Revision of the National Guideline for First-Line Comprehensive Management and Control of Sexually Transmitted Infections:What's New and Why?

A revised national guideline for the management and control of sexually transmitted infections (STIs) has recently been published by the national Department of Health according to the Essential Drugs List. Since 2004; there has been a marked rise in resistance to ciprofloxacin among Neisseria gonorrhoeae isolates in several South African cities; requiring a change from quinolones to cephalosporins to treat presumptive gonorrhoea. In keeping with WHO recommendations; acyclovir has been added as part of first-line therapy for the management of genital ulceration. The national guideline has been revised accordingly in order to improve management of several key STI syndromes

Mieux prescrire les fluoroquinolones

Les fluoroquinolones; en particulier la ciprofloxacine; sont utilisees dans diverses infections; parfois de facon abusive. Cibler les indications appropriees permet aux patients de tirer le meilleur parti de ces antibiotiques

Pattern of Presentation and Management of Typhoid Intestinal Perforation in Sagamu; South-West Nigeria: a 15 year Study

Background: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern; mode of therapy and outcome of cases diagnosed and treated as typhoid intestina perforation at Olabisi Onabanjo University Teaching Hospital; Sagamu; between January 1990 and December 2004. Methods: Complete records of 105 adult patients were studied. Results: The male to female ratio was 2:1. The mean age was 27years. Prior to arrival in our hospital; all the patients were on various combinations of antibiotics. Twenty-seven (26) patients had been hospitalized elsewhere during the current illness Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4) patients. Resistance to chloramphenicol was found in three (60) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations; mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure; multiple perforations by primary resection and anastomosis. Fifty-five (52.4) patients developed complications. Fourteen (13.3) patients died. There was a slight drop in mortality (8.8) in phase 2. Deaths were due to septicaemia in 8(57) patients. Conclusion: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation

Degradation kinetics of Metronidazole and its Mutual Prodrug with Ciprofloxacin : a Calorimetric Analysis

Calorimetric technique has aroused considerable interest as a versatile tool in pharmaceutical industry and academia to provide useful information about thermodynamic and kinetic aspects of drug molecules. The present paper utilizes this technique to monitor the hydrolytic degradation of metronidazole and its prodrug with ciprofloxacin; i.e. 2-(2-methyl-5-nitroimidazol-1-yl)ethyl-1-cyclopropyl-6-fluoro-1;4-dihydro-4-oxo-7-(1-piperazinyl)-quinoline-3-carboxylate. The synthesis of the present mutual prodrug was envisaged to combine the antiprotozoal and anaerobic antibacterial effects of metronidazole with antibacterial effects of ciprofloxacin. Heat flux microcalorimeter was used to determine the rate of heat evolved during the degradation of the drug and prodrug as a function of concentration; pH and temperature. In terms of enthalpy of hydrolysis the response is exothermic both for drug and prodrug. However; the absolute value of the enthalpy of reaction (?rH0) is low for the prodrug. The degradation followed pseudo first order kinetics; showed marked stability at pH 3-7 followed by accelerated hydrolysis at higher pH; characteristic of general acid-base catalysis. The catalytic rate constant for hydrogen ion (kH) and hydroxyl ion (kOH) were found to be 0.413 and 526.1 M-1h-1; respectively; at 318.15 K. The hydrolysis of the prodrug was found to be approximately 50-60 times faster than that of the drug. This may be attributed to the fact that hydrolysis of ester group in prodrug is assisted by keto group on the ciprofloxacin. However; there is no effect of protonation of nitrogen in piperazine ring in ciprofloxacin on the hydrolysis due to the distance from the ester moiety

The Sensitivities to First-Line Antibiotic Therapy of the Common Urinary Tract Bacterial Infections Detected in Urine Samples at a Hospital in Metropolitan Kampala (Uganda)

Background: Urinary tract infections (UTIs) are among the most common human infections. Many urinary tract bacteria are capable of expressing drug resistance. Resistant bacteria may be present from the commencement of the infection or may develop during treatment. This study focused on the problem of antibiotic resistance to the first-line drugs that were used to treat patients presenting with urinary tract infections at Rubaga hospital in Kampala; Uganda. Objectives: The objective of this study was to isolate and identify the major bacterial pathogens of symptomatic and asymptomatic UTIs among patients at Rubaga hospital. Furthermore; the study sought to determine the antimicrobial susceptibility patterns of the major bacterial isolates to the first-line drugs used to treat UTIs at Rubaga hospital. Methods: Urine samples were aseptically collected and exami- ned microscopically and were microbiologically cultured on blood agar; nutrient agar and on MacConkey agar. The isolates obtained were then identified using standard tests and tested for antimicrobial sensitivity by the Kirby-Bauer technique. Results: The isolated pathogens included Escherichia coli (10.9); Staphylococcus (31.9); Streptococcus (9.2); Klebsiella species (21.0) and Proteus species (10.1). 20 (16.8) of the isolates were lactose fermenting gram-negative rods that were also indole-negative. These isolates were termed 'unclassified coliforms' in this study but were probably Enterobacter species. On antimicrobial susceptibility testing; all the gram-negative isolates were significantly resistant to amoxycillin; cotrimoxazole; erythromycin; and to nalidixic acid; but were susceptible to nitrofurantoin. Among the gram-negative isolates; only Klebsiella species were significantly resistant (p0.05) to ciprofloxacin. The gram-positive cocci were susceptible to amoxycillin; ciprofloxacin; and to erythromycin but resistant to cotrimoxazole and nalidixic acid. Unlike the Staphylococcus species that were significantly resistant to nitrofurantoin; Streptococcus species were moderately susceptible to the drug. Conclusion: The common urinary tract bacteria detected in Rubaga hospital in Uganda were most sensitive to Ciprofloxacin and Nitrofurantoin