No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ؎ 2.47 months in P1, 6.52 ؎ 4.15 months in P2, and 5.18 ؎ 2.27 months in P3) (P ؍ 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n ؍ 5/166, 3.0%) and the oral therapy (n ؍ 4/42, 9.5%) (P ؍ 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n ؍ 6/166 [3.6%] versus n ؍ 6/42 [14.3%]; P ؍ 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n ؍ 6/42) compared to P1 (2.6%, n ؍ 3/117) and P3 (6.1%, n ؍ 3/49) (P ؍ 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.
Spinal subdural abscesses (SSA) are rare and to date only 57 cases have been reported. The exact incidence of the SSA is unknown. The most affected region is the thoraco-lumbar spine and the most common bacterial source is Staphylococcus aureus. The timing for magnetic resonance imaging is very important in these patients. Because early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits.
Combined treatment with pegylated interferon (PEG-IFN) and ribavirin is currently recommended for the treatment of chronic hepatitis C virus (HCV) infection. Many side effects including hair disorders have, however, been reported related to this treatment. Alopecia universalis is a severe form of hair disorder. Three cases of alopecia universalis during PEG-IFN and ribavirin combination therapy have been reported in the literature. Herein is reported a case of reversible alopecia universalis, with complete hair loss extending to the whole body, secondary to PEG-IFN alpha-2b and ribavirin combination therapy for chronic HCV infection. Hair regrowth began within 3 months of the completion of combined therapy. In case the liver disease is advanced, and virologic response occurs, treatment can still be completed, as it appears that these side effects are reversible.
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