ABSTRACT
This study was conducted in treatment-naive adults with drug-susceptible pulmonary tuberculosis in Port-au-Prince, Haiti, to assess the safety, bactericidal activity, and pharmacokinetics of nitazoxanide (NTZ). This was a prospective phase II clinical trial in 30 adults with pulmonary tuberculosis. Twenty participants received 1 g of NTZ orally twice daily for 14 days. A control group of 10 participants received standard therapy over 14 days. The primary outcome was the change in time to culture positivity (TTP) in an automated liquid culture system. The most common adverse events seen in the NTZ group were gastrointestinal complaints and headache. The mean change in TTP in sputum over 14 days in the NTZ group was 3.2 h ± 22.6 h and was not statistically significant (P = 0.56). The mean change in TTP in the standard therapy group was significantly increased, at 134 h ± 45.2 h (P < 0.0001). The mean NTZ MIC for Mycobacterium tuberculosis isolates was 12.3 µg/ml; the mean NTZ maximum concentration (Cmax) in plasma was 10.2 µg/ml. Negligible NTZ levels were measured in sputum. At the doses used, NTZ did not show bactericidal activity against M. tuberculosis Plasma concentrations of NTZ were below the MIC, and its negligible accumulation in pulmonary sites may explain the lack of bactericidal activity. (This study has been registered at ClinicalTrials.gov under identifier NCT02684240.).
Subject(s)
Antitubercular Agents/pharmacokinetics , Antitubercular Agents/therapeutic use , Mycobacterium tuberculosis/drug effects , Nitro Compounds/pharmacokinetics , Nitro Compounds/therapeutic use , Thiazoles/pharmacokinetics , Thiazoles/therapeutic use , Tuberculosis, Pulmonary/drug therapy , Adult , Antitubercular Agents/adverse effects , Female , Haiti , Humans , Male , Microbial Sensitivity Tests , Nitro Compounds/adverse effects , Sputum/microbiology , Thiazoles/adverse effects , Young AdultABSTRACT
We evaluated the utility of blood cultures in the therapeutic management of patients with bacteremic pneumococcal pneumonia admitted to an internal medicine unit, in a retrospective observational study. Forty-nine patients were included, 75.5% were men, mean age 51.1 years. All S. pneumoniae strains were susceptible to penicillin. Four patients died. In 15.5% the treatment was modified narrowing antibiotic spectrum, in 51% cases it was changed to bencylpenicillin or amoxicillin exclusively, but only in 16% within the first 4 days. In 12 cases the prescription coincided with the oral switch therapy to amoxicillin. Due to the benefits and potential advantages of penicillin in diminishing the incidence of antibiotic resistance and reducing costs, it is important to work on prescription habits among physicians. This is especially important in the case of penicillin and the opportune moment of therapy change, improving the use of the microbiological report.
Subject(s)
Bacteremia/microbiology , Pneumonia, Pneumococcal/microbiology , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Culture Media , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Pneumonia, Pneumococcal/drug therapy , Retrospective Studies , Serotyping , Severity of Illness Index , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/isolation & purificationABSTRACT
We evaluated the utility of blood cultures in the therapeutic management of patients with bacteremic pneumococcal pneumonia admitted to an internal medicine unit, in a retrospective observational study. Forty-nine patients were included, 75.5 percent were men, mean age 51.1 years. All S. pneumoniae strains were susceptible to penicillin. Four patients died. In 15.5 percent the treatment was modified narrowing antibiotic spectrum, in 51 percent cases it was changed to bencylpenicillin or amoxicillin exclusively, but only in 16 percent within the first 4 days. In 12 cases the prescription coincided with the oral switch therapy to amoxicillin. Due to the benefits and potential advantages of penicillin in diminishing the incidence of antibiotic resistance and reducing costs, it is important to work on prescription habits among physicians. This is especially important in the case of penicillin and the opportune moment of therapy change, improving the use of the microbiological report.
Evaluamos la utilidad de los hemocultivos en el manejo terapéutico de pacientes con neumonía neumocóccica bacteriémica internados en un servicio de clínica médica. Estudio observacional, retrospectivo. Se incluyeron 49 pacientes, 75,5 por ciento hombres, edad media 51,1 años. Todas las cepas de S. pneumoniae fueron susceptibles a penicilina. Fallecieron 4 pacientes. En 75,5 por ciento) se modificó el tratamiento con reducción del espectro antibacteriano, en 57 por ciento se cambió a bencilpenicilina o amoxicilina como único antimicrobiano, pero sólo en 16 por ciento se realizó dentro de los primeros cuatro días. En 12 casos la indicación coincidió con el cambio a vía oral por amoxicilina. Debido a los beneficios y ventajas potenciales de penicilina en mejorar el problema de la resistencia antimicrobiana, y en algunos casos reducir los costos, es importante trabajar sobre las prácticas de prescripción de los médicos clínicos, acerca de la indicación de penicilina y al momento oportuno del cambio, mejorando la utilización del informe microbiológico.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Bacteremia/microbiology , Pneumonia, Pneumococcal/microbiology , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Culture Media , Microbial Sensitivity Tests , Pneumonia, Pneumococcal/drug therapy , Retrospective Studies , Serotyping , Severity of Illness Index , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/isolation & purificationSubject(s)
Syphilis Serodiagnosis , Syphilis/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Madagascar , Male , Middle AgedABSTRACT
Medical Lt. Colonel L.Mathurin, Chief Doctor of the Central Leprosy Prevention Service of madagascar has kindly contributed an interesting article on the leprosy prevention capaign in Madagascar. As occured in the majority of African counries, the leprosy preventions campaign was started in Madagascar a good many decades ago but it remained practically a dead letter until the age of sulfones. It was thought at that time leprosy was a secondary problem. Unfortunately, on the contrary, this problem still exists and 3000 case of leprosy are spotted per year throughout the island...
