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Current antibiotic therapy for isolated urinary tract infections in women.

2017-05-19

Unilocular hydatid disease occurs in humans after oral intake of eggs of the dog tapeworm, Echinococcus granulosus. Cysts develop mostly in the liver, but sometimes also in the lung. The diagnosis of Echinococcus infection is based on history-taking, physical examination, ultrasound and CT examination and serological testing; the diagnosis is confirmed by parasitological examination of cystic fluid. Treatment until some 15 years ago consisted in operation. Subsequently, treatment with initially mebendazole, later with albendazole or with percutaneous drainage (puncture, aspiration, injection of a scolicidal, respiration (PAIR)), or with combinations of the same, became accepted forms of management. The PAIR method is reported to give high proportions of success, low proportions of recurrence and few complications. However, adequate evaluation is not yet possible because of the short follow-up period. For the prevention of leakage it is recommended to perform the PAIR method with a transhepatic puncture under continuous ultrasonographic or CT guidance; for avoidance of recurrences, one week's pretreatment and 1-4 weeks' after-treatment with albendazole are recommended. The results of albendazole monotherapy are hard to predict and highly variable: success: 30-88% (median: 71%); failure: 22-32% (median: 25%); recurrences: 9.5-31% (median: 16%). Both albendazole therapy and the PAIR management should be followed by protracted follow-up to check regression of cysts and detect recurrences. It is not clear which treatment is the best one.

Nine patients with complicated hydatid disease managed with surgery and mebendazole/albendazole are presented. Five patients received albendazole (1 treatment course) and 5 patients received mebendazole (3 had 2 treatment courses, 1 had a switch-over from mebendazole to albendazole). The mean durations of treatment and follow-up were respectively 7 +/- 2.5 months and 7 +/- 2.5 months (albendazole); 13 +/- 10 months and 29 +/- 31 months (mebendazole). A superior clinical and radiological response was seen in 1 patient with disseminated intra-abdominal disease on switching therapy from mebendazole to albendazole. Radiological improvement occurred in 3/5 courses of albendazole and in 2/8 courses of mebendazole. Clinical improvement occurred in 3/5 courses of albendazole and 0/8 courses of mebendazole. Radiological deterioration was demonstrated in 0/5 courses of albendazole and 2/8 courses of mebendazole. Although the impression was that albendazole was superior, good responses were also seen with mebendazole. The heterogeneity of the patients, their disease, short follow-up time, lack of more sensitive noninvasive assay techniques urges caution before firm conclusions can be drawn.

In order to determine the minimum effective dosages of praziquantel, albendazole, and mebendazole against Clonorchis sinensis infection in Sprague-Dawley rats, each rat was infected with 30 metacercariae and treated with one of three drugs. The rats were killed and examined 25 days after praziquantel treatment or 11 days after albendazole or mebendazole treatment. The minimum effective dosages were a single dose of praziquantel 375 mg/kg, albendazole 150 mg/kg, and mebendazole 150 mg/kg. Trials are required to determine whether these dosages are useful in the treatment of human clonorchiasis.

This study compiles observations on the reproductive capacity of O. volvulus. Adult parasites enzymatically isolated from excised onchocercomata of untreated and chemotherapeutically treated patients, and from inhabitants living in areas with long vector control, were investigated to assess their fecundity. Changes of microfilaria development in utero and microfilaria release were assessed or estimated after treatment of patients with micro-filaricidal drugs that interfered with the development of intra-uterine stages. Intra-uterine production of microfilariae: After treatment of patients with ivermectin a daily development of 2500 to 4000 uterine microfilariae per female worm was observed. Actual output of microfilariae: Microfilariae left actively the female worms. The daily microfilaria release in vivo was 700 to 900 microfilariae, assessed after treatment of patients with mebendazole. In vitro most worms isolated from untreated patients shed between 500 to 1500 microfilariae per day.-The microfilarial load of 56 adult patients calculated from microfilarial skin counts was 12 million on the average. Taken for granted a mean life span of a microfilaria of 1.0 to 1.5 years, 22 to 47 female worms per patient would suffice to maintain this microfilarial load on a constant level. Excision of all palpable nodules showed a geometric mean of 15.9 female worms in these patients. It is suggested that factors intrinsic in the host and the adult worms partially operate together to regulate and maintain a stable microfilarial density.

During a 10-yr period, 386 patients with hydatid disease of the lung were treated at our hospital. There were 165 male and 221 female patients with a mean age of 30.15 + 16.9 yr. There were 286 solitary, 20 multiple, and 21 bilateral cysts. In 59 patients, the cysts included the lung and other organs; in 54, the lung and the liver; in four, the lung and the kidney; in one, the lung and the peritoneum. Diagnosis was made using clinical criteria, serologic findings, and imaging techniques; 373 patients were treated surgically. Surgical procedures consisted of cystectomy in 93 patients, pericystectomy in 166 patients, and lung resection in 114 patients. Mebendazole and flubendazole were used in three patients. Postoperative complications occurred in 44 patients (15.8%). There were two operative deaths (mortality rate, 0.53%). Patients have been followed yearly, with a median follow-up of 6 yr. Active hydatid disease has been found in two patients.