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Charles C Chan - One of the best experts on this subject based on the ideXlab platform.
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comparison of atovaquone 566c80 with Trimethoprim sulfamethoxazole to treat pneumocystis carinii pneumonia in patients with aids
The New England Journal of Medicine, 1993Co-Authors: Walter W Hughes, Gifford G Leoung, Francoise Kramer, Samuel A Bozzette, Sharon Safrin, Peter P Frame, Danny Lancaster, Nathan Clumeck, Henry Masur, Charles C ChanAbstract:BACKGROUND: Both Trimethoprim-sulfamethoxazole and pentamidine are effective as treatments for Pneumocystis carinii pneumonia, but adverse effects frequently limit their use. Atovaquone (566C80) is a new hydroxynaphthoquinone with activity against P. carinii. METHODS: We conducted a double-blind, multicenter study in patients with the acquired immunodeficiency syndrome and mild or moderately severe P. carinii pneumonia. They were randomly assigned to 21 days of orally administered treatment three times daily with either atovaquone (750 mg) or Trimethoprim (320 mg) plus sulfamethoxazole (1600 mg). RESULTS: Of the 322 patients with histologically confirmed P. carinii pneumonia, 160 received atovaquone and 162 received Trimethoprim-sulfamethoxazole. Of those who could be evaluated for therapeutic efficacy, 28 of 138 patients given atovaquone (20 percent) and 10 of 146 patients given Trimethoprim-sulfamethoxazole (7 percent) did not respond (P = 0.002). Treatment-limiting adverse effects required a change of therapy in 11 patients in the atovaquone group (7 percent) and 33 patients in the Trimethoprim-sulfamethoxazole group (20 percent) (P = 0.001). Therapy involving only the initial drug was successful and free of adverse effects in 62 percent of those assigned to atovaquone and 64 percent of those assigned to Trimethoprim-sulfamethoxazole. Within four weeks of the completion of treatment, there were 11 deaths in the atovaquone group (4 due to P. carinii pneumonia) and 1 death in the Trimethoprim-sulfamethoxazole group (P = 0.003). Diarrhea at entry was associated with lower plasma drug concentrations (P = 0.009), therapeutic failure (P < 0.001), and death (P < 0.001) in the atovaquone group but not in the Trimethoprim-sulfamethoxazole group. CONCLUSIONS: For the treatment of P. carinii pneumonia, atovaquone is less effective than Trimethoprim-sulfamethoxazole, but it has fewer treatment-limiting adverse effects.
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comparison of atovaquone 566c80 with Trimethoprim sulfamethoxazole to treat pneumocystis carinii pneumonia in patients with aids
The New England Journal of Medicine, 1993Co-Authors: Walter W Hughes, Gifford G Leoung, Francoise Kramer, Samuel A Bozzette, Sharon Safrin, Peter P Frame, Danny Lancaster, Nathan Clumeck, Henry Masur, Charles C ChanAbstract:Background Both Trimethoprim-sulfamethoxazole and pentamidine are effective as treatments for Pneumocystis carinii pneumonia, but adverse effects frequently limit their use. Atovaquone (566C80) is a new hydroxynaphthoquinone with activity against P. carinii. Methods We conducted a double-blind, multicenter study in patients with the acquired immunodeficiency syndrome and mild or moderately severe P. carinii pneumonia. They were randomly assigned to 21 days of orally administered treatment three times daily with either atovaquone (750 mg) or Trimethoprim (320 mg) plus sulfamethoxazole (1600 mg). Results Of the 322 patients with histologically confirmed P. carinii pneumonia, 160 received atovaquone and 162 received Trimethoprim-sulfamethoxazole. Of those who could be evaluated for therapeutic efficacy, 28 of 138 patients given atovaquone (20 percent) and 10 of 146 patients given Trimethoprim-sulfamethoxazole (7 percent) did not respond (P = 0.002). Treatment-limiting adverse effects required a change of the...
Walter W Hughes - One of the best experts on this subject based on the ideXlab platform.
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comparison of atovaquone 566c80 with Trimethoprim sulfamethoxazole to treat pneumocystis carinii pneumonia in patients with aids
The New England Journal of Medicine, 1993Co-Authors: Walter W Hughes, Gifford G Leoung, Francoise Kramer, Samuel A Bozzette, Sharon Safrin, Peter P Frame, Danny Lancaster, Nathan Clumeck, Henry Masur, Charles C ChanAbstract:BACKGROUND: Both Trimethoprim-sulfamethoxazole and pentamidine are effective as treatments for Pneumocystis carinii pneumonia, but adverse effects frequently limit their use. Atovaquone (566C80) is a new hydroxynaphthoquinone with activity against P. carinii. METHODS: We conducted a double-blind, multicenter study in patients with the acquired immunodeficiency syndrome and mild or moderately severe P. carinii pneumonia. They were randomly assigned to 21 days of orally administered treatment three times daily with either atovaquone (750 mg) or Trimethoprim (320 mg) plus sulfamethoxazole (1600 mg). RESULTS: Of the 322 patients with histologically confirmed P. carinii pneumonia, 160 received atovaquone and 162 received Trimethoprim-sulfamethoxazole. Of those who could be evaluated for therapeutic efficacy, 28 of 138 patients given atovaquone (20 percent) and 10 of 146 patients given Trimethoprim-sulfamethoxazole (7 percent) did not respond (P = 0.002). Treatment-limiting adverse effects required a change of therapy in 11 patients in the atovaquone group (7 percent) and 33 patients in the Trimethoprim-sulfamethoxazole group (20 percent) (P = 0.001). Therapy involving only the initial drug was successful and free of adverse effects in 62 percent of those assigned to atovaquone and 64 percent of those assigned to Trimethoprim-sulfamethoxazole. Within four weeks of the completion of treatment, there were 11 deaths in the atovaquone group (4 due to P. carinii pneumonia) and 1 death in the Trimethoprim-sulfamethoxazole group (P = 0.003). Diarrhea at entry was associated with lower plasma drug concentrations (P = 0.009), therapeutic failure (P < 0.001), and death (P < 0.001) in the atovaquone group but not in the Trimethoprim-sulfamethoxazole group. CONCLUSIONS: For the treatment of P. carinii pneumonia, atovaquone is less effective than Trimethoprim-sulfamethoxazole, but it has fewer treatment-limiting adverse effects.
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comparison of atovaquone 566c80 with Trimethoprim sulfamethoxazole to treat pneumocystis carinii pneumonia in patients with aids
The New England Journal of Medicine, 1993Co-Authors: Walter W Hughes, Gifford G Leoung, Francoise Kramer, Samuel A Bozzette, Sharon Safrin, Peter P Frame, Danny Lancaster, Nathan Clumeck, Henry Masur, Charles C ChanAbstract:Background Both Trimethoprim-sulfamethoxazole and pentamidine are effective as treatments for Pneumocystis carinii pneumonia, but adverse effects frequently limit their use. Atovaquone (566C80) is a new hydroxynaphthoquinone with activity against P. carinii. Methods We conducted a double-blind, multicenter study in patients with the acquired immunodeficiency syndrome and mild or moderately severe P. carinii pneumonia. They were randomly assigned to 21 days of orally administered treatment three times daily with either atovaquone (750 mg) or Trimethoprim (320 mg) plus sulfamethoxazole (1600 mg). Results Of the 322 patients with histologically confirmed P. carinii pneumonia, 160 received atovaquone and 162 received Trimethoprim-sulfamethoxazole. Of those who could be evaluated for therapeutic efficacy, 28 of 138 patients given atovaquone (20 percent) and 10 of 146 patients given Trimethoprim-sulfamethoxazole (7 percent) did not respond (P = 0.002). Treatment-limiting adverse effects required a change of the...
Walter E Stamm - One of the best experts on this subject based on the ideXlab platform.
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short course nitrofurantoin for the treatment of acute uncomplicated cystitis in women
JAMA Internal Medicine, 2007Co-Authors: Kalpana Gupta, Thomas M Hooton, Pacita L Roberts, Walter E StammAbstract:Methods: To assess the efficacy of nitrofurantoin vs Trimethoprim-sulfamethoxazole, 338 women aged 18 to 45 years with acute uncomplicated cystitis were randomized to open-label treatment with either Trimethoprimsulfamethoxazole, 1 double-strength tablet twice daily for 3 days, or nitrofurantoin, 100 mg twice daily for 5 days. Clinical cure 30 days after therapy was the main outcome measure. Secondary outcomes included clinical and microbiological cure rates 5 to 9 days after therapy and, for Trimethoprim-sulfamethoxazole–treated women, clinical cure stratified by the Trimethoprim-sulfamethoxazole susceptibility of the uropathogen. Results: Clinical cure was achieved in 79% of the Trimethoprim-sulfamethoxazole group and in 84% of the nitrofurantoin group, for a difference of �5% (95% confidence interval, �13% to 4%). Clinical and microbiological cure rates at the first follow-up visit were also equivalent between the 2 groups. In the Trimethoprimsulfamethoxazole arm, 7 of 17 women (41%) with a Trimethoprim-sulfamethoxazole–nonsusceptible isolate had a clinical cure compared with 84% of women with a Trimethoprim-sulfamethoxazole–susceptible isolate (P.001). Conclusion: A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of Trimethoprim-sulfamethoxazole and should be considered an effective fluoroquinolone-sparing alternative for the treatment of acute cystitis in women. Trial Registration: clinicaltrials.gov Identifier: NCT00391651
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comparison of ciprofloxacin 7 days and Trimethoprim sulfamethoxazole 14 days for acute uncomplicated pyelonephritis in women a randomized trial
JAMA, 2000Co-Authors: David A Talan, Walter E Stamm, Thomas M Hooton, Gregory J Moran, Thomas Burke, Abdollah Iravani, Jonathan Reuningscherer, Deborah A ChurchAbstract:ContextThe optimal antimicrobial regimen and treatment duration for acute uncomplicated pyelonephritis are unknown.ObjectiveTo compare the efficacy and safety of a 7-day ciprofloxacin regimen and a 14-day Trimethoprim-sulfamethoxazole regimen for the treatment of acute pyelonephritis in women.DesignRandomized, double-blind comparative trial conducted from October 1994 through January 1997.SettingTwenty-five outpatient centers in the United States.PatientsOf 378 enrolled premenopausal women aged at least 18 years with clinical diagnosis of acute uncomplicated pyelonephritis, 255 were included in the analysis. Other individuals were excluded for no baseline causative organism, inadequate receipt of study drug, loss to follow-up, no appropriate cultures, and other reasons.InterventionsPatients were randomized to oral ciprofloxacin, 500 mg twice per day for 7 days (with or without an initial 400-mg intravenous dose) followed by placebo for 7 days (n = 128 included in analysis) vs Trimethoprim-sulfamethoxazole, 160/800 mg twice per day for 14 days (with or without intravenous ceftriaxone, 1 g) (n = 127 included in the analysis).Main Outcome MeasureContinued bacteriologic and clinical cure, such that alternative antimicrobial drugs were not required, among evaluable patients through the 4- to 11-day posttherapy visit, compared by treatment group.ResultsAt 4 to 11 days posttherapy, bacteriologic cure rates were 99% (112 of 113) for the ciprofloxacin regimen and 89% (90 of 101) for the Trimethoprim-sulfamethoxazole regimen (95% confidence interval [CI] for difference, 0.04-0.16; P = .004). Clinical cure rates were 96% (109 of 113) for the ciprofloxacin regimen and 83% (92 of 111) for the Trimethoprim-sulfamethoxazole regimen (95% CI, 0.06-0.22; P = .002). Escherichia coli, which caused more than 90% of infections, was more frequently resistant to Trimethoprim-sulfamethoxazole (18%) than to ciprofloxacin (0%; P<.001). Among Trimethoprim-sulfamethoxazole–treated patients, drug resistance was associated with greater bacteriologic and clinical failure rates (P<.001 for both). Drug-related adverse events occurred in 24% of 191 ciprofloxacin-treated patients and in 33% of 187 Trimethoprim-sulfamethoxazole–treated patients, respectively (95% CI, −0.001 to 0.2).ConclusionsIn our study of outpatient treatment of acute uncomplicated pyelonephritis in women, a 7-day ciprofloxacin regimen was associated with greater bacteriologic and clinical cure rates than a 14-day Trimethoprim-sulfamethoxazole regimen, especially in patients infected with Trimethoprim-sulfamethoxazole–resistant strains.
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randomized comparative trial and cost analysis of 3 day antimicrobial regimens for treatment of acute cystitis in women
JAMA, 1995Co-Authors: Thomas M Hooton, C Winter, Felice Tiu, Walter E StammAbstract:Objective. —To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women. Design. —A prospective randomized trial with a cost analysis. Study Population. —Women with acute cystitis attending a student health center. Interventions. —Treatment with 3-day oral regimens of Trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily. Results. —Six weeks after treatment, 32 (82%) of 39 women treated with Trimethoprim-sulfamethoxazole were cured compared with 22 (61%) of 36 treated with nitrofurantoin (P=.04 vs Trimethoprim-sulfamethoxazole),21 (66%) of 32 treated with cefadroxil (P=.11 vs Trimethoprim-sulfamethoxazole), and 28 (67%) of 42 treated with amoxicillin (P=.11 vs Trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with Trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%;P=.05 vs Trimethoprim-sulfamethoxazole) and amoxicillin (14%;P=.11 vs Trimethoprim-sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin-susceptible strains in the nitrofurantoin group. Trimethoprim-sulfamethoxazole was more successful in eradicatingEscherichia colifrom rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35%) of 46 patients receiving Trimethoprim-sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, and 13 (25%) of 52 receiving amoxicillin. The mean costs per patient were less with Trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155). Conclusions. —A 3-day regimen of Trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of Trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects againstE coliin the rectum, urethra, and vagina. (JAMA. 1995;273:41-45)
Gerardo Hernandezoliva - One of the best experts on this subject based on the ideXlab platform.
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comparison of short term treatment regimen of ciprofloxacin versus long term treatment regimens of Trimethoprim sulfamethoxazole or norfloxacin for uncomplicated lower urinary tract infections a randomized multicentre open label prospective study
Journal of Antimicrobial Chemotherapy, 2004Co-Authors: Jose Luis Arredondogarcia, Ricardo Figueroadamian, Alejandro Rosas, Arturo Jauregui, Mauricio Corral, Alexis Costa, Roberto Mauricio Merlos, Antonio Riosfabra, Carlos F Amabilecuevas, Gerardo HernandezolivaAbstract:Objective: To compare the bacteriological and clinical efficacy of three treatments for uncomplicated cystitis in ambulatory pre-menopausal women: ciprofloxacin 250 mg orally twice daily for 3 days, Trimethoprim/sulfamethoxazole 160/800 mg orally twice daily for 7 days, and norfloxacin 400 mg orally twice daily for 7 days. Materials and methods: A total of 455 women were randomly assigned to three treatment groups: 151 received ciprofloxacin, 150 received Trimethoprim/sulfamethoxazole, and 154 received norfloxacin. Bacteriological cure and clinical resolution were evaluated 5-9 days and 4-6 weeks after completion of treatment. Results: There was no significant difference among the three treatment groups: overall efficacy ranged from 78.5% for the Trimethoprim/sulfamethoxazole group, to 84.5% for the ciprofloxacin group. The highest overall incidence of drug-related adverse effects occurred in the Trimethoprim/sulfamethoxazole patients. Conclusions: These data indicate that a 3 day treatment with ciprofloxacin is at least as clinically and bacteriologically effective as 7 day treatments with Trimethoprim/sulfamethoxazole and norfloxacin for uncomplicated lower urinary tract infections.
Anne G M Schilder - One of the best experts on this subject based on the ideXlab platform.
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effect of long term Trimethoprim sulfamethoxazole treatment on resistance and integron prevalence in the intestinal flora a randomized double blind placebo controlled trial in children
Journal of Antimicrobial Chemotherapy, 2009Co-Authors: E L Van Der Veen, Anne G M Schilder, Tim K Timmers, Maroeska M Rovers, Ad C Fluit, Marc J M Bonten, M Leversteinvan A HallAbstract:Objectives: The aim of this study was to test the hypothesis that Trimethoprim/sulfamethoxazole selects for integron-positive and multidrug-resistant Enterobacteriaceae in the intestinal flora. Methods: During 1 year of follow-up, antibiotic susceptibility and the presence of integrons were determined in faecal Enterobacteriaceae isolated from 99 children with chronic active otitis media, randomly assigned to treatment with Trimethoprim/sulfamethoxazole or placebo (http://www.clinicaltrials.gov/; trial registration number NCT00189098). Results: At 6 and 12 weeks of follow-up, 32 (91%) and 24 (67%) children in the Trimethoprim/sulfamethoxazole group carried Trimethoprim/sulfamethoxazole-resistant Enterobacteriaceae versus 10 (21%) and 8 (17%) children in the placebo group [rate differences (RDs): 70 (95% CI: 55; 85) and 50 (95% CI: 31; 69)], respectively. Multiresistance also increased during Trimethoprim/sulfamethoxazole treatment. At 6 weeks of follow-up, the integron prevalence was 26 (79%) in the Trimethoprim/ sulfamethoxazole group and 10 (22%) in the placebo group [RD: 57 (95% CI: 39; 75)]. After 12 weeks the integron prevalence, and after 1 year the susceptibility levels, had returned to baseline values. Conclusions: Initially, Trimethoprim/sulfamethoxazole usage was strongly associated with the appearance of integron-positive (multi)drug-resistant Enterobacteriaceae in the intestinal flora. After prolonged exposure to Trimethoprim/sulfamethoxazole, however, this population of Enterobacteriaceae was substituted by a population with non-integron-associated resistance mechanisms. After Trimethoprim/ sulfamethoxazole was discontinued, susceptibility rates to all antibiotics returned to baseline levels.
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effectiveness of Trimethoprim sulfamethoxazole for children with chronic active otitis media a randomized placebo controlled trial
Pediatrics, 2007Co-Authors: Erwin L Van Der Veen, Maroeska M Rovers, Frans W J Albers, Elisabeth A M Sanders, Anne G M SchilderAbstract:OBJECTIVE: The goal was to determine the clinical effectiveness of prolonged outpatient treatment with Trimethoprim/sulfamethoxazole for children with chronic active otitis media. METHODS: We performed a randomized, placebo-controlled trial with 101 children (1-12 years of age) with chronic active otitis media (defined as otorrhea for > or =12 weeks). In addition to a short course of steroid and antibiotic eardrops, children were assigned randomly to receive 6 to 12 weeks of orally administered Trimethoprim/sulfamethoxazole (18 mg/kg, 2 times per day) or placebo and were monitored for 1 year. RESULTS: At 6 weeks, 28% of children in the Trimethoprim/sulfamethoxazole group and 53% of children in the placebo group had otomicroscopic signs of otorrhea. At 12 weeks, these values were 32% and 47%, respectively. At 1 year, the numbers of children with otorrhea were similar in the 2 groups (25% and 20%, respectively). One child in the Trimethoprim/sulfamethoxazole group developed a skin rash. Vomiting or diarrhea was reported for 9% of the Trimethoprim/sulfamethoxazole group and 2% of the placebo group. Pure-tone hearing levels and health-related quality of life improved during the study but did not differ between the Trimethoprim/sulfamethoxazole group and the placebo group. Pseudomonas aeruginosa was the most frequently isolated bacteria in the otorrhea samples from both groups. CONCLUSIONS: A 6- to 12-week course of high-dose, orally administered Trimethoprim/sulfamethoxazole therapy is beneficial for children with chronic active otitis media. The treatment effect is most pronounced with the shorter course and disappears if administration of the medication is discontinued.
