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Showing papers on "Penicillin published in 1988"


Journal ArticleDOI
TL;DR: Clindamycin demonstrated superior efficacy to penicillin among all the various treatment groups (P less than .05) and this results corroborate the failure of peniillin in this model of streptococcal infection and suggest that, unlikePenicillin, the efficacy of clind amycin is not adversely altered by the "Eagle effect."
Abstract: We investigated the relative efficacies of penicillin, clindamycin, and erythromycin in a mouse model of myositis due to Streptococcus pyogenes Penicillin was ineffective unless given at the time of bacterial injection, and treatment delays of 2 h reduced its efficacy such that survival was no better than that of untreated control animals (P less than 05) Survival of erythromycin-treated mice was greater than that of both penicillin-treated mice and untreated controls, but only if treatment was begun within 2 h Mice receiving clindamycin, however, had survival rates of 100%, 100%, 80%, and 70% even if treatment was delayed 0, 2, 6, and 165 h, respectively Thus, clindamycin demonstrated superior efficacy to penicillin among all the various treatment groups (P less than 05) Our results corroborate the failure of penicillin in this model of streptococcal infection and suggest that, unlike penicillin, the efficacy of clindamycin is not adversely altered by the "Eagle effect"

426 citations


Journal Article
TL;DR: In this article, it was shown that the growth of B. coli and a number of other bacteria belonging to the colityphoid group was not inhibited by penicillin.
Abstract: FLEMING1 noted that the growth of B. coli and a number of other bacteria belonging to the colityphoid group was not inhibited by penicillin. This observation has been confirmed. Further work has been done to find the cause of the resistance of these organisms to the action of penicillin.

355 citations


Journal ArticleDOI
TL;DR: Allergenicity of penicillins is the major clinical problem that precludes the use of this class of antibiotics in a significant portion of the general population who are believed to be sensitive.
Abstract: Introduction The discovery of penicillin by Fleming led to tremendous benefits in clinical medicine. Penicillin quickly became one of the most commonly prescribed drugs in the world. Despite a wide therapeutic index, it soon became clear that the penicillins could produce a vast array of immunological responses that could cause severe and fatal allergic reactions in some patients. The first reported case of anaphylaxis due to penicillin was in 1946 [I], and the first reported death was in 1949 [2]. Subsequently, a broad spectrum of allergic reactions to penicillin have been recognized. Available data do not permit exact conclusions as to the true frequency of allergic reactions to penicillin but they are reported to occur from 0-7 to S% of treatment courses in different studies [3], Allergenicity of penicillins is the major clinical problem that precludes the use of this class of antibiotics in a significant portion of the general population who are believed to be sensitive. In this article we will discuss allergic reactions to ^-lactam antibiotics, with special emphasis on IgE-dependent reactions in man.

311 citations


Journal ArticleDOI
TL;DR: Patients unresponsive to ceftriaxone were more likely to have received corticosteroid treatment than patients who responded to penicillin and were randomly assigned to intravenous treatment with either Penicillin or ceftRIaxone.

279 citations


Journal ArticleDOI
TL;DR: Intravenous penicillin should be given to patients with severe leptospirosis, even if therapy can be begun only late in the course of their disease, because of the favourable effect it has on every measurable aspect of the disease.

258 citations


Journal ArticleDOI
10 Mar 1988-Nature
TL;DR: A comparison of the sequences of the PBP-2 genes from penicillin-sensitive and peniillin-resistant strains, suggests that penicillins-resistant forms of PBP 2 may have arisen both by amino-acid substitutions and insertions, and by the exchange of a region encoding part of the penicillo-sensitive transpeptidase domain with the homologous region from a closely related species.
Abstract: Benzyl penicillin has been used extensively for ∼40 years in the treatment of gonorrhoea. The intense selective pressures resulting from the continual exposure of Neisseria gonorrhoeae to penicillin have resulted in the emergence of resistant strains that produce altered forms of penicillin-binding proteins (PBPs) with decreased affinity for the antibiotic1–3. A comparison of the sequences of the PBP-2 genes from penicillin-sensitive and penicillin-resistant strains, suggests that penicillin-resistant forms of PBP 2 may have arisen both by amino-acid substitutions and insertions, and by the exchange of a region encoding part of the penicillin-sensitive transpeptidase domain with the homologous region from a closely related species.

225 citations


Journal ArticleDOI
TL;DR: Children and adults with meningitis due to penicillin-resistant pneumococci may be adequately treated with high doses of intravenous cefotaxime if MICs ofPenicillin G are less than or equal to 4 micrograms/ml, although cases with higher resistance may require another antibiotic such as vancomycin.

159 citations


Journal ArticleDOI
TL;DR: Imipenem should only be administered to penicillin-allergic subjects with similar precautions ofPenicillin administration to such patients, and there was a good correlation between the peniillin and imipenems reagents to which the patients reacted.
Abstract: We examined the potential for IgE-mediated cross-reactivity between the carbepenems, a new class of beta-lactam antibiotics, represented by imipenem, and penicillins. In vivo skin testing with the relevant imipenem and penicillin determinants was undertaken. Having determined the concentrations of imipenem materials that did not induce false positive skin tests in nonpenicillin-allergic control subjects, we tested 40 subjects with a history of penicillin-allergic reactions. Twenty of these subjects were found to be nonallergic to penicillin on skin testing, and none of these subjects reacted to the imipendem determinants. In contrast, half the 20 subjects who were positive to one or more penicillin determinants also reacted to imipenem reagents. There was a good correlation between the penicillin and imipenem reagents to which the patients reacted. Imipenem should only be administered to penicillin-allergic subjects with similar precautions of penicillin administration to such patients.

147 citations


Journal ArticleDOI
TL;DR: In an analysis of 4766 consecutive strains of Streptococcus pneumoniae isolated from cultures of blood from 1979 to 1986 and of 1157 isolates from cerebrospinal fluid (CSF), resistance was found in 380 (8%) of blood and 107 (9.2%) of CSF isolates to one or more of the following antibiotics.
Abstract: In an analysis of 4766 consecutive strains of Streptococcus pneumoniae isolated from cultures of blood from 1979 to 1986 and of 1157 isolates from cerebrospinal fluid (CSF), resistance was found in 380 (8%) of blood and 107 (9.2%) of CSF isolates to one or more of the following antibiotics: penicillin, tetracycline, erythromycin, clindamycin, rifampin, and chloramphenicol. Resistance increased from 3.8% to 14.1% among isolates from blood and from 6.8% to 14.1% among CSF isolates during this period. Comparing 1979-1982 with 1983-1986, we found that significant increases (P less than .01) have occurred in penicillin resistance alone, rifampin resistance alone, and in strains showing multiple resistance. Resistance was found in 15 different serogroups and/or serotypes, although 92.2% of resistant strains belonged to serogroups 6 or 19 or to serotype 14. Of the serogrouped or serotyped strains, 97.4% are represented in the 23-valent vaccine by a vaccine or vaccine-related strain.

133 citations




Journal ArticleDOI
TL;DR: The in vitro susceptibilities of eight Chlamydia sp.
Abstract: The in vitro susceptibilities of eight Chlamydia sp. strain TWAR isolates were tested against tetracycline, erythromycin, penicillin, ampicillin, sulfisoxazole, and a new drug, trospectomycin. The ranges of inhibitory concentrations of these antimicrobial agents, except for sulfonamide, were similar to those for Chlamydia trachomatis. Sulfisoxazole was not inhibitory at the highest nontoxic concentration tested.

Journal ArticleDOI
TL;DR: In this, expert discussion of each aspect of the subject was recorded, summarised, and referenced in detail, before the recommendations were presented, and the time is right for an enlargement of work of the RCOG AID S subcommittee.

Journal ArticleDOI
TL;DR: It is concluded that penicillin has little effect on clinical outcome in icteric leptospirosis.
Abstract: A prospective, controlled randomized study of penicillin therapy in icteric human leptospirosis was carried out between 1 October 1983 and 31 December 1986. Thirty-eight patients received intravenous crystalline penicillin for 5 days, while 41 assigned to a control group received intravenous fluids only. A comparison of the results of laboratory tests made on the day of admission revealed no significant differences between the 2 groups. There was no significant difference in time for defervescence, return of biochemical parameters to normal, incidence of iritis, or mortality in the 2 groups. Three patients (7.3%) in the control group and 1 patient (2.6%) in the treatment group died. The overall mortality rate was 5.9%. Leptospira were recovered from urine cultures in 6 control patients but from none of the treated patients' post-treatment cultures. We conclude that penicillin has little effect on clinical outcome in icteric leptospirosis.

Journal ArticleDOI
TL;DR: Based on the data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis using a combination of penicillin plus either an aminoglycoside or a cephalosporin, unless Gram-positive diplococci are identified in a Gram-stained specimen of peritoneal fluid, in which casePenicillin alone should suffice.
Abstract: In a retrospective review of 214 children with nephrotic syndrome seen at Children's Medical Center and Parkland Memorial Hospital in Dallas throughout the 20-year period from 1967 to 1986, 62 cases of primary peritonitis were identified in 37 patients (17.3% rate). Streptococcus pneumoniae was the major pathogen, accounting for 38% of the cases. An additional 27% of patients had negative culture results but were clinically responsive to penicillin. Gram-negative organisms were cultured from only 3% of patients; 5% were caused by alpha-streptococci and 2% each by enterococcus and anaerobes. In 23% of cases the cause was unknown. Our findings differ from the recent trend in the literature in which Gram-negative organisms associated with these infections are increasingly implicated. The incidence and bacteriology of peritonitis do not appear to have changed significantly during the 20-year period. Clinically, peritonitis was characterized by abdominal pain (98%), fever (95%), rebound tenderness (85%), and nausea and vomiting (71%). A total of 79% of patients were either in relapse or receiving steroid therapy at the time peritonitis was diagnosed; 13% had infiltrates visible on their chest radiographs. Based on our data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis using a combination of penicillin plus either an aminoglycoside or a cephalosporin. This regimen should continue until culture results are available, unless Gram-positive diplococci are identified in a Gram-stained specimen of peritoneal fluid, in which case penicillin alone should suffice.

Journal ArticleDOI
TL;DR: In this paper, the authors showed that the cyclic antibiotic exposure generally used in the clinical setting may select primarily for enhanced survival, and that sustained antibiotic concentrations just above the MIC (concentrations that may be restricted to the tail-end trough of a dosing interval).
Abstract: Seventy percent of clinical isolates of penicillin-resistant pneumococci also exhibit defective lysis when treated with penicillin exceeding the minimal inhibitory concentration (MIC). To provide a possible explanation for the frequent association of these two traits, we exposed penicillin-susceptible pneumococci to two kinds of antibiotic pressures in the laboratory. Treatment of cultures with cycles of high concentrations of penicillin (20 X MIC) followed by growth of the survivors in drug-free medium selected for lysis-defective mutants that died only slowly during antibiotic treatment but had unchanged MICs. Exposure to sustained, low levels of penicillin produced resistant mutants, with elevated MICs, that lysed normally with penicillin. We suggest that the cyclic antibiotic exposure generally used in the clinical setting may select primarily for enhanced survival. From these survivors a second type of antibiotic exposure--sustained antibiotic concentrations just above the MIC (concentrations that may be restricted to the tail-end trough of a dosing interval)--selects for penicillin-resistant mutants.

Journal ArticleDOI
TL;DR: The mechanism of resistance in these meningococci relatively resistant to penicillin G was decreased affinity of PBP 3, which resulted in the amount of 3H-labeled peniillin G required for half-maximal binding being increased in comparison with that of P BP 3 of the two susceptible isolates.
Abstract: We examined clinical isolates of Neisseria meningitidis relatively resistant to penicillin G (mean MIC, 0.3 micrograms/ml; range, 0.1 to 0.7 micrograms/ml), which were isolated from blood and cerebrospinal fluid for resistance mechanisms, by using susceptible isolates (mean MIC, less than or equal to 0.06 micrograms/ml) for comparison. The resistant strains did not produce detectable beta-lactamase activity, otherwise modify penicillin G, or bind less total penicillin. Penicillin-binding protein (PBP) 3 of the six resistant isolates tested uniformly bound less penicillin G in comparison to the same PBP of four susceptible isolates. Reflecting the reduced binding affinity of PBP 3 of the two resistant strains tested, the amount of 3H-labeled penicillin G required for half-maximal binding was increased in comparison with that of PBP 3 of the two susceptible isolates. We conclude that the mechanism of resistance in these meningococci relatively resistant to penicillin G was decreased affinity of PBP 3.

Journal ArticleDOI
TL;DR: No correlation between PBP profile and susceptibility was observed with clinical isolates except that PBP-2b exhibited molecular weight changes in moderately susceptible strains, and PBP 2b was the first PBP to show an alteration in penicillin-binding affinity.
Abstract: Penicillin-binding protein (PBP) patterns of penicillin-resistant laboratory-constructed transformants were compared with the PBP profiles of 26 clinical isolates of Streptococcus pneumoniae. For transformation studies DNA from a penicillin-resistant clinical isolate was used to transform a susceptible laboratory strain. Penicillin resistance was achieved in two transformation cycles. The frequency of transformation appeared to be dependent on the genetic status of the recipient used for the second transformation cross. Penicillin resistance was also attained in a single transformation round when time was allowed for full expression of random multiple transformations. PBP 2b was the first PBP to show an alteration in penicillin-binding affinity. This PBP was not easily detected in those transformants for which penicillin MICs exceeded 0.2 mg/l. The PBP profiles of the clinical isolates were complex. In addition to previously-described PBPs, new intermediate classes were demonstrated. No correlation between PBP profile and susceptibility was observed with clinical isolates except that PBP-2b exhibited molecular weight changes in moderately susceptible strains.

Journal Article
TL;DR: The findings indicate that S. mutans endocarditis is capable of causing significant morbidity and mortality, as exemplified by the prolonged and complicated hospital course of the authors' patients and the ultimate death of one of them.

Journal ArticleDOI
TL;DR: It was concluded that penicillin and clindamycin produce similar good results in treating odontogenic infection when the rate ofPenicillin resistance among oral anaerobic bacteria is at a relatively low level.

Journal ArticleDOI
TL;DR: It was demonstrated that while B. burgdorferi may be sensitive to relatively small concentrations of penicillin and ceftriaxone, the organism is killed slowly, which implies that prolonged blood levels of these drugs may be necessary in order to ensure cure.
Abstract: 1. It was demonstrated that while B. burgdorferi may be sensitive to relatively small concentrations of penicillin and ceftriaxone, the organism is killed slowly. This implies that, as in syphilis, prolonged blood levels of these drugs may be necessary in order to ensure cure. In contrast, the activity of tetracycline is more rapid in its action but is more dependent on drug concentration achieved. Unfortunately, the MIC and MBC for some strains are at or above the peak level achieved under optimal conditions. 2. Increasing the concentrations of penicillin or ceftriaxone above the MIC for the organism has little effect on the rate of killing. In contrast, the killing by tetracycline can be augmented by increasing concentrations of the drug. 3. Ceftriaxone is more active than penicillin, as measured by MIC, against the five strains of B. burgdorferi tested. 4. Ceftriaxone was efficacious in the treatment of Lyme borreliosis, which was recalcitrant to penicillin therapy. In a randomized trial comparing ceftriaxone to high-dose penicillin therapy, ceftriaxone was significantly more efficacious than penicillin in the treatment of the late complications of Lyme borreliosis.

Journal ArticleDOI
TL;DR: It is concluded that peniillin-resistant viridans streptococci may cause serious infections even in patients not receiving chronic penicillin therapy, that this resistance is clinically significant and may result in failure of penichill therapy, and that the mechanism of resistance in these strains is associated with diminished affinity of thepenicillin-binding proteins for Penicillin.
Abstract: We investigated the mechanism of resistance to penicillin in two penicillin-resistant clinical isolates of viridans streptococci that caused life-threatening infections in two patients not receiving chronic penicillin therapy. The first was a strain of Streptococcus intermedius that was isolated from the cerebrospinal fluid of a patient with post-neurosurgical meningitis. The second was a strain of Streptococcus mitis recovered from the bloodstream of a leukemic patient with neutropenia. Both patients failed to respond to penicillin. The mechanism of resistance in these strains was associated with diminished affinity for penicillin of their penicillin-binding proteins, as compared with those of penicillin-susceptible control strains. We conclude that penicillin-resistant viridans streptococci may cause serious infections even in patients not receiving chronic penicillin therapy, that this resistance is clinically significant and may result in failure of penicillin therapy, and that the mechanism of resistance in these strains is associated with diminished affinity of the penicillinbinding proteins for penicillin.

Journal ArticleDOI
TL;DR: There was no statistically significant difference among treatment groups in both therapeutic trials, with the exception of different follow-ups due to the nonrandomized study design and different occurrence of the Jarisch-Herxheimer reaction in patients with erythema migrans.
Abstract: In a study on 121 consecutive patients with erythema migrans, 65 patients obtained oral penicillin, 36 tetracyclines, and 20 amoxicillin-clavulanic-acid. Follow-up was carried out for a median of 29, 17, and 7 months, respectively. In another limited trial on 29 patients with acrodermatitis chronica atrophicans (ACA), 14 patients received oral penicillin, 9 parenteral penicillin, and 6 tetracyclines. There was no statistically significant difference among treatment groups in both therapeutic trials, with the exception of different follow-ups due to the nonrandomized study design and different occurrence of the Jarisch-Herxheimer reaction in patients with erythema migrans. Later extracutaneous manifestations developed in 27% of the patients with erythema migrans and in 47% of the patients with ACA despite antibiotic therapy. We could not prove the superiority of any antibiotic tested in either early or late European Lyme borreliosis.

Journal ArticleDOI
TL;DR: The type and rate of bacteremia following dental extractions, dental cleaning, or other dental/oral surgical procedures were studied in 124 patients with valvular heart disease following parenteral antibiotic prophylaxis as recommended by the American Heart Association in 1977.
Abstract: The type and rate of bacteremia following dental extractions, dental cleaning, or other dental/oral surgical procedures were studied in 124 patients with valvular heart disease following parenteral antibiotic prophylaxis (penicillin G potassium with or without streptomycin sulfate, or vancomycin hydrochloride) as recommended by the American Heart Association in 1977. Generally, under penicillin G prophylaxis with or without streptomycin, detection of bacteremia in blood culture media containing no penicillinase was low (14.7% to 16.1% at five minutes and 3.1% to 9.0% at 30 minutes after the procedure). The number and types of organisms recovered from patients who received penicillin prophylaxis alone or with streptomycin were similar. Anaerobes were recovered twice as frequently as aerobes. Polymicrobial bacteremia was rare and only one patient had streptococci detected in the blood culture. Addition of penicillinase to one blood culture medium, however, and comparing it with a similar medium without penicillinase was accompanied with a sixfold greater recovery from patients of both aerobic and anaerobic bacteria, including six patients with streptococcal bacteremia. Vancomycin prophylaxis was accompanied with bacteremia in only one patient.

Journal ArticleDOI
TL;DR: Some homology of subsurface bacterial plasmid and chromosomal DNAs is revealed, indicating a potential for those bacteria to harbor catabolic genes on plasmids or chromosomes, and the incidences of antibiotic resistance and MICs of metals for subsurfaced bacteria were significantly different from those for drill mud bacteria, ruling out the possibility that bacteria from sediments were derived from drill muds.
Abstract: Bacteria were isolated from deep terrestrial subsurface sediments underlying the coastal plain of South Carolina. A total of 163 isolates from deep sediments, surface soil, and return drill muds were examined for plasmid DNA content and resistance to the antibiotics penicillin, ampicillin, carbenicillin, streptomycin, kanamycin, and tetracycline. MICs of Cu{sup 2+}, Cr{sup 3+}, and Hg{sup 2+} for each isolate were also determined. The overall frequency of plasmid occurrence in the subsurface bacteria was 33%. Resistance was most frequent to penicillin (70% of all isolates), ampicillin (49%), and carbenicillin (32%) and was concluded to be related to the concentrations of the individual antibiotics in the disks used for assaying resistance and to the production of low levels of {beta}-lactamase. The frequencies of resistance to penicillin and ampicillin were significantly greater for isolates bearing plasmids than for plasmidless isolates; however, resistance was not transferable to penicillin-sensitive Escherichia coli. Hybridization of subsurface bacterial plasmids and chromosomal DNA with a whole-TOL-plasmid (pWWO) probe revealed some homology of subsurface bacterial plasmid and chromosomal DNAs, indicating a potential for those bacterial to harbor catabolic genes on plasmids or chromosomes. The incidences of antibiotic resistance and MICs of metals for subsurface bacteria were significantly different from thosemore » drill mud bacteria, ruling out the possibility that bacteria from sediments were derived from drill muds.« less

Journal ArticleDOI
TL;DR: The in vitro susceptibility of human isolates of Pasteurella multocida to oral antimicrobial agents suggests that dicloxacillin, erythromycin, clindamycin, cephalexin, cefaclor, and cefadroxil should not be used for empiric therapy of animal bite wounds.
Abstract: The in vitro susceptibility of human isolates of Pasteurella multocida to oral antimicrobial agents from our current study and from a review of the literature suggests that dicloxacillin (oxacillin), erythromycin, clindamycin, cephalexin, cefaclor, and cefadroxil should not be used for empiric therapy of animal bite wounds. Agents that were consistently active against P. multocida were penicillin, ampicillin, amoxicillin-clavulanic acid, tetracycline, minocycline, chloramphenicol, trimethoprim-sulfamethoxazole, and cefuroxime. Possible reasons for the confusion regarding the activity of oral cephalosporins are addressed.

Journal ArticleDOI
TL;DR: Daptomycin significantly reduced bacterial counts of vegetations compared with no therapy but was significantly less effective than penicillin G procaine or vancomycin without and with gentamicin for treatment of experimental enterococcal endocarditis.
Abstract: This study compared daptomycin (LY146032) with penicillin G procaine and vancomycin without and with gentamicin for treatment of experimental enterococcal endocarditis. The strain of Streptococcus (Enterococcus) faecalis used in this study was killed by daptomycin in vitro in broth but not in serum. In rabbits treated for 3 days, daptomycin significantly reduced bacterial counts of vegetations compared with no therapy but was significantly less effective than penicillin G procaine or vancomycin. Daptomycin-gentamicin significantly reduced bacterial counts of vegetations compared with daptomycin alone but was significantly less effective than vancomycin plus gentamicin. The efficacy of daptomycin-gentamicin did not differ significantly from that of penicillin G procaine-gentamicin. The lack of enterococcal killing by daptomycin alone in serum and in experimental endocarditis is probably related to the high protein binding of the agent.

Journal ArticleDOI
TL;DR: The relative scarcity of penicillin allergy as compared with the frequent occurrence of anti-penicilloyl antibodies may be partly related to unavailable sites of penimeloyl groups within the albumin molecule.
Abstract: Penicilloyl groups, which have been connected to penicillin allergy, are derived from penicillin by cleavage of the beta lactam ring and bind covalently to proteins. Fixation of penicilloyl groups was studied in seven patients given large amounts of penicillin. Penicilloyl groups were found essentially on the albumin molecule at sites not accessible to anti-penicilloyl antibodies, except after pronase digestion. The amount of penicilloyl groups was proportional to the cumulated doses of penicillin. The decline of penicilloyl groups with time after treatment interruption was exponential. The half-life of penicilloylated albumin was lower than or equal to that of normal albumin. The presence of anti-penicilloyl antibodies was demonstrated in 19 out of 34 penicillin-treated patients (including the seven mentioned above). The relative scarcity of penicillin allergy as compared with the frequent occurrence of anti-penicilloyl antibodies may be partly related to unavailable sites of penicilloyl groups within the albumin molecule.

Journal ArticleDOI
TL;DR: Cefsulodin, vancomycin and amphotericin B would be suitable constituents of selective media for isolation ofCampylobacter pylori.
Abstract: The MICs of 21 antimicrobial agents were determined for 97 clinical isolates ofCampylobacter pylori. The beta-lactams (penicillin, ampicillin, cefoxitin and cephalexin), macrolides (erythromycin and azithromycin), quinolones (ciprofloxacin and ofloxacin), nitrofurans, gentamicin and tetracycline all had MIC90 values of ≤ 0.5 mg/l. Aztreonam, flucloxacillin, amifloxacin and rifampicin had moderate activity. All isolates were resistant to vancomycin, cefsulodin and amphotericin B. Five percent of the strains were inhibited by 8 mg/l of polymyxin. Of the oral agents tested, the nitrofurans and ampicillin are probably the most appropriate antimicrobial agents. Azithromycin and the oral form of cefuroxime are promising alternatives. Cefsulodin, vancomycin and amphotericin B would be suitable constituents of selective media for isolation ofCampylobacter pylori.

Journal ArticleDOI
TL;DR: The emergence and persistence of BLPB after penicillin therapy may have important implications for the antimicrobial management of infections of the upper respiratory tract.
Abstract: • The emergence and persistence of aerobic and anaerobic β-lactamase—producing bacteria (BLPB) were investigated in 26 children treated with penicillin for otitis media or pharyngitis and in 28 nontreated control children. β-Lactamase—producers were isolated in three (12%) of the treated children before therapy, in 12 (46%) seven to ten days after completion of therapy, in nine (35%) 40 to 45 days after therapy, and in seven (27%) 85 to 90 days after therapy. These organisms were present in three (11%) of the nontreated children, and the number of patients harboring BLPB stayed constant throughout the three-month follow-up. The predominant BLPB were Bacteroides species ( Bacteroides melaninogenicus group, Bacteroides oralis , and Bacteroides orisbuccae), Staphylococcus aureus, Haemophilus influenzae , and Branhamella catarrhalis . The emergence and persistence of BLPB after penicillin therapy may have important implications for the antimicrobial management of infections of the upper respiratory tract. ( Arch Otolaryngol Head Neck Surg 1988;114:667-670)