Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
BACTERIAL INFECTIONS IN ACQUIRED IMMUNODEFICIENCY SYNDROME
Infect Dis Ther; 3:231-51 1989. Unique Identifier : AIDSLINE ICDB/90665448 Koehler JE; Chaisson RE; Div. of Infectious Diseases, Dept. of Medicine, Univ. of; California, San Francisco, CA
Abstract:
Infections caused by bacterial pathogens have been recognized as complications in AIDS and HIV infection since early in the AIDS epidemic. Bacterial pathogens causing disease in patients (pts) with HIV infection include gram-positive organisms (Streptococcus pneumoniae, Streptococcus spp, Staphylococcus aureus, and Listeria monocytogenes), gram-negative organisms (Salmonella spp, Shigella, and Campylobacter), and spirochetes (Treponema pallidum). Pathogenesis, diagnosis, and therapy are reviewed for pulmonary bacterial infections, other bacterial diseases (syphilis and Listeria-induced meningitis), and bacterial gastrointestinal infections (enterocolitis and proctitis) in pts with AIDS. The incidence of certain infections, particularly pneumonias caused by encapsulated bacteria and enteritis and disseminated infections caused by Salmonella, is higher in populations infected with HIV. Clinical manifestations of bacterial infections in pts with HIV infection may differ from those in other populations, with an increased frequency of atypical presentations, including bacteremia, and high rates of relapse, despite appropriate therapy. Pts suspected of having Pneumocystis carinii or a bacterial pathogen in the lungs can be given trimethoprim-sulfamethoxazole (15 mg/kg trimethoprim/day), empirically, a regimen that will cover adequately P carinii, Haemophilus influenzae, other Haemophilus spp, S pneumoniae, and S aureus. Pts suspected of having bacterial pneumonia, but not pneumocystosis, should be treated with a second- or third-generation cephalosporin (eg, cefuroximine or ceftriaxone). For documented pneumococcal pneumonia, penicillin is the drug of choice; pts allergic to penicillin can be treated with a cephalosporin or with erythromycin. The quinolone antibiotics, norfloxacin and ciprofloxacin, demonstrate excellent activity against most bacterial enteric pathogens and provide a logical choice for empiric therapy when infection with Shigella, Campylobacter, or Salmonella spp is suggested. A quinolone should be considered for therapy of established infection with multiresistant or persistent Shigella flexneri. Suspected shigellemia should be treated with iv antibiotics, preferably trimethoprim-sulfamethoxazole (5-7.5 mg/kg trimethoprim per day), with treatment continued for 7-14 days. (74 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DIAGNOSIS Antibiotics/THERAPEUTIC USE Bacterial Infections/*COMPLICATIONS/DIAGNOSIS Enteritis/COMPLICATIONS Human HIV Infections/*COMPLICATIONS/DIAGNOSIS Microbial Sensitivity Tests Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS Pneumonia/COMPLICATIONS Septicemia/COMPLICATIONS JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 901030
M90A0688
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
