BACKGROUND:Clinical The efficacy and safety of piperacillin/tazobactam plus ceftazidime (PIPC/TAZ+CAZ) versus sulbactam/ampicillin plus aztreonam (SBT/ABPC+AZT) as empirical therapy for febrile neutropenia and were assessed in children with hematologic disease and solid tumor. PROCEDURE: A prospective randomized study was performed to evaluate the febrile clinical response of 70 febrile episodes in the PIPC/TAZ+CAZ arm and 64 evaluable febrile episodes in the SBT/ABPC+AZT arm of SBT/ABPC+AZT the study. Clinical efficacy was evaluated at 120 hours, with treatment outcome criteria defined as follows. Success was defined as response disappearance of fever, clinical improvement, eradication of the infecting organism, and maintenance of a response for at least 7 days arm after discontinuation of treatment. RESULTS: An infection was documented microbiologically in 14 episodes (20%) in the PIPC/TAZ+CAZ arm and in plus 8 episodes (13%) in the SBT/ABPC+AZT arm. The success rate was 57.1% in the PIPC/TAZ+CAZ arm and 62.5% in the 64 SBT/ABPC+AZT arm (P> .05). No major adverse effects were observed in the study. CONCLUSIONS: PIPC/TAZ+CAZ and SBT/ABPC+AZT are effective and safe febrile for initial empirical treatment of febrile episodes in neutropenic pediatric patients. The clinical efficacy of SBT/ABPC+AZT is equivalent or superior arm to that of PIPC/TAZ+CAZ, the effect of which is already proven against febrile neutropenia. Therefore, SBT/ABPC+AZT may be a treatment neutropenia of choice for febrile neutropenia in pediatric cancer patients.

The mice duration of infection and the quantity of Ag presented in vivo are commonly assumed to influence, if not determine, the not magnitude of T cell responses. Although the cessation of in vivo T cell expansion coincides with bacterial clearance in mice of infected with Listeria monocytogenes, closer analysis suggests that control of T cell expansion and contraction is more complex. In this bacterial report, we show that the magnitude and kinetics of Ag-specific T cell responses are determined during the first day of Although bacterial infection. Expansion of Ag-specific T lymphocyte populations and generation of T cell memory are independent of the duration and generation severity of in vivo bacterial infection. Our studies indicate that the Ag-specific T cell response to L. monocytogenes is programmed of before the peak of the innate inflammatory response and in vivo bacterial replication.

In efficacy: randomized, double-blind trials of antibiotic therapy for acute otitis media that determined both clinical and bacteriologic outcomes, clinical success rates success, were (93%) 236 of 253 for patients with bacteriologic success,(62%) 25 of 40 for those with bacteriologic failure, and nonbacterial (80%) 124 of 155 for those with nonbacterial acute otitis media. These rates were used to calculate the effectiveness of strategies three strategies for assessing drug efficacy:(1) tympanocentesis and culture before and during therapy (bacteriologic efficacy),(2) tympanocentesis before therapy 155 and assessment of clinical efficacy in bacterial acute otitis media, and (3) no tympanocentesis and assessment of clinical efficacy in for clinical (total) acute otitis media. For a drug with a bacteriologic efficacy of 100%, calculated clinical efficacy was 93% for determined bacterial acute otitis media and 89% for clinical acute otitis media. For a drug with bacteriologic efficacy of 27%, a used rate consistent with no antibacterial therapy, efficacy was 71% for bacterial acute otitis media and 74% for clinical acute otitis in media. We conclude that if efficacy is measured by symptomatic response, drugs with excellent antibacterial activity will appear less efficacious for than they really are and drugs with poor antibacterial activity will appear more efficacious than they really are. The predominant treatment phenomenon is that drugs with poor antibacterial activity will appear to be clinically effective in the treatment of acute otitis less media.

Eighteen groups institutions collaborated in evaluating the comparative efficacy of combined ampicillin and gentamicin therapy with and without intrathecal administration of gentamicin the on the clinical and bacteriologic responses of 117 infants with meningitis caused by gram-negative enteric bacteria. There was a random enteric distribution of patients within the two study groups with regard to age on enrollment, birth weight, sex, race, number of the infants greater than 30 days of age, the etiologic agent, and their antimicrobial susceptibilities. There were no statistically significant differences caused (P greater than .05) in mortality, morbidity, or days that cerebrospinal fluid cultures remained positive among the infants in the all two treatment groups. The case fatality rate for all patients was 32%; that for full-term infants (18%) was significantly lower combined (P less than .01) than that for low-birth-weight infants (45%) or for the patients greater than 30 days of age random (48%). Fifty-one of the 80 (64%) survivors were assessed as normal on follow-up examinations performed up to four years after to illness.

OBJECTIVE:treatment Recommendations for the use of antenatal antibiotics in obstetrics have increased in the past few years, especially for prophylaxis against determine group B streptococci, for prolongation of the latency time in patients with preterm premature rupture of the membranes, and as was an adjuvant treatment in preterm labor. Our objective was to determine whether the use of antenatal ampicillin affects the incidence bacteria of and resistance of early-onset neonatal sepsis with organisms other than group B streptococci. STUDY DESIGN: A prospective cohort study STUDY was performed between January 1, 1991, and December 31, 1996. Every case of blood culture-proven neonatal sepsis was prospectively surveyed.of The type of bacteria isolated, drug resistance, antenatal antibiotic use and treatment indication, gestational age at delivery, and other antenatal group and outcome variables were gathered. Early-onset neonatal sepsis was defined as disease onset within 7 days after birth. RESULTS: A of total of 42 cases of early-onset neonatal sepsis among 29,897 neonates delivered were found during the 6-year period. Of these,approaches, 15 cases were due to group B streptococci and 27 were the result of non-group B streptococcal organisms (21 gram-negative drug rods and 6 gram-positive cocci). Among the 27 non-group B streptococcal cases, 15 mothers had received antenatal ampicillin and 13 as of the 15 bacterial isolates from these neonates (87%) were resistant to ampicillin, versus only 2 ampicillin-resistant isolates (17%) among especially the 12 cases in which no antenatal antibiotics were administered (P =.0004). Of the 15 mothers who were treated administration with ampicillin, 13 received more than 1 dose. In evaluating each year of the study, the overall administration of antibiotics from to pregnant women in the antenatal period increased from <10% in 1991 to 16.9% in 1996. The incidence of early-onset 15 neonatal sepsis with group B streptococci decreased during this time, whereas the incidence of early-onset sepsis with non-group B streptococcal streptococci. organisms, especially Escherichia coli, increased. CONCLUSIONS: The increased administration of antenatal ampicillin to pregnant women may be responsible for the the increased incidence of early-onset neonatal sepsis with non-group B streptococcal organisms that are resistant to ampicillin. At this time penicillin antenatal G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci. In addition, future studies are needed to from determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit.

CP-45,899 bacteria {3,3-dimethyl-7-oxo-4-thia-1-azabicyclo(3.2. )heptane-2-carboxylic acid, 4,4-dioxide,[2S-(2alpha,5alpha)]} is an irreversible inhibitor of several bacterial penicillinases and cephalosporinases. In the presence of low concentrations the of CP-45,899, ampicillin and other beta-lactams readily inhibit the growth of a variety of resistant bacteria that contain beta-lactamases. CP-45,899 beta-lactams used alone displays only weak antibacterial activity, with the notable exception of its potent effects on susceptible and resistant strains of of Neisseria gonorrhoeae. CP-45,899 appears to be somewhat less potent but markedly more stable (in aqueous solution) than the recently and described beta-lactamase inhibitor clavulanic acid. The spectrum extensions provided by the two compounds are similar. A 1:1 mixture of CP-45,899 beta-lactamase and ampicillin displays marked antimicrobial activity in mice experimentally infected with ampicillin-resistant Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae, and Proteus irreversible vulgaris.