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clavulanate in the treatment of acute sinusitis in a sample of Iranian population
S672
17th ECCMID / 25th ICC, Abstracts accepted for publication only
quinolones (CE: OR= 0.86, 95% CI 0.60–1.24), or A/C and macrolides (ITT: OR= 0.99, 95% CI 0.49–2.04; CE: OR= 1.44, 95% CI 0.71–2.94). The treatment success in microbiologically evaluable patients was lower for macrolides compared with quinolones (OR= 0.46, 95% CI 0.32– 0.66), but it was similar between A/C and quinolones (OR= 0.83, 95% CI 0.49–1.40), and A/C and macrolides (OR= 1.31, 95% CI 0.57– 2.98). There was no difference regarding mortality between macrolides and quinolones. Less quinolone-recipients experienced a recurrence of ABECB after resolution of the initial episode compared with macrolide-recipients during the 26-week period after therapy (data from 2 RCTs). Adverse effects in general were similar between macrolides and quinolones (OR= 1.12, 95% CI 0.96–1.16); however, administration of A/C was associated with more adverse effects (mainly diarrhoea) than quinolones (OR= 1.37, 95% CI 1.04–1.79) or macrolides (OR= 1.72, 95% CI 1.22–2.42). Conclusion: Overall, macrolides, quinolones, and A/C may be considered equivalent for the treatment of patients with ABECB in terms of short-term effectiveness. However, quinolones are associated with better microbiological success and fewer recurrence of ABECB than macrolides, while A/C with more adverse effects than both comparators.
cultures, or (2) the finding of a titer >1/160 of standard tube agglutination antibodies. Patients with spondylitis, endocarditis or neurobrucellosis were excluded. Results: 10 patients were included in the doxycycline-streptomycin group and 10 int the doxycycline alone group. 90% of the patients were male and the mean age was 37 ± 11. 8 patients (44%) had positive blood cultures. Focal forms were arthritis (4 patients), orchitis (3 patients), sacroiliitis (1) and hepatitis (1). The 10 patients in the doxycyclinestreptomycin group cured without sequelae. 4 (40%) patients in the doxycycline alone group had relapses of the disease. Conclusions: The high percentage of relapses in the treatment with doxycycline alone does not allow to indicate this treatment for human brucellosis.
Antimicrobial clinical trials
Introduction: Pyomyositis is an acute pyogenic infection of the skeletal muscle. Pyomyositis is common in the tropics but rarely reported in temperate climates. High fever and painful swelling of the affected limb are the commonest symptoms. Leucocytosis is present with elevated erythrocytes sedimentation rate (ESR) and C-reactive protein (CRP). The most common causative organisms are Staphylococcus aureus and Streptococcus pyogenes. Magnetic Resonance Imaging (MRI) is the image modality of choice. Purpose: Diagnosis, clinical course and treatment outcome of children with pyomyositis. Material and Methods: Between 2002 and 2004 5 children, 2 boys and 3 girls were diagnosed and treated for pyomyositis. The mean age of patients was 7.2 years, ranging from 3 to 14 years. The locations of involvement were gluteus muscles in 3 cases, quadriceps in one case thus in one case there was bifocal involvement of gastrocnemius and biceps muscle. The causative organisms, cultured from blood, were St. aureus in 3 cases, Str. pyogenes in one case though in one patient no organism could be identified. 4 children had fever (>38.5ºC), elevated ESR and CRP (ESR: 73–110, CRP: 142–410) and raised WBC count (14580– 19900). One patient had normal temperature and increased ESR (<55). A history of prior trauma at lower limb was obtained in all patients. MRI plays a significant role in the early recognition and diagnosis of pyomyositis, identifying muscle inflammation and detecting bone involvement. Intravenous antibiotics were administered and were followed by oral agents for an additional period of time. The duration of therapy ranged from 6 to 8 weeks. No surgical intervention was needed. MRI was used in order to evaluate response to the therapy. Conclusion: Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of acute onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as abscess formation, which require surgical drainage, sepsis and other major systemic complications can be avoided.
R2316 Comparison of cefuroxime and amoxicillin/clavulanate in the treatment of acute sinusitis in a sample of Iranian population A. Rastegar lari, F. Alinejad, M. Rahmani, H. Mohamadi, H. Mostafavi, G. Farzandy, R. Alaghehbandan (Tehran, IR; St. John’s, CA) Objectives: Acute sinusitis is a common upper respiratory tract infection worldwide, which can be severely complicated if inappropriate treatment is applied. The aim of this study was to assess and compare efficacy of cefuroxime and amoxicillin/clavulanate in the treatment of acute sinusitis in an Iranian sample population. Methods: A randomised clinical trial study, comparing the efficacy of two oral antibiotics, cefuroxime (Exiroxime® ) and amoxicillin/clavulanate in the treatment of acute sinusitis, was conducted in 2005. A total of 99 patients were enrolled in the study. The clinical diagnosis of acute sinusitis was based on association of suborbital pain, purulent rhinorrea and purulent discharge on the middle nasal meatus. All patients were also radiographically examined and their diagnoses were confirmed. Patients were randomly assigned to either receive 10 days of treatment with cefuroxime 250 mg twice daily (n = 57) or receive amoxicillin/clavulanate 500/125 mg three times daily (n = 42). Patients’ responses to treatment were assessed during and at the end of the treatment. Results: A satisfactory clinical outcome (cure or improvement of symptoms) was found in 86% (49/57) and 71.4% (30/42) of the clinically evaluable patients treated with cefuroxime or amoxicillin/clavulanate, respectively (p > 0.05). Conclusion: Findings of this study suggest that cefuroxime (twice daily) is more effective than amoxicillin/clavulanate (three times a day) in the treatment of patients with acute sinusitis. A larger study is needed to elaborate on the findings of this study. R2317 Doxycycline and streptomycin versus doxycycline alone in the treatment of human brucellosis E. Mart´ınez Alfaro, P. Geijo, F. Marcos, F. Mateos, J. Blanch, I. T´arraga, C. Rosa, J. Solera (Albacete, Cuenca, Talavera de la Reina, ES) Background: Tetracyclines are at the present time the antibiotics of choice in human brucellosis. Brucellae is exquisitely susceptible to tetracyclines with MICs (minimum inhibitory concentration) <1 mg/L. Prolongued treatment reduces the rate of relapse. Objective: We conducted a pilot study comparing treatment with doxycicline 45 days plus streptomycin 14 days versus doxycycline alone 60 days. Material and Methods: 20 patients were included, all of them >18 years old. Diagnostic criteria were: (1) Isolation of Brucella species in blood
Paediatric infections R2318 Pyomyositis in children G. Manoudis, G. Mitsionis, V. Kontogeorgakos, N. Kordalis, I. Sionti, T. Xenakis (Ioannina, GR)
R2319 Invasive infections due to Haemophilus influenzae in paediatrics N. Rivas, G. Yerino, A. Gaiano, A. Medina, A. M´onaco, M. V´azquez, A. Procopio, E.L. L´opez (Buenos Aires, AR) The invasive infections by Haemophilus influenzae (Hi) b has decreased after vaccination. From January 1998 to December 2005 we carried out our study at Hospital de Ni˜nos. Objective: to describe the characteristics of Hi infections in our population. Data were collected from clinical files. Positive cultures for Haemophilus influenzae from sterile places were included. Invasive infections were 78 in 77 patients. Hi type b 20 (26%) and Hi not b 58 (74%). Age:18m (medium) range 8d-216m. Males 53/78 (69%).
17th ECCMID / 25th ICC, Abstracts accepted for publication only
quinolones (CE: OR= 0.86, 95% CI 0.60–1.24), or A/C and macrolides (ITT: OR= 0.99, 95% CI 0.49–2.04; CE: OR= 1.44, 95% CI 0.71–2.94). The treatment success in microbiologically evaluable patients was lower for macrolides compared with quinolones (OR= 0.46, 95% CI 0.32– 0.66), but it was similar between A/C and quinolones (OR= 0.83, 95% CI 0.49–1.40), and A/C and macrolides (OR= 1.31, 95% CI 0.57– 2.98). There was no difference regarding mortality between macrolides and quinolones. Less quinolone-recipients experienced a recurrence of ABECB after resolution of the initial episode compared with macrolide-recipients during the 26-week period after therapy (data from 2 RCTs). Adverse effects in general were similar between macrolides and quinolones (OR= 1.12, 95% CI 0.96–1.16); however, administration of A/C was associated with more adverse effects (mainly diarrhoea) than quinolones (OR= 1.37, 95% CI 1.04–1.79) or macrolides (OR= 1.72, 95% CI 1.22–2.42). Conclusion: Overall, macrolides, quinolones, and A/C may be considered equivalent for the treatment of patients with ABECB in terms of short-term effectiveness. However, quinolones are associated with better microbiological success and fewer recurrence of ABECB than macrolides, while A/C with more adverse effects than both comparators.
cultures, or (2) the finding of a titer >1/160 of standard tube agglutination antibodies. Patients with spondylitis, endocarditis or neurobrucellosis were excluded. Results: 10 patients were included in the doxycycline-streptomycin group and 10 int the doxycycline alone group. 90% of the patients were male and the mean age was 37 ± 11. 8 patients (44%) had positive blood cultures. Focal forms were arthritis (4 patients), orchitis (3 patients), sacroiliitis (1) and hepatitis (1). The 10 patients in the doxycyclinestreptomycin group cured without sequelae. 4 (40%) patients in the doxycycline alone group had relapses of the disease. Conclusions: The high percentage of relapses in the treatment with doxycycline alone does not allow to indicate this treatment for human brucellosis.
Antimicrobial clinical trials
Introduction: Pyomyositis is an acute pyogenic infection of the skeletal muscle. Pyomyositis is common in the tropics but rarely reported in temperate climates. High fever and painful swelling of the affected limb are the commonest symptoms. Leucocytosis is present with elevated erythrocytes sedimentation rate (ESR) and C-reactive protein (CRP). The most common causative organisms are Staphylococcus aureus and Streptococcus pyogenes. Magnetic Resonance Imaging (MRI) is the image modality of choice. Purpose: Diagnosis, clinical course and treatment outcome of children with pyomyositis. Material and Methods: Between 2002 and 2004 5 children, 2 boys and 3 girls were diagnosed and treated for pyomyositis. The mean age of patients was 7.2 years, ranging from 3 to 14 years. The locations of involvement were gluteus muscles in 3 cases, quadriceps in one case thus in one case there was bifocal involvement of gastrocnemius and biceps muscle. The causative organisms, cultured from blood, were St. aureus in 3 cases, Str. pyogenes in one case though in one patient no organism could be identified. 4 children had fever (>38.5ºC), elevated ESR and CRP (ESR: 73–110, CRP: 142–410) and raised WBC count (14580– 19900). One patient had normal temperature and increased ESR (<55). A history of prior trauma at lower limb was obtained in all patients. MRI plays a significant role in the early recognition and diagnosis of pyomyositis, identifying muscle inflammation and detecting bone involvement. Intravenous antibiotics were administered and were followed by oral agents for an additional period of time. The duration of therapy ranged from 6 to 8 weeks. No surgical intervention was needed. MRI was used in order to evaluate response to the therapy. Conclusion: Although pyomyositis is a rare disease, it should be considered in the differential diagnosis of acute onset of musculoskeletal pain in children. Early diagnosis and antibiotic treatment are important as abscess formation, which require surgical drainage, sepsis and other major systemic complications can be avoided.
R2316 Comparison of cefuroxime and amoxicillin/clavulanate in the treatment of acute sinusitis in a sample of Iranian population A. Rastegar lari, F. Alinejad, M. Rahmani, H. Mohamadi, H. Mostafavi, G. Farzandy, R. Alaghehbandan (Tehran, IR; St. John’s, CA) Objectives: Acute sinusitis is a common upper respiratory tract infection worldwide, which can be severely complicated if inappropriate treatment is applied. The aim of this study was to assess and compare efficacy of cefuroxime and amoxicillin/clavulanate in the treatment of acute sinusitis in an Iranian sample population. Methods: A randomised clinical trial study, comparing the efficacy of two oral antibiotics, cefuroxime (Exiroxime® ) and amoxicillin/clavulanate in the treatment of acute sinusitis, was conducted in 2005. A total of 99 patients were enrolled in the study. The clinical diagnosis of acute sinusitis was based on association of suborbital pain, purulent rhinorrea and purulent discharge on the middle nasal meatus. All patients were also radiographically examined and their diagnoses were confirmed. Patients were randomly assigned to either receive 10 days of treatment with cefuroxime 250 mg twice daily (n = 57) or receive amoxicillin/clavulanate 500/125 mg three times daily (n = 42). Patients’ responses to treatment were assessed during and at the end of the treatment. Results: A satisfactory clinical outcome (cure or improvement of symptoms) was found in 86% (49/57) and 71.4% (30/42) of the clinically evaluable patients treated with cefuroxime or amoxicillin/clavulanate, respectively (p > 0.05). Conclusion: Findings of this study suggest that cefuroxime (twice daily) is more effective than amoxicillin/clavulanate (three times a day) in the treatment of patients with acute sinusitis. A larger study is needed to elaborate on the findings of this study. R2317 Doxycycline and streptomycin versus doxycycline alone in the treatment of human brucellosis E. Mart´ınez Alfaro, P. Geijo, F. Marcos, F. Mateos, J. Blanch, I. T´arraga, C. Rosa, J. Solera (Albacete, Cuenca, Talavera de la Reina, ES) Background: Tetracyclines are at the present time the antibiotics of choice in human brucellosis. Brucellae is exquisitely susceptible to tetracyclines with MICs (minimum inhibitory concentration) <1 mg/L. Prolongued treatment reduces the rate of relapse. Objective: We conducted a pilot study comparing treatment with doxycicline 45 days plus streptomycin 14 days versus doxycycline alone 60 days. Material and Methods: 20 patients were included, all of them >18 years old. Diagnostic criteria were: (1) Isolation of Brucella species in blood
Paediatric infections R2318 Pyomyositis in children G. Manoudis, G. Mitsionis, V. Kontogeorgakos, N. Kordalis, I. Sionti, T. Xenakis (Ioannina, GR)
R2319 Invasive infections due to Haemophilus influenzae in paediatrics N. Rivas, G. Yerino, A. Gaiano, A. Medina, A. M´onaco, M. V´azquez, A. Procopio, E.L. L´opez (Buenos Aires, AR) The invasive infections by Haemophilus influenzae (Hi) b has decreased after vaccination. From January 1998 to December 2005 we carried out our study at Hospital de Ni˜nos. Objective: to describe the characteristics of Hi infections in our population. Data were collected from clinical files. Positive cultures for Haemophilus influenzae from sterile places were included. Invasive infections were 78 in 77 patients. Hi type b 20 (26%) and Hi not b 58 (74%). Age:18m (medium) range 8d-216m. Males 53/78 (69%).