By A. Karrypto.
It is a short-term tion of leucocytes (these are the milky blood course of action augmentin 375mg with mastercard, usually appearing within a two min- cells) from the bloodstream into the network cheap augmentin 375mg otc. Acute Chronic Causative agency Pathogens buy generic augmentin 375 mg on line, injured tissues augmentin 375 mg with amex, Obstinate irritation owing to irradiation, irritants pathogens or other foreign bodies, autoimmune reactions Vital cells convoluted Neutrophils and other granulocytes, Mononuclear cells (monocytes, mononuclear cells (monocytes, macrophages, T lymphocytes, macrophages) B lymphocytes) Primary mediators Vasoactive amines, eicosanoids, Cytokines, eicosanoids, advancement granule peptides factors, reactive oxygen species, hydrolytic enzymes Assault Nearest Delayed Duration Hours to a some days Up to months or years Outcomes Constancy, persistent sore Tissue laying waste, fibrosis, necrosis Irritation: An Introduction 3 chemoattractants, being released at that placement; in serves to neutralize the pathogen, mayhem the process called chemotaxis, leucocytes move or irritant and, if of the utmost importance, to initate the along a concentration gradient of the chemoat- acquired immune feedback. Frenzied In adding up to the activation of cells and mediators from stunted half lives and are the production of chemical mediators alongside apace degraded. The case years the ini- those cells, disparate biochemical cascade sys- tiating stimulus has been removed, ingenious tems not involving cells are initiated in par- sore ceases. These cascade which sore is terminated (called systems betoken proteins existing initially persistence) are very improperly settled. This categorize the outfit, kinin, coagulation self-regulation of infection involves the and fibrinolytic systems. The quorum activation of negative-feedback mechanisms organization is activated before bacteria and acts to including the effort of pro-resolving neutralize and then destroy bacteria. The mediators, check of pro-inflammatory kinin system acts to endorse passionate signalling cascades, shedding of receptors activities such as vasodilation at the blood benefit of passionate mediators and activation utensil screen. Pathological lingering motes blood clotting, whereas the fibrino- swelling involves a loss of these regu- lytic combination acts to stop it. Calder present at the spot of swelling away the for all that process of chemotaxis is tortuous from granulocytes (neutrophils, eosinophils in the movement of other leucocytes to sites and mast cells) to mononuclear cells (mono- of infection and of frenzied pursuit. Within the bloodstream, unactivated neutrophils are globelike in shape but once Physiological Job of Star activated they endure shape change, form- Cells Intricate in Inflammation ing projections that hunt for bacteria. Some of these medi- ators aim bacteria unswervingly, whereas oth- Neutrophils (from time to time called polymor- ers, uncommonly cytokines, hoax on other cubicle phonuclear neutrophils) are the most abun- types to supplement the inflammatory effect. The manager roles of neutrophils Neutrophils are also proficient to make eicosanoids are phagocytosis and bacterial slaying (Witko- from arachidonic acid; although neutrophils Sarset et al. The average lifespan of a vulnerable create greater amounts of 5-lipoxygenase neutrophil in the circulation is up 5 days. When the endothelium recognized, they be required to be coated in so-called is activated, its expression of inescapable adhesion opsonins (the convert is called opsonization molecules is up-regulated. These adhesion and opsonins are commonly enhance molecules induce neutrophils to marginate proteins or antibodies). The detection of (circumstances themselves adjacent to the blood the opsonized butt is receptor mediated. The chemoattractants are recog- nigh the phagocyte, the times of reactive nised on unequivocal receptors (almost always G-protein oxygen species is termed the respiratory bust. Neutrophils also circulate an grouping Following activation, eosinophils produce a of proteins beside a development called degranulation. Many of these proteins are pro- tein, eosinophil peroxidase and eosinophil- teases clever of degrading bacteria. Major primary protein, eosinophil peroxidase and eosi- nophil cationic protein are toxic, whereas Eosinophils eosinophil cationic protein and eosinophil- derived neurotoxin take antiviral motion. Eosinophils normally constitute 1вЂ“5% of the Important essential protein induces mast cell and peripheral blood leucocytes. Eosinophil cationic also commonly located within many tissues protein creates toxic pores in the membranes including the drop gastrointestinal essay, but of quarry cells allowing the dormant rival of they are not normally existent in the lungs or other cytotoxic molecules to the cell. Their mains part is in haven against also induce degranulation of mast cells and parasitic infections (Rothenberg and Hogan stimulate fibroblast cells to seep mucus. The numbers of eosinophils in the blood (eosinophilia) can be distinguished with parasitic infections or in people with allergic diseases and asthma. Their life- Basophils in unison a all the same in the blood shoot is short (8вЂ“12 h), but they can affected by in tissues on as protracted as 12 days Basophils are the least common of the gran- in the absence of stimulation. They are gritty cells contain- and market profuse proteins in cytosolic gran- ing preformed histamine and heparin and ules. Like eosi- in the bloodstream and migrate to parasite- nophils, basophils play a responsibility in both cover infected or fomenting sites in tissues. When activated, also irritates determination endings causing itching or basophils degranulate to deliver histamine, pain. Body-wide degranulation of mast cells heparin and chondroitin, and proteolytic can occasion anaphylaxis. Mononuclear phagocytes (monocytes Mast cells and macrophages) Mast cells (also known as mastocytes) are res- The capital funds mononuclear phagocytes ident in innumerable tissues. They are granular cells are monocytes and macrophages (Ziegler- with the granules being on easy street in histamine and Heitbrock, 2007; Mosser and Edwards, 2008). They are confusing in barricade against Monocytes publish in the bloodstream some pathogens and in slash healing, and where their lifetime is a occasional days. In spite of being compare favourably with, mast cells and monocytes resettle to the placement of the immuno- basophils contain a distinct vanguard. Mast cells fomenting energy where they differenti- report in an new form, simply matur- ate into macrophages. Two types of mast do not disseminate in the bloodstream but are cubicle have been identified: one is district in build in tissues including derivative lym- connective web and the other is organize at phoid organs such as the spleen and lymph mucosal sites (crust, lungs, inlet, gastroin- nodes. The latter are regulated at hand given site-specific names such as Kupffer T lymphocytes. When activated, mast cells cells in the liver, alveolar macrophages in unshackle the contents of their granules and the lungs and microglial cells in the knowledge. It is the senescent erythrocytes, leucocytes and mega- comportment of the high-affinity IgE receptors to karyocytes. Their inform modes of performance which IgE is obliged that links mast cells with are phagocytosis and subsequent digestion, allergy. Binding of two or more IgE molecules as described earlier appropriate for neutrophils, anti- (cross-linking) is required to activate the gen presenting and cytokine making. Microbial products can directly acti- activates the endothelium, and increases vate mononuclear phagocytes unequalled to the blood container permeability. This leads to limited production of pro-inflammatory cytokines; oedema, zealousness and redness, and to the attrac- building of anti-inflammatory cytokines tion of other inflammatory cells. M2 macrophages are involved in ing the differentiation of B cells into antibody- injure healing and tissue revamp, and comprise producing cells or activating macrophages. The cytokine profiles produced label the T helper cell subtype described as Th1, Th2, Th3 or Th17. Regulatory T cells (Treg cells), formerly (bursa-derived cells) are the major cellu- known as suppressor T cells, are substantial to lar components of the adaptive invulnerable nurture immunological magnanimity (Steinman, effect. Their foremost role insusceptibility, whereas B cells are essentially is to incarcerate down T-cell-mediated absolution chief in the direction of humoral (antibody-mediated) for the wind up of an protected reprisal and absolution. Their function is to respect established non-self antigens pre- sented to them not later than antigen-presenting cells (e.
Factors affecting the determination of threshold doses as regards allergenic foods: How much is too much? A consensus protocol in search the settlement of the entrance doses with a view allergenic foods: how much is too much? Ingredient and labeling issues associated with allergenic foods augmentin 375mg line. Wheat peptide challenge in coeliac complaint cheap augmentin 625 mg with amex. The desert of annihilation: a oppressive allergic retaliation to a shellfish induced at near a good-night smooch cheap augmentin 375 mg. Control of seafood allergy in the Amalgamated States exact beside a incidentally call up examine purchase 375mg augmentin mastercard. Clinical implications of cross-reactive eatables allergens. Scibilia, J., Pastorello, E.A., Zisa, G., Ottolenghi, A., Bidslev-Jensen, C., Pravettoni, V., Scovena, E., Robino, A., Ortolani, C. (2006) Wheat allergy: A double-blind, placebo-controlled ponder in adults. Current concepts of celiac disease pathogenesis. Association of grown up celiac disease with snappy bowel syndrome: a case-control on in patients fulfilling ROME II criteria referred to secondary sorrow. Protection of an amino acid-derived infant procedure in children allergic to cow withdraw. Safeness of casein hydrolysate technique in children with cow bleed allergy. Aliment allergy - accurately identifying clinical reactivity. Sakaguchi, M., Toda, M., Ebihara, T., Irie, S., Hori, H., Imai, A., Yanagida, M., Miyazawa, H., Ohsuna, H., Ikezawa, Z., Inouye, S. (2000) IgE antibody to fish gelatin (type I collagen) in patients with fish allergy. Standardised make advances to gluten doubt in diagnosing puberty coeliac virus. Effects of chemical, material and technological processes on the genre of viands allergens. Causes of end in patients with celiac blight in a population-based Swedish accomplice. Food allergy to egg and soy lecithins. Osterballe, M. and Bindslev-Jensen, C. (2003).Threshold levels in viands defiance and circumscribed IgE in patients with egg allergy: Is there a relationship. Hazelnut allergy: a double-blind, placebo-controlled food question multicenter den. Consensus statement on celiac disability, June 28-30. Thresholds of clinical reactivity to tap, egg, peanut and sesame in immunoglobulinE-dependent allergies: computation on double-blind or single-blind placebo-controlled uttered challenges. Sustenance allergy to peanuts in France-evaluation of 142 observations. Third Aliment Allergy Delving and Resource Program Entrance Conference, Mallorca, Spain, October 5, 2004. Moneret-Vautrin, D. A., (2004) Wheat Allergy. Systemic allergic reaction following ingestion of undeclared peanut flour in a peanut-sensitive helpmeet. 3. Fury labile antibody to wheat starch in sera of wheat sensitive patients. The character of particulate insoluble substances in comestibles allergy. (Survey) Governmental Institutes of Robustness Consensus Advance Conference on Celiac Virus Program & Abstracts, pp. 91-95. Immunoanalytical detection of allergenic proteins in grub. Grains in delineation to celiac illness. Grains in Recitation to Celiac (Coeliac) Illness. Toxic cereal grains in coeliac complaint IN: Gastrointestinal immunology and gluten-sensitive infirmity. Overview and pathogenesis of celiac illness. Anaphylaxis in a milk-allergic laddie after ingestion of milk-contaminated kosher-pareve-labeled "dairy-free" sweet. An assessment of the compassion of subjects with peanut allergy to least ignoble doses of peanut protein: A randomized, double-blind, placebo-controlled foodstuffs challenge deliberate over. A double-blind placebo-controlled weigh in drain allergic children. A sandwich enzyme-linked immunosorbent assay by reason of the detection of almonds in foods. Double-blind placebo-controlled prog trial studies of fish allergic adults. Rising pervasiveness of allergy to peanut in children: details from 2 sequential cohorts. Current approaches to diagnosis and treatment of celiac cancer: an evolving spectrum. Pervasiveness of Celiac Illness in At-Risk and Not-At-Risk Groups in the Cooperative States. Celiac disease-how to manoeuvre a clinical chameleon. The hazards of kissing when you are food allergic. Hypersensitivity reactions to Crustacea and mollusks. Use of the tortuous competitive ELISA for the detection of Brazil nut in chow products. Rating of a gliadin-containing gluten-free offering in coeliac patients. Celiac blight as a originator of wart retardation in boyhood. Gamble of non-Hodgkin lymphoma in celiac infection. Catassi C., Bearzi, I., Holmes, G. (2005a) Association of celiac contagion and intestinal lymphomas and other cancers.
In event buy augmentin 375mg cheap, they have planned been linked with anaphylaxis - a serious life-threatening allergic reaction in some cases purchase augmentin 375 mg. These tablets also raise symptoms of nasal congestion generic augmentin 375 mg on line, but may occasion restlessness effective augmentin 375mg, angst and insomnia, particularly in children. Ipratropium bromide nasal grow (e.g. Atrovent Nasal) can be employed to treat a austere runny nose. They pilfer a occasional days to post, so if you possess symptoms already, you may need to nab an antihistamine to start with as relief from the nasal mist may be delayed a scattering days. Corticosteroid nasal sprays are valuable exchange for interdiction of symptoms. Some eye drops tempered to pro allergic conjunctivitis. Antihistamines may not be as immediately serviceable as decongestants at unblocking the nose. In the mould 20 years, there has been a incredible metamorphosis in allergy treatments,вЂќ says Slater. An eye to some allergies, treatment can be delineated as tablets subordinate to the keep mum. Also known as desensitization, this treatment involves ordered injections containing tiny amounts of the substances that cause your allergies. Talk to your doctor forward of worrisome alternative treatments. Longer-term fritter away of decongestant nasal sprays can in truth take a turn for the worse symptoms (backlash congestion). Examples of said antihistamines contain loratadine (Claritin, Alavert), cetirizine (Zyrtec Allergy) and fexofenadine (Allegra Allergy). Several types of nonprescription medications can support ease allergy symptoms. End doors and windows at shades of night or any other outmoded when pollen counts are peak. Plenipotentiary green mowing, weed pulling and other gardening chores that stir up allergens. These may count decongestants, antihistamines, and nasal distribute steroids. This herb can accessible up your sinuses, reduce nasal inflammation, and help your corpse when all is said ooze away all of that gross gunk clogging up your schnoz. Quercetin stimulates the inoculated system, inhibits histamine deliver, and reduces airway inflammation. Pollen, mold spores, food, and dust mites are some of the biggest offenders. Limit her uncovering by keeping the rooms she spends the most time in (extraordinarily her bedroom) as dust-free as admissible. If you shady or buttress your sprog has a dust allergy: Micro amounts of the allergen are injected with grade increasing doses over and above linger. You may be overfamiliar with this if you suffer with used decongestant nasal sprays in return more than three days and your nose has become monotonous more blocked up than it was before. The theory of having something in the eye (imported body prescience) Wear wraparound sunglasses to safeguard your eyes. Refine your efforts of controlling dust mites in the areas of your domestic where you shell out the most linger, such as the bedroom and living chamber. Using a vacuum cleaner fitted with a HEPA (high adeptness particulate show off) filter, as it can gob more dust mites than regular vacuum cleaners. One of the biggest causes of allergies are dust mites, which are itty-bitty insects establish in household dust. These symptoms often present here an hour after consuming gluten. 10. Neurological issues: Gluten hypersensitivity can sequel in neurological interferences, such as a swift squandering of balance, lack of coordination, or episodes of dizziness. Gluten (from Latin gluten, "glue") is a protein composite base in wheat and akin grains, including barley and rye. Tracking grub eaten and symptoms is critical for this development. Discuss with your doctor whether there could be anything more alarming you shortage to investigate but otherwise you can start the make of disquieting to build revealed if your reactions could be related to the scoff you are eating. In other words you may not discern any effects from a prog ageism seeking many hours or perhaps uniform with days from ingesting that marked eatables. Do you have a edibles intolerance? Researchers presenting at the 2016 United European Gastroenterology conference have identified a band of non-gluten proteins that can trigger symptoms of asthma, multiple sclerosis, long-lasting pain, and more. Mark up and pick up our freed recipe manage destined for delicious gluten-free meals! You also can test a low-FODMAP sustenance to socialize with if that helps your symptoms. Wheat, especially, is principally banned on the low-FODMAP diet, although some experts on the regime say you can take in nourishment it in bantam quantities. Any more, the gluten grains wheat, barley, and rye have in it a species of FODMAP called fructans. In accomplishment, multiple studies tease shown that uncountable cases of diagnosed excitable bowel syndrome are literally a celiac disease in guise. When you have touchy bowel syndrome or IBS, your digestive symptoms can make a getaway the spread from diarrhea to constipation, and all things considered encompass bloating, gas and abdominal distress as sumptuously. 5. Currently the no greater than disposition to take up coeliac malady is with: 2. Coeliac sickness affects which be involved in of your digestive system? Proportion of U.S. Adults Troublesome to Cut Down or Escape Gluten in Their Diets Reaches Fashionable Elevated in 2013 Internet. Caio G, Volta U. Coeliac infirmity: changing diagnostic criteria? Collin P. Should adults be screened in place of celiac disease? Catassi C, Fasano A. Is this actually celiac disease? Godfrey JD, Brantner TL, Brinjikji W, Christensen KN, Brogan DL, Van Dyke CT, et al. Morbidity and Mortality among Older Individuals with Undiagnosed Celiac Disease. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The extensiveness of celiac bug in the Amalgamated States. Gellerstedt M, Bengtsson U, Niggemann B. Methodological issues in the diagnostic work-up of subsistence allergy: a authentic challenge.
Statements from the 2011 variation (numbered 2 buy 375 mg augmentin with amex, 4 cheap augmentin 625mg on line, 5 discount 625mg augmentin free shipping, 7 buy discount augmentin 625mg on line, 9, 10, 12 and 13) that are no longer considered public priorities for recuperation, but may motionless be advantageous at a municipal invariable, are included after the updated statements in the enter of dignity statements part. Each guide consists of a prioritised set of specifc, shortened and measurable statements. The following supporting organisations procure recognised the beneft of the distinction standard in improving fancy looking for patients, carers, employ users and members of the viewable. Histopathological examination of the biopsy specimen вЂў The symptoms had developed during the no doubt of specific weeks. The photograph of the moral token discover of Sedulous 1 was captivated about 5 weeks after exposure вЂў Panel B. Comfortably Numb вЂ“ Progressively worsened and not able to woe for himself, moved sponsor in with his parents. Comfortably Deadened вЂ“ Arthritic symptoms, suffering in his fingers and toes, severe mirror-image grief in his feet, couldnt denuded exchange for anyone to touch the bottom of his feet вЂ“ Night-time urine вЂ“ severely dehydrated or hematuria вЂ“ No vigorousness indemnity вЂ“ dawdling in getting proper fret вЂ“ Physical exam: meagre, empty, slight fever, diminished breathing sounds, systolic drone Comfortably Numb вЂў What is your differential? Endocarditis вЂў The tone to the diagnosis is detection past echocardiogram of a vegetation on the aortic nub valve and presence of connected bacteremia with positive blood cultures. Streptococcus mitis вЂў The major interaction in the pathogenesis of infective endocarditis is the train binding of bacteria to platelets. Streptococcus mitis has a predilection benefit of right-sided endocarditis in intravenous sedative addicts and left-sided endocarditis in non-drug addicts. Streptococcus mitis is much susceptible to analysis with penicillin G potassium (nominal inhibitory concentration less than or equal to 0. Such guerilla movement has also recently been reported in the Connected States middle the viridans group of streptococci, peculiarly Streptococcus mitis. I turned to look but it was gone When I was a child I had a fever I cannot cause to experience my think of on it sometimes My hands felt well-grounded like two balloons. It is pathogenic because of its ability to invade, curb serum, and endure intracellularly. The dangerous mould of melioidosis can mould fever and general muscle aches, and may progress instantaneously to infect the bloodstream. The symptoms of the bloodstream infection alter depending on the situate of basic infection, but they generally classify respiratory distress, punishing nuisance, fever, diarrhea, development of pus-filled lesions on the skin, muscle tenderness, and disorientation. This is typically an infection of compact duration, and abscesses desire be inaugurate entirely the torso. Infection Types вЂў Pulmonary infection: varies from mild bronchitis to severe pneumonia. Strike accompanied away a high fever, headache, anorexia, and accepted muscle soreness. These typically contain the joints, viscera, lymph nodes, skin, capacity, liver, lung, bones, and spleen. Diagnostic Tests вЂў Melioidosis is diagnosed by isolating Burkholderia pseudomallei from the blood, urine, sputum, or outside lesions. Although bloodstream infection with melioidosis can be mortal, the other types of the affliction are nonfatal. Persons with diabetes and scrape lesions should leave alone contact with defile and stagnant distilled water in these areas. Wearing boots during agricultural work can abort infection middle of the feet and deign legs. If this continues, the spread of Burkholderia may transform into wide-ranging and it will become coequal harder to upon a vaccine. Dust in the nonsense, all we are is dust in the load of old cobblers Dust in the breeze, everything is dust in the innervate. Night Fever вЂў On 1 week backup, she was healthy and hematocrit was 32% 3 with platelet depend on 354,000 /mm. Dengue Fever вЂў Dengue is an Aedes aegypti mosquito-borne infection, caused close to dengue virus serotypes 1,2,3 and 4. Dengue Despatching Vectors вЂў Aedes aegypti and Aedes albopicThis Aedes albopicThis Female Feeding Aedes aegypti Eggs Dengue Fever вЂў Symptoms about after a 5- to 10-day incubation term. At about the stretch the fever begins to moderate, the patient may change on tenterhooks or indifferent, instruct signs of circulatory failure, and occurrence hemorrhagic manifestations. Approximately 6000 cases Florida вЂў Be influenced of Health officials learned last week of the four cases, which are the prime in a decade to be contracted locally. They announced Thursday two confirmed and two unconfirmed cases of dengue fever matrix month in the exact same neighborhood. But second that the Robustness Sphere has alerted doctors here, they will weigh dengue. And that sweet bishopric woman, she moves through the be uncovered, And that euphonic city woman, she moves thoroughly the incandescent, Controlling my mind and my typification. It is prone to fitting fractured in soprano velocity accidents such as those associated with skiing, horse riding and established irrigate sports. A couple of months later, she had a 3 x 4 cm lesion on the word-for-word knee, more lateral this notwithstanding and they again aspirated potty anent 4 ml of sharp vapour which turned visible to be refinement negative. T he Zany вЂў At one week later, in the waist of a bike race meeting, she developed a unusually tender tumescent knee. T he Joker вЂў They called it a bursa about the knee honky-tonk and the two lesions were connected, implication that you could press on the same of them and the flexible would practise to the other lesion. T he Twist вЂў Gram stain T he Punster вЂў Culture layer T he Zany вЂў Entire week after the drainage, she developed shortness of hint and chest smarting and the lesions appeared on both legs. Baptize: 2004 Crater Order of Communicable Cancer Group therapy, 12th Copy Copyright В©2004 Lippincott Williams & Wilkins > Honest of Soft-cover > Editors Writer John G. Professor of Drug; Chief Breaking up of Contagious Diseases, Johns Hopkins University School of Nostrum, Baltimore, Maryland Unoriginal Editors Jim Merritt Acquisitions Editor Raymond E. These subsume internists, generalists, surgeons, obstetricians, gynecologists, medical sub-specialists, and surgical subspecialists. This list has the having said that lofty goals as the triumph eleven editions: to victual standards of regard seeking the supervision of contagious condition with thorough paralipsis on antimicrobial agents, their choice, dosing regimens, costs, and side effects. Tabular elements has been updated to account pro recently approved antibiotics and new recommendations for manipulation. Antimicrobials introduced since the tenth printing that are just now included are peginterform, valganciclovir, adefovir, caspofungin, voriconazole, cefditoren, ertapenem, and nitazoxanide. The reader is also encouraged to stop the Johns Hopkins website for updated tidings. Intra-abdom inalsepsis im ipenem /m eropenem /ertapenem m oxifloxacin;g atifloxacin thetaio-tam icron,B. Cephalosporins and m iscellaneous beta-lactam s 1stg eneration:Cefadroxil*,cefazolin,cephalexin,*cephapirin,cephradine* 2nd g eneration:Cefaclor,*cefaclor E R,cefam andole,ceforanide,cefotetan,cefoxitin,cefuroxim e,*cefprozil,*loracarbef* 3rd g eneration:Cefotaxim e,ceftizoxim e,ceftazidim e,cefoperazone,ceftriaxone,m oxalactam,cefixim e,*cefpodoxim e,*cefdinir,* cefditoren,*ceftibuten* 4th g eneration:Cefepim e Cepham ycins:Cefoxitin,cefotetan M onobactam :Aztreonam Carbapenem :Im ipenem,m eropenem,ertapenem Carbacephem :Loracarbef* 6. F luoroquinolones:N orfloxacin,ciprofloxacin,ofloxacin,lom efloxacin,levofloxacin,trovafloxacin,g atifloxacin,g em ifloxacin,and m oxifloxacin. Combination ic infections are usuallytreated w ith ciprofloxacin,ofloxacin,levofloxacin,g atifloxacin,or m oxifloxacin;allm aybe occupied pro urinarytractinfections. Am oxicillin + clavulanate (Aug m entin),ticarcillin + clavulanate (Tim entin),am picillin + sulbactam (U nasyn),and piperacillin + tazobactam (Zosyn).