Comparative Study of Parenteral Penicillin G vs. Amoxicillin-Clavulanate for the Treatment of Dentoalveolar Abscess in Hospitalized Children

Objectives: To compare the clinical efficacy and the safety profiles of parenteral penicillin G vs. amoxicillin-clavulanate for the treatment of dentoalveolar abscess (DA) in hospitalized pediatric patients.Methods: A retrospective cohort study that was conducted at the Schneider Children's Medical Center in Israel.Results: Seventy-one patients that were included, 25 received parenteral penicillin G and 46 amoxicillin-clavulanate. There were no significant differences in the baseline clinical features except for higher rate of females in the amoxicillin-clavulanate group. Patients that were treated with penicillin G had shorter duration of fever, swelling and total length-of-stay (4.16 vs. 5 days in the penicillin G vs. amoxicillin-clavulanate groups, respectively, p = 0.007) and lower need for surgical intervention. Side effect were minor in both groups. In multivariate analysis, antimicrobial regimen was the only significant factor related with the total length-of-stay (p < 0.001).Conclusions: In pediatric patients hospitalized for DA, parenteral penicillin G was associated with better outcome compared with amoxicillin-clavulanate.

Self-reported allergy to parenterally administered penicillin

Introduction: Penicillin and penicillin products are in use in everyday medical practice. The most frequently reported adverse drug reactions are those to penicillin. New penicillin allergies occur more often with parenteral than oral treatment. In patients who are allergic to penicillin, prescribed therapy is more often the one of antibiotics of broad spectrum, and this therapy is more expensive. The allergies to penicillin are immunologically mediated. Scope of Study: to present patients' self-reported allergy to penicillin and report on types of adverse reactions following the parenteral administration of penicillin. Methodology: Retrospective study of the work of one physician in the City Institute for EMS Belgrade in the period from 2017 to 2018 involving 2481 patients. Results: There were 242 patients who reported they were allergic to penicillin, of which 160 were able to explain what happened after they were given parenteral penicillin. The cohort group was between 18-85 years old, average age 49.64 ± 17.24, while 65% of them were females. Most frequently reported adverse reactions were rash, redness and itching of the skin, loss of consciousness, swelling of the face, mouth, arms or body in general. Serious reactions have been reported in about 40% of cases. Conclusion: There is a large percentage of self-reported allergies to penicillin, and only a small number of those who experienced serious adverse reactions: swelling, unconsciousness, coma or shock.

Cardiovascular syphilis

Clinicians need to be aware of cardiovascular syphilis in patients at risk of infection, with the time taken from initial infection to clinical manifestation ranging from 10 to 25 years, although this is accelerated in patients with HIV infection. Inadequate or interrupted antibiotic therapy may confound the development of cardiovascular syphilis and make diagnosis difficult. In diagnosis, serological testing is the mainstay: latent or inadequately treated syphilis should be suspected with the finding of a positive non-specific treponemal serological test (e.g. rapid plasma reagin) and a positive specific treponemal antibody test (e.g. Treponema pallidum haemagglutination), but negative serology does not absolutely exclude infection with T. pallidum, particularly in an immunocompromised host. Parenteral penicillin remains the treatment of choice for cardiovascular syphilis: the World Health Organization and European and United States guidelines recommend benzathine benzylpenicillin 2.4 × 106 units administered once weekly for 3 weeks by the intramuscular route.

Renal actinomycosis - a case report

Introduction. Actinomycosis of the urogenital tract mainly manifests with formation of renal and perirenal abscesses. When it comes to treating renal lodge abscesses caused by Actinomyces bacteria, the method of choice is mainly surgical evacuation of purulent collections, followed by administration of parenteral penicillin or cephalosporin antibiotics during a six week period. The definitive diagnosis is made based on the antibiogram findings, isolation of Actinomyces israelii from abscess collection, as well as by characteristic histological findings. The exact incidence and prevalence of urogenital actinomycosis is still unknown. Case Report. A 54-year-old female patient was admitted to the Emergency Department of the Clinical Center of Vojvodina for triage. She complained of pain in the left lumbar and gluteal region, weakness, malaise, and fever. She was treated with corticosteroids under the diagnosis of vasculitis five months prior to admission. Based on clinical, laboratory blood and urine tests, ultrasound examination of the abdomen and contrast CT of the abdomen and pelvis, the diagnosis of left kidney abscess was made. It also spread to the retroperitoneum (iliopsoas muscle, gluteus maxuimus and ipsilateral inguinal region). Urgent operative exploration of retroperitoneum and kidney was performed. A lumbotomy was performed in the left half of the retroperitoneum with evacuation of abscesses, as well as partial nephrectomy of the lower half of the left kidney. Subsequently, the obtained antibiogram of operatively sampled aspirate, renal actinomycosis was histopathologically verified. The surgically removed tissue that was sent for histopathology showed presence of connective tissue infiltrated with a pronounced inflammatory infiltrate composed of lymphocytes, plasma cells, histiocytes and granulocytes with numerous microabscesses and actinomycosis colonies.

Nervous System Involvement in Lyme Borreliosis

Lyme neuroborreliosis (involvement of the central and/or peripheral nervous system due to infection withB. burgdorferisensu lato) is the second most frequent manifestation of Lyme borreliosis in Europe, while it comprises the third most common expression of the disease in North America. Early Lyme neuroborreliosis, which is much better defined and far more common than late Lyme neuroborreliosis, is in Europe caused mainly byB. gariniiand comprises the classic triad of meningitis, radiculoneuritis and/or cranial neuropathy, while in American patients subacute meningitis with or without cranial neuropathy is the most common manifestation. Among chronic forms of European Lyme neuroborreliosis peripheral neuritis associated with acrodermatitis chronic atrophicans is most frequently observed. A reliable diagnosis of borrelial central nervous system infection requires demonstration of lymphocytic pleocytosis and the evidence of borrelial infection of the central nervous system, established by intrathecal synthesis of specific antibodies and/or isolation ofBorreliaefrom the cerebrospinal fluid. Treatment with oral doxycycline, or parenteral penicillin or third generation cephalosporins (most frequently ceftriaxone) for 2-4 weeks is efficient in the majority of patients..

Sexually transmissible infection management practices among primary care physicians in Singapore

Background: Primary care physicians manage a significant number of sexually transmissible infections (STI); however, there has not been a survey to assess the standard of medical care, completeness of notifications, provision of counselling and contact tracing by primary care physicians in Singapore. Methods: An anonymous postal survey was conducted in which 1557 questionnaires were mailed out to general practitioners (GP), and government primary care and emergency department doctors. Results: In all, 736 questionnaires (47.3%) were returned, and the majority of respondents were graduates from the local medical school, worked in solo or group practices and were males. One hundred and thirty doctors (17.7%) indicated they had received training attachments or postings in dermato-venereology departments. Almost one-third (30.8%) had been working as doctors for fewer than 10 years and 87.8% reported that they managed STI in their practice. Almost half did not investigate genital discharge patients, and one-third would still use ciprofloxacin to treat discharges. In the management of ulcers, over half indicated that they would order syphilis serology, and a significant minority would use parenteral penicillin. Most doctors provided history taking, screening for other STI, testing for HIV infection and STI counselling. A small minority of doctors undertook contact tracing, and there was incomplete notification of many STI. Conclusions: Overall medical management of STI by primary care physicians was acceptable. Skills in contact tracing and reminders on disease notification are areas that need particular attention.