Tuberculosis (TB) remains a major global health problem, and the incidence of TB cases has not significantly decreased over the past decade in Korea. The standard short course regimen is highly effective against TB, but requires multiple TB-specific drugs and a long treatment duration. Recent studies using late-generation fluoroquinolones and/or high-dose rifapentine-containing regimens to shorten the duration of TB treatment showed negative results. Extending the treatment duration may be considered in patients with cavitation on the initial chest radiograph and positivity in sputum culture at 2 months of treatment for preventing TB relapse. Current evidence does not support the use of fixed-dose combinations compared to separate drugs for the purpose of improving treatment outcomes. All patients receiving TB treatment should be monitored regularly for response to therapy, facilitation of treatment completion, and management of adverse drug reactions. Mild adverse effects can be managed with symptomatic therapy and changing the timing of the drug administration, but severe adverse effects require a discontinuation of the offending drugs.
Antitubercular Agents ; Drug-Related Side Effects and Adverse Reactions ; Fluoroquinolones ; Humans ; Incidence ; Korea ; Radiography, Thoracic ; Recurrence ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary*

Aged ; Anemia, Diamond-Blackfan ; complications ; Aza Compounds ; adverse effects ; Female ; Fluoroquinolones ; Humans ; Quinolines ; adverse effects ; Torsades de Pointes ; chemically induced ; complications

OBJECTIVE: To summarize the occurrences of adverse drug reactions (ADR) of gatifloxacin, and to guide the rational usage of antibacterial agents in clinical practice in the future. METHODS: A total of 1 077 ADR patient who received gatifloxacin were retrospectively studied in Hunan province from August 2003 to July 2007. RESULTS: Gatifloxacin could cause multi-system and multi-organ ADRs with wide variety of clinical manifestations. Of the 1 077 ADR patients, ADR incidence rate was slightly lower in males than that in females, the age of 821 (76.23%) ADR patients were 20 approximately 59 years; 905 (84.03%) were administered intravenously; and 682 (33.07%) had severe lesions of the digestive system, followed by lesions of the skin and the appendants (490 cases, 23.76%) and the nervous system (298 cases, 14.45%). CONCLUSION ADR caused by gatifloxacin should be monitored and reported so as to reduce or avoid ADR.
Adolescent ; Adult ; Adverse Drug Reaction Reporting Systems ; Aged ; Aged, 80 and over ; Anti-Infective Agents ; adverse effects ; Child ; Child, Preschool ; China ; Drug-Related Side Effects and Adverse Reactions ; Female ; Fluoroquinolones ; adverse effects ; Gatifloxacin ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Drug-induced immune haemolytic anaemia (DIIHA) is extremely rare. We herein report a case of life-threatening DIIHA due to levofloxacin. This is the second case reported in the literature. A 51-year-old woman presented with complaints of fatigue after 4-5 days of levofloxacin therapy for a lung infection. At presentation, she was found to have haemolysis with a positive Coombs test and IgG autoantibodies. Levofloxacin was identified as the probable culprit, using the Naranjo adverse drug reaction probability scale. Upon discontinuation of the drug and initiation of steroids, the patient's haematological parameters stabilised. Diagnosis of DIIHA is made through a history of intake of levofloxacin, clinical and laboratory features of haemolysis and a positive Coombs test. An autoantibody screen is most commonly positive for warm antibodies (IgG type). It is essential for clinicians to recognise this rare complication caused by a commonly prescribed medication, discontinue the offending drug and initiate treatment.
Anemia, Hemolytic ; chemically induced ; Anti-Bacterial Agents ; adverse effects ; therapeutic use ; Autoantibodies ; blood ; Female ; Fluoroquinolones ; adverse effects ; Hemolysis ; Humans ; Immunoglobulin G ; blood ; Levofloxacin ; adverse effects ; Male ; Middle Aged ; Steroids ; therapeutic use

New enrofloxacin microspheres were formulated, and their physical properties, lung-targeting ability, and tissue distribution in rats were examined. The microspheres had a regular and round shape. The mean diameter was 10.06 microm, and the diameter of 89.93% of all microspheres ranged from 7.0 microm to 30.0 microm. Tissue distribution of the microspheres was evaluated along with a conventional enrofloxacin preparation after a single intravenous injection (7.5 mg of enrofloxacin/kg bw). The results showed that the elimination half-life (t(1/2beta)) of enrofloxacin from lung was prolonged from 7.94 h for the conventional enrofloxacin to 13.28 h for the microspheres. Area under the lung concentration versus time curve from 0 h to infinity (AUC(0-infinity)) was increased from 11.66 h.microg/g to 508.00 h.microg/g. The peak concentration (Cmax) in lung was increased from 5.95 microg/g to 93.36 microg/g. Three lung-targeting parameters were further assessed and showed that the microspheres had remarkable lung-targeting capabilities.
Animals ; Anti-Bacterial Agents/*adverse effects ; Drug Delivery Systems/instrumentation/*methods ; Female ; Fluoroquinolones/*adverse effects ; Half-Life ; Humans ; Injections, Intravenous ; Lung/*drug effects ; Male ; *Microspheres ; Rats ; Rats, Sprague-Dawley ; Tissue Distribution

PURPOSE: To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy. MATERIALS AND METHODS: The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy. RESULTS: Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003). CONCLUSIONS: Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibiotic Prophylaxis/*methods ; Biopsy, Needle/adverse effects/methods ; Ceftriaxone/*therapeutic use ; Cross Infection/epidemiology/etiology/*prevention & control ; Drug Evaluation/methods ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Escherichia coli/drug effects ; Escherichia coli Infections/epidemiology/prevention & control ; Fluoroquinolones/*therapeutic use ; Humans ; Incidence ; Male ; Middle Aged ; Prostatic Neoplasms/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Ultrasonography, Interventional ; Young Adult

PURPOSE: Complications after prostate biopsy have increased and various causes have been reported. Growing evidence of increasing quinolone resistance is of particular concern. In the current retrospective study, we evaluated the incidence of infectious complications after prostate biopsy and identified the risk factors. MATERIALS AND METHODS: The study population included 1,195 patients who underwent a prostate biopsy between January 2007 and December 2012 at Chung-Ang University Hospital. Cases of febrile UTI that occurred within 7 days were investigated. Clinical information included age, prostate-specific antigen, prostate volume, hypertension, diabetes, body mass index, and biopsy done in the quinolone-resistance era. Patients received quinolone (250 mg intravenously) before and after the procedure, and quinolone (250 mg) was orally administered twice daily for 3 days. We used univariate and multivariate analysis to investigate the predictive factors for febrile UTI. RESULTS: Febrile UTI developed in 39 cases (3.1%). Core numbers increased from 2007 (8 cores) to 2012 (12 cores) and quinolone-resistant bacteria began to appear in 2010 (quinolone-resistance era). In the univariate analysis, core number> or =12 (p=0.024), body mass index (BMI)>25 kg/m2 (p=0.004), and biopsy done in the quinolone-resistance era (p=0.014) were significant factors. However, in the multivariate analysis adjusted for core number, the results were not significant, with the exception of BMI>25 kg/m2 (p=0.011) and biopsy during the quinolone-resistance era (p=0.035), which were significantly associated with febrile UTI. CONCLUSIONS: Quinolone resistance is the main cause of postbiopsy infections in our center. We suggest that further evaluation is required to validate similar trends. Novel strategies to find alternative prophylactic agents are also necessary.
Aged ; Anti-Bacterial Agents/*therapeutic use ; Antibiotic Prophylaxis/methods ; Cross Infection/etiology/prevention & control ; *Drug Resistance, Bacterial ; Fluoroquinolones/*therapeutic use ; Humans ; Image-Guided Biopsy/*adverse effects/methods ; Incidence ; Male ; Middle Aged ; Prostatic Neoplasms/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Ultrasonography, Interventional ; Urinary Tract Infections/epidemiology/*etiology/prevention & control

Adrenal Cortex Hormones ; therapeutic use ; Aged ; Anti-Infective Agents ; therapeutic use ; Anti-Inflammatory Agents ; therapeutic use ; Atropine ; therapeutic use ; Dexamethasone ; therapeutic use ; Eye Infections ; complications ; drug therapy ; Female ; Fluoroquinolones ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Mydriatics ; therapeutic use ; Ophthalmia, Sympathetic ; drug therapy ; etiology ; Prednisolone ; therapeutic use ; Scleral Buckling ; adverse effects ; Triamcinolone ; therapeutic use

To report on Achromobacter xylosoxidans keratitis in two healthy patients who had worn contact lenses foran extended period of time. A 36-year-old female and a 21-year-old female visited our hospital with ocular pain and blurred vision. Both patients had a history of wearing soft contact lenses for over fve years with occasional overnight wear. At the initial presentation, a slit lamp examination revealed corneal stromal infiltrations and epithelial defects with peripheral neovascularization in both patients. Microbiological examinations were performed from samples of corneal scrapings, contact lenses, contact lens cases, and solution. The culture resulting from the samples taken from the contact lenses, contact lens cases, and solution were all positive for Achromobacter xylosoxidans. Confrming that the direct cause of the keratitis was the contact lenses, the frst patient was prescribed ceftazidime and amikacin drops sensitive to Achromobacter xylosoxidans. The second patient was treated with 0.3% gatifoxacin and fortifed tobramycin drops. After treatment, the corneal epithelial defects were completely healed, and subepithelial corneal opacity was observed. Two cases of Achromobacter xylosoxidans keratitis were reported in healthy young females who wore soft contact lenses. Achromobacter xylosoxidans should be considered a rare but potentially harmful pathogen for lens-induced keratitis in healthy hosts.
Achromobacter denitrificans/*isolation & purification ; Adult ; Amikacin/administration & dosage ; Anti-Bacterial Agents/*administration & dosage ; Ceftazidime/administration & dosage ; Contact Lenses, Extended-Wear/*adverse effects ; Female ; Fluoroquinolones/administration & dosage ; Gram-Negative Bacterial Infections/diagnosis/*drug therapy/*microbiology ; Humans ; Keratitis/diagnosis/*drug therapy/*microbiology ; Tobramycin/administration & dosage