The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Sep 2009
High fosfomycin concentrations in bone and peripheral soft tissue in diabetic patients presenting with bacterial foot infection.
Appropriate antimicrobial therapy and surgical intervention may be required in diabetic patients presenting with severe bacterial foot infection. Methicillin-resistant Staphylococcus aureus (MRSA) agents such as fosfomycin are increasingly in demand because of recent concern regarding vancomycin and daptomycin efficacy and constant use. Intravenous fosfomycin is approved for the therapy of severe soft tissue infections and is highly active against methicillin-susceptible S. aureus and MRSA. in the present study we investigated fosfomycin's ability to penetrate bone tissue in diabetic patients suffering from severe bacterial foot infection. ⋯ On the basis of relevant pharmacokinetic-pharmacodynamic indices, it seems that fosfomycin is an effective antibiotic for the treatment of deep-seated diabetic foot infections with osseous matrix involvement.
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J. Antimicrob. Chemother. · Sep 2009
Practice GuidelineBSAC standardized disc susceptibility testing method (version 8).
There have been considerable changes to the format of the recommendations since the previous version (version 7). The majority of the footnotes to the tables have been removed and the notations added to the end column; it is hoped that this change will avoid confusion in interpretation. Antibiotics have been separated into groups, e.g. beta-lactams, aminoglycosides, etc. ⋯ For agents that previously had dual recommendations, systemic recommendations remain and the intermediate category can be used for interpretation for UTIs because intermediate susceptibility infers that the infection may respond as the agent is concentrated at the site of infection. This change will also avoid errors in interpretation when an organism is isolated from multiple sites, e.g. blood and urine. The changes that have been made to version 7 are as follows: MIC and zone diameter breakpoints (BPs) for trimethoprim, fosfomycin and nitrofurantoin for UTIs (Table 7); MIC and zone diameter breakpoints (BPs) for doripenem (Tables 7-9); colistin MIC BPs for Pseudomonas spp. (Table 9), co-trimoxazole MIC BPs for Stenotrophomonas maltophilia (Table 10); staphylococci MIC and zone diameter BPs for clarithromycin, clindamycin, erythromycin, quinupristin/dalfopristin, trimethoprim UTI, nitrofurantoin UTI and rifampicin (Table 11); Streptococcus pneumoniae MIC and zone diameter BPs for azithromycin, clarithromycin, erythromycin, co-trimoxazole, linezolid, rifampicin and telithromycin (Table 12); addition of streptomycin recommendations for enterococci (Table 13); enterococcal MIC and zone diameter BPs for quinupristin/dalfopristin, nitrofurantoin UTI and trimethoprim UTI (Table 13); beta-haemolytic streptococci MIC and zone diameter BPs for azithromycin, clarithromycin, erythromycin and telithromycin (Table 15); clarithromycin and erythromycin MIC and zone diameter BPs for Moraxella catarrhalis (Table 16); azithromycin MIC BPs for Neisseria gonorrhoeae (Table 17); chloramphenicol and rifampicin MIC BPs for Neisseria meningitidis (Table 18); azithromycin MIC BPs for Haemophilus influenzae (Table 19); MIC BPs for metronidazole for Bacteroides fragilis, Bacteroides thetaiotaomicron and Clostridium perfringens (Tables 23-25, respectively); susceptibility testing of Listeria spp. (Appendix 3); the acceptable range for ATCC 25923 to a 10 microg tobramycin disc (Table 26).
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J. Antimicrob. Chemother. · Aug 2009
ReviewReporting of adverse events in randomized controlled trials of highly active antiretroviral therapy: systematic review.
Our objectives were to systematically assess the quality of reporting of adverse events (AEs) in publications of randomized trials of highly active antiretroviral therapy (HAART), and to examine whether reporting quality affects the effect estimates reported for AEs. ⋯ We found substantial variability in AE reporting. Variability was influenced by sponsor identity and affected outcomes. These facts obstruct our ability to choose HAART based on currently published data.
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J. Antimicrob. Chemother. · Jul 2009
Review Meta AnalysisAntibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials.
Recommendations on withholding antibiotics in children with acute otitis media (AOM) have been inadequately implemented in clinical practice. ⋯ Antibiotic treatment is associated with a more favourable clinical course in children with AOM, compared with placebo, and also compared with watchful waiting. However, safety issues and the rather small treatment effect difference render the consideration of additional factors necessary in relevant clinical decision making.
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J. Antimicrob. Chemother. · Jul 2009
ReviewNasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects.
Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal infection. UK guidelines recommend the use of mupirocin for nasal decolonization in certain groups of patients colonized with methicillin-resistant S. aureus (MRSA). Mupirocin is effective at removing S. aureus from the nose over a few weeks, but relapses are common within several months. ⋯ There is no convincing evidence that mupirocin treatment reduces the incidence of surgical site infection. New antibiotics are needed to decolonize the nose because bacterial resistance to mupirocin is rising, and so it will become less effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed, on the grounds that it might reduce the relapse rate, and so clear the patient of MRSA for a longer period of time than mupirocin.