Meningococcal Meningitis — Suboptimal Response to Cephalothin Therapy
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Meningococcal disease continues to be a serious problem, and increasing recognition of sulfadiazine-resistant strains1 2 3 4 renders sulfonamide therapy untenable. For most persons either penicillin G or ampicillin has supplanted sulfonamides as the antimicrobial agents of choice in the treatment of meningococcal disease in man.3 , 5 However, selecting therapy for penicillin-sensitive patients remains a problem. Various cephalosporin derivatives have been suggested as bactericidal alternatives in life-threatening infections, but little experience with these agents has been reported in association with meningococcal disease. Binns and Pankey6 described a patient with meningococcal meningitis treated with cephalothin whose response was equivocal. They expressed the hope that others . . .Keywords:
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SummaryIt was observed that N1-heterocyclic derivatives of sulfanilamide, even if closely related, are soluble in one and the same solution almost to the extent of their separate solubilities. Based on this observation, the toxicity and antibacterial activity of sulfadiazine-sulfathiazole mixtures was investigated. It was found that the acute and chronic toxicity of this drug combination for albino rats is strikingly low if compared with the effect of similar or identical total concentrations of either sulfathiazole or sulfadiazine alone. Evidence derived from chemical analyses and post-mortem examinations pointed to a diminution of intrarenal obstruction from drug precipitate as the chief reason for the low toxicity of the mixture. In vitro antibacterial studies showed that the effectiveness of the mixture corresponded largely to the total concentration of free sulfonamide. On the basis of these observations, the substitution at the bedside of sulfathiazole or sulfadiazine by combinations of these two co...
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Case Reports1 September 1948THE DISADVANTAGES OF SULFONAMIDE COMBINATIONSWILFRED CARROL, M.D.WILFRED CARROL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-29-3-533 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptRecently there have appeared reports in the literature advocating the use of "sulfonamide combinations."1, 2The purpose in giving combinations of these similarly acting drugs has been to reduce the danger of "intrarenal drug precipitation" and "concrement formation." While giving comparatively small doses of each component of a mixture of sulfonamides, the danger of intrarenal drug precipitation should be only as great as if each compound had been administered alone. Yet the sum of the components could be completely effective in eradication of a given infection. This method of sulfonamide therapy at first sight appears very desirable but a case...Bibliography1. LEHR D: Inhibition of drug precipitation in the urinary tract by the use of sulfonamide mixtures. I. Sulfathiazole-sulfadiazine mixture, Proc. Soc. Exper. Biol. and Med., 1945, lviii, 11. CrossrefGoogle Scholar2. FRISKHAGENMANHELANDERSJÖGREN ARGSB: "Sulfa-Combination," New chemotherapeutic principle, British Med. Jr., 1947, l, 7. CrossrefGoogle Scholar3. BLANKENHORNVILTER MACF: Toxic reactions of the newer sulfonamides, Jr. Am. Med. Assoc., 1944, cxxvi, 691. Google Scholar4. FINLANDPETERSONGOODWIN MOLRA: Sulfadiazine, further clinical studies of its efficacy and toxic effects, Ann. Int. Med., 1942, xvii, 920. Google Scholar5. DOWLINGLEPPER HFMH: Toxic reactions following therapy with sulfapyridine, sulfathiazole and sulfadiazine, Jr. Am. Med. Assoc., 1943, cxxi, 1190. CrossrefGoogle Scholar6. DOWLING HF: Relative toxicity of sulfamerazine and sulfadiazine, Jr. Am. Med. Assoc., 1944, cxxv, 103. CrossrefGoogle Scholar7. SCHWARTZFLIPPINREINHOLDDOMM LHFJGAH: The effects of alkali on crystalluria from sulfathiazole and sulfadiazine, Jr. Am. Med. Assoc., 1941, cxvii, 514. CrossrefGoogle Scholar8. GILLIGANGARBPLUMMER DRSN: Prevention of crystalluria during sulfadiazine therapy, Proc. Soc. Exper. Biol. and Med., 1943, lii, 248. CrossrefGoogle Scholar9. GILLIGANGARBWHEELERPLUMMER DRSCN: Adjuvant alkali therapy in prevention of renal complications from sulfadiazine, Jr. Am. Med. Assoc., 1943, cxxii, 1160. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Newark, N. J.*Received for publication July 31, 1947. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAntibacterial Chemotherapy with Sulfonamides 1 September 1948Volume 29, Issue 3Page: 533-536KeywordsDrugsSulfonamide ePublished: 1 December 2008 Issue Published: 1 September 1948 PDF downloadLoading ...
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We characterized five Neisseria meningitidis serogroup C isolates from a Chicago outbreak of meningococcal disease that occurred in 2003 among a community of men who have sex with men. Isolates from this outbreak were identical to each other but distinct from the clone that caused a similar outbreak in Canada in 2001.
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ABSTRACT Nosocomial transmission of Neisseria meningitidis has only rarely been reported. Here, we present a significant spatiotemporal association of two cases of invasive meningococcal disease identified by retrospective cluster analysis with the program SaTScan. The most likely epidemiological link was simultaneous hospitalization, resulting in indirect nosocomial transmission.
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ABSTRACT Infections associated with Neisseria meningitidis are a major public health problem in England, Wales, and Northern Ireland. Currently, over 40% of cases are confirmed directly from clinical specimens using PCR-based methodologies without an organism being isolated. A nested/seminested multilocus sequence typing (MLST) system was developed at the Health Protection Agency Meningococcal Reference Unit to allow strain characterization beyond the serogroup for cases confirmed by PCR only. This system was evaluated on a panel of 20 meningococcus-positive clinical specimens (3 cerebrospinal fluid and 17 blood samples) from different patients containing various concentrations of meningococcal DNA that had corresponding N. meningitidis isolates. In each case, the sequence type generated from the clinical specimens matched that produced from the corresponding N. meningitidis isolate; the sensitivity of the MLST system was determined to be less than 12 genome copies per PCR. The MLST system was then applied to 15 PCR meningococcus-positive specimens (2 cerebrospinal fluid and 13 blood samples), each from a different patient, involved in three case clusters (two serogroup B and one serogroup W135) for which no corresponding N. meningitidis organisms had been isolated. In each case, an MLST sequence type was generated, allowing the accurate assignment of individual cases within each of the case clusters. In summary, the adaptation of the N. meningitidis MLST to a sensitive nested/seminested format for strain characterization directly from clinical specimens provides an important tool for surveillance and management of meningococcal infection.
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A meningitis epidemic due to Group A meningococci was unusual in that most of the strains isolated from patients were generally resistant to sulfadiazine. This is the first report of sulfonamide resistance in an epidemic strain of Neisseria meningitidis Group A.
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Neisseria meningitidis is a major world-wide cause of meningitis. N. meningitidis related diseases have become more pronounced in the last decade and changes in meningococcal-associated disease have opened new opportunities for prevention and vaccine development. Although multivalent vaccines have been developed against the N. meningitidis serogroups A, C, W-135, and Y, four of the most common serogroups, the diversity of N. meningitidis has increased the number of challenges for the development of an effective vaccine against all currently identified strains. Without the development of a vaccine against serogroup B, it will be difficult to effectively prevent global meningococcal disease. This review provides a background on N. meningitidis biology and focuses on the current status of meningococcal research and vaccine development. In addition, the efficacy of the currently marketed N. meningitidis vaccines will be discussed. Keywords: Neisseria meningitidis, meningococcal vaccines, meningitis
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The search for the ideal sulfonamide compound has directed our attention to sulfamethazine, the latest of the sulfonamide compounds. Sulfamethazine (2-sulfanilamido-4, 6-dimethylpyrimidine) is the dimethyl homologue of sulfadiazine. The few reports now in the literature credit it with less toxicity than the sulfonamide drugs now in use. Rose, Martin and Bevan1compared the solubility of this compound and its acetyl derivative with that of sulfapyridine, sulfadiazine and sulfathiazole. Sulfamethazine was found to be ten times more soluble in the free and five times more soluble in the acetylated form than sulfadiazine. Gilligan and Plummer2showed it to be the most soluble of all the sulfonamide compounds in the varying range of urinarypH in both its free and its acetylated form. Clinical studies have been made by Macartney and his associates3and others4on the use of the drug in the treatment of pneumonia in
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Summary 1. In a cholera epidemic, a study of the therapeutic effect of sulfonamide drugs has been made in 25 adult patients treated with sulfaguanidine, 25 with sulfadiazine and 29 without sulfonamides as control. 2. One death occurred in the control group and one in the group with sulfaguanidine treatment. 3. The average duration of diarrhea is shortened and the average amount of intravenous saline given is reduced in the sulfonamide-treated group as compared with the control. The differences are statistically significant. 4. There is no significant difference between the therapeutic results produced by these two sulfonamide drugs. 5. No striking effect of the sulfonamides on the time of disappearance of cholera vibrios from the stool has been observed. 6. With the dosage used in this study, only bacteriostatic concentration of the sulfonamides has been found in the stool of the patients under treatment.
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