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Query: UMLS:C0262471 (ENT)
 5,307 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Betalactamase-producing organisms are responsible for an increasing number of ENT and lower respiratory tract infections. Or cephalosporins and the combination of amoxicillin with the beta-lactamase inhibitor clavulanic acid are alternatives to ampicillin therapy. The killing activity of cefadroxil on the organisms most often responsible for ENT and respiratory infections was evaluated in vitro using a viable bacteria count method, comparatively with cefaclor, josamycin, and amoxicillin-clavulanic acid. Killing activity was found to be time-dependent for all the antimicrobial agents studied. Cefadroxil exhibited the same bactericidal effect on Streptococcus pyogenes and S. pneumoniae than the other agents. Haemophilus influenzae and an increasing number of Pneumococcus strains were resistant to josamycin which is therefore not appropriate for first-line therapy. As compared with amoxicillin and amoxicillin-clavulanic acid, cefadroxil was less active on H. influenzae and more active on Staphylococcus aureus. Production of beta-lactamase failed to influence the killing activity of cefadroxil. These bacteriologic data, together with results of pharmacologic studies (long half-life and good penetration within tissues) can explain the clinical successes obtained with cefadroxil in ENT and lower respiratory tract infections.
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PMID:[Bactericide activity of cefadroxil comparated with amoxicillin-clavulanic acid, cefaclor and josamycin]. 175 16

Determination of minimal inhibitory concentrations (MICs) provides data on the susceptibility or resistance of a bacteria; however, in susceptible bacteria this parameter is not predictive of effectiveness of the antimicrobial agent. Bactericidal activities of cefadroxil, of amoxicillin, and of the amoxicillin-clavulanic acid combination on bacteria commonly found in ENT and lower respiratory tract disease were studied comparatively. The antibiotics were given by the oral route to six healthy volunteers. With beta-lactamase-producing and non-beta-lactamase-producing strains of Escherichia coli, amoxicillin produced MICs consistent with susceptibility but failed to exhibit a bactericidal effect, whereas cefadroxil was bactericidal. Combination of amoxicillin with an inhibitor did not modify this activity on E. coli and failed to produce a bactericidal effect on Klebsiella pneumoniae similar to that seen with cefadroxil. Amoxicillin with and without clavulanic acid exhibited comparable effectiveness on Streptococcus pyogenes and S. Pneumoniae. The bactericidal effect of cefadroxil on S. pneumoniae was of similar magnitude but shorter duration than that of amoxicillin. Cefadroxil and the amoxicillin-clavulanic acid combination had similar bactericidal effects against Staphylococcus aureus. These antibiotics exhibited a time-dependent effect on Gram positive microorganisms. These pharmacodynamic data, together with measures of bactericidal activity, may be very helpful for selecting the appropriate antibiotic and dosage.
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PMID:[Bactericidal effect of cefadroxil, amoxicillin alone or in combination with clavulanic acid in sera of healthy volunteers]. 180 38

The combination of erythromycin ethylsuccinate and acetyl sulfafuroxazole (Pediazole = ES) is effective against Hemophilus influenzae, including beta-lactamase-producing strains, and against Streptococcus pneumoniae, including macrolide-resistant strains. In this study, mean daily dosage was 40-50 mg/kg for cefaclor and 50 mg/kg ES + 150 mg/kg sulfamide for Pediazole. Both products were given in three divided doses per day for ten days. Tolerance was evaluable in 106 children and effectiveness in 103 children including 52 in the ES group and 51 in the cefaclor group. Mean age was 23.5 months and both groups were comparable as concerns age, weight, previous ENT disease, and severity of the otitis media. Tolerance was satisfactory in both groups. Clinical results were as follows: failures before or at completion of the course, 5/52 in the ES group versus 13/51 in the cefaclor for the treatment of children with acute otitis media.
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PMID:[An open randomized trial, Pediazole versus cefaclor in the treatment of acute otitis media in children]. 202 23

During 1983-87, tympanostomy tubes were inserted in a total of 4952 ears of 2575 children remitted to the ENT Department of our hospital because of chronic or recurrent otitis media problems. The children were included in a prospective study and referred to one of three groups for comparison of findings. Group 1 included all 6- to 12-month-old infants undergoing primary tube treatment; group 2, all children 1 year or older who had their first ventilation tube(s) inserted in connection with adenoidectomy; and group 3, all children in whom tympanostomy had been performed one or more times previously. Middle ear effusion was aspirated from 2392 ears (48%); 67.6% of all ears were negative for bacteria and 22.1% of the ears with effusion grew pathogenic bacteria. S. pneumoniae was the most frequently cultured pathogen among the 6 to 12 month olds in group 1, but in groups 2 and 3 H. influenzae occurred more frequently than S. pneumoniae. Beta-lactamase-producing strains of pathogenic bacteria were formed in only 4% of all ears with effusion: H. influenzae in 1.2% and B. catarrhalis in 2.8%. Compared with figures from the United states, the frequency of beta-lactamase-producing strains is low in the present series. This is probably explained by differences in antimicrobial treatment practices; in Finland and the Scandinavian countries, penicillin V is the primary drug for acute otitis media. In light of present results, it seems well-suited for treatment of otitis media in young children.
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PMID:Bacterial findings in middle ear effusion in children. 211 35

The authors report the results of the study of 435 bacteriological samples taken in children presenting with acute otitis media, in the out-patient department of ENT at the hospital Bretonneau (Paris) and in Valognes (Manche) from October 1981 to September 1987. Three bacterial organisms prevailed: Haemophilus (37 and 22% respectively), S. pneumoniae (25 and 7%) and Staphylococcus (16 and 17%). Pseudomonas was fairly frequent in cases with otorrhea, even when recent. Comparison with other studies shows the clear progression of the incidence of Haemophilus in acute otitis media. The percentage of the strains secreting a beta-lactamase was 17% whether the children live in the country or in town. The frequency of S. pneumoniae was independent of age but was clearly lower in cases with prolonged or relapsing otitis. According to these results, the authors discuss the therapeutic strategy for acute otitis media. Amoxicillin still remains the antibiotic of choice. In case of persisting or relapsing otitis, the bacteriological examination will allow choosing the best adapted antibiotic: first generation cephalosporin, clavulanic acid and amoxicillin or trimethoprime and sulfamethoxazole.
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PMID:[Bacteriologic study of acute otitis media in hospitals and private practice]. 320 71

Five cases of meningitis due to Haemophilus influenzae type b are reported. In four, the same pathogen was recovered from blood. In every case, meningitis developed despite administration of macrolides for ENT infections (4 cases) or pneumonia (1 case). These five observations are conclusive evidence that macrolides failed to prevent meningeal diffusion of Haemophilus influenzae presumptively responsible for the initial focal infection. In vitro activity of macrolides against Haemophilus influenzae is poor. For the treatment of ENT infections in pediatric patients aged 2 months to 5 years, the age group most susceptible to infection by Haemophilus influenzae, we recommend amoxicillin which is more active and bactericidal. An adequate dosage should be used (50 to 100 mg/kg/24 h) divided into four oral doses given at six hour intervals. This therapeutic attitude may need to be revised if the prevalence of beta-lactamase-producing H. influenzae strains (5 to 10% as of now) were to increase. In this case, use of an amoxicillin-clavulanic acid combination under the same conditions as outlined above may prove satisfactory. Correct administration of judiciously chosen antibiotics in ENT infections in infants and children is the most effective means of preventing meningitis due to H. influenzae.
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PMID:[Haemophilus influenzae infections in infants and macrolides. Importance of the choice of an effective antibiotic and compliance with its administration schedule]. 389 73

The aim of the present investigation was to determine to what extent beta-lactamase producing Haemophilus influenzae (H.i.) and Branhamella catarrhalis (B.c.) were isolated in cases of failure of treatment of acute otitis media (AOM) with phenoxymethylpenicillin. Among children with suspected therapeutic failure referred to an ENT specialist altogether 11, 15% of those referred, fulfilled the criteria of AOM. Three of them were on erythromycin, 1 on ampicillin and 7 on phenoxymethylpenicillin. In 5 of the children treated with phenoxymethylpenicillin H.i. was isolated from middle ear exudate and/or the nasopharynx. All H.i. isolates were non-capsulated and beta-lactamase negative. One beta-lactamase producing B.c. was isolated from the nasopharynx in a patient with pure culture of H.i. in the ear exudate. The present investigation did not support the suggestion that beta-lactamase producing H.i. or B.c. are major causative agents in therapeutic failures of AOM treated with phenoxymethylpenicillin and did not produce any evidence supporting a change from the recommended ampicillin esters/amoxycillin in therapeutic failures.
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PMID:Phenoxymethylpenicillin and therapeutic failure in acute otitis media. 393 32

During the last decade a large number of novel antimicrobial agents has been developed and marketed. For the practitioner, three groups of oral substances are important, namely cephalosporins, fluoroquinolones and macrolides. The new oral cephalosporins have an improved beta-lactamase stability. Their serum half-life of 2 to 4 h is more than twice as long as that of older substances; however, their oral bioavailability is lower than that of older cephalosporins. They have an excellent activity against gram-negative bacteria, but no or only little activity against staphylococci. They are especially indicated in ENT and UT infections. The fluoroquinolones have an excellent bioavailability and are therefore ideal as oral drugs. Their microbiological spectrum is best against gram negative microorganisms. Pneumococci are not very susceptible to quinolones, with the exception of sparfloxacin. There is an increasing emergency of resistance due to a broad use of these substances. Main indications are UT infections, febrile enterocolitis, and bone and joint infections. New macrolides give less side effects and improved pharmacokinetics. Clarithromycin and azithromycin have high tissue concentrations. The main indications are upper respiratory tract infections and the community-acquired pneumonia. Newer indications for clarithromycin and azithromycin are non-tuberculous mycobacteriosis and in special cases toxoplasmosis in AIDS patients. Despite the different advantages of the new oral antibiotics, older substances such as aminopenicillins and cotrimoxazole are still important agents in the outpatient treatment.
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PMID:[Current antibiotics for clinical practice]. 896 13

Bacteriology of acute maxillary sinusitis was studied in 569 patients in 16 centers of 6 countries located throughout Europe during 1992-1994 by ENT specialists. Patients with symptoms of acute sinusitis lasting less than 3 weeks with ongoing purulent nasal discharge were included. Diagnosis was verified by sinus x-ray or ultrasonography and a positive aspiration finding in maxillary sinus puncture. One or more pathogens were isolated from the maxillary sinus aspirates of 375 (66%) patients. Fifty-six percent of patients harboured 1 pathogen and 10% multiple pathogenic organisms, respectively. Haemophilus influenzae was the most common pathogen isolated (148 isolates), occurring as a single pathogen in 14% of the patients. The occurrence of H. influenzae was highest in Finnish military hospital patients (43-48%), as compared with the non-military Finnish patients (9-11%) or to patients from other European centers (mean 13%). H. influenzae was more frequently beta-lactamase positive in other European centers (22%) than in Finnish centers (7%). Streptococcus pneumoniae was the most common pathogen isolated in other European centers (20%) but second most common in Finnish centers (13%). Moraxella catarrhalis occurred at quite similar frequency among Finnish centers (9-14%), but clearly less often in other centers (mean 4%). S. aureus, which in acute maxillary sinusitis is regarded as a contaminant from the nasal cavity, was more prevalent in other European centers (12%) than in Finnish centers (4%). In patients with acute maxillary sinusitis reliable bacteriological samples should be taken by antral aspiration directly from the diseased sinus.
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PMID:Bacterial findings in acute maxillary sinusitis--European study. 928

The activities of the pristinamycin and its two components (RP 12536 and RP 27404) were investigated using the reference agar dilution method M11A3, on 175 anaerobic strains in comparison with that of erythromycin, clindamycin, metronidazole, amoxycillin either alone or combined with clavulanic acid, piperacillin, cefoxitin, cefotetan and cefotaxime. beta-lactamase production was detected for all the 55 B. fragilis group strains and 8/12 Prevotella and 2/18 Fusobacterium strains, respectively. On the whole anaerobes, resistance rates (%) were respectively: RP 27404 (69), RP 12536 (64), pristinamycin (5) erythromycin (31), clindamycin (17), metronidazole (7) amoxycillin (24), amoxycillin-clavulanic acid (2), piperacillin (7), cefoxitin (14), cefotetan (21) and cefotaxime (27). RP 27404 and 12536 had low activities on anaerobes but acted synergistically as pristinamycin. The greatest anti-anaerobic potencies were obtained with amoxycillin-clavulanic acid combination, pristinamycin, metronidazole and piperacillin. As resistance was not found for pristinamycin among Prevotella, Fusobacterium, Gram+ rods and Peptostreptococcus, this streptogramin may be an appropriate agent for the treatment of periodontitis, pulmonary, ENT, gynecologic and soft tissue infections where these anaerobes are frequently involved.
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PMID:[In vitro activity of 10 antibiotics including pristinamycin and its two components (RP 12536 and 27404) against strict anaerobes]. 976 28


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