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kclj.si
OBJECTIVES: The recent information on the appearance of erythema migrans despite prophylaxis with 200 mg of doxycycline was the stimulus for a search among our patients for those who developed the skin lesion regardless of receiving antibiotics after a tick bite. METHODS: Data were reviewed for adult patients with erythema migrans diagnosed at our institution from 1994 to July 2001, targeting those who received antibiotics after a tick bite. RESULTS: Seven of 5056 (0.14%) patients, diagnosed with typical erythema migrans, developed the skin lesion despite receiving antibiotics after a tick bite. Antibiotics were prescribed by general physicians: in four cases as prophylaxis of Lyme borreliosis within one day after tick detachment and in three cases because of development of acute respiratory tract infection two, five, and eight days after the bite, respectively. The dosages were as follows: azithromycin in a total dose of 3 g in three patients and 1.5 g in the fourth patient, amoxicillin-clavulanic acid 625 mg t.i.d. for ten days in the fifth patient, amoxycillin 500 mg t.i.d. for seven days followed by azithromycin 250 mg o.d. for eight days in the sixth, and amoxycillin 500 mg t.i.d. for eight days in the seventh. The patients (five females and two males, aged 18-61 years) were referred to our Department on average six (1-19) days after the appearance of skin lesions. They had typical solitary (five patients) or multiple (two patients) erythema migrans with the characteristics usually seen in European patients, except for a rather long incubation period (median value 28 days, range 10-40 days). All laboratory tests, including the examination of cerebrospinal fluid in three patients with the disseminated form of the illness, were within normal range. Borrelial antibodies were demonstrated in only one patient. A skin biopsy specimen obtained from the site of the erythema migrans was culture positive for Borrelia in 2/4 patients. CONCLUSIONS: Our study did not enable us to assess the frequency of antimicrobial prophylaxis failure or the efficacy of individual antibiotics for the prevention of Lyme borreliosis. However, the seven patients presented demonstrate that antibiotic prophylaxis for Lyme borreliosis after a tick bite, at least in Europe, is not entirely effective.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12422612&dopt=Abstract
word match zithromax online literature
unc.edu
Uptake of [14C]-azithromycin into THP-1 human monocytes was determined at pH 7.4, 6.8 or 5.5 over 4-log antibiotic concentrations for 24 h under a number of conditions. Stimulation of cells was with bacteria, latex beads, lipopolysaccharide (LPS), or zymogen A. Subcellular organelle disposition was determined after isolation by ultracentrifugation or sucrose gradients. Hydrolytic enzyme activities and mediators of intracellular inflammation (IL-1, IL-6, IL-8, and TNFalpha) were assessed. Azithromycin uptake into human THP-1 monocytes was initially linear achieving approximately 2% of the extracellular concentration. At pH 7.4, uptake was both passive- and carrier-mediated, but as the pH became more acidic, the uptake was exclusively passive. The intracellular concentration was not pH-dependent over 24 h. Uptake was dependent upon temperature but not the presence of foetal calf serum. Intracellular disposition in zymogen A-stimulated and unstimulated cells was throughout all compartments of the cell, but was higher in the nucleus and cell sap. Phagosomes of stimulated cells contained higher level of the antibiotic. Efflux from THP-1 monocytes was complete between 3 and 4 h. After 1 h treatment with zymogen A, THP-1 monocytes demonstrated an increase in intracellular acidity, protein kinase C, SOD and NAG activities, and NO, H(2)O(2), TNFalpha and IL-1 release over the 1st h. After 2-4 h the pH became alkaline, activities of NADPH reductase, NAG and cathepsin were reduced, and the release of NO, H(2)O(2), TNFalpha and IL-6 were suppressed. Protein synthesis and killing of the bacteria was evident in bacteria kept in monocyte-free medium and those phagocytized by the THP-1 monocytes moderately at 2 h, but more significantly at 24 h. The early killing of the bacteria appears to be a cidal mechanism whereas later, a standard bacteriostatic mechanism was evident. Nevertheless, suppression of these chemical mediators and hydrolytic enzyme activities would reduce the infection and the spread to adjacent areas.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12431870&dopt=Abstract
word match zithromax online literature
J Chromatogr Sci. 2002 Oct;40(9):529-33.
Isocratic liquid chromatographic method for the analysis of azithromycin and its structurally related substances in bulk samples.
Kamau FN, Chepkwony HK, Ngugi JK, Debremaeker D, Roets E, Hoogmartens J.
Laboratorium voor Farmaceutische Chemie en Analyse van Geneesmiddelen, Faculteit Farmaceutische Wetenschappen, Katholieke Universiteit Leuven, Belgium.
An isocratic liquid chromatographic method with UV detection at 215 nm, which is suitable for the analysis of azithromycin (AZT) in bulk samples, is described. AZT is separated from its synthesis intermediates and a degradation product as well as from six unknown impurities on an XTerra RP18 column at 70 degrees C using a mobile phase consisting of acetonitrile-pH 6.5 0.2M K2HPO4-water (35:10:55, v/v/v) at 1.0 mL/min. The XTerra stationary phase contains methyl groups that are incorporated in the bulk structure of the material. This allows for special selectivities. Robustness is evaluated by a full factorial design experiment. The method shows good selectivity, repeatability, linearity, and sensitivity.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12433117&dopt=Abstract
word match zithromax online literature
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