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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of Arizona osteomyelitis of the spine which occurred 11 months after an episode of gastroenteritis and enteric fever is presented. As close biochemical and antigenic relative of Salmonella, Arizona infection produces a similar clinical course with gastrointestinal manifestations frequently preceding localized infections by several months. The boney lesion in the present case and in three of the four other cases of Arizona osteomyelitis described in the literature was a chronic inflammation which may have a xanthomatous component. The bone destruction caused by Arizona infection is less severe than that of tuberculosis or pyogenic osteomyelitis. Proposed treatment of Arizona osteomyelitis consists of debridement of the localized infection and long term antimicrobial therapy.
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PMID:Arizona hinshawii osteomyelitis with antecedent enteric fever and sepsis. A case report with a review of the literature. 127 93

The fluoroquinolones represent a relatively new class of antibiotics with outstanding therapeutic potential, attributable to their broad spectrum of antimicrobial activity and favourable tissue distribution. They are highly active against most Gram-negative pathogens, as well as Staphylococcus aureus and coagulase-negative staphylococci. In addition, the fluoroquinolones have useful pharmacokinetic properties: they are orally active, and their lipophilicity and low degree of plasma protein binding allow for excellent tissue penetration and concentrations, as reflected in their particularly large apparent volumes of distribution. Infections due to aerobic Gram-negative pathogens are considered those most susceptible to the quinolones. Disease indications in which these agents appear to offer the greatest therapeutic advantage over currently available alternatives include the following: complicated urinary tract infections (particularly those caused by Pseudomonas aeruginosa or resistant Gram-negative microorganisms); suspected bacterial gastroenteritis; eradication of Salmonella typhi from the faeces in known carriers; P. aeruginosa-associated respiratory exacerbation in patients with cystic fibrosis; and chronic Gram-negative bacterial osteomyelitis. Direct comparisons of the various quinolones are too limited to date to provide clear therapeutic options. Nevertheless, this class of compounds is likely to play a major role in providing effective oral therapy for conditions that have previously required prolonged parenteral treatment.
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PMID:The quinolones. An overview of their pharmacology. 131 65

Over the past decade, the quinolone antimicrobial class has enjoyed a renaissance with the emergence of the fluoroquinolone subclass. Norfloxacin, ciprofloxacin, ofloxacin, enoxacin, and lomefloxacin have the advantages of broad antimicrobial activity profiles including gram-positive and -negative aerobes, favorable pharmacokinetic profiles including substantial oral bioavailability and extensive tissue distribution, and in general, favorable safety profiles. As clinical experience accumulates, our understanding of their optimum roles will become more refined. In six instances, these agents may be preferred over currently available agents: complicated urinary tract infections, empiric therapy of suspected bacterial gastroenteritis, eradication of the Salmonella carrier state, respiratory exacerbations due to Pseudomonas aeruginosa in patients with cystic fibrosis, invasive external otitis, and chronic gram-negative bacillary osteomyelitis. The efficacy and convenience of these agents for the treatment of a broad range of infections have already resulted in their extensive use. Such use carries the risk of selection pressure for the development of resistance and the adverse consequences of increased cost over less expensive, equally effective alternatives. The use of the fluoroquinolones should focus on infections where there is demonstrated benefit of these agents over conventional agents or infections for which there are few or no alternatives.
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PMID:The role of the fluoroquinolones. 148 May 3

Many discriminative experimental animal models of infection have been utilized in the evaluation of newer fluoroquinolones. In vivo efficacy of many of the newer agents has been shown in experimental models of meningitis, endocarditis, pneumonia, urinary tract infections, pyelonephritis, osteomyelitis, abscesses of various types, septic arthritis, gastroenteritis, salmonellosis, listeriosis, tuberculosis, syphilis, sinusitis, prostatitis and burn wound sepsis, among others. This review focuses on recent developments in a few selected areas. Although the limitations of animal model studies are well described, these results provide a rationale for the appropriate clinical usage of the newer fluoroquinolones in humans.
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PMID:Evaluation of quinolones in experimental animal models of infections. 186 88

Although animal models of infection are associated with certain limitations in interpretation, properly performed studies provide important information for evaluating the efficacy of new antimicrobial agents in the treatment of human disease. The antibacterial efficacy of the newer quinolones, particularly ciprofloxacin, has undergone extensive evaluation in several animal models. Efficacy has been demonstrated in animal models of pneumonia, endocarditis, meningitis, skin and soft-tissue infections, septic arthritis, burn wound sepsis, empyema, intra-abdominal abscess, osteomyelitis, prostatitis, sinusitis, urinary tract infection, chronic gastroenteritis, granuloma pouch infection, and Pseudomonas septicemia. More recent studies have evaluated the efficacy of ciprofloxacin in animal models of tuberculosis and syphilis, as well as in infections caused by the intracellular pathogens Salmonella typhimurium, Legionella pneumophila, and Listeria monocytogenes.
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PMID:An update on the efficacy of ciprofloxacin in animal models of infection. 258 79

The fluoroquinolones, a new class of potent orally absorbed antimicrobial agents, are reviewed, considering structure, mechanisms of action and resistance, spectrum, variables affecting activity in vitro, pharmacokinetic properties, clinical efficacy, emergence of resistance, and tolerability. The primary bacterial target is the enzyme deoxyribonucleic acid gyrase. Bacterial resistance occurs by chromosomal mutations altering deoxyribonucleic acid gyrase and decreasing drug permeation. The drugs are bactericidal and potent in vitro against members of the family Enterobacteriaceae, Haemophilus spp., and Neisseria spp., have good activity against Pseudomonas aeruginosa and staphylococci, and (with several exceptions) are less potent against streptococci and have fair to poor activity against anaerobic species. Potency in vitro decreases in the presence of low pH, magnesium ions, or urine but is little affected by different media, increased inoculum, or serum. The effects of the drugs in combination with a beta-lactam or aminoglycoside are often additive, occasionally synergistic, and rarely antagonistic. The agents are orally absorbed, require at most twice-daily dosing, and achieve high concentrations in urine, feces, and kidney and good concentrations in lung, bone, prostate, and other tissues. The drugs are efficacious in treatment of a variety of bacterial infections, including uncomplicated and complicated urinary tract infections, bacterial gastroenteritis, and gonorrhea, and show promise for therapy of prostatitis, respiratory tract infections, osteomyelitis, and cutaneous infections, particularly when caused by aerobic gram-negative bacilli. Fluoroquinolones have also proved to be efficacious for prophylaxis against travelers' diarrhea and infection with gram-negative bacilli in neutropenic patients. The drugs are effective in eliminating carriage of Neisseria meningitidis. Patient tolerability appears acceptable, with gastrointestinal or central nervous system toxicities occurring most commonly, but only rarely necessitating discontinuance of therapy. In 17 of 18 prospective, randomized, double-blind comparisons with another agent or placebo, fluoroquinolones were tolerated as well as or better than the comparison regimen. Bacterial resistance has been uncommonly documented but occurs, most notably with P. aeruginosa and Staphylococcus aureus and occasionally other species for which the therapeutic ratio is less favorable. Fluoroquinolones offer an efficacious, well-tolerated, and cost-effective alternative to parenteral therapies of selected infections.
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PMID:Fluoroquinolone antimicrobial agents. 268 58

Malignant external otitis (MEO) is still a potentially lethal disease. Early treatment based on a correct diagnosis is the most important single factor in achieving a cure for the disease. The preferred treatment is long-term systemic antibiotics followed by surgical intervention. Hyperbaric oxygen therapy may be supplemented in refractory cases. A new fluoroquinolone, Ciprofloxacin, has been successfully used in four cases of MEO which did not respond to the accepted treatment. Ciprofloxacin is active against a broad spectrum of bacteria, including Pseudomonas aeruginosa, and several clinical studies have demonstrated its efficacy in the treatment of urinary tract and soft tissue infections, osteomyelitis, pneumonia, and gastroenteritis. This report is the first of which we are aware to document the use of Ciprofloxacin in the treatment of MEO.
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PMID:Malignant external otitis: treatment with fluoroquinolones. 317 62

While salmonellosis is often considered to affect primarily the gastrointestinal tract, infection at other sites may occur, producing characteristic clinical syndromes. We reviewed cases from our institutions and the literature on focal manifestations of salmonella infections. In the past, most extra-intestinal salmonella infections were caused by S. choleraesuis; however, we found S. typhimurium to be the predominant serotype. The mortality rate for patients in our series was considerably lower than the rate described for focal infections in other reviews. This may in part be due to lower proportion of infections due to S. choleraesuis, improved microbiologic and diagnostic techniques, increased use of ampicillin, and improved surgical techniques. Salmonella endocarditis usually occurs in patients with preexisting heart disease. Unlike other salmonella infections, S. choleraesuis is the most frequent serotype. Salmonella endocarditis is often very destructive, with a fatality rate of 70%. Nonvalvular (mural) endocarditis occurs in one-fourth of patients and survival has not been reported. While antibiotic therapy should be tried initially, if response is not prompt the clinician should look for an associated site of infection (intra- or extra-cardiac abscess), which will often require surgery. Salmonella pericarditis often presents with cardiac or pulmonary symptoms, but typical signs of pericardial disease (pulsus paradoxus, friction rub) or characteristic electrocardiographic changes (low voltage, elevated ST segments) are uncommon. Early diagnosis, before infection involves other areas of the heart, is crucial for survival. In addition to antibiotic therapy, pericardiocentesis or pericardiectomy is required. Salmonella may infect the peripheral or visceral arteries, but the abdominal aorta is the most frequent site of vascular infection. Most patients are men over age 50 with preexisting atherosclerosis of the aorta who do not have a previous history of gastroenteritis. About one-fourth of patients have associated lumbar osteomyelitis. No patients have been reported to survive with medical therapy alone. Specific guidelines for surgical removal of infected aneurysms have been proposed and these (in addition to increased use of ampicillin) may be responsible for higher survival rates in recent years. Due to the high incidence of relapses, postoperative blood cultures should be done routinely. Arterial infection should be considered in any elderly patient with salmonella bacteremia especially with prolonged fever or bacteremia after an "adequate course" of antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Extra-intestinal manifestations of salmonella infections. 330 60

The antibacterial efficacy of some of the newer quinolone antimicrobial agents in general, and ciprofloxacin in particular, in animal models of experimental septic arthritis, burn wound sepsis, empyema, chronic gastroenteritis, granuloma pouch infection, intraabdominal abscess, osteomyelitis, prostatis, sinusitis, urinary tract infection, and severe septicemia caused by Pseudomonas aeruginosa is reviewed. In addition, the efficacy of these newer quinolones has been studied in animal models of pneumonia, endocarditis, meningitis, skin and soft tissue infections, and a variety of other systemic infections. Although certain limitations are associated with animal models of infection, properly performed studies clearly have the potential to provide guidelines for evaluating the efficacy of antimicrobial agents in the treatment of some infections in humans.
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PMID:Efficacy of ciprofloxacin in animal models of infection. 355 64

The increased incidence of Salmonella osteomyelitis in patients with sickle cell disease has never been entirely explained. Problems such as cholelithiasis, intestinal infarction, and frequent antibiotic use in this population could possibly result in prolonged or chronic intestinal carriage of Salmonella after acute gastroenteritis. If prolonged carriage were a factor in the pathogenesis of osteomyelitis, attempts to eliminate the Salmonella with antibiotics would be indicated. We did a stool culture survey of 71 patients attending our pediatric sickle cell clinic to determine the incidence of asymptomatic Salmonella carriage. At least two rectal swab cultures were obtained from each patient; 69% of patients also mailed in a stool sample for culture. No Salmonella was isolated. It therefore appears unlikely that prolonged intestinal Salmonella carriage is an important mechanism in the development of Salmonella osteomyelitis in patients with major sickle hemoglobinopathies.
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PMID:Intestinal Salmonella carriage in patients with major sickle cell hemoglobinopathies. 397 46


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