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Herminia Combs
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PATIENTS AND METHODS. Ciprofloxacin after clinical failure of beta-lactam antibiotics in children with salmonellosisBACKGROUND. The mechanism is unclear. Other causes of jaundice were excluded. From to 2000, the bacteriology laboratory of a French pediatric hospital had identified 215 patients aged between 1 month and 15 years with positive blood or stools for Salmonella sp, 113 of them requiring hospitalization due to their clinical symptoms. Asymptomatic carriage was pain management contraceptive pills found in 5/22 patients (P < 0.05) after recovery. Male sex, advancing age, or prolonged treatment (more than 10 days) may increase the risk. In 72 children (mean age 3.6 years) antibiotics ceftriaxone treatment (amoxicillin in 5) for 5 or 7 days was rapidly effective. We report 9 patients who exhibited this characteristic. Three were excluded for sickle-cell disease or poor nutritional status. None of the patient treated with ciprofloxacin had side effect. The delay between stopping treatment and the onset of hepatitis varied from 13 days to 6 weeks after stopping antibiotics the drug. In severe salmonellosis, the clinical failure of treatment with ceftriaxone is not rare, particularly in S. To evaluate in a retrospective study usefulness, efficacy and safety of oral ciprofloxacin in patients amoxicillin 500 with severe salmonellosis and clinical failure of ceftriaxone or beta-lactam antibiotics. The strains involved in these 26 patients included the 4 S. Heidelberg) isolated was resistant to ceftriaxone or ciprofloxacin. Clinical upgrading with ciprofloxacin was obtained in less than 48 h. Due to their poor penetration into cells, beta-lactam antibiotics, even if active in vitro, are sometimes clinically ineffective because online pharmacy they cannot reach the intracellular sites of Salmonella multiplication. In the 26 other patients ceftriaxone (amoxicillin in 2) treatment was clinically ineffective, despite good in vitro activity, and was astonishment for oral ciprofloxacin (20 mg kg(-1) d(-1), 5 days) after 2 to 7 days of lasted vomiting and/or severe diarrhea. None of the 110 strains (including 4 S. Except for cases with few symptoms, a time interval between stopping treatment and the first manifestations (jaundice in most cases), sometimes of several weeks, may hinder action. Typhimurium (P < 0.05), 13/15 (P < 0.01) producing beta-lactamase. Two to 3 weeks after clinical recovery, asymptomatic carriage was present in 22/38 patients. Evoking the role of amoxicillin-clavulinic acid combinationAlthough infrequent, hepatitis associated with amoxicillin and clavulanic acid combination is probably underestimated. Complete recovery occurs within 1 to 4 months after discontinuation of treatment. Clinical and biological complication of hypersensitivity may suggest an immunoallergic reaction. Children with enteric fever or severe salmonella infections are usually treated with beta-lactam antibiotics, particularly ceftriaxone. Forty-one of the 110 strains (37.3%) produced a beta-lactamase. Delayed drug-induced hepatic injury. Apyrexia was obtained in 1.5 day after the start of treatment and the number of stools per day was 4 or less in 2.2 days. Twelve patients had a rapid recovery without antibiotic treatment, and 98 (mean age 3.9 years) were given antibiotics (ceftriaxone in 91 and amoxicillin in 7) for dysentery (43%), shock (15%) or persistent high fever and severe diarrhea (42%). Typhimurium producing beta-lactamase infection and short treatment with oral ciprofloxacin is safe and allows to obtain a rapid recovery.
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