Comparative efficacy and safety of cefixime and ciprofloxacin in the management of adults with community-acquired pneumonia in Ibadan, Nigeria

Background: Initial antibiotic therapy in upper and lower respiratory tract infections is usually empirical. However, the decreasing susceptibility of respiratory pathogens to antibacterials have raised concerns about the decreasing efficacy of currently available antibiotics.Objective: This study was conducted to compare the efficacy and safety of cefixime and ciprofloxacin in the empirical treatment of community-acquired pneumonia among adult Nigerian patients in Ibadan.Methods: This was an open-labelled, randomized, parallel-group study of seventythree (73) radiologically and bacteriologically confirmed adult cases of community-acquired pneumonia, between July 1 and September 31, 2011 at two health care facilities in Ibadan, Nigeria. All of these patients had severity index (CURB 65) scores of either 1 or 2. They were treated with either Cefixime, 400mg twice daily or Ciprofloxacin 500mg twice daily for 14 days. They were evaluated four times during the course of their treatment for clinical responses, radiological and bacteriological clearances and safety of therapy.Results: There were 39 (53.4%) patients in the Cefixime group and 34(46.6%) in Ciprofloxacin group. On day 7, patients on cefixime had a statistically significant lower temperature than patients on ciprofloxacin (P<0.01). By day 14, only 10.3% of patients in cefixime group still had persistent residual radiological changes compared to 38.2% in the ciprofloxacin group (P < 0.01). Bacteria cure was obtained in 96% of the patients in the cefixime group and 83% in the ciprofloxacin group.Conclusion: Cefixime was found to be superior to ciprofloxacin in terms of efficacy in the treatment of community-acquired pneumonia in adults in Nigeria. However, both antibiotics were well-tolerated by all the patients as there were no reports or documentation of adverse events.Keywords: Cefixime, Efficacy, Safety, Community-acquired pneumoni

Glycated haemoglobin levels in patients with multidrug-resistant tuberculosis infection during 6 months of treatment

Background: There is little information on the possible impact of drugs used in the treatment of  multi-drug resistant tuberculosis (MDR-TB) on glycaemic levels. This study therefore assessed changes in glycated haemoglobin levels in patients with MDR-TB.Materials and Methods: This longitudinal study involved 21 MDR-TB patients who were followed up for 6 months. Glycated haemoglobin (HbA1c) level of each patient was determined before the  commencement of MDR-TB drug regimen and at 2, 4 and 6 months post treatment as part of a study which investigated them every 2 months. Differences in means were assessed using the paired Student’s t-test and statistical significance was set at P<0.05.Results: A patient had undiagnosed diabetes mellitus (DM) with an HbA1c value of 6.5% and died before the second month sample collection; another patient became critically ill; therefore, 19 patients completed the study. Before the commencement of MDR-TB therapy, two patients had pre-diabetes with HbA1c values of 6.0% and 5.8% while the HbA1c values of the remaining patients were less than 5.7%. There was a significant reduction in the mean HbA1c level at 2 months post therapy compared with the baseline. However, the HbA1c levels increased slightly after the 2nd month of therapy but no significant change was observed in the HbA1c levels at 4 and 6 months of MDR-TB therapy compared with baseline.Conclusion: Diabetes mellitus is not common among Nigerians with MDR-TB and MDR-TB drug  regimen might have an acute effect on glycaemic changes in patients with MDR-TB.Keywords: Diabetes mellitus, Glycaemic change, Glycated haemoglobin, Multidrug resistant tuberculosis therap

Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria

Background: The HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians. Methods: The case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed. Results: A total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding. Conclusions: The moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB

Management of asthma: Facing challenges in special situations (pregnancy, surgery)

No Abstract.Annals of Ibadan Postgraduate Medicine Vol. 1 (2) 2004: pp. 44-4

Effectiveness of Preoperative Anaesthesia Assessment in a Multispecialty Hospital in Sub-Saharan Africa

Anaesthetists routinely visit patients before surgery for preoperative assessment. As this is often the first contact between the anaesthetist and the patient, the impact of this visit on subsequent patient cooperation may be significant. This study determine the effectiveness of preoperative anaesthetic assessment. This study was a prospective, descriptive cross-sectional study of 184 American Society of Anaesthesia (ASA) I and II consenting adult patients scheduled for surgical operations at the University of Ilorin Teaching Hospital. A questionnaire was administered to the patients on the day before surgery. The questions assessed the amount of information the patients had about the anaesthetist that conducted the pre-anaesthesia review, the conduct of anaesthesia and the extent of patient participation when determining the anaesthetic plan. The mean age of the participants was 43.52 ±14.30. When asked to identify the anaesthetist that visited them, 128 (69.57%) patients could not remember the name of the anaesthetist while 138 (75%) did not know the cadre of anaesthetist that visited them. This study found that pre-anaesthesia assessment was not effectively conducted. The same level of attention and care demonstrated in intraoperative care should be employed during its conduct. Key words: Anaesthesia assessment, Anaesthesia review, Preoperative assessmen