Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Adverse effects are common in patients with acquired immunodeficiency syndrome (AIDS) who receive trimethoprim-sulfamethoxazole (TMP-SMX). Two patients experienced a rare anaphylactoid syndrome. Within hours of receiving a double-strength TMP-SMX tablet, a 28-year-old human immunodeficiency virus (HIV)-positive man developed fever, hypotension, and bilateral pulmonary infiltrates. Broad-spectrum antimicrobial therapy was begun but discontinued 2 days later when signs and symptoms resolved and specimens for Pneumocystis carinii were negative. A 38-year-old man developed rash, fever, hypotension, hyperbilirubinemia, renal dysfunction, and bilateral pulmonary infiltrates after taking two doses of oral TMP-SMX. Several antimicrobial agents, including parenteral pentamidine, were administered despite lack of evidence for P. carinii or other infection. four case reports of similar reactions in patients with AIDS have been published. Notable differences exist between the syndrome described and anaphylaxis. The TMP-SMX anaphylactoid reactions in patients with AIDS mimic sepsis or opportunistic infection, thus making diagnosis difficult.
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PMID:Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review. 228 64

Sixty-three patients with acute nonlymphoid leukemia (ANLL) under cytostatic treatment were investigated in a randomized trial to determine whether oral administration of cotrimoxazole (TMP/STX) would reduce the rate of infection. Four significant differences were observed between the group given TMP/STX (30 patients) and the control group (33 patients): 1) the mean duration of severe granulocytopenia (less than or equal to 500 PMN/mm3) before the first febrile episode was longer in prophylaxis group, 14.26 days versus four in the control group (p less than 0.001); 2) the number of febrile episodes was 37 in TMP/STX group and 69 in control group (p less than 0.01); 3) 23 patients on prophylaxis presented at least one febrile episode versus 33 in the control group (p less than 0.01); 4) deaths due to infection were two in the TMP/STX group versus 11 in control group (p less than 0.05). Prophylaxis with TMP/STX appears to be useful since by reducing the number of febrile episodes and deaths due to infection, it increases the survival of leukemia patients under cytostatic drugs. Nevertheless, further studies on a larger number of patients are necessary in order to confirm the true efficacy of the drug in the reduction of sepsis and death due to infection.
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PMID:Cotrimoxazole prophylaxis in patients with leukemia and prolonged granulocytopenia. 637 70

Inadequate guidelines for the treatment of neonatal listeriosis led us to evaluate various antibiotics in a newborn rat model of Listeria monocytogenes type 4b sepsis. Minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC based on 99.9% killing), expressed as micrograms/ml, were determined for: ampicillin (MIC 0.46/MBC 3.20); ampicillin with subinhibitory concentrations of gentamicin (0.24/not done); erythromycin (0.14/3.59); gentamicin (0.38/1.11); gentamicin with subinhibitory concentrations of ampicillin (0.235/ND); piperacillin (2.7/16.8); rifampin (0.026/0.094); sulfamethoxazole (SMZ 47.5/ND); SMZ with subinhibitory concentrations of trimethoprim (0.74/1.48); trimethoprim (TMP 0.12/ND); and TMP with subinhibitory concentrations of SMZ (0.04/0.08). In the in vivo model, rats were challenged intraperitoneally with 2 X 10(6) cfu of L. monocytogenes at 3 days-of-age. Antibiotics (ampicillin, ampicillin + gentamicin, erythromycin, piperacillin or TMP/SMZ) were given every 12 h for 2 days starting on day 5 of life while rifampin was given once daily for 2 days. Survival tabulations and spleen cultures were done on day 8 of life. All animals who received antibiotics had better survival than the controls given saline (p less than 0.01 for rifampin, erythromycin, TMP/SMZ, ampicillin, ampicillin + gentamicin; p less than 0.05 for piperacillin). Rifampin, erythromycin and TMP/SMZ gave better survival than piperacillin (p less than 0.01). Although ampicillin plus gentamicin were superior to ampicillin alone (p less than 0.01) in reducing the number of organisms in the spleens, rifampin was superior to all regimens in this regard (p less than 0.0005 vs piperacillin, ampicillin, TMP/SMZ; p less than 0.05 vs ampicillin + gentamicin, erythromycin). Rifampin may be a useful addition to other regimens in speeding the elimination of the organism.
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PMID:In vitro and in vivo activity of various antibiotics against Listeria monocytogenes type 4b. 644 56

One hundred children with cancer and bacterial sepsis were observed for one month after completion of antibiotic treatment for subsequent episodes of infection. After satisfactory clinical and bacteriological responses were achieved and antibiotic therapy terminated, 38 of the patients were maintained on trimethoprim--sulfamethoxazole (TMP-SMZ) and 62 did not receive the drug combination. Of the 26 neutropenic patients not receiving TMP-SMZ 23 (88%) had episodes of infection, whereas 4 (36%) of the 11 given the drug had recurrent or re-infection episodes (P = less than 0.001). A difference of similar significance was observed in the non-neutropenic patients. Infections in children in relapse of their malignancy were twice as frequent in those not receiving the drug as in those who received it (P = less than 0.02, greater than 0.01). Of the 19 patients who died during the month of observation, none had received TMP--SMZ. This study shows that the administration of TMP--SMZ after bacterial sepsis reduces the number of infectious episodes in neutropenic and non-neutropenic patients, with the exception of the non-neutropenic patient in remission.
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PMID:Post-sepsis prophylaxis in cancer patients. 668 95

Urinary tract infections (UTIs) are still one of the most common bacterial infections in pregnant and non-pregnant women. It is estimated that about 10-20% of all women suffer from a UTI at some point in life. The presence of UTI is defined as the existence of urinary symptoms such as frequency of urination and dysuria with or without bacteriuria or pyuria. The prevalence of bacteriuria in females varies from less than 1% in infants to 10% and more in older women. There are major differences in the clinical features between young and elderly women depending on the different pathogenesis, microbiology and general condition. Especially for elderly women, symptomatic and asymptomatic bacteriuria presents a risk factor for bacteraemia, sepsis and also increased mortality. During pregnancy, the prevalence of bacteriuria does not change but there are some changes in the pathogenesis that increase the rate of pyelonephritis. Asymptomatic bacteriuria rarely resolves spontaneously during this time. For non-pregnant women, short therapy strategies are recommended, preferably 3 days of trimethoprim-sulphamethoxazole (TMP/SMX) or quinolones. In pregnant women, therapy with amoxycillin or an oral cephalosporin is considered optimal.
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PMID:Uncomplicated urinary tract infections in pregnant and non-pregnant women. 840 50

Infections are a major cause of morbidity and mortality in patients undergoing high-dose therapy and subsequent autologous or allogeneic haemopoietic stem cell transplantation, despite the change from topical to systemic anti-infection prophylaxis and the introduction of growth factors and new antimicrobial drugs. We report our single centre experience with data from 409 patients treated at our unit from its opening in 1990 until May 1997. Three hundred and seventy-eight patients were transplanted for the first time, 12 patients were retransplanted or boosted and 19 patients were readmitted for miscellaneous reasons. 245 patients were allografted and 157 autografted. Antimicrobial prophylaxis was mainly quinolones, fluconazole plus amphotericin-B orally, aciclovir, and TMP/SMX or pentamidine. Three hundred and nineteen (78%) developed fever of significantly longer duration in the allogeneic setting with anti-CMV seropositivity. The most frequent infection was fever of unknown origin (50.6%), followed by septicaemia (12.5%) and pneumonia (11.0%). Pathogens isolated in 24.6% of the infections were mostly gram-positive bacteria (57.9%), followed by non-fermenting rods (11.2%), Aspergillus spp. and Candida spp. (10.3%, each). Cumulative response rate to antimicrobial therapy was 66.9%. Infections were responsible for 62.5% (25/40) of deaths after transplantation. Predominant pathogens were Aspergillus spp. (11), Candida spp. (four), and Pseudomonas spp. (three). None of the patients died from gram-positive bacterial infection. The risk of dying from infection was 11.2% after allografting and 0.8% after autotransplantation. Infections remain a major risk for early death after allogeneic transplantation of haemopoietic stem cells. Infection with gram-negative bacteria can be prevented by quinolone prophylaxis. Predominant pathogens are Aspergillus spp. Candida spp. and nonfermenting rods. Systemic infection with these pathogens is associated with a poor prognosis. Antimycotic prophylaxis and the therapy must be improved.
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PMID:Early infections in patients undergoing bone marrow or blood stem cell transplantation--a 7 year single centre investigation of 409 cases. 1021 90

Within a 6-year period from January 1991 to December 1996, 19 patients with Salmonella choleraesuis bacteremia were enrolled for clinical and microbiological analysis. Young children, the elderly and patients with hematological malignancy (36.8%), liver cirrhosis (26.3%), systemic lupus erythematosus (10.5%), chronic renal impairment (10.5%), and peptic ulcer (10.5%) were at high risk of this infection. The ratio of male to female was 3:1. Three cases (15.8%) were nosocomially acquired. Fever (89.5%), chills (57.9%) and anorexia (52.6%) were the most common clinical manifestations. Seven patients (36.8%) presented no gastrointestinal manifestations. Normal white blood cell count was noted in seven patients (36.8%), and neutropenia caused by underlying diseases or severe infection was found in six cases (31.6%). Various types of metastatic focal infections were found, such as septic arthritis, cutaneous infection, spontaneous bacterial peritonitis, and pneumonia. The severe immunocompromised status of patients and the high virulence of this pathogen may contribute to the high case fatality rate (21%). Higher resistance rate to commonly used antimicrobial agents was noted in ampicillin (94.7%), chloramphenicol (89.5%), and TMP/SMZ (63.8%). All strains of S. choleraesuis were susceptible to third-generation cephalosporins and fluoroquinolones. Generally, S. choleraesuis bacteremia should be taken into account in the differential diagnosis of sepsis in immunocompromised patients, even without gastrointestinal manifestations. The third-generation cephalosporins and fluoroquinolones may be the first choice for treatment of this invasive infections.
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PMID:Salmonella choleraesuis bacteremia in southern Taiwan. 1033 Jul 99

Prophylaxis against Pneumocystis carinii pneumonia (PCP) is an essential part of the management of children with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). No dose-ranging studies were ever performed; therefore, the amount of trimethoprim-sulfamethoxazole (TMP-SMX) needed to suppress PCP in children with HIV/AIDS is not known. The dose recommended by the Centers for Disease Control (CDC) has been thought to be just above the threshold needed for prevention, based on anecdotal breakthrough PCP in cancer patients who were improperly dosed. We have been giving prophylaxis based on body weight rather than surface area, and this, combined with growth of our children, has led to a large experience with dosages lower than the currently recommended 150 mg/m2. The medical records of children with HIV who met CDC guidelines for institution of PCP prophylaxis were reviewed. To ascertain the per square meter (m2) dosage each child was receiving, body surface area was calculated from height and weight measurements. Dosages were recalculated every 6 months and at each dosage change. Data regarding PCP infection, bacterial infections, and side effects of TMP-SMX were extracted. Data were compiled from 1,719.5 child-months of TMP-SMX prophylaxis, including 1,532.5 child-months below the currently recommended dose. Sixty-seven percent of our child-months were at or below two-thirds the CDC recommended dose. There were no cases of proven or suspected PCP. Incidence of other serious bacterial infections was low. Bacteremia and sepsis with Streptococcus pneumoniae was the most common proven bacterial infection, at a rate of 5.5 episodes per 100 child-years. The incidence of bacterial infection did not vary by the dose of TMP-SMX. TMP-SMX prophylaxis was well tolerated; most reactions were mild and self-limited and did not recur with re-institution of the drug. Only 6.1% of this cohort had TMP-SMX prophylaxis discontinued due to perceived toxicity. These data show that the currently recommended dose of TMP-SMX (150 mg/m2) may not be required to prevent PCP in children with HIV/AIDS. The drug is well tolerated at all dosage levels. The incidence of serious bacterial infection in this cohort of patients did not depend upon the amount of TMP-SMX prescribed. A prospective, controlled clinical trial of low-dose TMP-SMX for children with HIV infection is warranted.
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PMID:Successful prophylaxis against Pneumocystis carinii pneumonia in HIV-infected children using smaller than recommended dosages of trimethoprim-sulfamethoxazole. 1153 Jul 67

Plasmaseparation is a treatment under discussion for critically ill patients, especially in sepsis and multiorgan failure. These patients receive a variety of different fluid substitutes, including hydroxyethylstarch (HES). HES is known to influence rheological properties, but nothing is known about the possible interactions between HES and the plamaseparation procedure. We used an in vitro plasmaseparation circuit with heparinized porcine blood. Before priming the system, 2 liters of blood were supplemented by adding 100 ml of either NaCl 0.9% or HES (n=6 in each group). We monitored the transmembrane (TMP) and the filtration pressure (PF) and measured free plasma hemoglobin (free Hb) and platelet counts before and after the two hours plasmaseparation procedure. The final transmembrane pressure was significantly higher with HES substitution. In the HES group we found negative filtration pressures from the very beginning with a significant further decrease toward the end of the experiments. A significant increase in free Hb and decrease in platelet counts were noted only in the HES group. Volume substitution with HES leads to impaired filtration properties and deteriorated hemocompatibility in in vitro plasmaseparation. Further studies have yet to evaluate whether or not the effects described also occur under clinical conditions.
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PMID:The influence of HES on the filtration properties of capillary membrane plasmaseparation. 1229 65

Trimethoprim-sulfadiazine (TMP-SDZ) (Tribressin tablets 120 - 100 mg sulfadiazine, 20-mg trimethoprim [Coopers Animal Health, Inc., A Pitman-Moore Company, Mundelein, Ill.]) is a broad spectrum antibiotic combination effective in the treatment of bacterial pneumonia, urinary tract infections, pyoderma, meningitis, and prostatitis.(1) In clinical trials in puppies and adult dogs, TMP-SDZ was considered safe at both the manufacturer's recommended dose (15 mg/kg, b.i.d., or 30 mg/kg, u.i.d., per os for < 14 days(2)) and at 10 times that dose for 20 dayS.(3) Many infections, however, require prolonged high-dose therapy for resolution. The following study describes two cases of aplastic anemia and sepsis associated with intermittent, chronic (17-25 days), high-dose (25-30 mg/kg, b.i.d., per os) TMP-SDZ therapy recommended for the treatment of pyoderma.(4-7)
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PMID:Aplastic anemia associated with prolonged high-dose trimethoprim-sulfadiazine administration in two dogs. 1266 95


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