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B. burgdorferi sensu lato was isolated in 12 of 134 (9%) patients. Eleven blood isolates were typed: 10 were found to be B. afzelii and 1 was Borrelia garinii. Comparison of blood culture-positive and -negative patients revealed no differences in pretreatment characteristics or in posttreatment clinical course. However, worsening of local and/or systemic signs and symptoms at the beginning of antibiotic therapy (Jarish-Herxheimer's reaction) was identified more often in the blood culture-positive than in the blood culture-negative group (5 of 12 vs. 17 of 122, respectively; P = 0.0274).
A study was carried out in general practice to assess the clinical effectiveness and tolerability of the oral cephalosporin, cefuroxime axetil, in the treatment of 369 patients presenting with acute infections of the upper respiratory tract. The main diagnoses were tonsillitis, pharyngitis, sinusitis and otitis media. Patients were treated for 7 days with 1 tablet of 250 mg cefuroxime axetil twice daily. Details of fever and signs and symptoms of infection such as pain, sinus tenderness and reddening of the eardrum were recorded before and after treatment. Response was assessed by the physician on the basis of the clinical findings (the microbiological findings will be reported separately), and by patients on their satisfaction with their therapy. The results indicated an overall clinical improvement rate of 89%: all clinical parameters showed significant improvement and most patients were symptom-free when seen after treatment. Only 2 patients were classified as treatment failures and withdrawn from the study. Complete resolution of the infection was seen more often in patients with tonsillitis and pharyngitis than in those with sinusitis or otitis media. Over 80% of patients expressed their satisfaction with therapy. Adverse events reported were few, even though patients were prompted with a non-leading question, and were mainly mild in nature. The most frequently reported were diarrhoea (5%) and loose motions (3%).
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This study was conducted with face-to-face survey method between April 2009 and June 2009. The physicians were asked to answer the prespecified questions about the etiopathogenesis, diagnosis and treatment criteria for ABRS by grading from 1 to 5. The demographic and undergraduate education information of the physicians, daily number of patients they see, the number of patients diagnosed with ABRS and family physicians specialization were asked. One hundred and forty two physicians visits were performed at 33 Health Centers or Public Health Centers. Sixty-nine doctors (34 males, 35 females; mean age 44.5±5.5 years; range 33 to 57 years) answered the survey.
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We report the case of 37-year-old woman who developed pruritic bullous lesions spread all over the body three weeks after her last dose of cefuroxime axetil. Antibiotic therapy was started due to rhino-sinusitis.
Studies were performed using three cefuroxime axetil solutions (11.8, 118 and 200 microM) in three selected intestinal segments and one cefuroxime axetil solution (118 microM) in colon of anaesthetized rats. First-order absorption rate pseudoconstants, k(ap) and effective permeability coefficients, P(eff), were calculated in each set. Absorption of cefuroxime axetil can apparently be described as a carrier-mediated transport, which obeys Michaelis-Menten and first order kinetics in the proximal segment of the small intestine and a passive diffusion mechanism in the mean and distal segments. The absorption kinetic parameters for cefuroxime axetil were obtained: Vm=0.613 (0.440) microM min-1; Km=31.49(28.31) microM and ka=0.011(0.003) min-1. Parameters characterizing degradation of the prodrug were obtained in each intestinal segment: proximal segment k(dp)=0.0049(0.0003) min-1, mean segment, k(dm)=0.0131(0.0007) min-1 and distal segment k(dd)=0.019(0.0009) min-1. Therefore, in situ intestinal absorption of cefuroxime axetil in the proximal segment of the rat in the presence of variable concentrations of cefadroxil has been investigated in order to examine the inhibitory effect of cefadroxil on cefuroxime axetil transport. The data suggest that cefadroxil and cefuroxime axetil share the same intestinal carrier.
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To study prognostic factors and the influence of long-term antibiotic treatment on the evolution of orthopedic implant infections.
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In this study, the authors compared the effects of amlodipine (AML) on the bioavailability of cephalexin (LEX) and cefuroxime axetil (CXM). Twenty-four healthy men were randomized to 4 treatments according to a crossover design with a 14-day washout. After an overnight fast, they were administered orally LEX 500 mg alone, LEX 500 mg 2 hours after oral administration of AML 5 mg, CXM 500 mg alone, and CXM 500 mg 2 hours after oral administration of AML 5 mg. All participants completed the whole study without side effects being observed. Pharmacokinetic data were analyzed by noncompartmental modeling with WinNonlin software. The geometric mean (GM) ratios were 1.38 (90% confidence interval [CI], 1.32-1.45) for the area under the concentration-time curve (AUC) for LEX and 1.27 (1.18-1.36) for the maximum concentration of drug in serum (C(max)) for LEX followed by AML versus alone. In contrast, no significant differences were found in the pharmacokinetic parameters of CXM between treatments (P < .05). They authors conclude that AML possesses an enhancement effect in β-lactam antibiotic bioavailability (in this case, LEX), and this interaction may be specific to the peptidomimetic β-lactam antibiotics.
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Cefuroxime axetil and cefaclor were compared for efficacy in the treatment of acute otitis media with effusion. Sixty-four pediatric outpatients had tympanocentesis for culture, and then were randomized to a ten-day course of treatment with cefuroxime axetil or cefaclor. Streptococcus pneumoniae and Haemophilus influenzae were isolated from 25 (39%) and 23 (36%) patients, respectively. Treatment was beneficial in 26 (90%) of the patients who received cefuroxime axetil, and in 16 (76%) of the cefaclor-treated patients. Treatment failed in five (24%) of the cefaclor-treated patients, and in only three (10%) patients who received cefuroxime axetil. Haemophilus influenzae was the initial causative pathogen in a disproportionate number of treatment failures. This study demonstrates the efficacy of cefuroxime axetil in the treatment of otitis media.
We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was based on the confirmation of an IgE-mediated aetiology by an oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloyl G and V, amoxicillin, ampicillin and cefaclor < 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroxime axetil.
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Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. As a group, these drugs are active against many gram-positive, gram-negative and anaerobic organisms. Information based on "expert opinion" and antimicrobial susceptibility testing supports certain antibiotic choices for the treatment of common infections, but less evidence-based literature is available to guide treatment decisions. Evidence in the literature supports the selection of amoxicillin as first-line antibiotic therapy for acute otitis media. Alternative drugs, such as amoxicillin-clavulanate, trimethoprim-sulfamethoxazole and cefuroxime axetil, can be used to treat resistant infections. Penicillin V remains the drug of choice for the treatment of pharyngitis caused by group A streptococci. Inexpensive narrow-spectrum drugs such as amoxicillin or trimethoprim-sulfamethoxazole are first-line therapy for sinusitis. Animal and human bites can be treated most effectively with amoxicillin-clavulanate. For most outpatient procedures, amoxicillin is the preferred agent for bacterial endocarditis prophylaxis. Beta-lactam antibiotics are usually not the first choice for empiric outpatient treatment of community-acquired pneumonia. Based on the literature, the role of beta-lactam antibiotics in the treatment of bronchitis, skin infections and urinary tract infections remains unclear.