Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Mar 2010
Randomized Controlled TrialTreatment with granulocyte-macrophage colony-stimulating factor is associated with reduced indoleamine 2,3-dioxygenase activity and kynurenine pathway catabolites in patients with severe sepsis and septic shock.
The immunoregulatory enzyme indoleamine 2,3-dioxygenase (IDO) controls tryptophan metabolism and is induced by pro-inflammatory stimuli. We investigated whether immunostimulatory treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF) influences IDO activity and tryptophan metabolism in sepsis. Thirty-six patients with severe sepsis/septic shock and sepsis-associated immunosuppression (assessed using monocytic human leukocyte antigen-DR (mHLA-DR) expression) were assessed in a controlled trial of GM-CSF or placebo treatment for 8 days. ⋯ Moreover, IDO activity correlated with procalcitonin (p< 0.0001, r = 0.56) and mHLA-DR levels (p = 0.005, r = -0.28) in the overall samples group. Thus, GM-CSF therapy is associated with decreased IDO activity and reduced kynurenine pathway catabolites in sepsis. This may be due to an improved antibacterial defence.
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Scand. J. Infect. Dis. · Jan 2007
Randomized Controlled TrialHigh-dose ampicillin-sulbactam as an alternative treatment of late-onset VAP from multidrug-resistant Acinetobacter baumannii.
The increased incidence of multidrug-resistant (MDR) Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients poses a severe therapeutic problem. The aim of this study was to evaluate the efficacy and safety of 2 high-dose treatment regimens of ampicillin-sulbactam (A/S) for MDR Acinetobacter baumannii VAP. We undertook a randomized, prospective trial of critically ill patents with (MDR) Acinetobacter baumannii VAP. ⋯ Both mortality rates did not differ significantly between the 2 groups. No major adverse reactions were recorded. We concluded that clinical and bacteriological results of the study support the use of high-dose regimen of ampicillin-sulbactam for MDR Acinetobacter baumannii VAP.
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Scand. J. Infect. Dis. · Jan 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA prospective, randomized, multicenter comparative study of clinafloxacin versus a ceftriaxone-based regimen in the treatment of hospitalized patients with community-acquired pneumonia.
In an open-label, phase 3, randomized, multicenter study, clinafloxacin (200 mg/d) was compared to ceftriaxone (2 g/d; with or without erythromycin) in 527 patients with acute community-acquired bacterial pneumonia (CAP). Primary efficacy parameters were clinical cure rate and microbiologic eradication rates (by pathogen and by patient) determined 5-9 d post-therapy (test of cure; TOC). ⋯ Both drugs were tolerated. Treatment of hospitalized CAP patients with clinafloxacin is a reasonable choice, especially when a resistant pathogen is anticipated.
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Scand. J. Infect. Dis. · Jan 1986
Randomized Controlled Trial Comparative Study Clinical TrialTrimethoprim and co-trimoxazole: a comparison of their use in respiratory tract infections.
A single blind prospective study was undertaken with 74 patients suffering from acute bronchitis, taken from general practice and one geriatric ward. Half were randomly allocated to treatment with 200 mg trimethoprim twice a day and the other half with 160 mg trimethoprim plus 800 mg sulphamethoxazole twice a day; both therapies were used for 7 days. We found little difference in the clinical or bacteriological responses to the different regimens although the higher concentration of trimethoprim in the single therapy gave a slightly more successful eradication of Haemophilus spp. Resistant bacteria appeared during and after therapy in a few cases but this was a greater problem with the sulphamethoxazole-containing preparation.
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Scand. J. Infect. Dis. · Jan 1984
Randomized Controlled Trial Comparative Study Clinical TrialA randomised comparison of single-dose vs. three-day and ten-day therapy with trimethoprim-sulfamethoxazole for acute cystitis in women.
The efficacy of a single-dose (4 tablets) trimethoprim-sulfamethoxazole (TMP-SMX) was compared with that of a 3-day and 10-day treatment with TMP-SMX, 2 tablets twice daily, in 464 female out-patients with symptoms denoting acute, uncomplicated urinary tract infection (UTI). 321 patients (70%) had significant bacteriuria. Treatment effect could be assessed in 279 women. ⋯ The incidence of adverse reactions was significantly greater in patients treated with a 10-day (28%) than in those treated with a single-dose (5%), or 3-day (9%) regimen (p less than 0.01). This study suggests that short treatment regimens for uncomplicated UTI in women are as effective as and cause fewer side-effects than the conventional 10-day chemotherapy.