Prophylactic ciprofloxacin plus roxithromycin during CDE chemotherapy reduced the incidence of FL, the number of infections, the use of therapeutic antibiotics and hospitalizations due to FL by approximately 50%, with reduced number of infectious deaths. For patients with similar risk for FL, the prophylactic use of antibiotics should be considered.

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The purpose of this study was to investigate the comparative efficacy and safety of equal doses of inhaled fluticasone propionate (FP) and inhaled budesonide (BUD) using their respective dry powder inhalers in a population of severe asthmatics requiring high doses of inhaled corticosteroid. This double-blind double-dummy parallel-group study compared the effects of 24 weeks of treatment with FP (2000 micrograms daily via a Diskhaler inhaler; Glaxo Wellcome, Evreux, France) and BUD (2000 micrograms daily via a Turbuhaler inhaler; Astra Pharmaceuticals, Rijswijka, Netherlands) on lung function and asthma exacerbations in 395 patients with asthma. FP was statistically significantly superior to BUD with respect to the percentage of symptom-free days (P = 0.02), the incidence of days free from rescue bronchodilator usage (P = 0.02) and the distribution of change in peak expiratory flow (PEF) expressed as a percentage of the predicted PEF (P = 0.04). During the treatment period FP was statistically significantly superior to BUD for change in forced expiratory volume in 1 sec (FEV1) at 8, 16 and 24 weeks, change in the median daytime symptom score during weeks 5-16, for incidence of symptom-free days and incidence of days free from rescue bronchodilator usage during weeks 17-24. There was no significant difference between FP and BUD with respect to the number of patients experiencing one or more asthma exacerbation (33.8 and 28.4% of patients, respectively). There was, however, evidence that the exacerbations were clinically less severe in patients treated with FP, in that the time to resolution was quicker (11.0 vs. 14.7 days; P = 0.035), mean duration of all exacerbations (for an individual patient) tended to be shorter (18.5 vs. 23.6 days; P = 0.12), the time off work was reduced (4.2 vs. 7.6 days; P = 0.012) and the lowest PEF recorded during the exacerbation was higher (301 vs. 263 l min-1; P = 0.07). There were no clinically relevant differences in the safety (serum cortisol levels, markers of bone turnover, adverse events) of FP and BUD at these microgram equivalent doses. The patients recruited into this study, in retrospect, probably had no need for such high doses of inhaled corticosteroid but, irrespective of this, FP at microgram equivalent doses showed evidence of superior efficacy to BUD with respect to lung function and severity of asthma exacerbations without producing any greater adverse systemic effect.

Spoligotyping was performed to study the population structure of Mycobacterium tuberculosis complex strains (n ‫؍‬ 224) from Bangladesh. Strains were split into principal genetic group 1 (PGG 1 [75.0%]) and PGG 2 and 3 (25%). Forty-nine strains with a new spoligotype signature and considered as south or southeast Asian-linked emerging clones were designated as "Matlab type."Spoligotyping is a powerful and simple fingerprinting technique for simultaneous detection and differentiation of Mycobacterium tuberculosis complex (MTC) (12, 15). The discriminatory power of spoligotyping is less than that of IS6110 restriction fragment length polymorphism typing (16). However, spoligotyping is more efficient for differentiating MTC strains with a small number of IS6110 copies, including Mycobacterium bovis (2). Limited genotypic information about clinical isolates of MTC is available from Bangladesh (1, 6). Therefore, this study was planned to search for the existence of internationally-recognized phylogenetic clades of MTC in Bangladeshi tuberculosis (TB) patients and to identify any new spoligotyping signature(s) phylogeographically specific for Bangladesh.During a period from July 2001 through November 2003, 224 MTC strains were isolated from nonhospitalized TB patients of selected urban (Dhaka) and rural (Matlab) areas of Bangladesh. These strains were genotyped using the standard spoligotyping technique (20). Spoligotype patterns were recorded as octal and binary formats in Excel spreadsheets and compared with the SpolDB4 database (5). A spoligotype-based unrooted dendrogram of all the isolates (n ϭ 224) was built ( Fig.1) (14) using the Taxotron software (11).Age and gender information was available from 211 of 224 TB patients (47 rural and 177 urban). The male (n ϭ 63)/ female (n ϭ 148) ratio was 1.42, and mean age was 36.5 years (range, 15 to 83 years; standard deviation, 16.1 years). Thirty percent of patients were within the 15-to 24-year age group.Using the standard spoligotyping format, 193 (86.0%) of 224 isolates were clustered into 31 shared types (ST) containing from 2 to 34 strains, whereas 31 strains (14.0%) were unique. After matching with the SpolDB4 database (available online from http://www.pasteur-guadeloupe.fr:8081/SITVITDemo), these strains (n ϭ 224) were further clustered into four major clades or lineages (Fig. 1). Seventy-five percent of all strains belonged to principal genetic group 1 (PGG 1) (18), which includes Beijing, East African-Indian (EAI), and Central Asian (CAS), whereas 25.0% belonged to PGG 2 and 3.EAI is the most prevalent clade and constitutes about 44.20% of all isolates (n ϭ 99; 30 from rural and 69 from urban TB patients). Based on the absence of specific spacers of the direct repeat region, most strains of the EAI clade could be classified into EAI1 to EAI5 (Fig. 1). Within the EAI clade, 49 strains had a new spoligotype signature and were designated EAI6-Bangladesh 1 (EAI6-BGD1). Other known EAI subclades, such as EAI2 (ST 19; Manila) (7), EAI4 (ST 139; Vietnam), and EAI8 (ST...

The efficacy and safety of ofloxacin 400 mg once daily and amoxycillin/clavulanic acid 500/125 mg three times daily were compared in a double-blind manner in patients with an acute exacerbation of chronic bronchitis. Of 102 patients enrolled, 95 (93%) could be assessed for effectiveness. Treatment success was achieved in 41 (84%) of 49 patients in the ofloxacin group compared with 41 (89%) of 46 patients in the amoxycillin/clavulanic acid group. One patient who received ofloxacin and four patients in the amoxycillin/clavulanic acid group stopped medication because of unacceptable side effects. Microbiological results were evaluable in 47% of the patients. Predominant initial pathogens were Haemophilus influenzae, Streptococcus pneumoniae, sometimes in combination, and less frequently Branhamella catarrhalis. In two patients with clinical failure, randomized to ofloxacin, the initial pneumococcal strains persisted in the sputum after treatment.