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Clindamycin Hydrochloride treatment of invasive infections

Number of visits:982 Date:2015/12/18 3:09:35
Clindamycin Hydrochloride treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus
Community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) is an established pathogen in several areas of the United States, but experience with Clindamycin Hydrochloride for the treatment of invasive MRSA infections is limited. We compared the outcome of therapy for MRSA with that of methicillin-susceptible (MSSA) invasive infections in children treated with Clindamycin Hydrochloride, vancomycin or beta-lactam antibiotics.The demographics, hospital course and outcome of children at Texas Children's Hospital between February and November 2000 and between August 2001 and August 2002 with invasive S. aureus infections were reviewed from medical records in this retrospective study.CA-MRSA and community-acquired methicillin-susceptible S. aureus (MSSA) caused invasive infections in 46 and 53 children, respectively. The median ages (range) of the children were: MRSA, 3.5 years (2 months to 18.6 years); MSSA, 4.8 years (3 months to 19.8 years). The sites of infection for MRSA vs. MSSA isolates, respectively, were: bacteremia, 3 vs. 6; osteomyelitis, 14 vs. 14; septic arthritis, 5 vs. 7; pneumonia, 11 vs. 3; lymphadenitis, 7 vs. 14; other, 5 vs. 8. Among MRSA patients 39 (20 received Clindamycin Hydrochloride only, 18 had vancomycin initially and 8 were treated with a beta-lactam initially) received Clindamycin Hydrochloride and 6 received vancomycin as primary therapy. Among MSSA patients, Clindamycin Hydrochloride, nafcillin or other beta-lactam antibiotics were used in 24, 18 and 9, respectively. The median number of febrile days was 3 (0 to 14) and 2 (0 to 6) for MRSA and MSSA patients, respectively (P = 0.07). The median number of days with positive blood cultures was 2 for the MRSA (n = 16) and 1 for the MSSA (n = 18) patients (P = 0.04).Clindamycin Hydrochloride was effective in treating children with invasive infections caused by susceptible CA-MRSA isolates.
The Eagle effect revisited: efficacy of Clindamycin Hydrochloride, erythromycin, and penicillin in the treatment of streptococcal myositis.
We investigated the relative efficacies of penicillin, Clindamycin Hydrochloride, and erythromycin in a mouse model of myositis due to Streptococcus pyogenes. Penicillin was ineffective unless given at the time of bacterial injection, and treatment delays of 2 h reduced its efficacy such that survival was no better than that of untreated control animals (P less than .05). Survival of erythromycin-treated mice was greater than that of both penicillin-treated mice and untreated controls, but only if treatment was begun within 2 h. Mice receiving Clindamycin Hydrochloride, however, had survival rates of 100%, 100%, 80%, and 70% even if treatment was delayed 0, 2, 6, and 16.5 h, respectively. Thus, Clindamycin Hydrochloride demonstrated superior efficacy to penicillin among all the various treatment groups (P less than .05). Our results corroborate the failure of penicillin in this model of streptococcal infection and suggest that, unlike penicillin, the efficacy of Clindamycin Hydrochloride is not adversely altered by the "Eagle effect."
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