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W M McCormack

Publications and source records attributed to W M McCormack.

176 records · Page 10Linked to original sources
PubMedDate not supplied

Comparison of enoxacin and ceftriaxone in the treatment of uncomplicated gonorrhea.

BACKGROUND AND OBJECTIVES: The increasing prevalence of resistant strains of Neisseria gonorrhoeae has prompted investigation of new agents for the treatment of this sexually transmitted disease. GOAL OF THIS STUDY: This study compared the efficacy and safety of a single oral dose of enoxacin to intramuscular ceftriaxone in the treatment of uncomplicated anogenital infection with N. gonorrhoeae. STUDY DESIGN: A randomized open trial was conducted at a sexually transmitted diseases clinic in Brooklyn, New York. Adults with uncomplicated gonorrhea were randomly assigned to receive 400 mg of enoxacin or 250 mg of ceftriaxone. A follow-up examination was conducted 5 to 9 days later. RESULTS: 59 women and 23 men were enrolled; 40 women and 19 men were evaluable. Enoxacin eradicated 18 of 19 endocervical, 10 of 10 urethral, 5 of 5 anorectal, and 3 of 3 pharyngeal gonococcal infections. Ceftriaxone eradicated 20 of 21 pharyngeal gonococcal infections. Fifty-nine pretreatment isolates of N. gonorrhoeae were available for antimicrobial susceptibility testing. The geometric mean minimal inhibitory concentration was 0.03 mg/1 for enoxacin and 0.005 mg/l for ceftriaxone. There were few sides effects in either group, and both drugs were ineffective against concomitant infection with Chlamydia trachomatis. CONCLUSION: Oral enoxacin appears to be a safe and effective method of treatment for anogenital infections caused by N. gonorrhoeae.

Administration, Oral↗
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Comparative evaluation of ofloxacin and metronidazole in the treatment of bacterial vaginosis.

BACKGROUND AND OBJECTIVES: The epidemiology and etiology of bacterial vaginosis is poorly understood. Many antimicrobial agents have been studied and suggested as treatment alternatives for this infection. Fluoroquinolones have in vitro activity against some of the organisms associated with bacterial vaginosis and may provide another treatment option. STUDY DESIGN: Women who presented with symptomatic bacterial vaginosis were randomly assigned to receive either oral ofloxacin 300 mg twice a day or oral metronidazole 500 mg twice a day for seven days. Twenty-seven of the 31 patients who were enrolled in this double-blinded study were evaluable. RESULTS: Fourteen women received ofloxacin. At follow-up, four had no residual symptoms, seven noted a reduction in symptoms, and three had no change in symptoms. Eight (57%) of the 14 women who received ofloxacin had secretions at follow-up that satisfied the criteria for the diagnosis of bacterial vaginosis. Thirteen women received metronidazole. Nine had no residual symptoms and four noted a reduction in symptoms. Eleven (85%) of the 13 women had normal vaginal secretions and two (15%) had secretions that were improved. None of the women who received metronidazole had secretions at follow-up that met the criteria for the diagnosis of bacterial vaginosis. CONCLUSION: We conclude that ofloxacin is less effective than metronidazole in the treatment of bacterial vaginosis.

Adult↗
PubMedDate not supplied

Multicenter, comparative study of cefotaxime and ceftriaxone for treatment of uncomplicated gonorrhea.

BACKGROUND AND OBJECTIVES: Cefotaxime is a third-generation cephalosporin that has in vitro activity against Neisseria gonorrhoeae, including beta-lactamase-producing strains. A single 1-g intramuscular dose is effective and is recommended by the Centers for Disease Control and Prevention as an alternative treatment for uncomplicated gonorrhea. GOAL OF THIS STUDY: This study was conducted to evaluate the efficacy and safety of a lower 500-mg dose of cefotaxime in the treatment of uncomplicated gonococcal infections. STUDY DESIGN: In a randomized multicenter study, patients who had uncomplicated gonorrhea were treated with 500 mg of cefotaxime or 250 mg of ceftriaxone. Both antibiotics were given intramuscularly. Efficacy and safety were assessed four to seven days following treatment. RESULTS: Six hundred thirteen patients were enrolled. Bacteriologic eradication rates for anogenital infection were 97.7% of the patients (213/218) in the cefotaxime group and 99.1% of the patients (221/223) in the ceftriaxone group (P = 0.243). Adverse events occurred in 4.2% and 7.5% of patients in the two groups, respectively. CONCLUSION: Cefotaxime 500 mg appears to be a safe and cost-effective alternative to ceftriaxone 250 mg for the treatment of uncomplicated gonorrhea.

Adolescent↗
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The incidence of genitourinary infections in a cohort of healthy women.

BACKGROUND AND OBJECTIVES: Few data are available on the incidence and frequency of occurrence of vaginitis and urinary tract infections in population-based groups. GOAL OF THIS STUDY: To assess the incidence and frequency of occurrence of vaginitis and urinary tract infections among a population of healthy adult women. STUDY DESIGN: A questionnaire regarding genitourinary infections was sent to 500 women, 315 (63%) of whom responded. RESULTS: A history of one or more urinary tract infections was reported by 199 (63.2%) of the women. Trichomoniasis was reported by 82 (26%) and bacterial vaginosis by 91 (29%) of the participants. A history of physician-diagnosed vulvovaginal candidiasis was noted by 210 (67%) of the respondents, 70 (22%) of whom had been treated for vulvovaginal candidiasis during the preceding year. Classical sexually transmitted conditions such as gonorrhea (4.8%), genital herpes (6.7%), and genital warts (7.6%) were reported less often than vaginal and urinary tract infections. CONCLUSION: Urinary tract infections and vaginal infections, especially vulvovaginal candidiasis, are common events among healthy adult women.

Adolescent↗
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Susceptibility of isolates of Neisseria gonorrhoeae to penicillin and tetracycline in Brooklyn, 1988-1992.

BACKGROUND AND OBJECTIVES: The aim of this analysis was to determine the rate of resistance of Neisseria gonorrhoeae to penicillin and tetracycline over 5 years. STUDY DESIGN: The authors studied 500 isolates of N. gonorrhoeae. Minimum inhibitory concentrations of various antimicrobial agents, including penicillins, tetracyclines, quinolones, cephalosporins, spectinomycin, and trospectomycin, were determined using agar dilution. Organisms that produced beta-lactamase were classified as penicillinase-producing N. gonorrhoeae, and those with tetracycline minimum inhibitory concentrations > 16 micrograms/ml were considered presumptive high-level tetracycline resistant. Organisms with Minimum inhibitory concentrations > 2.0 micrograms/ml were presumptively considered to have chromosomally mediated resistance to penicillin or tetracycline. Isolates with none of these forms of resistance were considered susceptible to penicillin and tetracycline. RESULTS: Penicillinase-producing N. gonorrhoeae represented 34.7%, 40.7%, and 44.9% of gonococcal isolates in 1988, 1989, and 1990, respectively. Only 14.3% and 15.0% of the isolates in 1991 and 1992 were penicillinase-producing N. gonorrhoeae. In 1988, 1.0% of isolates were chromosomally mediated penicillin resistant. In contrast, chromosomally mediated penicillin resistant gonococci represented 7.5% to 22.4% of isolates from 1989 to 1992. In 1988, 26.0% of isolates were high-level tetracycline resistant. The prevalence of presumptive high-level tetracycline resistant organisms decreased after 1988. From 1989 to 1992, only 8.2% to 14.8% of gonococcal isolates were presumptive high-level tetracycline resistant. No chromosomally mediated tetracycline resistant isolates were identified in 1988. In 1989 and 1990, 11.6% and 10.2%, respectively, of isolates were chromosomally mediated tetracycline resistant. Chromosomally mediated tetracycline resistant N. gonorrhoeae represented 2.0% of isolates in 1991 and 25.0% of isolates in 1992. All isolates tested were susceptible to the other antibiotics. CONCLUSION: Continued surveillance of sensitivity of contemporary gonococci to antimicrobial agents is important.

Female↗
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Evaluation of vaginal tampons for collection of specimens for detection of Chlamydial infection.

BACKGROUND AND OBJECTIVES: Previous studies have shown that self-inserted vaginal tampons can be used to obtain specimens for detection of Neisseria gonorrhoeae. There is a need to expand testing for infection with Chlamydia trachomatis to women who do not undergo regular gynecologic examinations. GOAL: To compare self-inserted tampons with clinician-obtained endocervical swabs for collection of samples to be examined for chlamydial infection. STUDY DESIGN: Women referred because of recently detected untreated chlamydial infection inserted a vaginal tampon. Two endocervical swabs were obtained after the tampon was removed. One swab was cultured for Chlamydia trachomatis. The other swab and the tampon were examined with the Testpack Chlamydia antigen detection test. RESULTS: Sixty-nine women were studied. Chlamydial infection was detected by culture in 75.4%, by Testpack (swab) in 63.8%, and by Testpack (tampon) in 52.2%. CONCLUSIONS: Tampon-obtained specimens evaluated in the Testpack Chlamydia test were relatively insensitive. More sensitive tests for the detection of Chlamydia trachomatis infection with self-obtained specimens should be evaluated.

Adult↗
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Comparison of methods for the detection of treponema pallidum in lesions of early syphilis.

BACKGROUND: The clinical diagnosis of primary and secondary syphilis can be difficult because of the wide variability of lesions. The available laboratory tests (dark-field microscopy and direct fluorescent antibody) require specialized microscopes and skilled technicians, and serologic tests are insensitive in early infection. METHODS: Dark-field microscopy and monoclonal antibody staining were compared to a new solid-phase enzyme-linked immunosorbent assay (Visuwell test) for detection of T. pallidum in lesion exudate of 188 patients with genital lesions. RESULTS: Sixty-four patients (34%) had lesions of early syphilis diagnosed by either dark-field, monoclonal antibody staining, or both. The Visuwell test and dark-field examination were positive in 52 (81.3%) and 55 (85.9%) of the 64 patients, respectively, whereas the monoclonal antibody staining technique demonstrated the presence of T. pallidum in 59 (92.2%) of the 64 patients. The Visuwell test gave a negative result in 111 of 124 patients who had negative dark-field and direct fluorescent antibody test results (89.5% specificity). CONCLUSIONS: The Visuwell test is an alternative method for evaluating genital ulcers but is less sensitive and specific than existing tests.

Enzyme-Linked Immunosorbent Assay↗
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Randomized comparison of cefotaxime and ceftriaxone in patients with uncomplicated gonorrhea.

Cefotaxime is a third-generation cephalosporin with excellent in vitro antimicrobial activity against Neisseria gonorrhoeae, including beta-lactamase-producing strains. A single, 1-gm, intramuscular dose has previously been shown to be effective in the treatment of uncomplicated gonorrhea. A randomized, multicenter study was conducted to evaluate the efficacy and safety of a lower, 500-mg dose of cefotaxime in comparison with ceftriaxone 250 mg, the standard treatment for uncomplicated gonorrhea. One hundred forty-two patients were enrolled and 115 were evaluable. Bacteriologic eradication rates were 95% in the cefotaxime group and 100% in the ceftriaxone group (P = 0.119). Adverse events that were possibly related to the study drug occurred in 3% and 8% of patients in the cefotaxime and ceftriaxone groups, respectively. Cefotaxime 500 mg appears to be a safe and cost-effective alternative to ceftriaxone 250 mg for the treatment of uncomplicated gonorrhea.

Adult↗
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Ureaplasma urealyticum: ecologic niche and epidemiologic considerations.

Ureaplasma urealyticum organisms primarily colonize the male urethra and the vagina. Other genital and nongenital mucosal sites are colonized less frequently. About one-third of neonates are colonized as a result of acquisition of organisms from the birth canal. Less than 10% of older children and sexually inexperienced adults are colonized. Following sexual debut colonization rates increase with an increase in the number of different sexual partners. Ureaplasmal colonization is common among healthy sexually experienced adults, a fact which must be considered in assessing the role of these organisms in human disease.

Adult↗
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Epidemiology of Mycoplasma hominis.

Mycoplasma hominis colonizes the vagina of women and the urethra of men. The organism is also isolated from beneath the foreskin of uncircumcised men. It is sexually transmitted. M. hominis is isolated from a small proportion of children and sexually inexperienced adults. Among sexually experienced adults, rates of colonization rise in relation to the lifetime number of sexual partners. Even with sexual experience taken into account, the organism is more prevalent among young individuals and among blacks. The use of barrier methods of contraception (condom and diaphragm) reduces the likelihood of colonization with M. hominis.

Adolescent↗
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Clinical spectrum of infection with Neisseria gonorrhoeae.

The traditional view that infections with Neisseria gonorrhoeae are predominantly symptomatic in men and predominantly asymptomatic in women has arisen from studies conducted in sexually transmitted disease clinics, which, by their nature, examine men with symptoms and women without symptoms. Recent studies have shown that most men and woen who are infected with N. gonorrhoeae develop symptoms as a result of that infection. These same studies have shown that a minority of patients develop asymptomatic gonococcal infection. Since asymptomatically infected men and women are less likely to seek treatment, they have a much longer duration of infection than do their symptomatic counterparts. Asymptomatically infected men and women thus accumulate, so that at any given time most of the men and women in the population who are infected with N. gonorrhoeae have no symptoms.

Boston↗