Use of ciprofloxacin for successful eradication of bacteremia due to Campylobacter cinaedi in a human immunodeficiency virus-infected person

A 36-year-old homosexual man who was infected with human immunodeficiency virus presented with a 2-month history of fever and intermittent diarrhea. Stool cultures were negative for bacterial pathogens, ova, parasites, and acid-fast organisms. An initial blood culture became positive after 5 days for a curved, gram-negative rod that was identified later as Campylobacter cinaedi. The patient received a series of antibiotic regimens, including a 2-week course of erythromycin followed by a 2-week course of tetracycline, but follow-up blood cultures continued to yield C. cinaedi. The patient was then treated with a 2-week course of oral ciprofloxacin; he remained asymptomatic 11 weeks later, at which time a blood culture was negative for C. cinaedi. To the best of our knowledge, this is the first documented case of symptomatic bacteremia due to C. cinaedi that was successfully treated with ciprofloxacin.

Development of resistance to quinolones in five patients with campylobacteriosis treated with norfloxacin or ciprofloxacin

Development of resistance to nalidixic acid, norfloxacin and ciprofloxacin was observed in five patients with Campylobacter jejuni or Campylobacter coli infection. From all these patients nalidixic acid- and quinolone-susceptible strains were isolated initially, whereas after therapy with norfloxacin or ciprofloxacin strains resistant to these antibiotics were found. Campylobacter strains from the same patient always belonged to the same species and, with the exception of one case, showed identical rRNA gene restriction (rDNA) patterns. This indicates that double-infection with a susceptible and a resistant strain was not responsible for the phenomenon but rather that the infecting strain rapidly developed resistance following treatment.

[Chronic active surface-positive Campylobacter antrum gastritis-- morphological changes 1 year after treatment with bismuth]

The works is based on a previous investigation published in the journal Vnitrní Lékarství, 36, 1990, 8, pp. 759-762. The authors investigated morphological changes of the gastric mucosa and the presence of Campylobacter pylori (CP) in probands with chronic active surface CP positive antrum gastritis one year after treatment with a bismuth preparation (Bismuth citrate 120 mg per capsule made on prescription) for a one-month period 4 capsules per day. This concerned probands with functional dyspepsia without a history of alcohol intake. After a one-year interval eradication of CP persisted in 8 probands (53.3%); in 7 patients (46.7%) there was a relapse of CP positivity. The authors confirmed that CP and active chronic gastritis are associated. Chronic non-specific inflammatory cellulitis persisted after one year with the same intensity in 17 probands (74%), in 6 it increased by one grade (26%). Improvement or complete recovery of the histological finding was not recorded in any of the patients. In the corpus of the stomach the unaltered finding persisted. Morphological changes were always directly proportional to the presence of CP. Its eradication appears to be causal treatment of chronic active surface CP positive antrum gastritis, one of the groups in the wide spectrum of chronic gastritis.

[Bismuth revisited in Helicobacter pylori gastro-duodenal infection]

The various hypothesis for the explantation of reversible bismuth encephalopathy are reviewed and discussed. Today, this side effect appears to be devoid of mystery, due to uncontrolled and inhibited ingestion of bismuth salts which increased the emergence of genetic and physiopathologic risk factors and brought about the cases of neurotoxicity. Bismuth therapy has shown major efficacy in the treatment of gastroduodenal ulcers. Colloidal bismuth subcitrate is as effective as the H2-receptor antagonists in peptic ulcer. In addition, it offers a lower rate of relapse. This therapeutic benefit has been attributed to a cytoprotective and demulcent action. Moreover bismuth acts as an antimicrobial agent, suppressing the organism Helicobacter pylori which occupies a central place in contemporary views on pathophysiology of ulcer disease. Side effects so far reported have been very infrequent mild and transient when the drug is used at low dosage providing blood-bismuth concentration above toxic values. Colloidal bismuth subcitrate complies to the requirements for a modern drug insofar as it is prescribed in period no longer than 6-8 weeks, followed by 8 weeks bismuth-free intervals.

[Comparison of clinical efficacy of rokitamycin (RKM) and ofloxacin (OFLX) for the treatment of Campylobacter enteritis by a double-blind method. The Research Committee for the Effect of Rokitamycin, Research Group for Infectious Enteritis]

The clinical efficacy, safety and usefulness of Rokitamycin (RKM), a new macrolide antibiotic, were compared with those of Ofloxacin (OFLX) for the treatment of Campylobacter enteritis by a double blind method. The daily dose level of RKM or OFLX was 600 mg. They were orally administered in three divided doses for 5 days. Of 223 cases studied, 106 cases were diagnosed as Campylobacter enteritis. Ninety cases (RKM group: 50, OFLX group: 40) except for 16 excluded or drop-out cases were analysed. There was no significant difference between the two groups in any background factors. The effectiveness and usefulness was evaluated in 88 cases (RKM group: 48, OFLX group: 40). The results obtained were as follows: 1. In a total of 82 strains of Campylobacter jejuni/coli (RKM group: 42, OFLX group: 40), the bacteriological efficacy rate of RKM (95.2%) was superior to that of OFLX (70.0%) with a significant difference (p = 0.006). 2. In 76 symptomatic patients (RKM group: 42, OFLX group: 34) on the day of the beginning of drug administration, the clinical efficacy rate was 97.6% in the RKM group and 85.3% in the OFLX group with no significant difference between the two groups. 3. In 88 evaluable patients, the global clinical efficacy rate of RKM (95.8%) was superior to that of OFLX (67.5%) with a significant difference (p = 0.001). 4. Side effect was observed in 1 (1.9%) of the 54 patients in the RKM group and none of the 44 patients in the OFLX group. Slightly abnormal laboratory findings were seen in 4 (10.8%) of the 37 patients treated with RKM and 3 (9.7%) of the 31 patients treated with OFLX, but there was no significant difference between the two groups. 5. In 88 evaluable patients, the clinical usefulness of RKM (91.7%) was superior to that of OFLX (67.5%) with a significant difference (p = 0.01). From these results, RKM is considered to be a very useful agent for the treatment of Campylobacter enteritis.

[A clinical experience of rokitamycin on Campylobacter enteritis. Research Group of Rokitamycin on Infectious Enteritis]

Rokitamycin, a newly developed macrolide, was administered to a total of 107 cases, 16 years old or more, in order to evaluate its clinical efficacy, safety and usefulness on Campylobacter enteritis. Daily dosage of 600 mg of rokitamycin was administered orally in three divided doses for 5 days. Bacteriological and clinical efficacies were judged by the attending doctors from the evaluation criteria made by the committee and from the days required for improvement of diarrhea, defervescence and so on, respectively. Antibacterial activities against the isolates were tested of rokitamycin (RKM), erythromycin (EM), josamycin (JM) and ofloxacin (OFLX). The results were as follows; 41 symptomatic patients and 5 carriers were evaluated. Clinical efficacy (n = 41) was 100% (excellent; 34.1%, good; 65.9%). Bacteriological efficacy (n = 41) was 97.6%. Eight of the 9 cases with consecutive stool cultures were free of the bacteria on and after one day of the drug administration. Clinical usefulness (n = 46) was 97.8%. Slight epigastric pain was seen in only one as a side effect. The items of abnormal laboratory findings were 4 elevated GPT and/or GOT and one increased number of WBC in 4 cases. MIC90 of RKM, EM, JM and OFLX against 41 clinical isolates of C. jejuni were 1.56, 3.13, 3.13 and 0.78 micrograms/ml, respectively. Rokitamycin was considered clinically useful to treat Campylobacter enteritis.

Use of quinolones in the treatment of gastrointestinal infections

Bacterial enteropathogens are responsible for between 40% and 80% of diarrheal illness depending upon the age of the persons affected and geographic areas where illness occurs. Antibacterial agents will shorten the illness associated with enteric infection caused by enterotoxigenic Escherichia coli, Shigella spp. and Campylobacter jejuni. These drugs also are effective in the therapy of certain clinical conditions (presumably because they are due to the same agents) which are characterized by moderate to severe diarrhea with one or more of the following: high fever, dysentery (passage of bloody mucoid stools), or high leukocyte counts in stools. Antimicrobial agents are also effective in the therapy of travelers' diarrhea. The quinolone drugs have several advantages in the management of bacterial diarrhea where strains causing illness from nearly all regions of the world will show general susceptibility: high concentrations are achieved in the intestinal lumen following oral administration and resistance development is unusual. A quinolone probably represents the optimal agent for therapy of bacterial diarrhea in adults in areas where trimethoprim-resistant enteric pathogens are common.

[Ciprofloxacin-omeprazole combination therapy for eradication of Helicobacter pylori]

20 H. pylori-positive patients with gastric or duodenal ulcer disease (n = 16, one with proof of gastric cancer obtained by histology) or severe non-ulcer dyspepsia (n = 4) were entered in a pilot study to examine the effect of a combination of omeprazole (40 mg) before breakfast and ciprofloxacin (2 x 500 mg) 1 hour after meals for 1 week to treat Helicobacter pylori (Hp). The eradication rate was 15% (3 out of 20 patients) 4 weeks after therapy. Ulcer healing occurred in 2 of 3 patients having eradication and 9 of 11 control patients with positive H. pylori urease test and/or culture 4 weeks after treatment. Despite some good theoretical background, this drug combination is inefficient to eradicate H. pylori and cannot be recommended for routine clinical practice. No major side effects of the therapy-regimen were observed.

[Comparative evaluation of the effectiveness of the treatment of gastroduodenal Campylobacter infection in children]

Schemes developed by the authors for antibacterial therapy of gastroduodenal bacterosis caused by Campylobacter spp. in children are described. The data on the treatment of 56 patients with duodenal ulcer and gastroduodenitis are presented. The efficacy of the treatment with medicines under the control of the clinical, endoscopic and microbiological indices was compared. The study showed that De-Nol, furazolidone and combination of trichopol (metronidazole) with vicair were the most efficient drugs for therapy of children with such diseases.

Campylobacter fetus infection of abdominal aortic aneurysm

A 61-year-old man with Campylobacter fetus infection of an abdominal aortic aneurysm treated surgically is presented herein, the fifth survival case reported in the literature. Fever and back pain preceded the enlargement of atherosclerotic abdominal aortic aneurysm. The patient tolerated satisfactorily total excision of the aneurysm followed by axillo-femoral prosthetic bypass. Antibiotic therapy consisted of intravenous infusion of fosfomycin and gentamicin and oral administration of minocycline. The organism cultured from the aneurysmal wall and intraluminal thrombi was identified as Campylobacter fetus from its typical characteristics. It is concluded that this organism should be considered in all cases of infected aneurysm in elderly or debilitated patients.

Hyperplastic gastric polyps associated with persistent Helicobacter pylori infection and active gastritis

We report two cases of patients with 3-yr histories of upper gastrointestinal symptoms, hyperplastic gastric polyps, and active chronic gastritis. Biopsies retrospectively stained with Giemsa revealed the persistent presence of Helicobacter pylori (HP) in gastric biopsies of both patients throughout the 3 yr. After treatment with amoxicillin and bismuth subsalicylate, both became asymptomatic, one demonstrating disappearance and recurrence of the gastric polyps in conjunction with the HP. These cases demonstrate 3 yr of hyperplastic gastric polyps associated with HP and active gastritis.

Campylobacter fetus subspecies fetus meningitis with chronic alcoholism and diabetes mellitus

A case of Campylobacter fetus subspecies fetus meningitis is reported. The patient had underlying diseases, namely chronic alcoholism and diabetes mellitus. The infection did not respond to Piperacillin and Cefotaxime, but did respond to Ampicillin and Moxalactam. The patient was discharged on the 33rd hospital day showing no neurological deficit complications, and has remained free of recurrent disease for one month after the discontinuation of therapy.

Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate

Persistence of Helicobacter pylori after duodenal ulcer healing is associated with high rates of ulcer relapse. We compared colloidal bismuth subcitrate alone with CBS combined with one of four antibiotic regimens in the treatment of duodenal ulcers. Endoscopy and antral biopsies were performed before treatment and four weeks afterwards. Biopsy specimens were examined for histological evidence of gastritis and by Gram stain and culture for H pylori infection. Altogether 141 patients were allocated to one of five treatment groups. Giving CBS and metronidazole (400 mg tid for 7 days) with and without amoxycillin (500 mg tid) achieved higher clearance rates of H pylori than treatment with CBS alone (p less than 0.01). These two combinations also achieved higher rates of antral gastritis healing than CBS alone (p less than 0.01 and p less than 0.05 respectively). Susceptibility to metronidazole was tested in 29 isolates before and in seven isolates after treatment with metronidazole by disc diffusion test and minimum inhibitory concentration assay. Twenty seven (93%) of the isolates were sensitive before treatment while six of seven (86%) were resistant afterwards. Four of the six resistant strains had acquired resistance during treatment and one of these had acquired metronidazole resistance despite concomitant treatment with amoxycillin, to which it remained sensitive. CBS with adjuvant metronidazole at a dose of 400 mg tid for seven days significantly improves the eradication of H pylori compared with CBS alone. Acquired metronidazole resistance, however, seems to be an important cause of failure to eradicate H pylori.

[Competitive activity of a bacterial preparation on colonization and pathogenicity of C. pylori. A clinical study]

The authors studied the ability of a live polymicrobial formulation containing Lactobacillus acidophilus 10(9) and Bifidobacterium bifidum 10(9) to act as an "ecological" therapy for gastritis and duodenitis. The study was carried out in volunteers suffering from these disorders which nowadays are attributed to C. pylori. The results obtained confirm previous findings in experimental animals. The polymicrobial formulation was found to be able to compete effectively with the microorganism responsible for the disorders and to improve the results obtained by traditional therapy.

Nodular gastritis and Helicobacter pylori

Numerous reports have established the association of Helicobacter pylori and peptic ulcer disease in adults. Recently, this association has also been demonstrated in children. We investigated 14 children and adolescents with recurrent abdominal pain. In six patients, endoscopy revealed gastritis and Helicobacter pylori was identified. Giemsa stain was more sensitive than culture or urease testing in identifying the bacteria. In four of the six, a nodular appearance of the antral mucosa was observed. The histological examination suggests lymphoid hyperplasia as the cause of the nodularity. All of the patients became symptomless after combined treatment with amoxicillin and bismuth subsalicylate. We conclude that nodular gastritis is a peculiar type of gastritis in children. It is frequently found in association with Helicobacter pylori infection.

[Campylobacter pylori--its role in diseases of the upper digestive tract. The present and future]

In the paper an outline of modern knowledge is presented on Campylobacter pylori (Helicobacter pylori) which participates in certain upper digestive tract diseases. The history is described of studies on this organism and modern methods of its identification are discussed. The sites of presence of this microorganism are presented in the upper part of the digestive tract and the diseases of this part of the digestive tract are described which are associated with the presence of Campylobacter pylori. The methods of treatment are mentioned in patients infected with this organism, with the criteria of treatment effectiveness.