For pneumococci

Andersson, B., Dahmen, J., Freid, R., Leffler, H., Magnusson, G., Noori, G., and Svanborg-Evan, C. (1983). Identification of an active disaccharide unit of glycoconjugate receptor for pneumococci attaching to human pharyngeal epithelial cells. /. Exp. Med. 158,559-570. 

Splenic sequestration crisis is a major cause of mortality in young patients with SCD. The sequestration of RBCs in the spleen may result in a rapid drop of hematocrit, leading to hypovolemia, shock, and death. Immediate treatment is red cell transfusion to correct hypovolemia. Broad-spectrum antibiotic therapy, which includes coverage for pneumococci and H. influenzae, may also be beneficial, because infection may precipitate crises. " ... 

If she has a community-acquired pneumonia, coverage must be provided for pneumococci and atypical pathogens. In such a case, the most appropriate drug treatment in this patient is... 

Immunization against pneumococcal pneumonia and bacteremia caused by the types of pneumococci included in the vaccine Active immunization against Streptococcus pneumoniae for infants and toddlers... 

These proteins are called acute phase proteins (or reactants) and include C-reactive protein (CRP, so-named because it reacts with the C polysaccharide of pneumococci), ai-antitrypsin, haptoglobin, aj-acid glycoprotein, and fibrinogen. The elevations of the levels of these proteins vary from as little as 50% to as much as 1000-fold in the case of CRP. Their levels are also usually elevated during chronic inflammatory states and in patients with cancer. These proteins are believed to play a role in the body s response to inflammation. For example, C-reactive protein can stimulate the classic complement pathway, and ai-antitrypsin can neutralize certain proteases released during the acute inflammatory state. CRP is used as a marker of tissue injury, infection, and inflammation, and there is considerable interest in its use as a predictor of certain types of cardiovascular conditions secondary to atherosclerosis. Interleukin-1 (IL-1), a polypeptide released from mononuclear phagocytic cells, is the principal—but not the sole—stimulator of the synthesis of the majority of acute phase reactants by hepatocytes. Additional molecules such as IL-6 are involved, and they as well as IL-1 appear to work at the level of gene transcription. 

Staphylococcus aureus is less sensitive to erythron rdn than are pneumococci or haemolytic streptococci, and there may be a rapid development of resistance, especially of staphylococci, in vitro. However, in vivo with successM short courses of treatment, resistance is not usually a serious clinical problem. On the other hand, resistance is likely to develop when the antibiotic is used for long periods. 

The pneumococci all belong to different types of the same species, namely, Streptococcus pneumoniae. This was earlier called Diplococcus pneumoniae, but has been renamed.5 6 7 There are some 80 different types of pneumococcus, and two systems of nomenclature, the Danish, used in Europe, and Eddy s, used in the United States.8 Tables correlating the Danish and American designations have been published.8 The Danish system, with Arabic numerals and common abbreviations, such as Phi for Type 1 and SI for its type-specific, capsular polysaccharide, will be used in this article. 

Prevenar is the pneumococcal polysaccharide-conjugate vaccine and contains polysaccharide, from seven capsular types of pneumococci, which is conjugated to diphtheria toxin (protein). Prevenar is recommended for individuals at increased risk of pneumococcal infection including those over 65 years, patients with chronic heart, renal, respiratory or liver disease, diabetics and immune deficiency. It is a component of the primary course of childhood immunisation. 

Penicilhns that are resistant to penicilhnase are the drug of choice for infections resistant to penicillin G, Staph, aureus, or coagulase-negative staphylococci. They are also effective for infections caused by nonenterococcus types of streptococci, such as streptococci groups A, B, C, and G, as weh as pneumococci. 

This drug is effective for infections caused by streptococci, gonococci, pneumococci, staphylococci, and also colon bacillus. Sulfacytine is used for pneumonia, cerebral meningitis, staphylococcal and streptococcal sepsis, and other infectious diseases. A synonym of this drug is renoquid. 

This drag has antibacterial activity with respect to streptococci, pneumococci, staphylococci, meningococci, gonococci, colon bacillus, pathogenic dysentery, and others. It is not very toxic. It is generally used for acute, uncomplicated infections of the urinary tract that... 

Worldwide Streptococcus pneumoniae % susceptibility to penicillin is decreasing. In some countries up to two-thirds of the clinical isolates have reduced susceptibility to penicillin or are highly resistant to this drug. Moreover, the rate of resistance to other drugs commonly used for RTI including erythromycin, tetracycline and trimethoprim-sulfamethoxazole is higher in penicillin-resistant than penicillin-susceptible strains. Monitoring local or hospital resistance patterns of pneumococci is, therefore, needed. 

Infections of the external eye can be caused by viruses and by bacteria from the respiratory tract such as pneumococci and Haemophilus influenzae. Infections of the internal eye can be caused by the same bacteria through spread from a corneal (traumatic) ulcer or by S. aureus. The same pathogens are responsible for periorbital spread in severe sinusitis. Treponema pallidum, CMV and Toxoplasma cause intra-ocular infections. 

These semisynthetic penicillins are indicated for infection by 3-lactamase-producing staphylococci, although penicillin-susceptible strains of streptococci and pneumococci are also susceptible. Listeria, enterococci, and methicillin-resistant strains of staphylococci are resistant. In recent years the empirical use of these drugs has decreased substantially given increasing rates of methicillin-resistance in staphylococci. However, for infections caused by methicillin-susceptible strains of staphylococci these are considered the drugs of choice. 

Cefaclor, cefuroxime axetil, cefprozil, and loracarbef can be given orally. The usual dosage for adults is 10-15 mg/kg/d in two to four divided doses children should be given 20-40 mg/kg/d up to a maximum of 1 g/d. Except for cefuroxime axetil, these drugs are not predictably active against penicillin-resistant pneumococci and should be used cautiously, if at all, to treat suspected or proved pneumococcal infections. Cefaclor is more susceptible to 13-lactamase hydrolysis compared with the other agents, and its usefulness is correspondingly diminished. 

Because of potential toxicity, bacterial resistance, and the availability of many other effective alternatives, chloramphenicol is rarely used. It may be considered for treatment of serious rickettsial infections such as typhus and Rocky Mountain spotted fever. It is an alternative to a B-lactam antibiotic for treatment of meningococcal meningitis occurring in patients who have major hypersensitivity reactions to penicillin or bacterial meningitis caused by penicillin-resistant strains of pneumococci. The dosage is 50-100 mg/kg/d in four divided doses. 

Sulfonamides are infrequently used as single agents. Many strains of formerly susceptible species, including meningococci, pneumococci, streptococci, staphylococci, and gonococci, are now resistant. The fixed-drug combination of trimethoprim-sulfamethoxazole is the drug of choice for infections such as Pneumocystis jiroveci (formerly P carinii) pneumonia, toxoplasmosis, nocardiosis, and occasionally other bacterial infections. 

A combination of trimethoprim-sulfamethoxazole is effective treatment for a wide variety of infections including P jiroveci pneumonia, shigellosis, systemic salmonella infections, urinary tract infections, prostatitis, and some nontuberculous mycobacterial infections. It is active against most Staphylococcus aureus strains, both methicillin-susceptible and methicillin-resistant, and against respiratory tract pathogens such as the pneumococcus, Haemophilus sp, Moraxella catarrhalis, and Klebsiella pneumoniae (but not Mycoplasma pneumoniae). However, the increasing prevalence of strains of E coli (up to 30% or more) and pneumococci that are resistant to trimethoprim-sulfamethoxazole must be considered before using this combination for empirical therapy of upper urinary tract infections or pneumonia. 

Antibacterial Spectrum. Hawley reported that various species and strains of the genera Staphylococcus, Streptococcus, Neisseria, Bacillus, Clostridium, and Corynebacterium are inhibited by nisin (Hawley 1957A, B). Mattick and Hirsch (1947) added actinomycetes, pneumococci, mycobacteria, and Erysipelothrix to this list. The nisin concentration required for complete inhibition is organism specific and ranges from 0.25 to 500 units per milliliter. Inhibition of L. casei by antibiotics from S. lactis and S. cremoris was observed by Baribo and Foster (1951). Inhibition of Propionibacterium by nisin but not of coliform bacteria was reported by Galesloot (1957). 

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