1. Identify the organisms causing nocardial infections in humans. 2. Describe the presenting symptoms of nocardial infections. 3. Explain the treatment of nocardial infections.
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Antimicrobial shortages have made treating certain infections more difficult. A web-based survey asking about experience with antimicrobial drug shortages was distributed in 2011 to 1328 infectious diseases physician members of the Emerging Infectious Diseases Network of the Infectious Diseases Society of America. A majority (78%) of 627 respondents reported needing to modify antimicrobial choices because of drug shortages within the past 2 years. Antimicrobials most often reported as not available or available but in short supply were trimethoprim-sulfamethoxazole injection (by 65% of respondents), amikacin (by 58%), aztreonam (by 31%), and foscarnet (by 22%). Most respondents (55%) reporting a shortage indicated that the shortage adversely affected patient outcomes and that they were forced to use alternative and second line agents which were either less effective, more toxic, or more costly. Most (70%) indicated that they learned about the shortage from contact with the pharmacy after trying to prescribe a drug in short supply. More effective means of informing physicians about drug shortages is critical to lessen the impact on patient care.
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All adult patients with S. aureus bacteremia should undergo echocardiography. Characteristics of low-risk patients with S. aureus bacteremia for whom transesophageal echocardiography can be safely avoided have been identified. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of S. aureus bacteremia are needed.
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Eligible infants were randomly assigned to 7 days of: (1) procaine penicillin [50,000 units/kg once daily (OD) by intramuscular injection (IM)] and gentamicin (5 mg/kg OD IM) reference arm, (2) ceftriaxone (50 mg/kg OD IM), or (3) oral trimethoprim-sulfamethoxazole (TMP-SMX) at 10 mg/kg/day divided twice daily and gentamicin IM OD. Primary outcome was treatment failure, defined as death, deterioration in clinical condition during therapy or no improvement after 2 days.
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A postpartum patient had a unilateral breast infection that responded to cephalosporin treatment. During therapy, the contralateral breast developed a methicillin-resistant Staphylococcus aureus infection. The patient was hospitalized and treated successfully with intravenous vancomycin. Obstetricians should be alert to this possibility when treating patients with postpartum mastitis.
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To determine effects of 14 days of oral administration of trimethoprim-sulfamethoxazole on aqueous tear production in clinically normal Syrian hamsters.
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Recent reports indicated a significant association between fixed drug eruption (FDE) and HLA class I antigens. A strong correlation was found between B22 antigen and feprazone-induced FDE.
Eight healthy, male subjects participated in a balanced randomized crossover study to investigate the effect of a course of co-trimoxazole (CT; combination of sulphamethoxazole 800 mg and trimethoprim 160 mg, twice daily for 5 days) on the pharmacokinetics and urinary metabolite profile of an orally administered dose of theophylline (TH). There were no significant differences (p greater than 0.05) between the control and treatment phases with respect to any of the following pharmacokinetic parameters of TH: area under the plasma total TH concentration time curve; fraction unbound in plasma; area under the plasma unbound TH concentration time curve; terminal half-life; apparent volume of distribution; apparent total plasma clearance and renal clearance. The urinary recoveries of 1-methyluric acid, 1.3-dimethyluric acid and of theophylline were not significantly different (p greater than 0.05) between the two study phases. There was a significant difference (p less than 0.05), however, in the urinary recovery of 3-methylxanthine (11.3 +/- 2.6 per cent TH alone versus 13.9 +/- 3.6 per cent TH-CT) and in the total urinary recovery of TH and its metabolites (76.5 +/- 8.2 per cent versus 85.3 +/- 7.0 per cent), the latter finding suggesting that CT may have caused a small increase in the extent of TH absorption. The results of the study indicated that CT did not inhibit the biotransformation of TH.