Evaluation of predictor variables of diagnostic [18F] FDG-PET/CT in fever of unknown origin.

BACKGROUND: Fever of unknown origin (FUO) is defined as an illness having fever which lasts at least 3 weeks of duration and is higher than 38.3 ºC on several measurements. The causes are infections, malignancies, noninfectious inflammatory diseases and miscellaneous. If [18F]FDG-PET/CT helps the final diagnosis, it is called contributory. The aim of the study is to evaluate the predictor variables effecting a contributory PET/CT for the diagnosis. METHODS: This is a retrospective cohort study conducted between June 2006 and May 2015 including 76 patients. The evaluated predictor variables are age, sex, ESR, CRP, fibrinogen, ferritin, albumin, haemoglobin level, platelet count, total leukocyte count, neutrophil percentage, lymphocyte percentage, ALP, LDH, ALAT, ASAT, GGT, total bilirubin, CK, RF, ANA, urinanalysis, chest radiography, abdominal US, lymphadenopathy, duration of fever, comorbid diseases and previous therapies. RESULTS: ESR (P=0.001), CRP (P=0.001), fibrinogen (P=0.009), lymphopenia (P<0.001), neutrophilia (P<0.001), ferritin (P<0.001), leukocytosis (P=0.003), duration of fever before PET/CT (<3 months) were found to be statistically significant for positive contribution of PET/CT results to the diagnosis. CONCLUSIONS: [18F]FDG-PET/CT is helpful and contributory for the diagnosis of FUO in patients having higher levels of CRP, ESR, ferritin, fibrinogen, leukocytosis, neutrophilia and shorter durations of fever (<3 months).

Can imaging modalities be used as follow-up criteria after brucellar sacroiliitis treatment?

INTRODUCTION: This study aimed to identify a follow-up modality that can be used to evaluate therapeutic responses in patients receiving treatment for brucellar sacroillitis and to determine whether antibiotherapy can be stopped. METHODOLOGY: A total of 32 patients with sacroiliac joint involvement demonstrated via magnetic resonance imaging or bone scintigraphy were followed up and treated. Patients received 200 mg/day of doxycycline and 600-900 mg/day of rifampicin for 3-21 months, and 1 g/day of streptomycin for 21 days. RESULTS: The mean age of the 32 patients involved was 21.81±4.09. In total, 10/32 patients did not complete therapy, and the remaining 22 patients received combination antibiotic treatment for a mean of 8.95±4.34 months. Of the 22 patients, 15 underwent MRI, and 7 of them did not consent to MRI. Similarly, 17 patients were followed up by bone scintigraphy, and 5 patients did not have scintigraphy results. In 9/17 patients followed up with bone scintigraphy, sacroiliitis findings were found to reduce after a mean of 7.44±3.71 months, whereas in 12/15 patients on whom MRI was performed,  there were no active sacroiliitis findings for a mean of 6.95±2.83 months. CONCLUSIONS: While active involvement findings in bone scintigraphy were observed for a longer period in scintigraphy images, active sacroiliitis findings disappeared in a relatively shorter period of time with MRI. Therefore, we have demonstrated that high-resolution MRI is a very sensitive technique compared to scintigraphy.

A case of mucosal leishmaniasis: Mimicking intranasal tumor with perforation of septum.

A 79-year-old male suffering from nasal congestion was referred to our hospital. Endoscopic examination revealed a hyperemic mass obstructing the left nasal passage. The lesion's surface was smooth. The findings of imaging studies were consistent with a benign tumor despite the erosion and perforation of the septum. The lesion originated from the middle concha and was attached to it with a thin stalk. It was removed easily by endoscopic resection. Histopathology revealed significant infiltration of mononuclear inflammatory cells, mostly lymphocytes and histiocytes, into the edematous subepithelial connective tissue. High-power magnification showed numerous Leishmania amastigotes in the cytoplasm of the histiocytes. A polymerase chain reaction experiment for Leishmania also confirmed the morphological diagnosis. No relapse was observed in the 12 months after surgery and the patient was doing well.

Brucellar epididymo-orchitis: a retrospective multicenter study of 28 cases and review of the literature.

OBJECTIVE: To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis. MATERIAL AND METHOD: Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥ 1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis. RESULTS: The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy. CONCLUSION: Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.

Comparison of probe disinfection procedures in routine ultrasonography: hot water versus antiseptic wiping.

OBJECTIVE: It is commonly known that ultrasonography (US) transducers function as both a reservoir and means of transfer for hospital infections. The current study aimed to compare the antimicrobial effectiveness of using >80 °C water versus antiseptic wipes to disinfect US transducers. METHODS: Subsequent to abdominal inspections in three groups of 20 patients, a swab culture was taken from the transducer in each case. Neither a mechanical nor chemical disinfection was applied to the transducer in the first group. As for the second group, the transducer was placed in >80 °C hot water for five minutes. In the third group, the transducer was wiped clean using antiseptic wipes. RESULTS: Of the 60 swab samples collected, 40 did not produce any growth. The number of samples exhibiting growth in the first group involved 18 cases of coagulase-negative staphylococcus (CNS), as well as 15 cases of Listeria spp., one case of Corynebacterium spp. and one case of Bacillus spp., while only one case of CNS was observed in the second and third groups, respectively. The culture growth and colony forming units rate were significantly higher in the samples obtained from the first group than in those obtained from the other groups (p<0.01). As for the second and third groups, no significant differences were found in terms of the amount of colonization and growth (p=1.00). CONCLUSION: Being a practical and a simple method for particular use in developing and underdeveloped countries, where it is hard to access relatively costly transducer disinfection materials, such as antiseptic wipes, hot water disinfection may play an active role in fighting hospital infections.

Oropharyngeal tularemia cases admitted to a military hospital in Ankara, Turkey.

INTRODUCTION: This study aimed to review the possible sources of infection of 16 oropharyngeal tularemia hospital cases, and to document their epidemiological and demographical characteristics, laboratory findings, treatment methods, and treatment results. METHODOLOGY: Sixteen cases from a Turkish military hospital between January 2011 and December 2012 were retrospectively evaluated. The age, sex, occupation, place of residence, symptoms, duration of symptoms, laboratory results, treatment and duration, and treatment results were recorded. Tularemia was diagnosed through tularemia-specific tests once the other conditions that may have caused lymphadenopathy were excluded. RESULTS: Twelve of the patients included in this study were males. The average age of the patients was 32.1 ± 17.2 years. Sore throat, fatigue, and fever were the most frequent symptoms. The mean duration of symptoms was 21.6 ± 6.9 days. All the patients had been treated for tonsillopharyngitis in primary healthcare institutions previously. However, despite the treatment, cervical lymphadenopathy had developed in these cases. Patients were given streptomycin, doxycycline, and ciprofloxacin monotherapy or in combination. Ten of the cases fully recovered, while five required surgical lymph node drainage. Spontaneous drainage occurred in the single remaining case. CONCLUSIONS: Turkey is considered to be an endemic country with regards to tularemia. Prompt diagnosis and proper treatment of the disease is imperative in providing cure. Since it can be potentially confused with tuberculous lymphadenitis, differential diagnosis is vital. Patients presenting with a condition of tonsillopharyngitis in endemic areas must be carefully monitored.

Predictive Value of Soluble CD14, Interleukin-6 and Procalcitonin For Lower Extremity Amputation in People with Diabetes with Foot Ulcers: A Pilot Study.

OBJECTIVE: The aim of this pilot study was to determine clinical and laboratory factors that predict amputation surgery and to evaluate the predictive value of soluble CD14 (sCD14), interleukin-6 (IL-6), and procalcitonin (PCT) in patients with diabetic foot ulcers (DFUs). METHODS: Twenty-seven (20 males, 7 females) Diabetic Foot Ulcers (DFU) patients admitted to our department were consecutively enrolled. The patients' demographics and wound characteristics were noted. IL-6, PCT, and sCD14 were measured at admission. RESULTS: Six of the 27 patients (22%) eventually underwent lower extremity amputation. Compared to the non-amputation group, a previous history of amputation (p=0.017), the presence of gangrene (p=0.044), the Wagner grade (p=0.011), the IL-6 concentration (p=0.018), the white blood cell count (WBC) (p=0.036), and the erythrocyte sedimentation rate (ESR) (p=0.042) were significantly high in the amputation group. However, the sCD14 and PCT concentration were not significantly different. CONCLUSION: We have shown for the first time that IL-6 may have predictive value for lower extremity amputation in patients with DFU. Further studies are needed to confirm its predictive value in this patient group.

Antibiotherapy with and without bone debridement in diabetic foot osteomyelitis: A retrospective cohort study.

BACKGROUND AND OBJECTIVE: The treatment of diabetic foot osteomyelitis (DFO) is a controversial issue, with disagreement regarding whether the best treatment is surgical or conservative. The purpose of this study was to compare the outcome of patients with DFO who were treated with antibiotherapy alone and those who underwent concurrent minor amputation. METHODS: Hospital records of patients who were diagnosed as having DFO within a 2-year study period were retrospectively reviewed. Patients were divided into two groups: those who received antibiotherapy alone and those who underwent concurrent minor amputation. Groups were compared in terms of duration in hospitalization, antibiotherapy, and wound healing. RESULTS: Thirty seven patients were included in the study. These comprised patients who received antibiotherapy alone (ABG, n=15) and patients who underwent concurrent minor amputation (AB-MAG, n=22). Hospitalization duration was 37.2 (± 16.2) days in ABG and 52.8 (± 40.2) days in AB-MAG (p = 0.166). Mean duration of antibiotherapy was 45.0 (± 21.7) days in ABG and 47.7 (± 19) days in AB-MAG (p = 0.689). Wound healing duration was 265.2 (± 132.7) days in ABG and 222.6 (± 85.9) days in AB-MAG (p = 0.243). None of the outcome measures were significantly different between ABG and AB-MAG. CONCLUSIONS: Our results have shown similar outcomes for both patient groups who received antibiotherapy alone and who underwent concurrent minor amputations. Considering the small sample sizes in this study, it is important to confirm these results on a larger scale.

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study.

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series.

Mortality indicators in pneumococcal meningitis: therapeutic implications.

BACKGROUND: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. METHODS: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers. RESULTS: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). CONCLUSIONS: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment.

The role of human leukocyte antigen tissue groups in hepatitis B virus vaccination in Turkey.

BACKGROUND/PURPOSE: Between 5% and 10% of the vaccinated population responds less well to standard vaccination schedules irrespective of hepatitis B virus (HBV) vaccination. This manuscript aims at describing possible correlation of different major histocompatibility complex (MHC) Class-I and MHC Class-II haplotype to anti-HBV humoral responsiveness following HBV vaccination. MATERIALS AND METHODS: The study was conducted on 944 vaccinated hospital staff members and concentrated on the 38 nonresponders as defined by enzyme-linked immunosorbent assay (ELISA) results. In order to define significance of the different haplotypes from the nonresponders, their frequency was compared to the frequency of the same haplotype in 18 randomly selected responders. Human leukocyte antigen (HLA)-A and HLA-B antigens were typed among total mononuclear cells using a standard two-stage microlymphocytotoxicity test. The typing method of HLA Class-II is based on a technique that involves amplification of the second exon of different HLA Class-II genes by PCR. RESULTS: Positive correlations were found between four HLA-DR (HLA-DRB1*04X, DRB1*0401X, DRB1*11/13, and DRB1*0401X0201) haplotypes and nonresponders but there was a negative correlation with one Class-I (HLA-B13). CONCLUSION: This study suggested that certain HLA types are associated with nonresponsiveness to vaccination. The different HLA of ethnic groups should also be kept in mind when evaluating the response to hepatitis vaccination. The different HLA gene frequencies of ethnic groups should be examined in further large-scale population-based studies.

Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality.

PURPOSE: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. MATERIALS AND METHODS: An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses. RESULTS: Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality. CONCLUSION: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.

Adult onset Still's disease as a paraneoplastic syndrome--a case report and review of the literature.

Adult onset Still's disease (AOSD) is a systemic inflammatory disease with unknown etiology and characterized by evanescent salmon pink rash, sore throat, liver dysfunction, lymphadenopathy, hepatosplenomegaly, arthritis, and leukocytosis. It is a diagnosis of exclusion; however, there are case reports in the literature about patients with malignancies and AOSD-like signs and symptoms. Here we report a patient with AOSD seems to be associated with sarcomatoid renal cell carcinoma. This phenomenon is not distinguishable from primary AOSD either in presentation or in treatment; except for the main purpose of the management should be targeted to the underlying malignancy.

Effect of vegetation change from native broadleaf forest to coniferous plantation on selected soil properties.

The objective of this study was to examine the effects of vegetation change from a native broadleaf forest to a coniferous plantation on selected soil properties, including soil texture, pH, organic matter, total nitrogen (N), total phosphorus (P), exchangeable cations (Ca(2+), K(+), Na(+)), and cation exchange capacity (CEC). Results showed that the amount of clay particles, Ca(2+), and K(+) values significantly increased, whereas Na(+), total N, and organic matter and soil pH values decreased on the treatment plot after vegetation change. Soil acidity also increased and soil textural group changed from moderately fine-textured soils (clay loam) to medium-textured soils (loam) under both control and treatment plots. Organic matter, total N, and Na(+) values increased, whereas Ca(2+) concentration decreased through time on the control plot. Soil pH, total P, K(+), and CEC did not show significant changes through time on the control plot.

Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey.

BACKGROUND: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. METHODS: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. RESULTS: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. CONCLUSIONS: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease.

First molecular characterization of a Turkish orf virus strain from a human based on a partial B2L sequence.

Cases of orf virus infection in human in Turkey have been reported for many years. Scab material from a man was found positive by PCR using pan-parapox-specific primers for parapoxvirus infection. The amplicon was purified and sequenced. The present study provides for the first time a phylogenetic analysis of parapoxviruses from Turkey. The partial B2L gene sequence of a Turkish orf virus from a human presented here may be useful for characterization of parapoxvirus infections in Turkey based on the phylogenetic analysis studies.

[Comparison of endotracheal aspiration and mini-BAL culture results in the diagnosis of ventilator-associated pneumonia]. / Ventilatörle Iliskili Pnömoni Tanisinda Kullanilan Endotrakeal Aspirat Kültürü ile Mini-BAL Kültürünün Karsilastirilmasi

The objective of this study was to compare the results of cultures obtained by mini-bronchoalveolar lavage (BAL) and endotracheal aspiration (ETA) techniques, used for rapid and accurate determination of pathogens causing ventilator-associated pneumonia (VAP) in intensive care units. Of the 92 patients on mechanical ventilation followed at the emergency intensive care unit of our hospital between June 2010 and June 2011, 30 (32.2%) patients were diagnosed as VAP and they were included in this study. VAP diagnosis were based on the clinical and radiological findings. Clinical pulmonary infection score (CPIS) of > 6 was accepted as the clinical criteria of VAP. Initially ETA samples were collected from the patients followed by mini-BAL sampling 15 minutes later, together with urine and two blood cultures. Microbiological evaluation and identification were performed by conventional methods and Phoenix 100 (BD Diagnostic Systems, ABD) automated system. In quantitative culture analysis, > 10.000 cfu/ml for BAL and > 100.000 cfu/ml for ETA were accepted as the positive result. The mean ages of VAP-developed (n= 30; 18 were male) and nondeveloped (n= 62; 39 were male) patients were 68.23 ± 16.19 and 52.16 ± 10.41 years, respectively, and the mean durations of mechanical ventilation were 29.57 ± 15.78 and 12.11 ± 6.01 days, respectively. Multivariate logistic regression analysis showed that older age (p< 0.001) and duration of mechanical ventilation (p< 0.001) were independent risk factors for VAP development. There was also a statistically significant difference in CPIS values between patients who developed VAP and not (6.8 ± 1.15 and 2.71 ± 1.06, respectively; p< 0.001). The use of CPIS for VAP diagnosis was found to be useful in patients on mechanical ventilation. In our study, a total of 16 strains (six A.baumannii, three P.aeruginosa, one K.pneumoniae, six S.aureus) were isolated from ETA cultures, while 34 strains (16 A.baumannii, six P.aeruginosa, four K.pneumoniae, two E.coli, six S.aureus) were isolated from mini-BAL cultures of 30 VAP patients. The contamination rate for ETA cultures was found as 27% (8/30), however there was no contamination in mini-BAL samples. The rates of negative cultures for ETA and mini-BAL were 20% (6/30) and 7% (2/30), respectively. Seven (87.5%) of the eight contaminated ETA samples, yielded pathogenic bacterial growth (six A.baumannii, one K.pneumoniae) in mini-BAL samples. Similarly, of the six negative ETA samples, 5 (83%) yielded bacterial growth (two E.coli, two K.pneumoniae, one P.aeruginosa) in mini-BAL samples. Statistical analysis with Spearman test indicated no positive correlation between the culture results of mini-BAL and ETA (p= 0.464), and the concordance between the culture results of those methods was found as 50%. It was concluded that the use of mini-BAL instead of ETA samples for the isolation of causative microorganisms of VAP seemed to be more useful due to the high contamination risk in ETA culturing techniques and higher bacterial isolation rates in mini-BAL sampling.

Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study.

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.