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Trimethoprim and Trimethoprim–Sulfamethoxazole (Cotrimoxazole)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Jason A. Trubiano, M. Lindsay Grayson
Renewed interest in CoT for skin and soft tissue infections, in particular impetigo and S. pyogenes infections, has occurred in the setting of potential overestimation of the rates of S. pyogenes resistance historically (Bowen et al., 2012). In a randomized controlled noninferiority trial of indigenous Australian children aged 3 months to 13 years with purulent or crustered impetigo, CoT (TMP, 4 mg/kg twice daily for 3 days, or TMP, 8 mg/kg daily for 5 days) was compared with i.m. benzathine benzylpenicillin, and CoT was found to be noninferior (Bowen et al., 2014). However, the addition of CoT to outpatient cephalexin therapy in a cohort of patients with cellulitis without abscesses was found to have no additional benefit (Pallin et al., 2013). CoT can be used as an alternative to i.m. penicillin for impetigo; however, combination therapy with other streptococcal-active agents (e.g. cephalexin) does not appear warranted.
Case 13: Loss of Vision and a Maculopapular Rash
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
A lumbar puncture was planned but not performed. Over the next 24–48 hours, the patient developed a maculopapular rash covering his limbs, abdomen and torso. This was initially thought to represent a drug reaction, possibly related to the aciclovir, but, as the rash progressed, the ophthalmology consultant advised that the rash was consistent with secondary syphilis. Blood tests were sent for syphilis serology and Treponema pallidum antibodies were detected (RPR titre of 1:32, consistent with active syphilis infection). The patient commenced intramuscular benzathine benzylpenicillin treatment.
Treatment outcomes of acute streptococcal tonsillitis according to antibiotic treatment. A retrospective analysis of 242,366 cases treated in the community
Published in European Journal of General Practice, 2022
Mattan Bar-Yishay, Ilan Yehoshua, Avital Bilitzky, Yan Press
Compared to penicillin-V, benzathine benzylpenicillin treated patients had the highest odds of developing a peritonsillar or retropharyngeal abscess, with an adjusted odds ratio (aOR) of 8.61 (CI 2.71–27.38, p < .001). For the development of any complication, benzathine benzylpenicillin treated patients showed an adjusted odds ratio of 10.77 (CI 4.37–26.56, p < .001) compared to penicillin-V treatment. Patients treated with amoxicillin with clavulanate also recorded significantly more complications, with aOR of 6.26 for peritonsillar or retropharyngeal abscess (CI 4.85–8.09, p < .001) and 5.28 for any complication (CI 4.15–6.71, p < .001), compared to penicillin-V.