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Two multicenter trials compared single-dose oral therapy with 400 mg of ofloxacin or 3 g of amoxicillin plus 1 g of probenecid in the treatment of uncomplicated gonorrhea in 160 men and 102 women. Patients with a known diagnosis of Chlamydia trachomatis infection were excluded. All pretreatment isolates of Neisseria gonorrhoeae were susceptible to ofloxacin (minimal inhibitory concentration less than or equal to 2 micrograms/ml), whereas roughly 50 percent exhibited intermediate susceptibility to ampicillin (minimal inhibitory concentration, 0.125 to 2.0 micrograms/ml). Post-treatment culture results showed that ofloxacin had eradicated N. gonorrhoeae in 97.5 percent (41 men) of 42 men and all 28 women evaluated. Amoxicillin-probenecid achieved microbiologic cures in 92.7 percent (51 men) of 55 men and 92.6 percent (25 women) of 27 women evaluated. Clinical cure rates among initially symptomatic patients were 84.6 percent (33 men) of 39 men and 81.8 percent (nine women) of 11 women with ofloxacin and 83.0 percent (44 men) of 53 men and 66.7 percent (10 women) of 15 women with amoxicillin-probenecid. No drug-related adverse effects were noted in ofloxacin-treated patients. One patient each in the amoxicillin-probenecid group reported nausea, diarrhea, and vaginitis. These results demonstrate that single-dose ofloxacin is as effective as amoxicillin-probenecid in eradicating N. gonorrhoeae and relieving clinical signs and symptoms of gonococcal infections in both men and women.
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PMID:Single-dose efficacy of ofloxacin in uncomplicated gonorrhea. 251 17

32 hospitalized adult patients with infective episodes of bronchiectasis were enrolled in an ongoing double-blind, placebo-controlled study comparing ofloxacin with amoxicillin. They were randomized to receive either 200 mg ofloxacin or 1 g amoxicillin, both t.i.d. orally for ten days. In the ofloxacin group (15 patients), clinical response was excellent (clinical cure) in 11 and fair (clinical improvement or early reinfection) in three patients with one failure. In the amoxicillin group (17 patients), clinical response was excellent in six, fair in five, and poor (treatment failure) in six patients. Ofloxacin levels at 2 h (day 5) were 2.3 to 8.2 mg/l (mean 3.9 mg/l) for serum and 1.3 to 15 mg/l (mean 4.5 mg/l) for sputum. Sputum: serum ratio was 1.2:1. Amoxicillin levels at 2 h were 10 to 40 mg/l (mean 19.9 mg/l) for serum and 0 to 1.5 mg/l (mean 0.3 mg/l) for sputum, with no amoxicillin detected in sputum in 10 of 17 patients. Sputum: serum ratio was 0.02:1. One patient in the ofloxacin group had nausea. In the amoxicillin group, four patients had nausea and stomach pain, one had vertigo and one had transient peripheral eosinophilia. Ofloxacin thus yielded higher sputum concentration and appeared to be more effective and better tolerated than amoxicillin in infective episodes of bronchiectasis.
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PMID:A double-blind randomized study comparing ofloxacin and amoxicillin in treating infective episodes in bronchiectasis. 354 47

Amoxicillin in single oral doses of 2.0 g, 2.0 g plus 1.0 g probenecid, or 3.0 g was compared with ampicillin 3.5 g plus 1.0 g probenecid in the treatment of 203 males with uncomplicated acute gonococcal urethritis. Cure rates above 95% were produced by all treatments except the 2.0-g amoxicillin dose, which cured 89% of patients. Of 198 pretreatment gonococcus isolates tested by an agar dilution technique for susceptibility to penicillin G, ampicillin and amoxicillin, over 50% showed relative resistance (MIC > 0.06 mug/ml) to the antibiotics. However, amoxicillin was somewhat more active against isolates showing considerable resistance (MIC >/= 1.0 mug/ml) to penicillin G or ampicillin. Adverse effects of amoxicillin were few: two patients reported transient nausea and six noted short-lived diarrhea. No hypersensitivity reactions were observed.
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PMID:Comparison of amoxicillin and ampicillin in single-dose oral treatment of males with gonococcal urethritis. 421 59

The chemistry, microbiology, pharmacokinetics, therapeutic use, adverse effects, and dosage of amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination, are reviewed. Clavulanic acid is a "suicide" inhibitor of bacterial beta-lactamase enzymes and has been effective in preventing destruction of penicillins by these enzymes. Clavulanic acid alone has weak antibacterial activity against most organisms. After oral administration, clavulanic acid is rapidly absorbed; amoxicillin appears to increase its absorption. Absorption of amoxicillin-clavulanic acid is not affected by food. Amoxicillin-clavulanic acid is effective in treating both acute uncomplicated and complicated urinary-tract infections and exacerbations of chronic bronchitis caused by amoxicillin-resistant organisms in adults. It appears to be comparable in efficacy to cefaclor for treating uncomplicated urinary-tract infections in adults and children, acute bronchitis and bronchopneumonia, and acute sinusitis, otitis media, and skin and soft-tissue infections in children. Other infections for which the combination has been effective include cellulitis and intra-abdominal and pelvic sepsis caused by mixed aerobic/anaerobic organisms. Amoxicillin-clavulanic acid has also successfully cured urethritis in men caused by penicillinase-producing Neisseria gonorrhoeae and is superior to amoxicillin alone for beta-lactamase-positive Haemophilus ducreyi infections (chancroid). Diarrhea or loose stools is the most common side effect seen with amoxicillin-clavulanic acid; nausea, vomiting, and skin rash may also occur. Nausea, vomiting, and diarrhea may be lessened by taking the combination with food.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination. 639 83

Current recommendations for antibiotic prophylaxis of bacterial endocarditis include oral amoxycillin, and erythromycin or clindamycin for the penicillin-allergic patient. The authors report the serum concentrations and side effects which may be expected after the recommended oral doses of these compounds. Single doses of 3 g amoxycillin and 600 mg clindamycin, and two doses of erythromycin (1.5 g and 0.5 g 6 h apart) were administered in a random sequence to each of 12 volunteers. After administration, peak serum concentrations of amoxycillin and clindamycin were 27 mg/l and 5.5 mg/l respectively. Amoxycillin was eliminated more rapidly than clindamycin. Serum concentrations of erythromycin were below the sensitivity limit of the assay (0.03 mg/l) in 3 volunteers at 1 h and in 2 at 2 h. The mean peak serum concentrations was 3.1 mg/l. Peak levels were associated with gastrointestinal side effects such as nausea, abdominal cramps and vomiting. The implications of these findings are discussed with respect to use of these antibiotics for the prophylaxis of bacterial endocarditis.
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PMID:[Prevention of endocarditis using amoxycillin, clindamycin or erythromycin. Pharmacokinetic observations]. 648 53

Three grams of amoxycillin administered twice daily for seven days, as an oral powder (Amoxil 3G sachets, Bencard) dispersed in water, to 17 patients with bronchiectasis resulted in striking clinical, spirometric and bacteriological improvement in 11 of 12 patients who were producing purulent sputum from which Haemophilus influenzae was cultured by a selective bacteriological technique (Roberts & Cole, 1980). In the five patients from whose sputum this organism could not be cultured, and in one from whom it could, there was no improvement. Untoward effects were limited to nausea in one patient and acceptability of the regimen by the remaining patients was unanimous. There was no evidence of accumulation of the drug in serum or sputum. The rapidity of effect and oral form of the treatment suggest that it may provide a simple out-patient regimen for chronic bronchial sepsis and severe purulent exacerbations of chronic bronchitis from which H. influenzae can be cultured.
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PMID:A simple oral antimicrobial regimen effective in severe chronic bronchial suppuration associated with culturable Haemophilus influenzae. 660 Nov 2

Antibiotic use was evaluated retrospectively in 1229 patients of a university hospital (Basle, Switzerland). The frequency with which antibiotics were prescribed, the indication, duration of treatment, side-effects and clinical results were compared in relation to various subspecialities. 38.1% of medical, 36.4% of surgical and 24.4% of gynecological patients received one or more antibiotic during hospitalization. The main indications for antibiotic treatment were respiratory infection (57.8%) and urinary tract infections (21%) in medical patients, prophylaxis (38%) and urinary tract infections (23%) in surgery, and urinary tract infections (43%) and adnexitis or endometritis (23%) in gynecology. Amoxycillin or penicillin G were the first-line drugs for respiratory infection, cotrimoxazole for urinary tract infection and cefalothin or cefacetrile for surgical prophylaxis. Patients with endometritis or adnexitis usually received clindamycin in combination with an aminopenicillin. Aminoglycosides were employed in only 9.5% of antibiotic courses. Information on adverse reactions in the records was scanty, only generalized exanthem (13 cases) and nausea/vomiting (2 cases) being specifically mentioned. The therapeutic result was classified by the responsible physician as cure in 50.8% or definite improvement in 16.4% of patients. However, in 118 cases (29.7%) the contribution of antibiotics to the clinical outcome could not be evaluated retrospectively.
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PMID:[Use of antibiotics in hospitalized patients. Comparison of medical, surgical and gynecological units]. 720 74

A case report of toxicity following concurrent administration of high-dose methotrexate and amoxycillin is presented. A 16-year-old male patient was administered 10 high-dose methotrexate cycles for treatment of a fully malignant osteogenic sarcoma. Methotrexate was administered at a dosage of 8 g/m2 and infused intravenously over a 6-h period. The patient received pre- and posttreatment hydration and sodium bicarbonate for alkalinization of urine. Calcium folinate rescue was performed when appropriate. During the 10th cycle, coadministration of amoxycillin (1 g/6 h, p.o.) resulted in prolonged and marked enhancement of methotrexate serum levels. Pharmacokinetic parameters obtained in cycle 10 indicate significant differences for total plasma clearance, mean residence time, and distribution half-life when compared to those in cycles 1-9. Amoxycillin decreased the renal clearance of methotrexate, probably by competition at the common tubular secretion system and by secondary methotrexate-induced renal impairment. The patient experienced acute and subacute toxicity with renal failure, myelosuppression, mucositis, nausea, vomiting, fever, and dermatologic abnormalities. Patients receiving amoxycillin during methotrexate therapy should be closely monitored to avoid severe toxicity.
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PMID:Pharmacokinetic interaction between high-dose methotrexate and amoxycillin. 824 43

Major extensive surgery still represents a cornstone of therapy of gynaecological cancer, and the adoption of implemented clinical guidelines for perioperative management can significantly decrease patient morbidity and mortality and reduce hospital stay. The overall risk of deep venous thrombosis in patients undergoing gynaecological surgery ranges from 7% to 45%, and fatal pulmonary embolism occurs in approximately 1% of these women. A meta-analyses of randomised trials showed a significant decrease in deep venous thrombosis in women receiving unfractioned heparin [UFH] compared with controls, and revealed no significant difference in deep venous thrombosis and pulmonary embolism between patients who received UFH and those who received low-molecular weight heparin [LMWH]. Potential advantages favouring LMWH over UFH include once-daily versus repeated daily injections and a lower risk of heparin-induced thrombocytopenia. All patients undergoing major surgical operations should receive LMWH that should be started preoperatively and then given for 7-10 days at least and prolonged for up to 4 weeks in high-risk cases. Antithrombotic mechanical methods can be added to pharmacological agents, but should not been used alone. Cephalosporins and amoxicillin-clavulanic acid have been widely used in gynaecological surgery prophylaxis. Both amoxicillin-clavulanic acid and cefazolin have good in vitro activity against the microbes more frequently involved in postoperative infections, such as Gram-negative bacilli, but amoxicillin-clavulanic acid is more effective against anaerobes. A single dose of antibiotics has been shown to be as effective as multiple doses in many trials that have compared a single-dose regimen with a multiple-dose regimen. Amoxicillin-clavulanic acid prophylaxis at the induction of anaesthesia can be suggested for gynaecological cancer patients undergoing major gynaecological surgery with or without colorectal resection. An additional antibiotic dose is recommended for prolonged operations or when intraoperative blood loss is important. Cephalosporins can be administered to women with a history of penicillin allergy not manifested by an immediate hypersensitivity reaction, whereas tigecyclin should be reserved to patients with a prior anaphylactic reaction to beta-lactams. Recent meta-analyses of randomised trials on patients undergoing elective colorectal surgery found more anastomotic leakages in patients who had preoperative mechanical bowel preparation with oral administration of different solutions than in those who had not, whereas there were no significant differences between the two arms as for wound infections, other septic complications, and non-septic complications. Therefore, preoperative mechanical bowel cleansing is not warranted for gynaecological cancer patients scheduled for surgery that may involve colon-rectum. After major abdominal gynaecological surgery, early oral feeding (within the first 24h regardless of the resolution of postoperative ileus) appears to be associated with increased nausea, shorter time to the presence of bowel sound, shorter time to first solid diet, and a trend toward shorter hospital stay when compared with delayed feeding. Since early oral feeding is safe but associated with increased nausea, the decision whether to adopt this postoperative regimen should be individualised. Decision making processes about thromboprophylaxis, antibiotic prophylaxis, bowel preparation for surgery that may involve colon-rectum, and timing of postoperative oral feeding will become more and more relevant for improved safety and quality of life of women with gynaecological cancer.
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PMID:The perioperative management of patients with gynaecological cancer undergoing major surgery: A debated clinical challenge. 1935 47

Amoxicillin-Clavulanic acid continues to be one of the most commonly used antibiotic combinations. Hepatic injury due to this antibiotic is rare. We report a case of amoxicillin-clavulanic acid induced hepatitis causing painless jaundice to bring to attention this rare side effect of this commonly used antibiotic. This is a case of a 62-year-old Caucasian female, who presented with acute onset severe painless jaundice, nausea, vomiting, and pruritus of less than 1-week duration. She had completed a course of amoxicillin-clavulanic acid 3 weeks prior to presentation. A careful history pointed to this simple diagnosis. It may be easily missed without an in-depth history and the patient may be subjected to unnecessary expensive tests. This case is reported to highlight cost conscious care by keeping in mind a rare side effect of the commonly used antibiotic.
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PMID:An Uncommon Side Effect of a Commonly Used Antibiotic: Amoxicillin-Clavulanic Acid Induced Hepatitis. 2902 93


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