Suppression of cytomegalovirus retinitis in persons with AIDS with high-dose intravenous acyclovir

Article Abstract:

AIDS is caused by infection with the human immunodeficiency virus (HIV). The virus attacks and destroys the immune system, resulting in immunodeficiency or decreased ability to fight infection. People who develop AIDS are more susceptible to opportunistic infections which do not usually affect individuals with normal immune function. Eye infection due to cytomegalovirus (CMV) is common in patients with AIDS. CMV retinitis (inflammation of the retina) is estimated to occur in 6 to 40 percent of this patient population. At present, foscarnet and ganciclovir are the only drugs that have been shown to be effective in treating CMV retinitis. However, foscarnet is not commercially available in the United States, and prolonged treatment with ganciclovir has been reported to cause neutropenia (abnormally low number of white blood cells known as neutrophils). Acyclovir is an antiviral drug that has been used to treat infections with herpes simplex virus and Epstein-Barr virus. This drug has also been shown to be beneficial in treating transplant patients who develop CMV infections. A study was performed to determine if high doses of intravenously administered acyclovir could be effective in treating CMV retinitis in AIDS patients. Twelve men with AIDS and CMV retinitis were treated with ganciclovir for 12 to 14 days. Following this treatment, the patients received daily treatments with acyclovir and zidovudine (AZT). For half the patients retinitis did not progress during 32 days or more of acyclovir and AZT treatment. During the study period, 10 patients who were evaluated did not develop CMV retinitis in the uninfected eye. In a previous study, retinitis spread from one eye to the other in 60 percent of the patients. These findings indicate that, in patients with AIDS, acyclovir may be beneficial for delaying the progression of CMV retinitis and preventing the spread of retinitis to the unaffected eye. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Infection, AIDS patients, Cytomegalovirus infections, Dosage and administration, Eye, Acyclovir

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Empiric antimicrobial therapy of domestically acquired acute diarrhea in urban adults

Article Abstract:

Antibiotics are generally not given to treat acute or sudden diarrhea for several reasons. Acute diarrhea is often caused by several different types of bacteria and no single antibiotic is effective against all bacterial types. Antibiotic therapy may upset the physiologic balance of bacteria that normally occupy the gut, and may cause the development of strains of bacteria that are resistant to antibiotic action. Acute diarrhea is more commonly treated by correcting dehydration or water loss. Antibiotics may be used under toxic conditions or when the microorganisms causing the illness have been identified. However, if antibiotics are given at time of presentation of diarrheal symptoms, these drugs may decrease the duration and severity of the illness. The effectiveness of ciprofloxacin was compared to that of sulfamethoxazole combined with trimethoprim in treating acute diarrhea in adults. Results were also compared with the effects of a placebo, a substance of no known therapeutic effect. The types of bacteria isolated from the patients included Campylobacter in 35 cases, Shigella in 18 cases, and Salmonella in 15 cases. Compared with the placebo, ciprofloxacin decreased the duration of the diarrhea and increased the number of treated or improved patients. Sulfamethoxazole and trimethoprim caused effects similar to the placebo, suggesting that this combined antibiotic regimen was ineffective in treating acute diarrhea in adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Antibiotics, Diarrhea, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination)

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Successful treatment of acquired immunodeficiency syndrome-related Mycobacterium avium complex disease with a multiple drug regimen including amikacin

Article Abstract:

Opportunistic infections are caused by infectious agents that preferentially affect individuals with an impaired immune system, such as occurs with AIDS. Mycobacterium avium complex (MAC) disease is one of the opportunistic infections the afflicts AIDS patients. It is estimated that 20 to 40 percent of patients with AIDS develop MAC disease at some point during their illness, and that it may hasten their death. The bacterium infects many organs, and is often found in the blood as well. Unfortunately, it is often resistant to drug treatment. Five AIDS patients who developed MAC disease were treated with a multiple drug regimen that included amikacin, ciprofloxacin (both antibiotics), rifampin, clofazimine and ethambutol (antituberculosis drugs). One patient, who developed MAC disease just three months after being diagnosed with AIDS, recovered completely, with no evidence of MAC in his blood, stool, or sputum. He was still alive 25 months after MAC disease was diagnosed, and 28 months after the diagnosis of AIDS. The other four patients also recovered with no indication of the bacterium in blood or stool; they subsequently died of other AIDS-related complications. This drug regimen was effective in treating MAC disease in five patients with AIDS, and caused few serious side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mycobacterial infections, Mycobacterium infections, Mycobacterium avium, Rifampin, Ethambutol, Amikacin, Clofazimine

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