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Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Amoxicillin’s prevalence in aquatic environments, stemming from widespread medical usage, serves as a significant indicator of pharmaceutical contamination. Adsorption stands out as the preferred method for addressing this issue due to its simplicity, efficacy, practicality, and cost-effectiveness. This systematic review delves into peer-reviewed literature on amoxicillin removal through adsorption, drawing from databases like ScienceDirect and Scopus. Researchers have investigated adsorption equilibrium under varied conditions, exploring parameters such as pH, temperature, and adsorbent dosage. The diverse range of observed elimination levels underscores the critical importance of careful adsorbent selection, with capacities spanning from 10 to 1500 mg/g. Pseudo-second-order kinetic models and the Langmuir isotherm model frequently offer suitable descriptions of experimental data. Future research avenues could explore alternative kinetic models to deepen our understanding of amoxicillin adsorption mechanisms and foster the development of innovative adsorbents.

Résumé: Malgré la disponibilité de la culture bactérienne dans les laboratoires publics et privés, l'examen est rarement pratiqué simplement parce que la grande majorité des patients ayant une endoscopie n'ont pas de symptômes ou de maladies évocateurs de la gastrite liée à la bactérie. La découverte de H. pylori est donc le plus souvent fortuite sur des prélèvements à visée anatomo-pathologique. Deux traitements empiriques sont également envisageables : la quadrithérapie bismuthée de dix jours et la trithérapie optimisée associant amoxicilline- clarithromycine avec un IPP. Concernant la trithérapie, il paraît important de respecter une longue durée de prescription de 14 jours, des posologies d'amoxicilline de 3 g/j (ou de 50 mg/kg/j) et la prescription des certains IPP, comme l'ésoméprazole et le rabéprazole. Après un traitement empirique contenant du métronidazole à forte posologie et ou prolongé, la represcription de cet antibiotique est associée à un risque d'échec d'éradication. Le GEFH assure une réunion de concertation pluridisciplinaire composée de cliniciens, bactériologistes et pharmaciens pour des cas d'éradications difficiles de H. pylori. Despite the availability of bacterial culture in public and private laboratories, the test is rarely performed simply because most patients undergoing endoscopy have no symptoms or pathology suggestive of gastritis related to the bacteria. The discovery of H. pylori is therefore most often incidental on pathological specimens. Two empirical treatments are also possible: 10-day bismuth quadruple therapy and optimised triple therapy combining amoxicillin and clarithromycin with a PPI. In the case of triple therapy, it seems important to respect a long prescription period of 14 days, amoxicillin doses of 3G/d (or 50 mg/kg/d) and the prescription of certain PPIs, such as esomeprazole and rabeprazole. After empirical treatment with high-dose and/or prolonged metronidazole, re-prescribing this antibiotic is associated with a risk of eradication failure. The GEFH provides a multidisciplinary consultation meeting composed of clinicians, microbiologists, and pharmacists for cases of difficult eradication of H. pylori. [ABSTRACT FROM AUTHOR]

Introduction- Drug stability in healthcare establishments is a recurring problem in practice of hospital pharmacists. Apart from the expired drugs, instabilities are often confirmed by changes in appearance or color observed during drug’s period of validity. The objective of this work was to evaluate the stability and hospital practices likely to induce instabilities of valid parenteral drugs. Materials and methods- Firstly, a cross-sectional descriptive study was carried out over three months in three hospital in western of Algeria. Bad conditions of storage, preparation and administration as well as instabilities have been identified on parenteral drugs with long expiry dates. Secondary, photostability test was carried out under normal conditions of administration after exposure to daylight of both ascorbic acid solution in slow infusion and amoxicillin solution for injection after reconstitution. Results- About 546 parenteral drugs examined, 131 non compliances were identified, including 43% related to poor storage at the pharmacy, 33% related to administration and 24% related to preparation or reconstitution. Among the non-conformities related to storage and those related to administration, exposure to light for photosensitive drugs was predominant at 54% and 53.8% respectively.In addition, photostability study showed reduction of 10% of ascorbic acid content from the 30th minute of infusion and a yellowing of amoxicillin solution after one hour of daylight exposition. Conclusion- These studies showed the importance of having a quality assurance system within the hospital, which will ensure the application of good hospital pharmacy practices and thus guarantee the drug’s stability and efficacy, particularly for liquid parenteral forms.

Acute kidney injury is a common drug adverse reaction and may concerned antibiotics. We report a case of an acute renal failure due to amoxicillin occurring twice in the same patient. Two mechanisms have been described for amoxicillin, with an immuno-allergic origin observed in our case. The diagnosis, supported by kidney biopsy, was confirmed by rechallenge with this patient.

Résumé L’anaphylaxie à l’amoxicilline correspond à une réaction d’hypersensibilité immédiate par activation mastocytaire soit de mécanisme allergique impliquant les immunoglobulines E soit de mécanisme non allergique. Les réactions les plus sévères (stade ≥ II) sont considérées allergiques et les tests cutanés et/ou biologiques sont positifs. Cependant, il arrive que ce bilan soit négatif chez des patients pourtant allergiques à l’amoxicilline (faux négatif ?), à l’origine d’un risque de réaction grave iatrogène au moment de la reprise du médicament. Nous rapportons le cas de deux patientes ayant développé une anaphylaxie à l’amoxicilline grade II/III. Les tests cutanés (prick, intradermoréaction) et biologiques (test d’activation des basophiles) étant négatifs, l’amoxicilline a été réintroduite chez les deux patientes et a déclenché un choc anaphylactique immédiat de grade II/III. Ces cas cliniques posent la question de la sensibilité des tests allergologiques mais aussi de la possibilité de réactions anaphylactiques allergiques dues à des effecteurs de l’immunité spécifique autres que les immunoglobulines E, ce qui est actuellement évoqué par plusieurs observations expérimentales. Amoxicillin-induced anaphylaxis is an immediate hypersensitivity reaction with mast cell activation either by an allergic mechanism involving immunoglobulin E or by some non-allergic mechanism. The most severe reactions (grade ≥ II) are considered to be allergic, with skin tests and/or blood tests typically positive. However, these tests may be negative in spite of true amoxicillin allergy (false negative tests?); severe reactions upon reintroduction of the drug in such cases have been reported. We report the case of two patients who experienced a grade II/III anaphylactic reaction to amoxicillin with subsequent skin tests (prick and intradermal) and blood test (basophil activation) negative. When amoxicillin was then administered to these two patients, it triggered an immediate anaphylactic shock reaction grade II/III. These cases address the question of the sensitivity of the allergy tests but also the possibility of an anaphylactic reaction mediated by non-IgE-specific immune effectors; this possibility has been supported by several experimental observations. [ABSTRACT FROM AUTHOR]

Résumé Sophie S. est une femme de 45 ans en bonne santé qui présente comme unique antécédent des crises de coliques néphrétiques. Elle ne prend pas de médicament et n’a aucune allergie. Elle souffre d’une angine pour laquelle son médecin généraliste lui a prescrit un traitement à base d’amoxicilline, de prednisolone et de paracétamol. Summary Sophie S. is a 45-year-old woman in good health who in the past has only ever suffered from renal colic. She does not take any medication and has no allergies. She has a throat infection for which her doctor has prescribed a treatment based on amoxicillin, prednisolone and paracetamol. [ABSTRACT FROM AUTHOR]

Dog bites are a frequent reason for medical consultation. These can be responsible for severe infectious complications. Bacteria of the genus Capnocytophaga species are Gram-negative bacilli commonly found in the oral cavity of certain animals such as dogs and cats. Following a dog bite or wound contamination with animal spit, these bacteria can cause local (cellulitis), systemic and invasive manifestations (bacteremia, endocarditis, meningitis) or lead to rare and dreadful complications such as thrombotic microangiopathies. The identification of Capnocytophaga is slow due to their specific characteristics and their culture conditions. The treatment of Capnocytophaga species infections is based on antibiotic therapy with amoxicillin - clavulanic acid as the first choice. Although different types of Capnocytophaga have been described, C. Canimorsus appears to be associated with a higher rate of atypical complications. Here is the description of an immunocompetent patient who presented with C. Canimorsus bacteremia complicated by hemolytic uremic syndrome following a dog bite.

Abstract: An increased incidence and severity of invasive group A streptococcus (GAS) infections over the past decade have been reported by several authors, but GAS remains an uncommon cause of bacterial meningitis. The aim of this study was to describe and analyze the clinical and biological data of GAS meningitis by reporting 10 new cases of pediatric GAS meningitis and making a literature review. The mean age of patients, seven girls and three boys, was 3 years. There was a history of preexisting or concomitant community-acquired infection in five patients over 10. The outcome was fatal in two cases. All patients received an initial empirical antimicrobial therapy with a third generation cephalosporin switched in six cases to amoxicillin. The prognosis for this type of streptococcal meningitis is usually good, but death may occur even in children without any identified risk factor for severe infection. [Copyright &y& Elsevier]

Summary: Clostridium difficile reactive arthritis is a rare disease; only 5 pediatric cases have been reported in the literature. Its diagnosis is challenging. It manifests as asymmetric aseptic poly- or oligoarthritis, contemporary to infectious colitis, usually after a period of antibiotic therapy. We report a new case in a 7-year-old boy who presented with unusual polyarthritis affecting 12 joints 1 month after antibiotic therapy with amoxicillin-clavulanate. Punctures of both hip joints proved sterile but significantly improved symptoms. Diarrheic stool cultures during hospitalization provided the diagnosis. Antibiotic therapy using metronidazole completely resolved pain and joint swelling within a week. After 1 year of follow-up, there has been no recurrence. We present a review of the literature on this disease and underline the advantages of joint aspiration in this condition with the dual aim of not missing septic arthritis and effectively relieving pain. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Intravenous infusion takes an important place in the current therapy in hospitals and pharmaceutical firms keep improving their infusion medical devices, particularly with the development of an intravenous administration set with an automatic infusion stop. The aim of our study consists in an evaluation of the stability of acetaminophen, ketoprofen and amoxicillin during infusion and stasis of drugs for several hours in the dropper chamber and in the tube of this device. Study design: Analytical study. Materials and methods: Ten milligram per millilitre acetaminophen (acetaminophen 1 and acetaminophen 2), 1mg/mL ketoprofen and 20mg/mL amoxicillin were prepared and infused individually and successively with the intravenous administration set under ambient light and temperature. Collected samples of each drug during the infusion and after 24hours of stasis in the medical device were monitored by a visual inspection, pH and osmolality assessment and chromatographic analysis of each drug with a validated stability-indicating method. Results: Repeated individual perfusions of 10mg/mL acetaminophen 1 or 1mg/mL ketoprofen are possible through a fail-safe intravenous administration set, while repeated individual amoxicillin infusions are not because of the unstability of this drug. There is also no problem to infuse successively acetaminophen and ketoprofen through this medical device because these drugs are stable. However, we underlined an incompatibility between acetaminophen 2 and ketoprofen, which advises against the use of intravenous administration set for successive infusions of these two drugs. Conclusion: Despite the technical innovation of a fail-safe intravenous administration set, we have to stay aware of mixture consequences in intravenous infusion field. [Copyright &y& Elsevier]

Abstract: Purpose: A few studies only have focused on ambulatory management of erysipelas. Methods: To assess the diagnostic and therapeutic management of erysipelas by general practitioners, and their adherence to the French Society of Infectious Diseases and Dermatology joint 2000 recommendations, we surveyed 114 general practitioners during a 1 year period (from May 1st, 2005 to April 30th, 2006). Results: Seventy-three general practitioners accepted to participate to the study and 54 cases of erysipelas were reported. Median age of patients was 63 years (range, 18–94) and sex ratio was 0.77. Lower limbs were affected in 83% out of the cases. A skin lesion was reported in 65% of the cases. None of the 15 doppler ultrasonography that were performed identified deep vein thrombosis. Five patients (9%) were initially hospitalized. Only 18% out of the patients were treated by amoxicillin. Most prescribed antimicrobial agents were pristinamycin (31%) and amoxicillin-clavulanate (27%). Median duration of treatment was 10 days. Six patients received an anti-inflammatory drug. Among the 44 patients who had a follow-up visit, 37 patients (84%) recovered and two patients were hospitalized after this follow-up assessment. Two patients experienced a recurrence of erysipelas during the study. Conclusion: As previously reported in the literature, outcome of erysipelas after ambulatory management remains excellent, although recommendations are poorly followed. [Copyright &y& Elsevier]

Summary: The healthy carrier of Streptococcus pneumoniae (S. pneumoniae) has been studied very little at the national level. With the emergence of antibiotic-resistant strains worldwide, and the emergence of new serotypes, an epidemiological survey is needed before the vaccine can be introduced in Morocco. Objectives: This study''s objective was to determine the prevalence and risk factors of pneumococcal nasopharyngeal carriage in children less than 2years of age in the Marrakech region and to assess the antibiotic susceptibility of the isolates and the serotypes present prior to the introduction of the conjugate pneumococcal vaccine. Patients and methods: From 2008 to 2009, 660 nasopharyngeal samples were collected on children under 2years of age during scheduled visits to dispensaries for routine immunization in the Marrakech region. Results: S. pneumoniae carriage was found in 45.8% of children. Of the 660 samples, 302 strains were isolated. The percentage of pneumococcal strains with reduced susceptibility to penicillin (PRSP) was 34.7%. Among these strains, 87.1% showed low-level resistance and 12.9% high-level resistance. Resistance to amoxicillin was found in 3.3% of the strains and no strains were resistant to cefotaxime. Several risk factors for pneumococcal carriage were identified, the main ones being breastfeeding less than 2 months, the presence of more than one sibling, passive smoking, and low socioeconomic level. The most frequent serotypes were 19F, 6, 14, 23, 18, and 9. The study of the vaccine serotype distribution showed that the theoretical vaccine coverage of the 7 valent vaccines was at 57% for all the isolates. Conclusion: These data show the frequency and the risk factors on nasopharyngeal carriage, and report the status of penicillin resistance of strains carrying children less than 2years of age in the Marrakech region. The fluctuation of circulating serotypes at the national level underscores the importance of epidemiological surveillance carried out before the introduction of the heptavalent vaccine in Morocco. [ABSTRACT FROM AUTHOR]

Summary: A 15-month-old boy treated with amoxicillin and clavulanic acid therapy for 8 days was admitted for persistent gastroenteritis and fever. He received ceftriaxone for pneumonia modified on day 4 for cefotaxime and josamycin due to extension of alveolar lesions. On day 7, persistent fever and worsened respiratory distress led to addition of rifampicin. The child was then admitted to an intensive care unit. A hemophagocytic syndrome was suspected based on clinical signs and laboratory findings and confirmed by cytological examination of bone marrow. Adenovirus type 7 was identified by polymerase chain reaction and culture of bronchoalveolar fluid. Prognosis was good within 3 weeks. B and T immunologic evaluations were normal 5 months after the infection. This case of severe adenovirus pneumonia was associated with hemophagocytic syndrome in a child without identified primary immunodeficiency. Adenovirus type 3 and 7 are most frequently responsible for severe or fatal respiratory infections. [ABSTRACT FROM AUTHOR]

Abstract: Aims of the study: This study examines the activity of doripenem, a new carbapenem compound compared with amoxicillin-clavulanic acid, piperacillin+tazobactam, imipenem, clindamycin and metronidazole against 316 anaerobes. Methods: Inoculum preparation and agar dilution method were performed according to the CLSI method for anaerobes (M11A7). Results: At a concentration of 4μg/ml doripenem and imipenem (IMP) inhibited 122 (96 %) and 126 (99 %) strains of the Bacteroides fragilis group, respectively. In contrast, doripenem appeared more potent than IMP against Gram-positive anaerobes inhibiting at the same concentration of 4μg/ml 145/145 strains (100 %) versus 115/145 for IMP (79.3 %). Against 316 anaerobic strains, the carbapenem doripenem had an MIC50 of 0.25μg/ml and an MIC90 of 2μg/ml. Results were similar to those for imipenem (MIC50 of 0.125μg/ml and MIC90 of 4μg/ml). If we consider the resistant breakpoints of the two carbapenems as defined by EUCAST, the resistance rate for doripenem (MIC>4μg/ml) 1.6 % is similar to that of imipenem (MIC>8μg/ml) 1.3 %. Conclusion: Thus independently of the PK/PD parameters the two carbapenems demonstrated very close activity; doripenem was more potent on Gram-positive anaerobes and slightly less potent against Gram-negative anaerobes mainly the B. fragilis group. Further clinical studies are needed to assess its usefulness in patients. [Copyright &y& Elsevier]

Abstract: Objectives: To assess the quality of prescription of fluoroquinolons, aminosids and amoxicillin-clavulanic acids in medicine departments. Methods: Data on target antibiotic prescription were collected on a given day and confronted to local recommendations and literature guidelines. Evaluation of antibiotic therapy was done by assessing molecule choice, administration conditions (dosages, route and administration schedule, treatment duration), reassessment of treatments 48–72h later, dose adaptation of aminosids depending on serum monitoring. Results: Sixty-three patients were included and 67 “target” antibiotics were prescribed. Prevalence of antibiotic-treated patients was 24.4%, and 14.6% for “target” antibiotic-treated patients. Antibiotic choice was appropriate in 67% of prescriptions. Dosages were adequates in 94% of case and administration schedule in 97% of cases. The oral route administration as soon as possible was applied to half of patients. Treatment duration were respected for 94% of prescriptions. Reassessment of antibiotic therapy 48–72h later was realized in 66% of cases. Dose adaptation of aminosids, when necessary, was realized on one third of cases. For all the quality criteria assessed, the overall frequency of prescription conformity was 44%. Conclusion: Large diffusion of protocols, systematic reassessment of treatments at 48–72h, promotion of training sessions for new prescribers in the institution, reinforcing the function of medical correspondents in antibiotic therapy and infectiologists, periodic evaluation of antibiotic therapy, should improve the quality of antibiotic therapy. [Copyright &y& Elsevier]

Abstract: Introduction: Pelvic actinomycosis is a rare suppurative disease that should be included in the differential diagnosis of gynecological cancers. Case reports: We report two women aged 40 and 41 years with pelvic tumor-like actinomycosis. Physical examination disclosed a pelvic mass in both cases. CT-scan showed annexial infiltrative tumor in both cases with liver metastasis and peritoneal carcinosis in one case each. Surgical procedure consisted in right annexectomy in one case and peritoneal biopsy in the other. Pathologic diagnosis was diagnostic of actinomycosis. Both patients were treated by penicillin G 20 million IU/day during two weeks and then by amoxicilline 3g/day per day during six months. Clinical outcome showed significant improvement in both cases with complete regression of hepatic and pelvic lesions on CT-scan in one case. Conclusion: Pelvic actinomycosis is a rare suppurative disorder, commonly associated with a long term wearing of intra-uterine device. Diagnosis is difficult, often delayed and pelvic actinomycosis could mimic gynaecologic neoplasia. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to determine the antimicrobial activity of amoxicillin–clavulanic acid against Escherichia coli urinary strains, especially those resistant to amoxicillin, and to analyze the results according to the susceptibility testing methods. Method: This prospective study was made from April to May 2008, on 301 E. coli strains isolated from urine samples. The susceptibility to antibiotics was studied by agar disk diffusion according to French Society of Microbiology Antibiogram Committee recommendations. MIC were determined with the E-test. Results: According to the antibiogram, 59.8% of strains were resistant to amoxicillin, 33.2% to amoxicillin–clavulanic acid, 1.7% to cefotaxim, 8.3% to nalidixic acid, 6.6% to ofloxacin, 4.7% to ciprofloxacin, 4.7% to gentamicin and 38.1% to cotrimoxazole. After determining the MIC of E. coli strains resistant to amoxicillin and susceptible to amoxicillin–clavulanic acid, 37.5% (n =30) remained susceptible, 61.25% (n =55) were of intermediate susceptibility and only one strain (1.25%) was resistant. Among E. coli strains resistant to amoxicillin and intermediately susceptible to amoxicillin–clavulanic acid, 83.3% (n =55) remained intermediately susceptible, 13.7% (n =9) became susceptible and two strains (3%) were resistant. Conclusion: The susceptibility testing methods, especially for amoxicillin–clavulanic acid, must be standardized to avoid the discrepancies noted between standard antibiograms and an accurate determination of MIC. [Copyright &y& Elsevier]

Abstract: Objectives: Between 1st January and 31st December 2007, 331 Streptococcus pneumoniae strains were collected from 20 participating laboratories in the Pneumococcus Network Pays de la Loire county to assess their susceptibility to antibiotics and to evaluate serogroups of strains. Method: The coordinating centre performed MICs of penicillin G, amoxicillin and cefotaxime by the reference agar dilution method. Results were interpreted according to CA-SFM breakpoints. Sensitivity to other antibiotics were studied and serotyping of each strain performed. Results: Three hundred and thirty one strains were isolated in 2007. They were collected from 30 cerebrospinal fluids, 239 blood samples, 53 middle ear fluids and nine pleural fluids. The percentage of pneumococci with decreased susceptibility to penicillin G (PDSP) was 39% and was higher in children (51%) than in adults (35%). The PDSP were often multidrug resistants especially with a high percentage of resistance to erythromycin (87.6% versus 8.4% for pneumococci sensitive to penicillin G). Finally, the most prevalent serogroup was the serogroup 19 (29.6% of isolates). Conclusion: A decrease of PDSP was observed since 2001 and high-level resistant strains to β-lactams remain low. The rate of PDSP in Pays de la Loire is in the national average. [Copyright &y& Elsevier]

Abstract: The aim of the study was to determine predictive factors of epidemic extended spectrum beta-lactamase-producing Escherichia coli acquisition. All patients presenting any type of culture positive for ESBL-producing E. coli between November 2006 and October 2007 were included. An epidemic case was defined as a patient colonized with a clonal strain having epidemiological link with an another patient harbouring the same strain. Clinical and administrative data were recorded. Groups were compared by univariate and multivariate analysis using SAS software. Were included in this study 148 patients: 60 epidemic and 88 sporadic cases. Multivariate analysis showed several predictive factors of epidemic strain acquisition: female gender, high Charlson index, treatment by amoxicillin or ticarcillin–clavulanic acid, admission to emergency unit and hospitalisation in a high number of different care units. Identification of predictive factors of epidemic ESBL-producing E. coli strains acquisition may help to limit cross transmission of such strains. [Copyright &y& Elsevier]

Abstract: We report a 38-year-old immunocompetent patient who presented with a neutropenic rectitis after a treatment by amoxicillin for nasopharyngitis. Neutropenic colitis is a digestive wall inflammation, preferentially localized in the ileo-caecal area and the right colon, which leads to necrosis and sepsis, and usually occurs in neutropenic patients treated by chemotherapy with an incidence of 6%. It is a serious and often lethal disease. The treatment is supportive, and surgery is limited to the occurrence of complications (perforation, bleeding). Neutropenic colitis occurring in a rectal location after antibiotic therapy in an immunocompetent patient has been rarely described. [Copyright &y& Elsevier]

Abstract: Anaphylaxis is a relative uncommon event in pregnancy that can have serious implications for both mother and foetus. Two cases of grade 3 anaphylactic shock occurring at the end of the third trimester of pregnancy are reported; the causal agents were respectively amoxicilline and suxamethonium. Maternal and foetal outcome was good after adequate resuscitation and caesarean section performed in both cases because of severe bradycardia. A review of the literature confirms the good maternel outcome; neurologic damage in the newborn is frequent. On the basis of physiologic findings degranulation of placental mast cell is evoked in the genesis of birth asphyxia. [Copyright &y& Elsevier]

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Scarlet fever is a rare disease in adult patients. We report a patient in whom scarlet fever was associated with hypertrophic gastritis and multiple organ failure. A 62-year-old woman presented with septic shock and multiple organ failure. Bacteriological survey was negative. Abdominal tomodensitometry showed an hypertrophic gastritis. Histological analysis demonstrated a non specific gastritis without any tumoral sign. Cefotaxime and amoxicillin led to improvement and hypertrophic gastritis progressively resolved. A sandpaper rash over the body with finger desquamation, elevation of antistreptolysin O and a recent contact with an infected grandson led to the diagnosis of scarlet fever. Due to antibiotic prescription, scarlet fever is now uncommon. Although classical, ENT or gastroenteritis presentations may be puzzling for the diagnosis of scarlet fever. As 150 years ago, diagnosis of scarlet fever is still a clinical challenge. [Copyright &y& Elsevier]

The aim of this study was to precise the capsular type of Haemophilus influenzae, to determine its susceptibility to β-lactam agents, and to search for an eventual clonality between the clinical strains of the pathogen. Polymerase chain reaction was carried out to confirm the capsular type and to determine the β-lactamase type. Minimum inhibitory concentrations (MICs) of β-lactam agents for H. influenzae were determined by the agar dilution method on Haemophilus test medium, and the strains were analyzed by pulsed-field gel electrophoresis after SmaI restriction. Among 157 strains of H. influenzae studied, 12.1% was of serotype b. Sixty-seven strains (42.7%) were resistant to amoxicillin, among which 51 were resistant through production of TEM-type β-lactamase while 16 showed high MICs for amoxicillin, amoxicillin + clavulanic acid, and cefuroxim, which suggested a resistance by modification of penicillin-binding proteins. Among the latter strains, five were producing TEM-type β-lactamase. Cefotaxim, cefixim, and cefpodoxim had low MICs in all cases. The pulsed-field gel electrophoresis revealed 110 pulsotypes. All H. influenzae strains, including noncapsulated strains and serotype-b encapsulated strains, had a high level of heterogeneity, with diversity indices of respectively 0.67 and 0.94. [ABSTRACT FROM AUTHOR]

Summary: We report the case of a pregnant woman with listeriosis at 26gestational weeks followed by premature labor at 30 gestational weeks. Bacterial meningitis was suspected in the neonate with ventriculitis on sonography, a high level of protein in the cerebrospinal fluid (CSF), and an identified specific bacterial genome of Listeria monocytogenes (PCR 16S rDNA and sequencing and specific amplification of L. monocytogenes hly gene) in CSF. Neonatal meningitis was complicated with cerebral venous sinus thrombosis and ventriculomegaly. Listeriosis during pregnancy can lead to severe complications in the neonate. Thus, listeriosis should be a diagnostic concern in febrile pregnant women at any stage of pregnancy. First-line treatment is based on high-dose amoxicillin (≥6g/day) and must be used for at least 3 weeks for treatment of listeriosis during pregnancy. If the fetus survives, longer therapy until delivery can be discussed. [Copyright &y& Elsevier]

Abstract: Meningoencephalitis is a disease with many drawbacks: it is usually severe and its etiology will frequently remain unsolved even with thorough investigations. Pathogen diversities and the wide range of differential diagnosis are further limitations, while there are neither guidelines nor conferences consensus available, in France and elsewhere. However, there are many valuable data in the literature and major advances have already been obtained, the most striking being advances in imaging techniques and molecular biology, as illustrated by the significant impact of HSV PCR advent in patient management. On emergency settings, physicians have to recognize and initiate appropriate treatment for patients who may have herpes simplex meningoencephalitis, and to consider bacteria for which prompt treatment has a positive prognostic impact. At this stage, intravenous acyclovir and amoxicillin should be widely prescribed, even with limited suspicion. Then, physicians will have to collect pertinent information and diagnostic tests results, and may seek expertise from other specialties when needed. Continuous improvements in diagnostic tests should allow significant progress in pathogen identification in meningoencephalitis, thus leading to better patients management. We also have to be prepared for changes, as the recent emergence of four agents of encephalitis reminded us (West Nile, Nipah, Hendra and Japanese encephalitis). [Copyright &y& Elsevier]

Summary: Objectives: The aim of this study was to systematically evaluate adverse drug reactions (ADRs) in children consulting at the pediatric emergency unit during a 6-month period. Method: The regional pharmacovigilance center (CRPV) and the department of clinical pharmacology prospectively and systematically recorded all potential ADRs among patients younger than 18 years of age in the pediatric emergency unit reported at the daily staff meetings. All cases were then screened and validated by the CRPV. For validated cases, preventability, seriousness, and off-label use were evaluated. Results: During the study period, from 1 March to 1 September 2005, 90 children presented potential adverse drug events. ADRs were confirmed in 43 patients, 19 females and 24 males. Thirty-four patients (79%) were under the age of 5. According to the European definition, 14 patients (33%) had serious ADRs. One anaphylactic shock after amoxicillin injection; antimalarial prophylaxis misuse leading to convulsive status epilepticus, convulsion, and coma after hepatitis B and MMR vaccines were deemed life-threatening. Three ADRs were considered avoidable. Antibiotics and vaccines were the most common possible cause of ADRs (76%). Skin reactions (n =27), fever (n =8), and gastric disorders (n =5) were the most common clinical manifestations. Conclusions: Because ADRs were reported by clinicians on a voluntary basis, serious ADRs were probably reported more systematically. Compared to a similar period without active monitoring, active drug monitoring of ADRs doubled the number of confirmed cases 43 vs 17, p<0.001. Close collaboration between the pharmacovigilance center, pharmacologists, and clinicians is necessary and seems feasible for improving the monitoring of ADRs in children. [Copyright &y& Elsevier]

Abstract: Objective: Prospective study of amoxicillin–clavulanic acid (amox–clav) prescriptions in the medical departments of a teaching hospital that prescribes this antibiotic very often. Design: From April to May 2004, each patient treated by amox–clav was included. Data were collected (age, sex, past diseases, associated-diseases, reason for hospitalization, prior antibiotic therapy, date of amox–clav prescription, indication for amox–clav prescription, other associated antibiotics, nosocomial or community-acquired infection, site of infection, bacteriologic samples and bacterial identification, treatment duration and status of the physician). Data were analysed by a muldisciplinary group and compared with a referential used for antibiotic prescriptions in our hospital. Results: One hundred and two medical files were analysed. Seventy-one percent of amox–clav prescriptions were in adequation with the referential. Combination of three criteria (indication of antibiotic therapy, choice of amox–clav and of an antibiotic combination) showed that 58 (57%) was acceptable, 29 (28%) was debatable and 15 (15%) was unacceptable. Unacceptable prescriptions were often made by a junior. The majority of inadequate antibiotic prescriptions referred to acute pulmonary infections. Antibiotic combinations were often inadequate and treatment duration was too long. The quality of the prescription was more accurate when made by a senior. Conclusion: An effort should be made in our teaching hospital to optimize antibiotic prescriptions. [Copyright &y& Elsevier]

Abstract: Study aims: The aim was to evaluate the in vitro effects of amoxicillin and its combination with clavulanic acid, two β-lactams intravenously injected, on the oxidative metabolism of polymorphonuclear neutrophils. These cells play the major role in the “respiratory burst” as they produce superoxide anion to kill the infectious agent. An activation of this process by the injected antibiotics could enhance the bactericidal action or explain some of adverse effects. Materials and methods: Two models were used to estimate the O2 – amounts produced in the presence of the antimicrobial agents. In the cellular model, O2 – was generated by neutrophils artificially stimulated or not (separated by a gradient centrifugation through Histopaque 1077). In the acellular model, O2 – was produced by the xanthine–xanthine oxidase system. O2 – was measured by spectrophotometry using the ferricytochrome C reduction. Results: The O2 – production by polymorphonuclear neutrophils was increased when both antibiotics were added to the reaction mixture. A significant activation of the cell oxidative metabolism was observed with amoxicillin using various stimulating agents, that was higher without stimulation and lower when amoxicillin and clavulanic acid were associated. Conclusion: Amoxicillin could either activate polymorphonuclear neutrophils NADPH-oxidase or cause its activation by a membrane effect, or interfere with the zymosan activation way. It could then be supposed that this antimicrobial agent intensified the bactericidal effects. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this article is to provide clinicians with guidelines for the antibiotherapy of early-localized Lyme disease. The outcome measures are the clearance of erythema migrans and associated symptoms of early localized Lyme disease and the prevention rate of late complications, with a low risk of adverse effects. Design. The reviewed studies were selected by Medline with the keywords: “erythema migrans, treatment”. Sixteen studies comparing treatment or duration of treatment were analyzed. Results: Amoxicillin, doxycycline, and cefuroxim axetil are equally efficacious for early-localized Lyme disease. Azithromycin is an alternative. Most patients respond completely and less than 10% fail to respond. All antibiotics are associated with a low frequency of adverse effects, with the exception of Jarisch Herxheimer reaction which occurs in about 15% of the patients. Conclusions: We recommend treating adults with amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (100 mg bid) for 14 days (erythema migrans) to 21 days (early localized Lyme disease with associated symptoms). For children, we recommend amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (4 mg/kg/day in 2 intakes, maximum 100 mg/dose) above 8 years of age. Cefuroxim axetil (500 mg twice daily for adults or 30 mg/kg/day in 2 intakes, maximum 500 mg/dose, for children), and azithromycin (500 mg/day for adults and 20 mg/kg/day for children for 7–10 days) are second line treatment. [Copyright &y& Elsevier]

Abstract: Optimal antibiotic treatment of community-acquired pneumonia (CAP) remains controversial. The clinical impact of S. pneumoniae resistance to macrolides is well documented. By contrast high dosage amoxicillin (1 g tid) remains active against such strains and no failure has been reported. The aim of this paper was to review clinical trials in community-acquired pneumonia, published from January 1, 1999, to December 31, 2005. One hundred seventy-three articles were collected, using Medline, 35 of which were analyzed, and 16 finally used. Telithromycin and pristinamycin may be used in mild to moderate CAP. Anti-pneumococcal fluoroquinolones such as levofloxacin and moxifloxacin may be used in at risk patients, but levofloxacin has only been investigated in patients with severe CAP and patients with Legionnaire''s disease. Amoxicillin 1 g tid remains the drug of choice for pneumococcal CAP. [Copyright &y& Elsevier]

Abstract: Objective: This study had for aim to define the pattern of Haemophilus influenzae infections in a Tunisian hospital during the prevaccination era. We determined serotypes, biotypes, and antibiotic susceptibility of H. influenzae strains. Design: 187 H. influenzae strains were identified in various samples between 1999 and 2002. Results: Strains were isolated essentially from respiratory samples in 63.7% and cerebrospinal fluid in 21.4 %. The mean age of children with invasive infections was 16 months. All invasive strains belong to serotype b. Biotypes I, II and III were the most frequent (84.7%). Ampicillin resistance with betalactamase producing mechanism occurred in 26,7% of isolates, this type of resistance was more frequent among invasive strains (37.2%) than in non-invasive ones (22.8%). All betalactamase producing strains had amoxicillin MICs above 1 mg/l, these strains were susceptible to amoxicillin+clavulanate. Three strains were betalactamase negative ampicillin resistant with ampicillin MICs: 1.5, 3, and 4 mg/l. All strains were susceptible to cefotaxim with MICs<0.19 mg/l. Antibiotic resistance concerned: chloramphenicol: 7.5%, tetracycline: 6.9% and trimethoprime-sulfamethoxazole: 13.9%. 8.1% of the strains were kanamicin resistant but concerned only betalactamase producing strains. Conclusion: Before the introduction of a conjugate vaccine, all invasive infections in young children were caused by H. influenzae b strains. [Copyright &y& Elsevier]

Abstract: Antibiotics were extensively used, both for curative as for prophylactic purposes, to prevent an explosive spread of the 2004 cholera epidemic in Douala. It was thus necessary to control the antibiotic susceptibility of Vibrio cholerae. Objective: The authors had for aim to describe the epidemic, the use of antibiotics, and to follow the susceptibility of V. cholerae. Design: The 14 hospitals in the study all used the same diagnostic, treatment, and preventive protocols, as well as in community practice with home visits. All cases were clinically confirmed and reported. Samples were systematically taken at the beginning and at the end of the epidemic, and randomly during the epidemic. Each identified strain was tested by the disk method for antibiotic susceptibility. Results: Between January and September 2004, 5013 patients and 177,353 people in contact with the patients were given a single dose of doxycycline or amoxicillin for 3 days. Sixty-nine deaths were recorded (lethality 1.37%). One hundred (and) eleven strains of V. cholerae were identified in 187 samples. All of them were resistant to sulfamides and colistin, but susceptible to cyclins, betalactams, and fluoroquinolones, without any modification during the 8 months of follow-up. Conclusion: Despite the risk of a massive and prolonged use of antibiotics, strictly prescribed and controlled, no resistance developed in the identified strain. Chemoprophylaxis must follow rigorous protocols and be continuously monitored. [Copyright &y& Elsevier]

Abstract: Study objective. – Evaluation of efficacy and safety of pristinamycin (PRI), compared with amoxicillin (AMX), both at 3 g daily for 7 to 10 days in adults with community-acquired pneumonia (CAP). Patients and methods. – Multinational, randomized, double blind, double dummy clinical trial of non-inferiority was conducted in 399 patients with a CAP. Results. – At inclusion, the mean age was 47.8±18.3 years, 24.3% patients were 65 or older. The Fine score was≤III in 85.4% patients. The bacterial etiology was documented in 34.8% of patients: Streptococcus pneumoniae (48.1%), Mycoplasma pneumoniae (18.6%), Haemophilus influenzae (14.7%), Chlamydia pneumoniae (13.2%), Legionella pneumophila (9.3%). In the clinical perprotocol population, the clinical success rate was 87.6% in each group: 149/170 patients (PRI) and 148/169 (AMX); The 95% confidence interval was [–6.61%; 7.23%]. In modified intend to treat population, the clinical success rate was 79.9% (151/189) in the PRI group and 83.0% (151/182) in the AMX group [CI 95% (–10.87%; 4.69%)]. A satisfactory bacteriological response was observed in 82.3% (51/62) of PRI patients and 88.1% (59/67) of AMX patients. Treatment related adverse events occurred similarly in both groups according to the expected tolerance profile of the two drugs. No serious adverse events in both groups were related to the study drugs. Conclusions. – In this study, PRI 3 g daily was clinically as effective and well tolerated as AMX 3 g daily, for 7 to 10 days, in PPc, in the treatment of bacterial community-acquired pneumonia. [Copyright &y& Elsevier]

Abstract: Introduction. – The adverse effects caused by drugs are classified as toxic, pharmacological or allergic. Allergic side effects are hypersensitivity reactions that involve antibodies (immediate hypersensitivity reactions) or T lymphocytes (delayed hypersensitivity). We describe the results of a study evaluating an in vitro method using peripheral blood T lymphocytes for the diagnosis of erythematous drug-induced delayed hypersensitivity reactions. Materials and methods. – Three groups of patients were included: Group A, patients allergic to amoxicillin (N =14); Group B, patients who tolerate amoxicillin without side effects (N =5); and Group C, patients who had developed a non-allergic type of reaction to amoxicillin (N =10). The diagnosis of allergic reactions (Group A) was demonstrated by a positive skin test reaction 48 to 96 hours after applying amoxicillin to the skin. The lymphocyte transformation test (LTT) and the Elispot test for IFN-γ were done simultaneously. Ceftriaxon served as the negative control reagent for both the skin and in vitro tests. Results. – The results observed for the LTT indicated a level of sensitivity of 71% when the stimulation index (SI) was greater than 2.5. Under the conditions used, the results of the IFN-γ assay demonstrated the presence of specific T lymphocytes in Group A with a mean of 70 spots/1 106 cells in the presence of amoxicillin, whereas re-stimulation of the cells with the antibiotic control, ceftriaxone, resulted in no IFN-γ secretion. After stimulation with amoxicilln, 12 out of the 14 patients in Group A had a significantly increased number of spots in comparison with ceftriaxone. Discussion. – These results demonstrate that the Elispot IFN-γ in vitro assay provides a method to estimate the number of amoxicillin-specific T cells in peripheral blood. This test appears to differentiate patients who are allergic to drugs from those who are not. The test is interesting because it is simple to carry out, a large number of drugs can be tested at the same time, and the results are obtained rapidly. If these results can be confirmed with other drug molecules, then the ELISPOT IFN-γ in vitro assay could be included in the battery of in vitro tests for delayed hypersensitivity reactions to drugs. [Copyright &y& Elsevier]

Objective. – We had for aim to investigate the efficacy of an amoxicillin-clavulanic acid treatment, corresponding to human doses, in E. coli bacteremia producing intermediate level beta-lactamase, in a Yucatan micro pig model.Methods. – We developed an experimental bacteremia model in 15 micro pigs, using one intravenous injection of 4.8  ×  109 CFU (mean) at D1T0. 9 animals were treated with 3 intravenous injections of amoxicillin-clavulanic acid (1g–0.1g) per day for 1 week. This dosage regimen was equivalent to a 2g-0.2g dosage regimen in the human model and reproduced amoxicillin-clavulanic acid human pharmacokinetics. The treatment began 24 hours after the injection of bacteria (D2) and lasted for 7 days (D2 to D8). Bacteriological, clinical and biological parameters of the treated group (n = 9) were then compared to the control untreated group (n = 6) at D5.Results. – Before antibiotic treatment, the 15 micro pigs developed a severe sepsis with bacteremia (15/15), fever (39.3 at D1T7 vs 37.9°C at D1T0), adynamia, anorexia, leucopenia (2.3 × 103 at D1T1 vs 12.1 × 103 cells/mm3 at D1T0) followed by hyperleucocytosis (23.9 × 103 at D2 vs 12.1 × 103 cells/mm3 at D1T0) and thrombopenia (81 × 103 at D2 vs 325 × 103 platelets/mm3 at D1T0). In the control group, bacteremia lasted up to D5 in 5/6 micro pigs with a persistent biological infectious syndrome. In the treated group, bacteremia disappeared at D5 in 8/9 micro pigs with an early clinical improvement and a decrease of the erythrocyte sedimentation rate.Conclusion. – The therapeutic protocol used was efficient in our model, foreboding its possible efficiency in the human model. [Copyright &y& Elsevier]

Objective: The aim of this study, was to compare the efficacy and safety of cefpodoxime proxetil (CPD): 8mg/kg bid for 10 days to amoxicillin-clavulanate (AMC): 80mg/kg tid for 10 days, for acute pediatric rhinosinusitis.Patients and methods: Two hundred and seventy eigth children 3 to 8 years of age (mean: 5) were randomly included by 26 pediatricians from March 1999 to March 2000. The diagnosis of rhinosinusitis was based on the persistence of rhinopharyngitis symptoms (rhinorrhea, cough, nasal obstruction, headache) for more than 10 days and less than 30 days without tendency to improvement for at least 2 of these symptoms. The main endpoint was the clinical efficacy in the per-protocol (PP) analysis at the end of treatment: clinical success (cure and improvement), or failure.Results: In PP analysis, 266 patients were analysed (133 in each group). The clinical success rate at the end of treatment was 88.7% (CPD) and 87.2% (AMC), 90% IC: [–5.1%; +8.1%]. No clinical relapse was confirmed in 193 of 258 patients followed-up at distance (V3–V4), with rates of success of 75.6% (CPD) and 74.0% (AMC), 90% IC: [–7.3%; +10.4%]. These results demonstrate an equivalence of both treatments at the end of treatment and at follow-up. The safety analysis showed that the number of children suffering from an adverse event related to the treatment was significantly lower in the CPD group (4/134) than in the AMC group (27/140) (P < 0.0001). These adverse events were essentially due to digestive symptoms. [Copyright &y& Elsevier]

In 1999, in Rhoˆne-Alpes region, in a survey of resistance to antibiotics of Streptococcus pneumoniae, 35 cases of meningitis were observed. A retrospectic questionnary was sent to each participant. MICs to Penicillin, Amoxicillin and Cefotaxime were determined with ATB-PNEUMO gallery or E-test and by disk diffusion for the other antibiotics. The results were interpreted according to the recommendations of the CA-SFM. Mean age was 38.1 years (range : 1 month –78 years) and sex-ratio 2/5. Eight patients had previously received antibiotics, 22 patients had risk factors and 23 were transfered in intensive care unit. The patients received C3G + glycopeptide in 15 of 16 children and in 13/19 adults according to the consensus recommendations. Diagnostic was made on the direct examination of CSF in 83%, and blood cultures was positive in 74.3% of cases. The percentage of PRP was 48.6% with 17.1% of intermediate-amoxicilline and 14.3% intermediate-cefotaxime strains. Resistance to trimethoprim-sulfamethoxazole was 45.7%, to chloramphenicol 30% and to fosfomycin 6.9%. All the strains were susceptible to rifampicin and vancomycin. Among the 17 PRP strains, 7 were belonging to serotype 6 (6 in children). The clinical outcome was fatal in 7 male cases (20%), without risk factors in 3 children and 6 of 7 strains were susceptible to penicillin. Six patients (17%) had auditive and/or neurologic sequellaes. This study shows that nearly 50% of strains isolated in meningitis, in Rhoˆne-Alpes region, were not susceptible to penicillin, and confirms the frequency of sequellaes while the mortality is not related with the resistance of strains to the antibiotics. [Copyright &y& Elsevier]

Clinical study – The in vitro activity (MIC) of 9 β-lactam agents was determined against 280 clinical isolates of H. influenzae exhibiting various mechanisms of resistance to ampicillin.Results – When β-lactamase was produced (the most frequent mechanism of antibiotic-resistance in H. influenzae) the MICs of amoxicillin were increased and, for the majority of these strains, the activity of the other β-lactam antibiotics was unchanged except for a few β-lactamase producing strains exhibiting less susceptibility to co-amoxiclav and cephalosporins. The study on 85 ampicillin resistant non-β-lactamase-producing H. influenzae strains of strains (ARNBL) showed an increase in the MICs of all β-lactam-agents. This increase was weak and variable according to β-lactam-agents and to the strains: the modal MIC value was increased 2 times for cefixime, cefotaxime, imipenem and 4 times for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, cefpodoxime, and ceftriaxone. The clinical consequences are unknown; these strains are still rare and the resistance level is low. Understanding the intricacy of resistance mechanisms should lead to the development of reliable tests for the detection of such strains. [Copyright &y& Elsevier]

AOM in situation of clinical failure are more common nowadays (5 %) than in the eighties. This value appears to be low, as regards to the percentage of Haemophilus and Pneumococcus strains which are resistant to antibiotics. This lower increase than expected is probably due to adequate treatment strategies. Nevertheless, actual AOM in situation of clinical failure still exist and are caused by SPPR.Risk factors of treatment failures are well known and are discussed in the article. Utilization of high doses of Amoxicillin of Ceftriaxone in such situations appears to be the only solutions. [Copyright &y& Elsevier]