The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform

Lindsay E Nicolle - One of the best experts on this subject based on the ideXlab platform.

  • Short-term Therapy for urinary tract infection: success and failure.
    International journal of antimicrobial agents, 2007
    Co-Authors: Lindsay E Nicolle
    Abstract:

    The pharmacokinetic characteristics of some antimicrobials lead to very high urinary concentrations. This, together with the superficial nature of bladder infection and effective voiding, supports the use of Short-Course antimicrobial Therapy for treatment of acute uncomplicated cystitis. Even a single dose is effective for >90% of episodes for some antimicrobials. Short-Course Therapy for 3 days is, however, the current accepted standard of Therapy for acute uncomplicated urinary tract infection (UTI). Complicated UTI is a more diverse clinical entity. For individuals with some underlying abnormalities, including incomplete drainage of urine or renal failure, Short-Course Therapy is never appropriate. However, some individuals with complicated UTI have adequate urinary emptying, infection limited to the bladder and normal renal function. For these persons, the same principles that promote effective Short-Course Therapy for treatment of acute uncomplicated UTI should also apply. However, clinical studies reported to date do not support the use of Short-Course Therapy for treatment of complicated cystitis. Further studies enrolling well-characterised patient populations with consistent clinical presentations are required to define the role, if any, of Short-Course Therapy in complicated UTI.

  • Best pharmacological practice: urinary tract infections.
    Expert opinion on pharmacotherapy, 2003
    Co-Authors: Lindsay E Nicolle
    Abstract:

    Urinary tract infection is the most frequent bacterial infection. Acute uncomplicated urinary infection and acute non-obstructive pyelonephritis occur in young women with normal genitourinary tracts. Empirical Short-Course Therapy is preferred for the management of acute cystitis, but evolving resistance requires continuing reassessment of optimal antimicrobial selection. Empirical trimethoprim or trimethoprim/sulfamethoxazole has been recommended, but increasing resistance to these agents suggests that pivmecillinam, nitrofurantoin and perhaps fosfomycin trometamol should be considered. Although flouroquinolones are effective as Short-Course Therapy, widespread empirical use of these agents should be discouraged because of potential promotion of resistance. For acute non-obstructive pyelonephritis, flouroquinolones are the empirical oral treatment of choice, although urine culture results should direct continuing Therapy. Complicated urinary tract infection occurs in men or women of all ages with underlying abnormalities of the genitourinary tract. Treatment of complicated urinary infection is individualised, taking into consideration the underlying abnormality and susceptibilities of the infecting organism. Asymptomatic bacteriuria should not be treated except in pregnant women, in patients prior to undergoing an invasive surgical procedure, or renal transplant recipients in the early postrenal transplant period.

Barry M. Farr - One of the best experts on this subject based on the ideXlab platform.

  • Short-Course Therapy of catheter-related Staphylococcus aureus bacteremia : a meta-analysis
    Annals of internal medicine, 1993
    Co-Authors: John A. Jernigan, Barry M. Farr
    Abstract:

    OBJECTIVE To determine, through structured methodologic review of published articles, the effectiveness of Short-Course (< or = 2 weeks) antibiotic Therapy for catheter-related Staphylococcus aureus bacteremia. DATA SOURCES English-language publications on catheter-related S. aureus bacteremia identified using MEDLINE (1966 to the present) and bibliographic review of relevant articles and textbooks. STUDY SELECTION Any study reporting outcome data for patients with catheter-related S. aureus bacteremia who were treated with Short-Course Therapy. DATA EXTRACTION Epidemiologic criteria were applied to assess the quality of protection provided by each study against four important types of biases. In addition, the statistical precision of each study was assessed. DATA SYNTHESIS Eleven studies were identified. Reported late complication rates varied from 0% to 29%; the pooled estimate of the late complication rate was 6.1% (95% Cl, 2.0% to 10.2%). Ten of the 11 studies were uncontrolled. Only three provided adequate protection against treatment allocation bias. None of the studies adequately defined the illness under study, and only four provided adequate follow-up. The relapse rates in all 11 studies had low statistical precision. The complication and mortality rates for catheter-related S. aureus bacteremia when published data were pooled, regardless of duration of Therapy, were 24% and 15%, respectively. CONCLUSIONS The available data regarding the safety of Short-Course Therapy for catheter-related S. aureus bacteremia are potentially flawed by both bias and statistical imprecision. The optimal duration of treatment remains unknown. Short-Course Therapy should be viewed with caution in treating this serious infection until randomized trials determine the comparative rates of late complication.

  • Short-Course Therapy of Catheter-related Staphylococcus aureus Bacteremia
    Annals of Internal Medicine, 1993
    Co-Authors: John A. Jernigan, Barry M. Farr
    Abstract:

    Objective: To determine, through structured methodologic review of published articles, the effectiveness of Short-Course ( 2 weeks) antibiotic Therapy for catheter-related Staphylococcus aureus bac...

Jeffrey J. Collins - One of the best experts on this subject based on the ideXlab platform.

  • Effectiveness of Short-Course Therapy (5 days) with grepafloxacin in the treatment of acute bacterial exacerbations of chronic bronchitis.
    Clinical therapeutics, 1999
    Co-Authors: C. Andrew Deabate, Robert B. Bettis, Zev M. Munk, Harold Fleming, Nancy Munn, Ernie Riffer, Barbara Bagby, Gregory Giguere, Jeffrey J. Collins
    Abstract:

    Three hundred eighty-nine patients were enrolled in a double-masked, multicenter, randomized clinical trial comparing the clinical and bacteriologic efficacies and safety of a 5-day Course (n = 195) versus a 10-day Course (n = 194) of grepafloxacin 400 mg once daily in the treatment of acute bacterial exacerbations of chronic bronchitis (ABECB). Patients in the 5-day treatment group received placebo on days 6 through 10. Bacteriologic assessments were based on cultures of sputum specimens obtained before and, when possible, during and after treatment. Organisms were isolated from the pretreatment sputum specimens of 332 of 388 (86%) patients, the primary pathogens being Haemophilus parainfluenzae, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Staphylococcus aureus (29%, 19%, 4%, 5%, and 5% of isolates, respectively). Among isolates tested for betalactamase production, results were positive in 25% of H influenzae isolates and 90% of M catarrhalis isolates. Forty-two percent of S pneumoniae isolates demonstrated reduced susceptibility (intermediate or high-level resistance) to penicillin. A satisfactory clinical outcome (cure or improvement) was achieved in 83% (128 of 155) and 81% (122 of 150) of clinically evaluable patients treated with grepafloxacin for 5 or 10 days, respectively. Pathogens were eradicated or presumed eradicated in 77% (106 of 138) and 80% (98 of 123) of bacteriologically evaluable patients treated with grepafloxacin for 5 or 10 days, respectively. The 2 treatment groups were equivalent with respect to both clinical and bacteriologic efficacy, and no statistically significant differences in the incidence of drug-related adverse events were seen between the 2 groups. Substantial symptom relief was evident with both treatment regimens by the first during-treatment measurement, which occurred between days 3 through 5. These results indicate that treatment with 400 mg grepafloxacin once daily for 5 days is as well tolerated and effective as treatment for 10 days in patients with ABECB. The lower cost compared with a 10-day regimen and the increased likelihood that patients will complete the entire Shorter, once-daily regimen make the 5-day grepafloxacin regimen a useful therapeutic option in the treatment of ABECB.

  • Effectiveness of Short-Course Therapy (5 days) with cefuroxime axetil in treatment of secondary bacterial infections of acute bronchitis.
    Antimicrobial agents and chemotherapy, 1995
    Co-Authors: Dan C. Henry, Gregory Giguere, Gary E. Ruoff, J Rhudy, Anthony Puopolo, Margaret Drehobl, J Schoenberger, Jeffrey J. Collins
    Abstract:

    Five hundred thirty-seven patients were enrolled in two independent, investigator-blinded, multicenter, randomized clinical trials comparing the clinical and bacteriologic efficacies and the safety of 5- or 10-day treatment with cefuroxime axetil with those of 10-day treatment with amoxicillin-clavulanate in the treatment of secondary bacterial infections of acute bronchitis. Patients received either 5 or 10 days of treatment (n = 177 in each group) with cefuroxime axetil at 250 mg twice daily or 10 days of treatment (n = 183) with amoxicillin-clavulanate at 500 mg three times daily. Patients in the cefuroxime axetil (5 days) group received placebo on days 6 to 10. Bacteriologic assessments were based on sputum specimen cultures obtained preceding and, when possible, following treatment. Organisms were isolated from the pretreatment sputum specimens of 242 of 537 (45%) patients, with the primary pathogens being Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and Staphylococcus aureus (28, 25, 13, 9, and 8% of isolates, respectively). Pathogens were eradicated or presumed to be eradicated in 87% (52 of 60), 91% (53 of 58), and 86% (60 of 70) of bacteriologically evaluable patients treated with cefuroxime axetil (5 days), cefuroxime axetil (10 days), and amoxicillin-clavulanate, respectively. A satisfactory clinical outcome (cure or improvement) was achieved in 82% (107 of 130), 86% (117 of 136), and 83% (130 of 157) of the clinically evaluable patients treated with cefuroxime axetil (5 days), cefuroxime axetil (10 days), and amoxicillin-clavulanate, respectively. Treatment with amoxicillin-clavulanate was associated with a significantly higher incidence of drug-related adverse events than was treatment with cefuroxime axetil for either 5 or 10 days (P = 0.001), primarily reflecting a higher incidence of drug-related gastrointestinal adverse events (37 versus 19 and 15%, respectively; P < 0.001), particularly diarrhea and nausea. These results indicate that treatment with cefuroxime axetil at 250 mg twice daily for 5 days is as effective as treatment for 10 days with either the same dose of cefuroxime axetil or amoxicillin-clavulanate at 500 mg three times daily in patients with acute bronchitis. In addition, treatment with cefuroxime axetil for either 5 or 10 days is associated with significantly fewer gastrointestinal adverse events, particularly diarrhea and nausea, than is 10-day treatment with amoxicillin-clavulanate.

  • Two-Day Therapy with Cefuroxime Axetil Is Effective for Urinary Tract Infections in Children
    American journal of nephrology, 1994
    Co-Authors: Allan Eric Kornberg, Kathy Sherin, Patricia A. Veiga, Patricia K. Mydlow, Jeffrey J. Collins, Leonard G. Feld
    Abstract:

    Short-Course Therapy for pediatric urinary tract infection (UTI) remains controversial. The present study was undertaken to compare the effectiveness of cefuroxime axetil (Ceftin®) as Short-Course (2-

John A. Jernigan - One of the best experts on this subject based on the ideXlab platform.

  • Short-Course Therapy of catheter-related Staphylococcus aureus bacteremia : a meta-analysis
    Annals of internal medicine, 1993
    Co-Authors: John A. Jernigan, Barry M. Farr
    Abstract:

    OBJECTIVE To determine, through structured methodologic review of published articles, the effectiveness of Short-Course (< or = 2 weeks) antibiotic Therapy for catheter-related Staphylococcus aureus bacteremia. DATA SOURCES English-language publications on catheter-related S. aureus bacteremia identified using MEDLINE (1966 to the present) and bibliographic review of relevant articles and textbooks. STUDY SELECTION Any study reporting outcome data for patients with catheter-related S. aureus bacteremia who were treated with Short-Course Therapy. DATA EXTRACTION Epidemiologic criteria were applied to assess the quality of protection provided by each study against four important types of biases. In addition, the statistical precision of each study was assessed. DATA SYNTHESIS Eleven studies were identified. Reported late complication rates varied from 0% to 29%; the pooled estimate of the late complication rate was 6.1% (95% Cl, 2.0% to 10.2%). Ten of the 11 studies were uncontrolled. Only three provided adequate protection against treatment allocation bias. None of the studies adequately defined the illness under study, and only four provided adequate follow-up. The relapse rates in all 11 studies had low statistical precision. The complication and mortality rates for catheter-related S. aureus bacteremia when published data were pooled, regardless of duration of Therapy, were 24% and 15%, respectively. CONCLUSIONS The available data regarding the safety of Short-Course Therapy for catheter-related S. aureus bacteremia are potentially flawed by both bias and statistical imprecision. The optimal duration of treatment remains unknown. Short-Course Therapy should be viewed with caution in treating this serious infection until randomized trials determine the comparative rates of late complication.

  • Short-Course Therapy of Catheter-related Staphylococcus aureus Bacteremia
    Annals of Internal Medicine, 1993
    Co-Authors: John A. Jernigan, Barry M. Farr
    Abstract:

    Objective: To determine, through structured methodologic review of published articles, the effectiveness of Short-Course ( 2 weeks) antibiotic Therapy for catheter-related Staphylococcus aureus bac...

Leonard G. Feld - One of the best experts on this subject based on the ideXlab platform.