Q fever endocarditis treated with trimethoprim and sulphamethoxazole.

Freeman, R.; Hodson, M E

doi:10.1136/bmj.1.5797.419

Cited by 43 publications

(15 citation statements)

References 5 publications

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“…In contrast, the Priscilla isolate, implicated as a cause of chronic Q fever in goats (21)-and possibly humans-exhibited significant resistance to all antibiotics that were effective against the Nine Mile isolate. This observation is in agreement with the fact that chronic Q fever in humans, including Q-fever endocarditis, is not successfully managed with either antibiotic treatment or a combination of antibiotic treatment and surgical procedures (7,18,22,24,26,27).…”

Section: Methodssupporting

confidence: 86%

“…The use of antibiotics in treating patients with Q-fever endocarditis has been relatively unsuccessful (7,18,22,24,26,27 …”

Section: Methodsmentioning

confidence: 99%

“…Antibiotic management of acute Q fever is generally successful in noncompromised patients, whereas antibiotic management of chronic Q-fever endocarditis or hepatitis is poor at best (7,11,18,22,23,25,27). In light of these observations, we have previously demonstrated that rifampin and several 4-quinolone antibiotics (ciprofloxacin, difloxacin, and oxolinic acid) are highly effective in reducing persistent in vitro infections caused by Nine Mile C. burnetii (28).…”

mentioning

confidence: 99%

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Antibiotic susceptibilities of two Coxiella burnetii isolates implicated in distinct clinical syndromes

Yeaman

Roman

Baca

1989

Antimicrob Agents Chemother

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Antibiotic susceptibility testing of two isolates of the Q-fever agent, Coxiella burnetii, was performed with recently and persistently infected L929 fibroblast cells. The two genetically distinct isolates, Nine Mile and Priscilla, are implicated in two different clinical disease syndromes, acute and chronic Q fever, respectively. We compared the efficacies of rifampin, doxycycline, and five 4-quinolone compounds (ciprofloxacin, difloxacin, ofloxacin, norfloxacin, and pefloxacin) in reducing persistent C. burnetii infection of L929 fibroblasts. In persistently infected cells, the Priscilla isolate was less susceptible to all antibiotics tested when compared with the Nine Mile isolate. The most effective antibiotics against the Priscilla isolate were ofloxacin, pefloxacin, and ciprofloxacin (50% inhibitory concentrations of 0.5, 2.2, and 2.5 micrograms/ml, respectively). In persistently infected cells, the Nine Mile isolate was highly susceptible to all antibiotics tested except doxycycline. In contrast, the Priscilla and Nine Mile isolates in recently infected cells were somewhat susceptible to doxycycline; the Priscilla isolate was significantly more susceptible to ofloxacin and rifampin in recently infected host cells than in persistently infected cells. Persistently infected L929 cells were also treated with antibiotic combinations. Although ciprofloxacin and doxycycline had no synergistic effect on the Priscilla isolate, ciprofloxacin and rifampin acted synergistically. Collectively, these in vitro results are in accord with the fact that chronic Q fever in humans is generally not successfully managed with antibiotics. They also indicate that early diagnosis may be essential and that combination antibiotic therapy that includes quinolones may be effective in treating chronic Q fever.

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Section: Methodssupporting

confidence: 86%

“…The use of antibiotics in treating patients with Q-fever endocarditis has been relatively unsuccessful (7,18,22,24,26,27 …”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Antibiotic susceptibilities of two Coxiella burnetii isolates implicated in distinct clinical syndromes

Yeaman

Roman

Baca

1989

Antimicrob Agents Chemother

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“…Results obtained with combinations including co-trimoxazole are still controversial. Reports (6,7,9,29,34) show that nine patients required valve replacement, since viable C. burnetii were recovered from six patients after therapies of various durations. In our study, one patient was treated with cotrimoxazole combined with doxycycline and died 30 months after initiation of therapy.…”

Section: Resultsmentioning

confidence: 99%

Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis

Lévy¹,

Drancourt²,

Etienne³

et al. 1991

Antimicrob Agents Chemother

112

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We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment. Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized. Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case). Two patients died before the beginning of the treatment. Nineteen patients had hemodynamic failure and subsequently underwent valve replacement. Nine valve tissue cultures were positive despite previous antibiotic treatment. In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant. We conclude that the addition of quinolones to doxycycline is beneficial. On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics. We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.

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“…Results obtained with combinations including co-trimoxazole are still controversial. Reports (7,8,10,36,43) show that among nine patients requiring valve replacement and receiving therapies of various durations including co-trimoxazole, viable C. burnetii was recovered from six. One patient was treated with co-trimoxazole combined with doxycycline and died 30 months after initiation of therapy.…”

Section: Antibiotic and Surgical Treatment Of Chronic Q Fevermentioning

confidence: 99%