1/7. Penicillin treatment failure in group A streptococcal tonsillopharyngitis: no genetic difference found between strains isolated from failures and nonfailures.Despite penicillin (pcV) treatment, tonsillopharyngitis caused by group A streptococci (GAS) is associated with bacterial failure rates as high as 25%. The reason for this rate of failure is not fully understood. One explanation might be that certain dna profiles of GAS strains are responsible for treatment failures. Using arbitrarily primed polymerase chain reaction (AP-PCR), we compared the dna profiles of GAS strains from 4 patients with several treatment failures following pcV treatment of tonsillopharyngitis with the profiles of strains of the same T type from patients who were clinically and bacteriologically cured after a single course of pcV. The isolates were obtained during the same time period and from the same geographic area. Thirty-seven strains of T types 4, 12, and R28 were investigated. Eleven different dna profiles could be detected with the AP-PCR technique. Five dna profiles were identified as T type 12, 3 as T type 4, and 3 as T type R28. The dna profiles of the strains from the 4 patients with several treatment failures differed, but all isolates from each one of these patients exhibited the same or a very similar profile. The dna profiles of the failure strains were also represented in nonfailure strains. treatment failure in these 4 patients therefore seems to be due to insufficient eradication of GAS, rather than to reinfection with a new strain. The finding that the same dna profile can be present in both failure and nonfailure strains suggests that the treatment failure may be to some extent host-related and not only due to bacterial factors.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
2/7. Infective endocarditis due to abiotrophia defectiva: a report of two cases.BACKGROUND AND AIM OF THE STUDY: endocarditis due to abiotrophia sp. is rare and often associated with negative blood cultures. The rates of treatment failure, infection relapse and mortality are higher than in endocarditis caused by other viridans streptococci. methods: A retrospective review of A. defectiva endocarditis in a patient with prosthetic aortic valve and in a patient with marfan syndrome was performed. RESULTS: A. defectiva, susceptible to penicillin (MIC 0.064 mg/l and 0.016 mg/l, respectively) was isolated from blood cultures of both patients. Treatment with penicillin and gentamicin was started in both patients. Since the first patient developed a macular rash and leukopenia, penicillin was substituted with ceftriaxone. Both patients responded well to antibiotic treatment, did not need prosthetic valve insertion or reinsertion, and were without any sequelae at one year follow up. CONCLUSION: Standard treatment of bacterial endocarditis with penicillin and gentamicin was effective in both patients. In contrast to previous reports, the present patients had a favorable outcome on completion of treatment and at one-year follow up.- - - - - - - - - - ranking = 0.125keywords = treatment failure (Clic here for more details about this article) |
3/7. New cause of penicillin treatment failure.A large empyema infected with a penicillin-sensitive haemolytic group B streptococcus failed to respond to high doses of penicillin. After two weeks' treatment the pus aspirated was found not only to contain no penicillin, but also to inactivate penicillin added to it. We believe that the inactivating agent is an enzyme that may destroy various penicillins and cephalosporins but has no effect on other common antibiotics. When treatment was changed to doxycycline the patient made a rapid recovery.- - - - - - - - - - ranking = 0.5keywords = treatment failure (Clic here for more details about this article) |
4/7. endocarditis caused by streptococcus morbillorum.Although patients with nutritionally variant streptococcal endocarditis have been reported in recent years, the specific clinical features of this disease have not been well characterized. We report here the clinical and laboratory features of a particularly unusual case of persistent bacteremia caused by streptococcus morbillorum , one of the nutritionally variant streptococci. The patient was successfully treated with a combination of penicillin and rifampin after two treatment failures. We also review cases of nutritionally variant streptococcal endocarditis published in the English literature since 1971, in an attempt to understand some difficulties encountered in diagnosing and treating this type of endocarditis.- - - - - - - - - - ranking = 0.125keywords = treatment failure (Clic here for more details about this article) |
5/7. Cerebritis due to group B streptococcus.A premature infant who died of early-onset group B streptococcal meningitis was found to have cerebritis with direct bacterial infection of the basal ganglia. Although the organism was sensitive to penicillin by in vitro testing, it was not eradicated from the cerebrospinal fluid after 48 h of antibiotic treatment. These findings illustrate that suppurative extension with cerebritis of the basal ganglia as a complication of group B streptococcal meningitis may be one of the factors responsible for treatment failure.- - - - - - - - - - ranking = 0.125keywords = treatment failure (Clic here for more details about this article) |
6/7. Prevention of streptococcal neurosis.Despite the decrease in the incidence and severity of rheumatic fever and rheumatic heart disease in the united states, overzealous emphasis on proper diagnosis and treatment of group A streptococcal pharyngitis in order to prevent these illnesses may often result in a frustrating, anxiety-provoking condition known as "streptococcal neurosis." physicians, parents, and patients may all suffer from this condition, which often occurs even after all possible and appropriate treatment has been used to eradicate the group A streptococci. "Streptococcal neurosis" and the perplexing problem of treatment failure can be avoided or alleviated by utilizing knowledge of the interrelationship of the human host, the group A streptococcus, and nonsuppurative sequelae.- - - - - - - - - - ranking = 0.125keywords = treatment failure (Clic here for more details about this article) |
7/7. Failure of prostatitis treatment secondary to probable ciprofloxacin-sucralfate drug interaction.Metal cations such as aluminum, magnesium, ferrous sulfate, and zinc are thought to form chelation complexes with fluoroquinolone antibiotics and prevent the drugs from being absorbed. sucralfate, which has a high aluminum content, reduces the bioavailability of ciprofloxacin to approximately 4%. The concomitant administration of ciprofloxacin and sucralfate resulted in treatment failure for a patient with prostatitis and a subsequent 5-day hospitalization. Fluoroquinolone antibiotics should be administered at least 2 hours before agents containing metal cations to allow for their absorption. In addition, sucralfate should not be administered less than 6 hours before fluoroquinolone antibiotic administration.- - - - - - - - - - ranking = 0.125keywords = treatment failure (Clic here for more details about this article) |