Explore chapters and articles related to this topic
Anatomical and Physiological Changes in Pregnancy
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Joanna Shepherd, Stephen Radley
Antibiotics:Amoxicillin or cephalosporin are safe.Trimethoprim: avoid during the 1st trimester.Anti-folate properties increase the risk of neural tube defects.Nitrofurantoin: avoid during the 3rd trimester.Increases risk of neonatal jaundice.Gentamicin: not routinely recommended.Cranial VIII nerve damage in the foetus.
Infections
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
There are many reports on small, randomised, controlled trials of short course therapy in children with lower UTI. Results have been variable and 3 recent meta-analyses, comparing 4 day or shorter treatment with longer courses, have reached different conclusions [17–19]. When short courses are used, it is important to take into account that the antibiotics have different pharmacokinetic properties. Antibiotics that are rapidly excreted (serum half-life of about 1 hour) have no antibacterial activity in urine after 8 to 12 hours; examples are some oral cephalosporins and nitrofurantoin. Trimethoprim, on the other hand, has a serum half-life of about 10 hours that results in effective antibacterial concentrations in urine for several days. This means that a 3 day course with trimethoprim, with or without sulphonamide, is equivalent to at least 5 days treatment with cefadroxil or nitrofurantoin. Single dose or 1 day courses are not recommended, whereas a 3-day course of co-trimoxazole was as effective as longer courses. In a single centre study of 300 consecutive children with acute cystitis, treated with nitrofurantoin or trimethoprim for 5 days, the bacteriological cure rate was 99%; recurrences within 1 month occurred in 2% [20]. With such clear-cut results, it can be firmly concluded that children with acute cystitis need treatment for a maximum of 5 days; there is no need for a controlled trial. But the importance of checking for the resistance pattern of the bacteria is emphasised again.
Infections
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Treatment of asymptomatic bacteriuria reduces the risk of acute pyelonephritis by 75% and possibly reduces the risk of premature birth by about 40%.48 It is uncertain how long a course of treatment should last. Single-dose therapy is not advised, but treatment for longer than three to seven days offers no additional advantage.48,51 Amoxycillin, nitrofurantoin and cefalexin are safe to use in pregnancy (Table 11.1).50,52,53 Amoxycillin is becoming less useful due to increasing rates of resistant E. coli.50 Nitrofurantoin is contraindicated in women suspected or known to have glucose-6-phosphate dehydrogenase (G6PD) deficiency, due to the risk of haemolysis. Trimethoprim has not been shown to harm the fetus if given during pregnancy. It is not recommended, however, especially in the first trimester, as it is a folate antagonist and theoretically teratogenic.44 Quinolones are not recommended because of adverse effects on developing cartilage in animal studies.44 Co-amoxiclav (a beta-lactam/beta-lactamase inhibitor combination) is probably safe, but experience is limited.53
Spiro heterocycles bearing piperidine moiety as potential scaffold for antileishmanial activity: synthesis, biological evaluation, and in silico studies
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2023
Mounir A. A. Mohamed, Asmaa M. Kadry, Salma A. Bekhit, Mohammed A. S. Abourehab, Kikuko Amagase, Tamer M. Ibrahim, Ahmed M. M. El-Saghier, Adnan A. Bekhit
To validate our design that the synthesised compounds possess their antileishmanial activity via the antifolate mechanism, we employed the approach reported by Mendoza-Martínez et al. for the two most active compounds 8a and 9a30. The approach involves exposing the parasite to concentrations of the tested compounds above their IC50s after the addition of folic acid and folinic acid using trimethoprim as a positive control. Exposure to trimethoprim after addition of folic acid led to an increase in parasite survival up to nearly 100%. It is worthy to mention that folic acid competes for the active sites of both DHFR and PTR1 while folinic acid involves in DNA synthesis without any necessity to undergo activation. As seen in Table 3, reversal of antileishmanial effect of compounds 8a and 9a took place upon addition of folic acid with percentage parasite growth in the range of 72–87%.
Disseminated Nocardia farcinica infection associated with bacteraemia and osteomyelitis pubis in an elderly patient
Published in Infectious Diseases, 2023
Domingo Fernández Vecilla, Mary Paz Roche Matheus, Mikel Joseba Urrutikoetxea Gutiérrez, Felicitas Elena Calvo Muro, Cristina Aspichueta Vivanco, Iñigo López Azkarreta, Mikel Grau García, José Luis Díaz de Tuesta del Arco
Trimethoprim-sulfamethoxazole is considered the first choice of treatment in infections caused by Nocardia spp. due to the synergistic effect of trimethoprim with sulfamethoxazole and its excellent tissue penetration and this is the reason why it was used in the case presented. Other therapeutic alternatives include linezolid, imipenem or amikacin. While other species of Nocardia (such as those belonging to the Nocardia abscessus complex) are generally susceptible to cefotaxime, ceftriaxone, imipenem or meropenem, N. farcinica has a high degree of resistance to 3rd generation cephalosporins, meropenem, ciprofloxacin and minocycline and should be avoided as empirical treatment [7]. If an intravenous antibiotic regimen is used, the duration of treatment could be 2–6 weeks, but the traditional recommendation is to prescribe 3–6 months-long treatment [25,26]. Focus control by draining the associated collections is mandatory when possible to achieve a rapid recovery and avoid relapses in this infections [27]. Successful treatment of previous cases of osteomyelitis included therapeutic aspiration, multiple debridements or instrumentation associated with long-term antibiotic treatment with trimethoprim-sulfamethoxazole or amikacin, which is consistent with treatment performed in the patient of the presented case. However, the patient’s fragility is considered the main reason for the treatment failure and death of the patient.
Early infectious risk in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis according to remission-induction therapy
Published in Scandinavian Journal of Rheumatology, 2023
M Gérard, H de Boysson, R Morello, N Martin-Silva, A-C Leroux, A Dumont, G Maigné, J Boutemy, K Khoy, D Mariotte, T Lobbedez, A Aouba, S Deshayes
In our cohort, the median infection-free survival was 3 months in the RTX group, which is concordant with previous studies (26–29). This highlights the highly immunosuppressed status of AAV patients and the importance of implementing prophylactic measures as early as possible. Among these, vaccination against pneumococcal disease is recommended in AAV patients but also prior to RTX use (6, 39). As previously reported, the absence of prophylactic use of trimethoprim–sulfamethoxazole was a strong risk factor for both severe infection and infections of any severity in univariate and multivariate analyses (27). In contrast, patients treated with aerosolized pentamidine were at increased risk of infections in univariate analysis. This fact highlights the dual benefit of trimethoprim–sulfamethoxazole, which prevents both Pneumocystis and usual bacterial infections and should be associated with induction treatment in AAV patients (6, 40). Severe infections were predominantly bacterial, confirming the clear role of trimethoprim–sulfamethoxazole in the prevention of these infections.