- Entero-neovesical fistula after radical cystectomy and orthotopic ileal neobladder: A report of two cases requiring surgical management. [Journal Article]
- UUrologia 2018 Mar 01; :391560318758939
- CONCLUSIONS: Conservative treatment of entero-neovesical fistula can be attempted only in patients with small openings in the small bowel and no systemic symptoms. In all other cases, surgical treatment with bowel resection and either closure of the neobladder opening or undiversion should be the preferred option.
- Characterization of SPR994, an Orally Available Carbapenem, with Activity Comparable to Intravenously Administered Carbapenems. [Journal Article]
- AIACS Infect Dis 2018 Aug 17
- Carbapenems are potent antibacterials with broad-spectrum activity. However, poor oral absorption generally confines this important drug class to in-hospital use by intravenous (IV) administration. T...
Carbapenems are potent antibacterials with broad-spectrum activity. However, poor oral absorption generally confines this important drug class to in-hospital use by intravenous (IV) administration. The continued rise in drug resistant pathogens creates a need for alternative oral therapies with broad-spectrum activity. SPR994 is a novel formulation of the orally bioavailable pivoxil prodrug of SPR859 (tebipenem) and is being developed as the first oral carbapenem for treatment of complicated urinary tract infections (cUTIs) in adults. Herein, we describe characteristics beneficial to oral administration and compare the in vitro and in vivo activity of SPR859 or SPR994 with IV carbapenems.
- Ceftibuten plus amoxicillin-clavulanic acid for oral treatment of urinary tract infections with ESBL producing E. coli and K. pneumoniae: a retrospective observational case-series. [Journal Article]
- EJEur J Clin Microbiol Infect Dis 2018 Aug 16
- This study aimed to evaluate the clinical and bacteriological effect of oral treatment with ceftibuten plus amoxicillin-clavulanic acid in patients with a urinary tract infection (UTI) caused by an e...
This study aimed to evaluate the clinical and bacteriological effect of oral treatment with ceftibuten plus amoxicillin-clavulanic acid in patients with a urinary tract infection (UTI) caused by an extended-spectrum β-lactamase (ESBL)-producing micro-organism. In this retrospective observational case-series, oral treatment with ceftibuten 400 mg QD plus amoxicillin-clavulanic acid 625 mg TID for 14 days was evaluated in ten patients with pyelonephritis caused by an ESBL-positive micro-organism resistant to ciprofloxacin and co-trimoxazole. Presence of ESBL genes was confirmed using PCR and micro-array. EUCAST breakpoints were used for susceptibility testing. Ten patients (five women) were evaluated in 2016 and 2017. Six patients were from outpatient hospital care, and four from primary care. Urinary cultures yielded seven E. coli and three K. pneumoniae ESBL-positive isolates. Using Vitek-2, all isolates were resistant to cefotaxime, and resistant (n = 7) or intermediately susceptible (n = 3) to ceftazidime. With disc diffusion, all isolates were susceptible to ceftibuten (zones 25-32 mm), while with MIC test strips eight of ten isolates were resistant to ceftibuten (MICs 0.5-4 mg/L). An amoxicillin-clavulanic acid disc next to the ceftibuten disc extended the ceftibuten zone by 2-8 mm. All patients experienced clinical cure. Bacteriological cure (absence of pretreatment micro-organism in the first follow-up culture obtained within 3 months after treatment) was observed in all eight patients with follow-up cultures. This case-series shows that the synergistic combination of ceftibuten plus amoxicillin-clavulanic acid may be an option for oral treatment of UTIs caused by ESBL producing E. coli or K. pneumoniae.
- Nitrofurantoin: friend or foe? [Journal Article]
- BCBMJ Case Rep 2018 Aug 16; 2018
- Nitrofurantoin remains the gold standard treatment of uncomplicated cystitis as well as prophylactic treatment of recurrent urinary tract infections. Drug-induced hepatotoxicity presents in acute (3 ...
Nitrofurantoin remains the gold standard treatment of uncomplicated cystitis as well as prophylactic treatment of recurrent urinary tract infections. Drug-induced hepatotoxicity presents in acute (3 in 1 000 000) and chronic (1 in 1500) forms. We present a patient with acute liver failure after 5 days of treatment. A 69-year-old man admitted for chronic obstructive pulmonary disease exacerbation 5 days into treatment for cystitis with nitrofurantoin. On admission he was noted to be jaundiced with elevated liver enzymes and normal international normalised ratio. Investigation for infectious, autoimmune and cholestatic causes of hepatotoxicity was negative. The patient improved after discontinuation of the drug and 10 days of methylprednisolone. There are scant data on acute liver failure in the setting of short-term nitrofurantoin administration. The mechanism of toxicity remains unclear, but is hypothesised to be an autoimmune process in which steroids may play a role in treatment. Diagnosis is one of exclusion as the only definitive method of diagnosis is rechallenge.
- Keratinising squamous metaplasia of the bladder. [Journal Article]
- BCBMJ Case Rep 2018 Aug 16; 2018
- Keratinising squamous metaplasia of the bladder is a very rare entity that carries a risk of progression to malignancy. We present a case of a 62-year-old man found to have the condition and discuss ...
Keratinising squamous metaplasia of the bladder is a very rare entity that carries a risk of progression to malignancy. We present a case of a 62-year-old man found to have the condition and discuss the management dilemma with a review of the literature.
- Infections During Pregnancy. [Review]
- PCPrim Care 2018; 45(3):567-586
- Several infections have unique consequences or considerations in pregnancy. Some common infections such as urinary tract infections, influenza, sexually transmitted diseases, and vaginitis affect pre...
Several infections have unique consequences or considerations in pregnancy. Some common infections such as urinary tract infections, influenza, sexually transmitted diseases, and vaginitis affect pregnant women differently than the general population, can cause pregnancy complications, and require treatments that are safe in pregnancy. Infections such as hepatitis B and C and human immunodeficiency virus can be transmitted vertically and therefore management focuses on decreasing perinatal transmission. Certain infections can be transmitted in utero and cause congenital infections. Classically, these were grouped together as the TORCH infections, although now several others, including varicella virus, parvovirus, and Zika virus, have also been recognized.
- Urinary Tract Infection Antibiotic Resistance in the United States. [Review]
- PCPrim Care 2018; 45(3):455-466
- Urinary tract infection (UTI) is one of the most common entities in medicine and affected patients present daily in a typical family medicine practice. The patients often present with the "classic sy...
Urinary tract infection (UTI) is one of the most common entities in medicine and affected patients present daily in a typical family medicine practice. The patients often present with the "classic symptoms" of dysuria and increased frequency, but sometimes they are asymptomatic or have a mixed picture. In most cases, an antibiotic is prescribed, and this practice is likely contributing to increasing worldwide antibiotic resistance. To help combat this problem, it is important that clinicians seek out their local bacterial resistance patterns and antibiograms, properly diagnose and treat UTI if indicated, and recognize their role in antibiotic stewardship.
- A pre and post intervention study to reduce unnecessary urinary catheter use on general internal medicine wards of a large academic health science center. [Journal Article]
- BHBMC Health Serv Res 2018 Aug 16; 18(1):642
- CONCLUSIONS: The SafetyLEAP program can help provide a systematic approach to the detection, and reduction of safety incidents. Future studies should aim at refining and implementing this intervention broadly.
- Bladder emptying method is the primary determinant of urinary tract infections in patients with spinal cord injury: results from a prospective rehabilitation cohort study. [Journal Article]
- BIBJU Int 2018 Aug 16
- CONCLUSIONS: Bladder emptying method was identified as the main risk factor for UTI in patients with SCI. As spontaneous voiders have the lowest UTI rate, further research is warranted to reduce voiding dysfunction, for instance using neuromodulation procedures. This article is protected by copyright. All rights reserved.
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- Characterization of Maternal and Neonatal Pharmacokinetic Behavior of Ceftazidime. [Journal Article]
- JCJ Clin Pharmacol 2018 Aug 16
- Ceftazidime is a parenteral cephalosporin frequently used in pregnant women for treatment of urinary tract or intrauterine infections. Despite its regular use in pregnant women, ceftazidime dispositi...
Ceftazidime is a parenteral cephalosporin frequently used in pregnant women for treatment of urinary tract or intrauterine infections. Despite its regular use in pregnant women, ceftazidime disposition in both mother and fetus is not well understood, and a pharmacokinetic (PK) model that allows characterization and simulation of both maternal and preterm neonatal ceftazidime disposition is not available. In this study, 10 pregnant women with suspected or proven intrauterine infections in the late second and early third trimester were treated with 1 g of ceftazidime intravenously every 6 hours. During ceftazidime treatment, one maternal and umbilical cord blood sample was taken at delivery to quantify ceftazidime concentrations in the mother and preterm neonate. Data showed that ceftazidime concentrations in the mother were comparable to those observed in the neonate. Based on these data, a PK model was developed to describe maternal disposition, ceftazidime distribution over the placenta, and elimination in the neonate. The maternal substructure of the model was parameterized according to a previously reported ceftazidime model with minor adjustments to account for pregnancy-related effects on renal elimination of ceftazidime. The expanded population PK model with an additional neonatal compartment was fitted to measured drug concentrations in the neonate. The neonatal elimination rate constant at delivery was close to that estimated for the mother. The presented results show that ceftazidime readily crosses the placenta and indicate that perinatal PK behavior of ceftazidime in preterm neonates can be expected to be similar to those observed in their mothers.