Active substances: Ciprofloxacin
We excluded patients with severe sepsis, abscesses, prostatitis, recurrent or catheter-associated urinary tract infection, or urinary tract obstruction. We randomized eligible patients on Day 7 of effective treatment and assessed them at Weeks 1 and 6 after treatment completion.
The primary outcome was retreatment for recurrent urinary tract infection.
At the end of 6 weeks, no patient in the truncated treatment arm required retreatment, whereas 1 patient in the continued treatment arm was retreated.
Upper bound of the difference 6. Patients in the truncated treatment arm had significantly shorter hospital stay 8 vs.Filner pleaded guilty to one criminal count of false imprisonment by violence, fraud, menace and deceit and two misdemeanor counts of battery.
Conclusion Stopping the effective non-FQ antibiotics following clinical improvement at Day 7 is non-inferior to continued treatment until Day 14 in selected patients with APN requiring hospitalization.
Citation: Rudrabhatla P, Deepanjali S, Mandal J, Swaminathan RP, Kadhiravan T Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: A randomized non-inferiority trial.
Data Availability: All relevant data are within the paper and its Supporting Information files.
JIPMER is a publicly-funded hospital that provides free treatment to patients, including the trial participants. Introduction Acute pyelonephritis APN is one of the most common community-acquired infections requiring treatment with antibiotics.
Traditionally, the duration of treatment for APN has been 10—14 days. Based on recent trials, current clinical guidelines recommend shorter regimens of fluoroquinolones FQs for 5—7 days to treat uncomplicated APN in non-pregnant women in the outpatient setting.
While several clinical trials in the past had compared the clinical efficacy of these agents with another antibiotic such as FQs in patients with APN, none of the trials assessed the optimal duration of treatment regimens using non-FQ antibiotics other than co-trimoxazole; trials on hospitalized APN patients are particularly lacking.
On hospital day 4, the initial CSF culture grew a gram-negative coccobacillus that was confirmed to be F tularensis by the New Mexico State health laboratory the following day, and subtype analysis was not performed.
Use of the other antibiotic agents was stopped, and the patient was treated with intravenous chloramphenicol sodium succinate, 1 g every 12 hours, and intravenous streptomycin sulfate, 1 g every 12 hours, for 14 days, followed by 14 days of oral ciprofloxacin hydrochloride, 750 mg twice daily.
The patient showed clinical improvement within 48 hours, and he eventually had complete resolution of symptoms.
On 8-month follow-up, the patient's only complaint was fatigue, his physical examination findings were normal, and his F tularensis serum antibody titer was by means of microagglutination testing. Comment Tularemic meningitis is rare; only 16 cases have been reported Table.
The worldwide incidence of tularemia is unknown and likely underrecognized. Tularemia not infrequently occurs in the United States and other developed countries in the northern hemisphere.
Between 1990 and, human cases from 44 states were reported to the Centers for Disease Control and Prevention. Most cases occur in late spring and summer, 21 when individuals are exposed to infected arthropods ticks and biting flies or to aerosolized bacteria from handling hay, cutting brush, or mowing over dead infected animals.
All human cases of tularemia must be reported to the Centers for Disease Control and Prevention. Seven patients with meningitis presented with ulceroglandular disease, defined as ulcerations on the skin with regional lymph node enlargement.
Five patients had the typhoidal form, characterized by an influenzalike syndrome with chills, fever, headache, and generalized aches without lymphadenopathy, skin ulcers, or pneumonia.
Four patients had pharyngeal disease painful sore throat with enlarged tonsils and formation of a yellow-white pseudomembrane.
In this series with often incomplete histories and examinations, most patients had confusion, headaches, meningismus, and fevers.