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Biomedical subjects

J L Harkness

Publications and source records attributed to J L Harkness.

9 recordsLinked to original sources
PubMed1992

Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS.

OBJECTIVE: To determine the efficacy of low-dose trimethoprim-sulfamethoxazole (trimethoprim, 160 mg plus sulfamethoxazole, 800 mg; one tablet twice daily, 2 days per week) as primary prophylaxis against toxoplasmic encephalitis in patients with human immunodeficiency virus (HIV) infection and previous Pneumocystis carinii pneumonia. DESIGN: A retrospective study. SETTING: Tertiary referral teaching hospital. PATIENTS: During a 3-year period after primary episodes of P. carinii pneumonia, 60 patients received trimethoprim-sulfamethoxazole, and 95 patients received pentamidine (aerosolized in 78 patients and intravenous in 17 patients) as secondary prophylaxis. RESULTS: No patient in the trimethoprim-sulfamethoxazole group and no patient seronegative for Toxoplasma gondii developed toxoplasmic encephalitis, compared with 12 of 36 (33%; 95% Cl, 19% to 51%) seropositive patients in the pentamidine group (trimethoprim-sulfamethoxazole compared with pentamidine, P = 0.008). A significant difference was seen in the time to development of toxoplasmic encephalitis between the trimethoprim-sulfamethoxazole group (no case at 1153 days) and the pentamidine group (median time, 460 days) (P = 0.004). Neither the CD4+ lymphocyte count at the start of prophylaxis nor zidovudine therapy during the period of prophylaxis influenced the rate of toxoplasmic encephalitis in any group. CONCLUSIONS: Low-dose trimethoprim-sulfamethoxazole (four tablets per week) appears to be effective prophylaxis against toxoplasmic encephalitis in HIV-infected patients with previous P. carinii pneumonia. A prospective, randomized, controlled study is needed to further evaluate these findings.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Sulphadiazine desensitization in patients with AIDS and cerebral toxoplasmosis.

The objectives of this study were to evaluate the efficacy of a sulphadiazine desensitization protocol to treat patients with AIDS and cerebral toxoplasmosis (CT) and known sulphonamide allergy, to ensure that an adequate dose of sulphadiazine (2-4 g/day) was achieved rapidly (within 4-5 days), and to assess the effect of concurrent corticosteroid (CS) administration on the success rate of the regimen. Sixteen patients with CT and a past history or current manifestations of sulphonamide allergy were desensitized to sulphadiazine from October 1988 to December 1989. The protocol employed the oral administration of gradually increasing increments of sulphadiazine 3-hourly over 5 days. Success was defined as tolerance of 2-4 g oral sulphadiazine per day for at least 7 days until death or the present time without any allergic reactions. Our success rated overall was 10 out of 16 patients (62%). Seven patients achieved a final dose of 4 g/day and three a dose of 2 g/day. Concurrent CS administration did not appear to affect the outcome in the small number of patients studied. Our sulphadiazine regimen rapidly, successfully and safely desensitized patients with CT and sulphonamide allergy, allowing the optimal first-line treatment to continue. The aetiology of allergy in HIV-infected patients and the mechanisms by which desensitization works are unknown.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Successful control of endemic MRSA in a cardiothoracic surgical unit.

After a substantial increase in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the Cardiothoracic Surgical Unit at St. Vincent's Hospital, Sydney, a prospective study was undertaken in early 1986 to ascertain the carrier status of all patients entering the Unit. Of 84 patients, 27.4% were found to carry MRSA and the perineum was the major site of carriage, with 69.6% of MRSA positive cases carrying the organism in this site. As a result of these findings, the period of perioperative antibiotic cover was shortened, whole-body washing of patients with a 1% triclosan preparation was instituted and routine postoperative perineal swabs were taken. During the 18 months after implementation of these policies, a highly significant reduction in the number of MRSA carriers and infections was observed. The monitoring of perineal colonization proved to be a useful marker for increases in MRSA in the Unit.

Carrier State↗
PubMed1978

Clinical usefulness of susceptibility testing of anaerobes.

We have studied the clinical usefulness of antibiotic susceptibility testing of fresh clinical isolates of anaerobes (primarily from blood cultures). Analysis of 65 patients showed that susceptibility reports were used in only 13 instances (20%), representing mainly orothopedic and CNS infections. Of the 47 patients whose susceptibilities were not used, 20 received therapy (appropriate in each case) based on the culture report, and 27 were treated empirically. Only six patients in the empirically treated group received inappropriate treatment, but four of those six died, and patients in this group as a whole had a worse outcome than did patients in the other groups. However, these empirically treated patients also had a somewhat worse prognosis. We suggest that susceptibility testing of anaerobes be reserved for bacteremic patients and for managing severe, chronic anaerobic infections, such as septic arthritis, osteomyelitis, and brain abscesses.

Anti-Bacterial Agents↗
PubMed1975

Effects of atmosphere of incubation and of routine subcultures on detection of bacteremia in vacuum blood culture bottles.

Studies comparing isolation rates of bacteria and yeasts from vented and unvented vacuum blood culture bottles containing soybean-casein digest broth showed significantly more frequent and more rapid recovery of Candida and Pseudomonas from the vented bottle and no other statistically significant differences between the two. Subculture of bottles on the day of their collection was shown to accelerate recovery of 48% of positive cultures by day 1. A second subculture of known positive cultures yielded additional organisms in 1.5% of cultures.

Air↗