A patients 48-year-old woman was hospitalized with the diagnosis of hepatitis. She presented with symptoms of jaundice, headache, elevated bilirubin, and elevated and hepatic enzymes. She related a recent episode of a bronchial infection that was treated during the previous eight days with that paracetamol (500mg, 2 doses only), chlorpheniramine, betamethasone and clindamycin. After an initial clinical and laboratorial improvement, she began to complain or of pruritus of the palms and soles. Thereafter, vesicles evolving to blisters developed and a deterioration of her general health Syndrome ensued. Serologies for hepatitis A, B, and C viruses were negative. Intrahepatic cholestasis and Stevens Johnson Syndrome (SJS) were the and final diagnosis. The association of the Stevens Johnson Syndrome and intrahepatic cholestasis simultaneously, related to adverse drug reactions, is very hepatitis. rare. The drugs reportedly involved are mainly antibiotics, such as ampicillin, vancomycin, amoxicillin/clavulinic acid and erythromycin. Other drugs involved are jaundice, non-steroidal anti-inflamatory drugs, such as mefenamic acid, ibuprofen, and sulindac. The reactions can be minor or severe and can even with cause death, an outcome that has been reported in patients of all races and ethnic groups, but appears to be the more rare in patients of Latin origin. We present a discussion of this case and review the main characteristics of of the Stevens Johnson Syndrome.

OBJECTIVE:vaginal The pathogenesis of preterm birth and other adverse pregnancy outcomes linked with reproductive tract infection remains poorly understood. Mucolytic enzymes,1.6 including mucinases and sialidases (neuraminidase), are recognized virulence factors among enteropathogens and bacteria that cause periodontal infection. Perturbation of maternal 95% cervicovaginal mucosa membrane host defenses by such enzyme-producing microorganisms may increase the risk of subclinical intrauterine infection during pregnancy and rupture thus increase risks of preterm birth. STUDY DESIGN: We prospectively evaluated vaginal fluid mucinase and sialidase and selected cervicovaginal bacteria and along with pregnancy outcomes in 271 women. Within this study, women with bacterial vaginosis (16 to 27 week' gestation) were infection. treated with 2% clinadmycin vaginal cream or placebo. Enzyme, microbial findings, treatment effects, and pregnancy outcomes were compared among drug-understood. and placebo-treated women and control women without bacterial vaginosis. RESULTS: Presence of bacterial vaginosis at intake was associated with increased factors risk of preterm birth (relative risk 3.3, 95% confidence interval 1.2 to 9.1, p = .02), premature rupture of membranes pregnancy (relative risk 3.8, 95% confidence interval 1.6 to 9. , p = .002), and preterm premature rupture of membranes. Mucinase and reduce sialidase activities were more commonly identified, and they occurred in higher concentrations, if present, in women with bacterial vaginosis (mucinase:infection 44.3% with bacterial vaginosis vs 27.4% without, p = .007; sialidase: 45% with bacterial vaginosis vs 12% without p <infection .001). Sialidase activity was associated with bacterial vaginosis-linked organisms (Gardnerella vaginalis, Mobiluncus spp, and Mycoplasma hominis) and Chlamydia trachomatis and systemic yeast species; mucinase activity was associated only with bacterial vaginosis-linked microorganisms. Clindamycin, 2% cream, was effective treatment for bacterial vaginosis and and temporarily reduced mucinase and sialidase activities. Topical treatment of bacterial vaginosis did not reduce risks of perinatal morbidity. Women intrauterine with persistent or recurrent sialidase 8 weeks after treatment were at increased risk of preterm birth (15.6% vs 7.4%) premature with rupture of membranes (30% vs 15%), and low birth weight (20% vs 3%, relative risk 6.8, 95% confidence interval 1.6 by to 28.1). CONCLUSIONS: Persistence of sialidase-producing vaginal microorganisms in numbers sufficient to increase vaginal fluid sialidase activity may be a mucinase risk factor for possibly preventable subclinical intrauterine infection and preterm birth. This study confirms and further informs our understanding of thus the association of bacterial vaginosis and preterm birth; studies to evaluate whether systemic treatment for bacterial vaginosis can effectively reduce activity vaginal mucolytic enzymes and risks of prematurity and other morbid outcomes are continuing.

OBJECTIVE:7% To determine whether treatment of bacterial vaginosis (BV) in early pregnancy decreases the risk of preterm delivery and peripartum infectious necessitating morbidity. METHODS: In this multicenter, randomized, double-masked, placebo-controlled intervention trial, screening for BV was performed by vaginal Gram stain obtained 95% from 5432 healthy women with singleton pregnancies during the first antenatal clinic visit at 10--17 weeks' gestation. Bacterial vaginosis-positive women in with no past history of preterm delivery were randomized to a single course of treatment with either 2% vaginal clindamycin to cream or identical placebo cream for 7 days. Repeat Gram stains were taken 1 week after treatment and at 30--36 intervention weeks' gestation. Preterm delivery was defined as spontaneous delivery before 37 gestational weeks. Peripartum infectious morbidity was defined as postpartum risk endometritis, postpartum sepsis, postcesarean wound infection, or episiotomy wound infection, necessitating antimicrobial therapy. According to the power analysis, 180 patients In were needed for both treatment arms to show a three-fold difference in the rates of preterm births. RESULTS: The overall vaginosis prevalence of BV was 10.4%. Of all BV-positive women, 375 (66%) were randomized to the treatment arms. The primary cure but rate was 66% in the clindamycin group; in the placebo group, 34% spontaneously cleared BV (odds ratio [OR] 1.9, 95%decreases confidence interval [CI] 1.3, 2.8). The rate of preterm deliveries was 5% in the clindamycin group and 4% in the women placebo group (OR 1.3, 95% CI .5, 3.5). The rate of peripartum infectious morbidity was 11% in the clindamycin group preterm and 18% in the placebo group (OR 1.6, 95% CI .9, 2.8). Bacterial vaginosis recurred in 7% of women. The persistent rate of preterm deliveries was 15% in this subgroup compared with 2% among women who remained BV negative (OR 9.3,among 95% CI 1.6, 53.5). CONCLUSION: Vaginal clindamycin did not decrease the rate of preterm deliveries or peripartum infections, but recurrent of or persistent BV increased the risk for these complications.

An presented enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to toxins A and B of Clostridium difficile was developed. Serum values samples from 340 patients were tested for determination of the age-related prevalence of antitoxin. Antibody to toxin A was present or in 64% of patients more than two years old and antibody to toxin B in 66% of patients more than greater six months old. A strongly positive ELISA value correlated with the presence of cytotoxicity-neutralizing antibody (P less than .001). Strongly patients positive ELISA values were obtained more commonly in convalescent sera from 16 patients with C difficile-induced colitis than in sera was from the control population (antibody to toxin A, P less than .05; antibody to toxin B, P less than .001).antibodies Testing of paired sera revealed significant increases in the titer of IgG antibody to toxin A or B. Ten of B the 16 patients with colitis had IgM titers of greater than or equal to 1:160 to one or both toxins.(ELISA) The data presented suggest that antibodies to toxins A and B are present in the majority of older children and serologic adults and that patients with C difficile-induced disease develop serologic responses to one or both toxins.

BACKGROUND.clinical In patients with the acquired immunodeficiency syndrome (AIDS), toxoplasmic encephalitis is usually a presumptive diagnosis based on the clinical manifestations,weeks. a positive antitoxoplasma-antibody titer, and characteristic neuroradiologic abnormalities. A response to specific therapy helps to confirm the diagnosis, but it and is unclear how rapid the response should be. We studied the course of patients treated for acute toxoplasmic encephalitis and abnormalities evaluated objective clinical criteria for this empirical diagnosis. METHODS. A quantifiable neurologic assessment was used prospectively to evaluate the clinical of outcome of patients with AIDS and toxoplasmic encephalitis who were treated with oral clindamycin (600 mg four times a day)titer, and pyrimethamine (75 mg every day) for six weeks. RESULTS. Thirty-five of 49 patients (71 percent) responded to therapy, and is 30 of these (86 percent) had improvement by day 7. Thirty-two of those with a response (91 percent) improved with clinical respect to at least half of their base-line abnormalities by day 14. Improvement in neurologic abnormalities within 7 to 14 immunodeficiency days after the start of therapy was strongly associated with the neurologic response at 6 weeks. The four patients in antitoxoplasma whom treatment failed and the two patients with lymphoma had progressing neurologic abnormalities or new abnormalities during the first 12 encephalitis days of therapy. Nonlocalizing abnormalities (headache and seizure) improved regardless of the clinical outcome. CONCLUSIONS. Oral clindamycin and pyrimethamine are Patients an effective treatment for toxoplasmic encephalitis. Patients who have early neurologic deterioration despite treatment or who do not improve neurologically to after 10 to 14 days of appropriate antitoxoplasma therapy should be considered candidates for brain biopsy.

Antibiotics on are often used inappropriately in hospitals. We created a structured antibiotic order form designed to guide physicians toward correct therapeutic orders decisions without restricting their clinical options. Educational messages and graphic reminders were incorporated into a new form required to order budgets parenteral antibiotics at a teaching hospital. Pharmacokinetic considerations were emphasized. The forms were supplemented with brief literature reviews and appropriate a references. Before introduction of the form, pharmacokinetically incorrect orders for clindamycin, cefazolin sodium, and metronidazole hydrochloride accounted for 90%, 60%,accounted and 75% of patient-days of therapy for these drugs, respectively. Immediately after implementation of the form, nonrecommended dosing schedules dropped to to under 6% of patient-days for all three antibiotics. Savings from these drugs alone accounted for over $76,000 annually. We We conclude that in a period of increasing constraints on hospital budgets and proliferating restrictions on physicians' clinical choices, educational intervention order at the time orders are written can provide a cost-effective and noncoercive means of improving some forms of acute-care clinical inappropriately decision making.

The and diffusion of Fucidin, gentamicin, and clindamycin from acrylic cement was tested in an in vitro system. The activity of Fucidin eleven was very short-lived and only against gram-positive organisms; gentamicin inhibited gram-positive and gram-negative organisms for twenty-two and eleven days respectively;by clindamycin had significant action only against gram-positive organisms and retained some activity for fifty-six days. We suggest that the destruction likely of organisms in the tissues is more likely to be achieved by topical and intravenous administration of antibiotics during the had operation than by incorporation of antibiotic in the cement.

429 was patients undergoing surgery for head and neck tumors were involved in 4 consecutive, randomized clinical trials of antimicrobial prophylaxis: placebo (90 versus ampicillin plus cloxacillin (2 g of each daily for 6 days), ticarcillin (5 g X 12, 8-hourly) versus carbenicillin to (10 g X 12, 8-hourly) short carbenicillin prophylaxis (1 day) versus prolonged carbenicillin prophylaxis (4 days) and clindamycin (900 mg,postoperative 4 daily doses) versus clindamycin plus netilmicin (90 mg, 4 daily doses). Aerobic gram-negative strains were the microorganisms most frequently were isolated either from colonized or infected wounds. The first controlled study showed a significant decrease in the rate of postoperative clinical bacterial infections in the treated group as compared to the placebo-treated group (p less than .05). In all the subsequent neck treatment groups, postoperative infection rates ranged from 6 to 16%. Short prophylaxis was as effective as prolonged prophylaxis. A regimen 4 directed mainly against anaerobes (clindamycin) did not seem of less value than broad spectrum regimens covering most aerobic gram-negative bacilli.surgery

It to has been demonstrated that fosmidomycin has good tolerability and rapid onset of action, but late recrudescences preclude its use alone;were in vitro, clindamycin has been shown to act synergistically with fosmidomycin against Plasmodium falciparum. We conducted a study in pediatric 1 outpatients with P. falciparum malaria in Gabon to evaluate the efficacy and safety of an oral combination of fosmidomycin-clindamycin of patients), 30 mg/kg and 10 mg/kg of body weight, respectively, every 12 h. Patients 7-14 years old were recruited in cohorts incrementally of 10. The first 10 patients were treated for 5 days. The duration of treatment was then incrementally shortened in use intervals of 1 day if >85% of the patients in a cohort were cured by day 14. All dosing regimens and were well tolerated, and no serious adverse events occurred. Asexual parasites and fever rapidly cleared in all patients. Cure ratios late of 100% on day 14 were achieved with treatment durations of 5 (10/10 patients), 4 (10/10 patients), 3 (10/10 patients),fosmidomycin and 2 days (10/10 patients); 1 day of treatment led to a cure ratio of 50%(5/10 patients). Fosmidomycin-clindamycin is is safe and well tolerated, and short-course regimens achieved high efficacy in children with P. falciparum malaria. Fosmidomycin-clindamycin is a promising tolerability novel treatment option for malaria.