ABSTRACT
The purpose of this study was to assess the results of therapy with mycophenolate mofetil (MMF) in children with idiopathic nephrotic syndrome (INS) who were both steroid- and cyclophosphamide-resistant. Treatment lasted a minimum of 6 months, and follow-up data were collected over a 2-year period. The children were divided into two groups: Group 1 (n=34) comprised patients who had received cyclosporine A (CsA) before the initiation of MMF therapy; Group 2 (n=18) comprised patients who received only MMF. Among the 34 patients of Group 1, complete and partial remission were achieved in seven (20.6%) and 13 patients (38.6%), respectively; there was no response in 14 patients (41.2%). Among the 18 patients in Group 2, complete and partial remission occurred in five (27.8%) and six (33.3%) patients, respectively; there was no response in seven patients (38.9%). Eight patients developed chronic kidney disease. The main side-effects were gastrointestinal complaints (n=11, 21%), recurring severe infections (n=1, 1.9%), and mild thrombocytopenia/leucopenia (n=1, 1.9%). MMF proved to be therapeutically effective in 59.5% of the cases. These beneficial effects need to be confirmed in studies with a long-term follow-up after discontinuation of the treatment. Our statistical analysis of the results of therapy with MMF did not reveal any significant difference between its use alone or following CsA administration.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Cyclophosphamide/therapeutic use , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/analogs & derivatives , Nephrotic Syndrome/drug therapy , Steroids/therapeutic use , Adolescent , Age of Onset , Anti-Inflammatory Agents/adverse effects , Child , Child, Preschool , Cyclosporine/therapeutic use , Drug Resistance , Ethnicity , Female , Humans , Kidney Function Tests , Male , Mycophenolic Acid/adverse effects , Mycophenolic Acid/therapeutic use , Nephrotic Syndrome/pathology , Sex CharacteristicsABSTRACT
Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77%. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55% and 51%). The antibiotic resistance rates for E. coli were: nitrofurantoin (6%), nalidixic acid (14%), 1st generation cephalosporin (13%), 3rd generation cephalosporins (5%), aminoglycosides (2%), norfloxacin (9%) and ciprofloxacin (4%). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population.
Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Infective Agents, Urinary/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Urinary Tract Infections/microbiology , Adolescent , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents, Urinary/therapeutic use , Child , Child, Preschool , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Disk Diffusion Antimicrobial Tests , Drug Resistance, Multiple, Bacterial , Escherichia coli/drug effects , Female , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Humans , Infant , Male , Prevalence , Urinary Tract Infections/drug therapyABSTRACT
Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77 percent. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55 percent and 51 percent). The antibiotic resistance rates for E. coli were: nitrofurantoin (6 percent), nalidixic acid (14 percent), 1st generation cephalosporin (13 percent), 3rd generation cephalosporins (5 percent), aminoglycosides (2 percent), norfloxacin (9 percent) and ciprofloxacin (4 percent). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population.
