis B infection and fulminant hepatitis. Despite promising results in the treatment of chronic hepatitis and its use in selected patients with acute hepatitis B, there is no consensus on lamivudine treatment in severe acute hepatitis portending a fatal clinical outcome. case reports: Of the ten patients with malignant haematological disorders who became infected with the same strain of hepatitis b virus during hospitalisation in a haematology ward, five received lamivudine (and in some cases, ganciclovir and famciclovir). The other patients received only supportive therapy, since deteriorating clinical conditions hampered specific treatment efforts. Eight patients died from acute liver failure and one from a fatal course of the haematological disease; one had a favourable outcome from the therapy. There was no significant difference in terms of survival between the treated and untreated patients. CONCLUSIONS: Although lamivudine has proved promising in the therapy of chronic hepatitis B and of recurrent hepatitis after liver transplantation, its use in de novo severe acute hepatitis should be investigated further, particularly in immunocompromised patients.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
2/5. Acute budd-chiari syndrome with liver failure: the experience of a policy of initial interventional radiological treatment using transjugular intrahepatic portosystemic shunt.BACKGROUND AND AIMS: The optimal management of acute budd-chiari syndrome (BCS) with liver failure is controversial. Options include anticoagulation, portal systemic shunting or liver transplantation. In recent years, transjugular intrahepatic portosystemic shunts (TIPS) have been tried in place of shunt surgery. We report our experience with a policy of initial interventional radiological treatment (TIPS) in this patient group. methods: A consecutive, non-selected series of five patients with acute BCS with liver failure presenting to our liver unit over a 36-month period from October 2000 were treated with a policy of initial attempt at transjugular shunt. RESULTS: stents were successfully inserted in four patients. In one patient the hepatic vein remnant could not be cannulated. One of the four stented patients had a hepatic venous web. Rapid recurrent portal and hepatic vein thrombosis occurred in one patient despite anticoagulation and trans-shunt thrombectomy. This patient and the patient with failed stenting underwent successful liver transplantation. One successfully stented patient died unexpectedly at home 2 weeks after TIPS insertion. Four of five patients are alive (80%) at a mean follow-up time of 30 months. CONCLUSION: Initial TIPS, with liver transplantation for treatment failures, may be a reasonable, cost-effective and surgery-sparing treatment for acute Budd-Chiari presenting with liver failure.- - - - - - - - - - ranking = 0.25keywords = treatment failure (Clic here for more details about this article) |
3/5. daptomycin cure after cefazolin treatment failure of methicillin-sensitive staphylococcus aureus (MSSA) tricuspid valve acute bacterial endocarditis from a peripherally inserted central catheter (PICC) line.Right-sided acute bacterial endocarditis (ABE) is an infrequent complication of central intravenous (IV) lines. We report a case of methicillin-sensitive staphylococcus aureus tricuspid valve (TV) ABE related to a peripherally inserted central catheter line (PICC). patients with right-sided ABE present with symptoms of fever and chills, and symptoms and signs of pulmonary emboli. In the patient presented, the PICC line was removed and high-dose cefazolin therapy, 2 g (IV) every 8 hours, was initiated. Although the patient's blood cultures became negative during the third week of cefazolin therapy, her erythrocyte sedimentation rate and teichoic acid antibody titers remained high. Pulmonary emboli developed. A large TV vegetation (1 x 2 cm) remained unchanged after 4 weeks of cefazolin therapy. For these reasons, cefazolin treatment was considered a treatment failure. Therapy with daptomycin was initiated at a dose of 6 mg/kg (IV) every 24 hours. During daptomycin therapy, the patient's erythrocyte sedimentation rate and teichoic acid antibody titers gradually returned to normal. Repeat transthoracic echocardiograph revealed the TV vegetation was gone and the methicillin-sensitive staphylococcus aureus ABE was cured with daptomycin. We conclude daptomycin is a rapidly bactericidal antistaphylococcal antibiotic reliably effective even when other usually effective antistaphylococcal antibiotics have failed.- - - - - - - - - - ranking = 1.25keywords = treatment failure (Clic here for more details about this article) |
4/5. Partial characterization of chlamydia trachomatis isolates resistant to multiple antibiotics.in vitro susceptibility testing was done on urogenital isolates of chlamydia trachomatis from five patients, four of whom were suspected treatment failures. At least one isolate from each patient was resistant to tetracycline at concentrations greater than or equal to micrograms/ml, although less than 1% of a population of organisms showed high-level resistance. Fully resistant populations selected by passage through 8 micrograms/ml tetracycline either died or lost their resistance on further passage in antibiotic-free medium. Relatively large inocula were required to demonstrate resistance, and morphology of inclusions was altered at high tetracycline concentrations. The observed resistance may be a new characteristic of the organism or merely newly recognized. Isolates resistant to tetracycline were resistant to doxycycline, erythromycin, sulfamethoxazole, and clindamycin but sensitive to rifampin, ciprofloxacin, and ofloxacin. Thus, resistance to tetracycline, erythromycin, and clindamycin occurs in C. trachomatis and may be a factor in some treatment failures.- - - - - - - - - - ranking = 0.5keywords = treatment failure (Clic here for more details about this article) |
5/5. Strategies for dealing with amoxicillin failure in acute otitis media.Acute otitis media is the most common bacterial infection in pediatric patients. The predominant pathogens of acute otitis media are streptococcus pneumoniae, haemophilus influenzae, and moraxella catarrhalis. Traditionally, amoxicillin has been the first-line therapeutic choice for patients with uncomplicated acute otitis media. However, with the increasing isolation of beta-lactamase-producing organisms and penicillin-resistant S pneumoniae, the frequency of amoxicillin treatment failures also appears to be increasing. Several issues should be considered when alternative antibiotics are selected to treat amoxicillin failures, such as the most likely pathogens with their susceptibility patterns, and antibiotic issues including clinical efficacy for specific pathogens, adverse reactions, palatability, dosing schedules, and cost. Consequently, enhanced beta-lactamase stability, activity against penicillin-resistant S pneumoniae, and once- or twice-daily dosing regimens must be considered when antibiotics are chosen for patients in whom amoxicillin therapy has failed.- - - - - - - - - - ranking = 0.25keywords = treatment failure (Clic here for more details about this article) |