Bacterial infections, treatment

Treatment of aplastic crisis is primarily supportive. Blood transfusions may be indicated for severe or symptomatic anemia. Antibiotic therapy is not warranted because the most common etiology is viral, not bacterial, infection. Treatment options for splenic sequestration include observation alone, especially for adults because they tend to have milder episodes chronic transfusion to delay splenectomy and splenectomy after a hfe-threatening crisis, after repetitive episodes, or for chronic hypersplenism. 

In general, penicillins exert thek biological effect, as do the other -lactams, by inhibiting the synthesis of essential structural components of the bacterial cell wall. These components are absent in mammalian cells so that inhibition of the synthesis of the bacterial cell wall stmcture occurs with Htde or no effect on mammalian cell metaboHsm. Additionally, penicillins tend to be kreversible inhibitors of bacterial cell-wall synthesis and are generally bactericidal at concentrations close to thek bacteriostatic levels. Consequently penicillins have become widely used for the treatment of bacterial infections and are regarded as one of the safest and most efficacious classes of antibiotics. 

Frequendy, the treatment of helminthic diseases requites adjunct medication. Allergic reactions are commonly seen as a result of tissue invasion by worms or as a consequence of anthelmintic therapy. Antihistamines and corticosteroids may be necessary adjuncts to therapy. Anemia, indigestion, and secondary bacterial infections can also occur and may requite concomitant therapy with hematopoietic drugs and appropriate antibiotics. 

The penicillins are a class of compound having the general structure (1). Because of their unique effectiveness in the treatment of bacterial infections in humans, these compounds have been investigated intensively from the chemical, microbiological and clinical points of view since about 1940. The early history of these developments (see especially B-80MI51100, B-49MI51100) contains the following pivotal studies ... 

The importance of the penicillins as a class of heterocyclic compounds derives primarily from their effectiveness in the treatment of bacterial infections in mammals (especially humans). It has been estimated that, in 1980, the worldwide production of antibiotics was 25 000 tons and, of this, approximately 17 000 tons were penicillins (81MI51103). The Food and Drug Administration has estimated that, in 1979 in the U.S.A., 30.1 x 10 prescriptions of penicillin V and 44.3 x 10 prescriptions of ampicillin/amoxicillin were dispensed. This level of usage indicates that, compared to other methods of dealing with bacterial infection, the cost-benefit properties of penicillin therapy are particularly favorable. Stated differently, penicillin treatment leads to the elimination of the pathogen in a relatively high percentage of cases of bacterial infection at a relatively low cost to the patient in terms of toxic reactions and financial resources. 

More then a dozen representatives of the above ring systems were introduced into the human therapy. Actisomide (2) and trequinsin (3) are used as antiarrhytmic and antihypertensive agents, respectively. Sunepitron (4), a a 2-adrenoceptor antagonist, is under clinical trials for the treatment of anxiety and depression. Representatives of the third generation of antibacterial quinolone-3-carboxylic acids the blockbluster ofloxacin (5), its levorotatory enantiomer, levofloxacin (6), and rufloxacin (7) have gained wide acceptance for the treatment of bacterial infections of the respiratory and urinary tracts, skin, and soft tissues, as well as sexually transmitted diseases, and pazufloxacin (8) is under development. Praziquantel (9) is widely applied for the treatment of schistosomes- and cestode-caused infection in both veterinary and human therapies (Scheme 4). 

Although the advent of the antibiotics revolutionized the treatment of bacterial infections, tuberculosis has proven unusually resistant to chemotherapeutic attack. Although many antibiotics are effective to some extent in arresting the progress of... 

Cleanliness and good housekeeping in machine shops do much to avoid bacterial infection, and their importance cannot be overstressed. Various techniques such as heat treatment, centrifuging and filtration can be used to advantage, although economic considerations may restrict their use to systems containing large volumes of soluble oil. Chemical sterilization with bactericides can be more convenient. 

Chemotherapy is the control and treatment of disease by synthetic drugs. Most of these are organic compounds, often of remarkably simple structure. Sulfanilamide is one example of an organic compound synthesized by chemists for the treatment of bacterial infections. 

The discovery and production of antibiotics has been of tremendous importance to human and animal health care. Prior to their discovery about half a century ago, many bacterial infections caused debilitating diseases and fatalities were high. The discovery of antibiotics was a major step in the treatment of infectious diseases, especially those caused by bacteria. Today about 50,000 tonnes of antibiotics are produced annually. About a third of this consists of penicillins, whilst tetracyclines make up about a quarter of the market. 

Tetracycline and its derivative doxycycline are antibiotics widely used in the treatment of bacterial infections. They also exert an antimalarial activity. Tetracyclines inhibit the binding of aminoacyl-tRNA to the ribosome during protein synthesis. 

The use of antibiotics is not recommended, except for the treatment of infectious exacerbations of COPD and other bacterial infections. Influenza vaccines decrease illness and death in COPD patients. Pneumococcal vaccination is also recommended. 

As with all drugs, the specific side effects of the quinolones must be considered when they are chosen for treatment of bacterial infections [5]. Reactions of the gastrointestinal tract and the central neivous system are the most often observed adverse effects during therapy with quinolones. It should be underlined, however, that compared with many other antimicrobials, diarrhea is less frequently observed during quinolone treatment. Antibiotic-associated colitis has been observed rarely during quinolone therapy. Similarly, hypersensitivity reactions, as observed during therapy with penicillins and other (3-lactams, is less frequently caused by quinolones. Some other risks of quinolone therapy have been defined and must be considered if a drug from this class is chosen for treatment of bacterial infections. 

II cleaves the two complementary strands of DNA four base pairs apart and the resulting 5 -phosphoryl groups become covalently linked to a pair of tyrosine groups, one in each half of the dimeric topoisomerase II enzyme. Several groups of drugs are known that selectively inhibit topoisomerases in bacteria (quino-lones) or mammalian cells (etoposide, tenoposide). Quinolones are used to treat bacterial infections inhibitors of mammalian topoisomerases are cytostatic drugs used for the treatment of cancer. 

The natural and semi ynthetic penicillins are used in tire treatment of bacterial infections due to susceptible microorganisms. Fbnicillins may be used to treat infections such as urinary tract infections, septicemia, meningitis, intra-abdominal infection, gonorrhea, syphilis, pneumonia, and other respiratory infections. Examples of infectious microorganisms (bacteria) that may respond to penicillin therapy include gonococci, staphylococci,... 

The expected outcomes of the patient may include an optimal response to therapy, which includes control of die infectious process or prophylaxis of bacterial infection, an absence of adverse drug effects, and an understanding of and compliance with die prescribed treatment regimen. 

Before therapy is begun, culture and sensitivity tests (see Chap. 7) are performed to determine which antibiotic will best control the infection. These drug are of no value in the treatment of infections caused by a virus or fungus. There may be times when a secondary bacterial infection has occurred or potentially will occur when the patient has a fungal or viral infection. The primary health care provider may then order one of die... 

When considering anti-infective therapy, one first thinks of a curative treatment, aiming at the rapid elimination of the pathogen from the human organism. This concept holds true for the treatment of most bacterial infections with antibiotics however, in the case of antiviral therapy, a curative treatment is the exception rather than the rule. Many human virus infections are characterized by an acute, self-limiting... 

Testes from the males examined 43 days after the 8-D treatment appeared normal. However, the epididymis was involved in an inflammatory process with sperm granulomas formation. The granulomatous epididymal lesion resembled the lesion seen in auto-immune reaction following bacterial infections or tissue response to foreign bodies (16, 17,... 

The treatment of bacterial infections of the central nervous system highlights a number of important therapeutic considerations. Bacterial meningitis is caused by a variety of bacteria although their incidence varies with age. In the neonate, E. coli and group B streptococci account for the majority of infections, while in the preschool child H. influenzae is the commonest pathogen. Neisseria meningitidis has a... 

If conventional treatment fails, unresolved diaper rash can also lead to secondary bacterial infections. Staphylococcus aureus and streptococci are the most likely pathogens responsible for these infections and require treatment with systemic antibiotics.3 37 While topical protectants may be used as an adjunct in treatment, suspected bacterial infections should always be referred to a physician for accurate diagnosis and the selection of an appropriate antibacterial regimen.34 Figure 62-7 shows a useful algorithm for the effective treatment of diaper dermatitis. 

Sinusitis, or inflammation of the paranasal sinuses, is better described as rhinosinusitis that also involves inflammation of contiguous nasal mucosa, which occurs in virtually all cases of viral respiratory infections. Acute rhinosinusitis is characterized by symptoms that resolve completely in less than 4 weeks, whereas chronic rhinosinusitis typically persists as cough, rhi-norrhea, or nasal obstruction for more than 90 days. Acute bacterial rhinosinusitis (ABRS) refers to an acute bacterial infection of the sinuses that can occur independently or be superimposed on chronic sinusitis. The focus of this section will be on ABRS and appropriate treatment. 

Onychomycosis is a chronic infection that rarely remits spontaneously. Adequate treatment is essential to prevent spread to other sites, secondary bacterial infections, cellulitis, or gangrene. Due to the chronic nature and impenetrability of nails, topical agents have low efficacy rates for treating onychomycosis. Oral agents that can penetrate the nail matrix and nail base, such as itraconazole and terbinafine, are more effective than ciclopirox lacquer. Itraconazole and terbinafine demonstrate mycological cure rates of 62%37 and 76%,38 respectively, while ciclopirox has a cure rate of 29% to 36%.39... 

Bone marrow suppression ZDV Onset Few weeks to months Symptoms Fatigue, risk of T bacterial infections due to neutropenia anemia, neutropenia 1. Advanced HIV 2. High dose ZDV 3. Preexisting anemia or neutropenia 4. Concomitant use of bone marrow suppressants Avoid in patients with high risk for bone marrow suppression avoid other suppressing agents monitor CBC with differential at least every 3 months Switch to another NRTI D/C concomitant bone marrow suppressant, if possible for anemia Identify and treat other causes consider erythropoietin treatment or blood transfusion, if indicated for neutropenia Identify and treat other causes consider filgrastim treatment, if indicated... 

When combined with a (i-lactam antibiotic, both clavulanic acid and sulbactam provide very effective treatments for general bacterial infections, and overcome the resistance that would otherwise been encountered due to the expression of (i-lactamases. Clavulanic acid is sold in combination with the antibiotic amoxicillin and sulbactam is sold in combination with ampicillin. 

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