Osteonecrosis in human immunodeficiency virus-infected patients may not be related to immune reconstitution.
نویسنده
چکیده
with ciprofloxacin at a dosage of 500–750 mg b.i.d. for 10–28 days. It should be noted, however, that, in the latter report, the interval between onset of disease and start of treatment with ciprofloxacin was not specified, and, in 4 of 7 cases with relapse, ciprofloxacin was used as a secondary therapy. We recently reported successful treatment of ulceroglandular tularemia with oral ciprofloxacin in 12 pediatric patients [3]. Here we report additional data from an outbreak of this disease in 1998 in central Sweden, where 43 patients (median age, 51 years; range, 21–83 years) were treated primarily with oral ciprofloxacin. Diagnosis was confirmed by use of serological tests and/or culture, and in 11 cases also by use of PCR, all performed according to methods described elsewhere [4]. For 41 of the 43 patients (24 with ulceroglandular, 3 with pulmonary, and 14 with typhoidal tularemia), the response to ciprofloxacin at a dosage of 500–750 mg b.i.d. for 10 days was excellent and no complications or relapse occurred. For these patients, the mean interval from onset of disease to initiation of ciprofloxacin therapy was 3.7 days (median, 3 days; range, 0–14 days). Two patients experienced complications. One patient, who presented 5 days after onset of typhoidal/pulmonary tularemia, responded well to a 10-day course of ciprofloxacin but relapsed 7 days after the end of treatment, with fever, arthralgia, and a pulmonary infiltrate. For another patient, treatment with ciprofloxacin was initiated 3 weeks after the onset of ulceroglandular tularemia; 20 days later, a lymph node abscess developed. With respect to new options for the treatment of tularemia, conclusions should be based mainly on results from primary use of a drug. For patients who have previously received a course of treatment with another drug, the evaluation is more difficult. Moreover, in cases where there is considerable delay before initiation of treatment, the development of lymph node abscesses or other complications may no longer be prevented by antibiotic agents that are appropriate for Francisella tularensis [5]. Previous reports on clinical use of quinolones [1, 3] and the present data, together with in vitro assays showing that quinolones have MIC values well below 0.1 mg/ml [3, 6, 7] and have in vivo efficacy with experimentally induced tularemia [8], argue strongly for the use of quinolones as alternative agents for the treatment of tularemia.
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ورودعنوان ژورنال:
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
دوره 33 2 شماره
صفحات -
تاریخ انتشار 2001