Tags: Nalidixic Acid

Enteritis Caused by Escherichia coli & Shigella & Salmonella Species

The Enterobacteriaceae are a diverse family of bacteria that, in nature, exist in soil, on plant material, and in the intestines of humans and other animals. Another ecological niche in which these organisms thrive is the hospital. Many of these organisms cause a wide variety of extraintestinal diseases that are often nosocomial and commonly present in debilitated or immunocompromised hosts.

Shigella species

Shigella species are unique among bacterial enteric pathogens in that < 200 and possibly = 10 organisms may transverse the gastric acid barrier and cause disease. For this reason, person-to-person transmission is common. Person-to-person transmission results in increased frequencies of shigellosis in day care centers, schools, and custodial-care facilities.

Group B Streptococcus (S Agalactiae) Clinical Syndromes

Early-onset group B streptococcal neonatal infection has three major clinical expressions: bacteremia with no identifiable focus of infection, pneumonia, and meningitis (Box 1). Signs and symptoms of early-onset group B streptococcal neonatal infection include lethargy, poor feeding, jaundice, abnormal temperature, grunting respirations, pallor, and hypotension.

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Nalidixic acid, the first quinolone, first introduced in 1962, is now only rarely used and has been supplanted by the fluoroquinolones. It is almost completely absorbed from the gastrointestinal tract and is rapidly eliminated by the kidneys, resulting in urinary concentrations 4-6 times higher than plasma concentrations.

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There have been reports of chloramphenicol-resistant H. influenzae from various countries, but there have been few cases. Outbreaks of chloramphenicol-resistant S. typhi have been observed in several countries. High-level chloramphenicol-resistant strains of N. meningitidis serogroup B were isolated from 11 patients in Vietnam and one patient in France. Resistance was due to the presence of the catP gene on a truncated transposon that has lost mobility because of internal deletions.

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Antimicrobial prophylaxis to prevent inhalational anthrax has been recommended for people potentially exposed to Bacillus anthracis as a result of recent bioterrorist attacks. Of 3428 people taking ciprofloxacin, 666 (19%) reported severe nausea, vomiting, diarrhea, or abdominal pain; 484 (14%) reported fainting, light-headedness, or dizziness; 250 (7%) reported heartburn or acid reflux; and 216 (6%) reported rashes, hives, or an itchy skin. Of those taking ciprofloxacin, 287 (8%) stopped taking it, 116 (3%) because of adverse events, 27 (1%) because of fear of possible adverse events, and 28 (1%) because they “did not think it was needed”. The imaging of inflammation/infection withTm-labeled ciprofloxacin in 96 patients had a sensitivity of 81% and specificity of 87%.

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Nitrofurantoin is a synthetic nitrofuran that belongs to a group of organic substances characterized by a heterocyclic ring consisting of four carbon atoms and one oxygen atom. Its mechanism of action is not understood. Nitrofurans enter bacterial cells and interact with several enzymes; thereby inhibiting bacterial growth. Nitrofurantoin is active against many Gram-positive and Gram-negative bacteria.

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For amebiasis there is still discussion about the use of a single high dose versus repeated lower doses, both as regards efficacy and adverse effects. The use of metronidazole against infections with anerobic bacteria has increased over the years, and with this indication the use of metronidazole in combination with many other drugs used by patients with conditions likely to develop secondary anaerobic bacterial infections. With increased use there is also a widespread and increasing incidence of resistance of various strains of bacteria. The use of metronidazole as an added medication merely “to make assurance double sure” is to be discouraged.

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Antimicrobial prophylaxis to prevent inhalational anthrax has been recommended for people potentially exposed to Bacillus anthracis as a result of recent bioterrorist attacks. Of 3428 people taking ciprofloxacin, 666 (19%) reported severe nausea, vomiting, diarrhea, or abdominal pain; 484 (14%) reported fainting, light-headedness, or dizziness; 250 (7%) reported heartburn or acid reflux; and 216 (6%) reported rashes, hives, or an itchy skin.

Bacterial Infections

Enterotoxigenic (cholera-like) Diarrhea. Escherichia coli. Pseudomembranous Colitis (Clostridium difficile).