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Journal of Veterinary Pharmacology and... Jun 2018Amoxicillin has become a major antimicrobial substance in pig medicine for the treatment and control of severe, systemic infections such as Streptococcus suis. The... (Review)
Review
Amoxicillin has become a major antimicrobial substance in pig medicine for the treatment and control of severe, systemic infections such as Streptococcus suis. The minimum inhibitory concentration 90% (MIC 90) is 0.06 μg amoxicillin/ml, and the proposed epidemiological cut-off value (ECOFF) is 0.5 μg/ml, giving only 0.7% of isolates above the ECOFF or of reduced susceptibility. Clinical breakpoints have not been set for amoxicillin against porcine pathogens yet, hence the use of ECOFFs. It has also been successfully used for bacterial respiratory infections caused by Actinobacillus pleuropneumoniae and Pasteurella multocida. The ECOFF for amoxicillin against A. pleuropneumoniae is also 0.5 μg/ml demonstrating only a reduced susceptibility in 11.3% of isolates. Similarly, P. multocida had an ECOFF of 1.0 μg/ml and a reduced susceptibility in only 2.6% of isolates. This reduced susceptibility disappears when combined with the beta-lactamase inhibitor, clavulanic acid, demonstrating that it is primarily associated with beta-lactamase production. In contrast, amoxicillin is active against Escherichia coli and Salmonella species but using ECOFFs of 8.0 and 4.0 μg/ml, respectively, reduced susceptibility can be seen in 70.9% and 67.7% of isolates. These high levels of reduced susceptibility are primarily due to beta-lactamase production also, and most of this resistance can be overcome by the combination of amoxicillin with clavulanic acid. Currently, amoxicillin alone is considered an extremely valuable antimicrobial in both human and animal medicine and remains in the critically important category of antibiotics alongside the fluoroquinolones and macrolides by the World Health Organization as well as the third- and fourth-generation cephalosporins, but these cephalosporins show marked resistance to basic beta-lactamase production and are only destroyed by the extended-spectrum beta-lactamases. Amoxicillin alone and in combination with clavulanic acid are currently classed together in Category 2 in the European Union. By reviewing the pharmacodynamic data and comparing this with pharmacokinetic data from healthy and infected animals and clinical trial data, it can be seen that the product has a good efficacy against S. suis and A. pleuropneumoniae, in spite of usage over many years. However, it may be much less efficacious on its own against E. coli, due to reduced susceptibility and resistance associated with beta-lactamase production, which is largely overcome by the use of clavulanic acid. It is felt that this differentiation may be useful in future classification of amoxicillin alone, in comparison with its combined use with clavulanic acid and thereby preserve the use of the more critically important antibiotics in veterinary medicine and reducing the risk of their resistance being transmitted to human.
Topics: Amoxicillin; Animals; Anti-Bacterial Agents; Bacterial Infections; Drug Resistance, Bacterial; Swine; Swine Diseases
PubMed: 29352469
DOI: 10.1111/jvp.12482 -
Chinese Medical Journal Jan 2023Bismuth-containing quadruple therapy (BQT) has long been recommended for Helicobacter pylori ( H. pylori ) eradication in China. Meanwhile, in the latest national... (Review)
Review
Bismuth-containing quadruple therapy (BQT) has long been recommended for Helicobacter pylori ( H. pylori ) eradication in China. Meanwhile, in the latest national consensus in China, dual therapy (DT) comprising an acid suppressor and amoxicillin has also been recommended. In recent years, the eradication rate of H. pylori has reached >90% using DT, which has been used not only as a first-line treatment but also as a rescue treatment. Compared with BQT, DT has great potential for H. pylori eradication; however, it has some limitations. This review summarizes the development of DT and its application in H. pylori eradication. The H. pylori eradication rates of DT were comparable to or even higher than those of BQT or standard triple therapy, especially in the first-line treatment. The incidence of adverse events associated with DT was lower than that with other therapies. Furthermore, there were no significant differences in the effects of dual and quadruple therapies on gastrointestinal microecology. In the short term, H. pylori eradication causes certain fluctuations in the gastrointestinal microbiota; however, in the long term, the gastrointestinal microbiota eventually returns to its normal state. In the penicillin-naïve population, patients receiving DT have a high eradiation rate, better compliance, lower incidence of adverse reactions, and lower primary and secondary resistance to amoxicillin. These findings suggest the safety, efficacy, and potential of DT for H. pylori eradication.
Topics: Humans; Helicobacter Infections; Anti-Bacterial Agents; Helicobacter pylori; Proton Pump Inhibitors; Drug Therapy, Combination; Amoxicillin; Treatment Outcome
PubMed: 36805362
DOI: 10.1097/CM9.0000000000002565 -
Swiss Dental Journal 2017Non-surgical periodontal therapy is often performed as a combinational approach using supplemental systemic amoxicillin and metronidazole. Better clinical outcomes, less...
Non-surgical periodontal therapy is often performed as a combinational approach using supplemental systemic amoxicillin and metronidazole. Better clinical outcomes, less need for periodontal surgery and limited systemic complications are arguments to justify such an approach. However, combination therapy with systemic antibiotic treatment is still a matter of debate due to emerging antibiotic resistance patterns. In this case report, a 61-year-old women suffering from an acute pancreatitis following systemic antibiotic combinational treatment as part of a non-surgical periodontal therapy is described. Following adequate symptomatic treatment during a hospitalization of three days, the patient recovered and periodontal conditions improved significantly thereafter. This case report illustrates a rare, but potentially serious complication when prescribing systemic combinational antibiotics in non-surgical periodontal therapy. Adequate history taking and timely diagnosis of pancreatitis if developing is important to provide relevant treatment and to avoid pancreatitis-associated complications.
Topics: Amoxicillin; Biofilms; Combined Modality Therapy; Dental Scaling; Female; Humans; Metronidazole; Middle Aged; Pancreatitis, Acute Necrotizing; Periodontitis; Referral and Consultation
PubMed: 28480950
DOI: 10.61872/sdj-2017-04-04 -
Drugs Mar 2024Treatment for the eradication of Helicobacter pylori infection, a leading cause of peptic ulcer disease and an important risk factor for gastric cancer and... (Review)
Review
Treatment for the eradication of Helicobacter pylori infection, a leading cause of peptic ulcer disease and an important risk factor for gastric cancer and mucosa-associated lymphoid tissue lymphoma, is indicated whenever infection is identified. However, treatment success rates with current guideline-recommended proton-pump inhibitor (PPI)-based regimens remain suboptimal, with one potential factor associated with treatment failure being inadequate acid suppression. Vonoprazan (Voquezna) is a first-in-class potassium-competitive acid blocker with the potential to provide potent and sustained acid suppression. Following clinical trials conducted mainly in Asia (supported by post-marketing experience from Asia) and the phase III PHALCON-HP trial conducted in the USA and Europe, vonoprazan is now approved in the USA for use in combination with amoxicillin (dual therapy) or amoxicillin and clarithromycin (triple therapy) for the treatment of H. pylori infection in adults. The vonoprazan-based dual and triple therapy regimens were generally well tolerated in PHALCON-HP. In addition, vonoprazan has advantages including a rapid onset of action and no food effect, making vonoprazan-based dual and triple therapy regimens valuable alternatives to standard PPI-based triple therapy in the treatment of H. pylori infection.
Topics: Adult; Humans; Helicobacter Infections; Anti-Bacterial Agents; Helicobacter pylori; Drug Therapy, Combination; Amoxicillin; Clarithromycin; Pyrroles; Proton Pump Inhibitors; Treatment Outcome; Sulfonamides
PubMed: 38388872
DOI: 10.1007/s40265-023-01991-5 -
BMC Microbiology Aug 2023The microbiome of the human gut serves a role in a number of physiological processes, but can be altered through effects of age, diet, and disturbances such as...
BACKGROUND
The microbiome of the human gut serves a role in a number of physiological processes, but can be altered through effects of age, diet, and disturbances such as antibiotics. Several studies have demonstrated that commonly used antibiotics can have sustained impacts on the diversity and the composition of the gut microbiome. The impact of the two most overused antibiotics, azithromycin, and amoxicillin, in the human microbiome has not been thoroughly described. In this study, we recruited a group of individuals and unrelated controls to decipher the effects of the commonly used antibiotics amoxicillin and azithromycin on their gut microbiomes.
RESULTS
We characterized the gut microbiomes by metagenomic sequencing followed by characterization of the resulting microbial communities. We found that there were clear and sustained effects of the antibiotics on the gut microbial community with significant alterations in the representations of Bifidobacterium species in response to azithromycin (macrolide antibiotic). These results were supported by significant increases identified in putative antibiotic resistance genes associated with macrolide resistance. Importantly, we did not identify these trends in the unrelated control individuals. There were no significant changes observed in other members of the microbial community.
CONCLUSIONS
As we continue to focus on the role that the gut microbiome plays and how disturbances induced by antibiotics might affect our overall health, elucidating members of the community most affected by their use is of critical importance to understanding the impacts of common antibiotics on those who take them. Clinical Trial Registration Number NCT05169255. This trial was retrospectively registered on 23-12-2021.
Topics: Humans; Anti-Bacterial Agents; Amoxicillin; Azithromycin; Metagenomics; Macrolides; Drug Resistance, Bacterial
PubMed: 37528343
DOI: 10.1186/s12866-023-02949-z -
Journal of Hospital Medicine Jan 2017The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report.... (Review)
Review
The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant.
Topics: Amoxicillin; Anti-Bacterial Agents; Diagnosis, Differential; Exanthema; Female; Fever; Humans; Infant; Mucocutaneous Lymph Node Syndrome
PubMed: 28125832
DOI: 10.1002/jhm.2675 -
Helicobacter Oct 2023Antibiotic resistance is a well-known factor of Helicobacter pylori eradication failure. Heteroresistance indicates the coexistence of resistant and susceptible strains...
BACKGROUND
Antibiotic resistance is a well-known factor of Helicobacter pylori eradication failure. Heteroresistance indicates the coexistence of resistant and susceptible strains and might lead to underestimating antimicrobial resistance. This study aims to evaluate the susceptibility profile, the frequency of heteroresistance of H. pylori strains, and their effect on eradication success in a pediatric population.
MATERIALS AND METHODS
Children aged 2-17 years who underwent an upper gastrointestinal endoscopy from 2011 to 2019 with positive H. pylori status were included. Susceptibility was measured by disk diffusion and E-test. The difference in susceptibility profiles between isolates from the antrum and the corpus was used to detect heteroresistance. For those who received eradication treatment, we evaluated eradication rate and factors affecting treatment success.
RESULTS
Inclusion criteria were met by 565 children. Strains susceptible to all antibiotics were detected in 64.2%. Primary resistance rates for clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), tetracyclin (TET), and amoxicillin (AMO) were 11%, 22.9%, 6.9%, 0.4%, and 0% and secondary resistance rates were 20.4%, 29.4%, 9.3%, 0%, and 0%. Heteroresistance was present in untreated children in 2%, 7.1%, 0.7%, 0.7%, and 0% for CLA, MET, LEV, TET, and AMO. First-line eradication rates were 78.5% in intention-to-treat (ITT), 88.3% in full-analysis-set (FAS), and 94.1% in per-protocol (PP). Factors affecting eradication success were the duration of treatment when the triple-tailored treatment was used, the number of daily doses of amoxicillin administered, and the patient's adherence to treatment.
CONCLUSIONS
This study shows the presence of relatively low primary resistance rates for H. pylori isolates but demonstrates the presence of heteroresistance in our population. Routine biopsies from the antrum and corpus must be considered for susceptibility testing to allow tailored treatments and increase eradication rates. Treatment success is affected by treatment choice, correct dosing of medications, and adherence. All these factors should be considered when evaluating the efficacy of an eradication regimen.
Topics: Child; Humans; Helicobacter Infections; Helicobacter pylori; Anti-Bacterial Agents; Clarithromycin; Amoxicillin; Metronidazole; Levofloxacin; Drug Resistance, Bacterial; Tetracycline; Drug Therapy, Combination
PubMed: 37402147
DOI: 10.1111/hel.13006 -
Clinical Infectious Diseases : An... Jan 2023
Topics: Humans; Fluoroquinolones; Amoxicillin; Anti-Bacterial Agents
PubMed: 36001452
DOI: 10.1093/cid/ciac691 -
Intensive Care Medicine Aug 2020
Topics: Acute Kidney Injury; Amoxicillin; Anti-Bacterial Agents; Humans
PubMed: 32095849
DOI: 10.1007/s00134-020-05970-2 -
The International Journal of Oral &... 2022The objective of this study was to determine the effect of two antibiotics (amoxicillin and clindamycin) and one antiseptic (chlorhexidine digluconate [CHX]) on the...
PURPOSE
The objective of this study was to determine the effect of two antibiotics (amoxicillin and clindamycin) and one antiseptic (chlorhexidine digluconate [CHX]) on the growth and differentiation capacity of primary human osteoblasts.
MATERIALS AND METHODS
Osteoblast proliferation was determined by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) technique after a 1-minute treatment with 400 μg/mL amoxicillin or 150 μg/mL clindamycin or CHX (0.12% or 0.2%). Flow cytometry was used for apoptosis/necrosis analysis. The study of cell differentiation was performed using a mineralization medium and staining of the nodules formed using red alizarin at 15 and 22 days of treatment with 400 μg/mL amoxicillin or 150 μg/mL clindamycin. Spectrophotometry was used to determine alkaline phosphatase (ALP) activity after 1 minute of treatment.
RESULTS
Treatment of osteoblasts with 0.12% and 0.2% CHX for 1 minute induced a strong dose-dependent reduction in cell proliferation (P < .001) with a significant increase in the percentage of apoptotic cells (P = .004 and < .001, respectively). However, cell proliferation significantly increased (P < .05) after treatment with 150 μg/mL clindamycin. Treatment of the osteoblasts with 150 μg/mL clindamycin for 1 minute significantly increased the expression of ALP (P = .002). Calcium deposition was significantly higher (P < .001) in the 150 μg/mL clindamycin group.
CONCLUSION
These data support the use of low doses of clindamycin and amoxicillin for intraoral bone graft decontamination and raise questions about the use of CHX. Osteoblast growth and differentiation may be favored by low doses of clindamycin, and it may be the decontaminant of choice for intraoral bone grafts, while CHX is shown as a less bone-friendly agent.
Topics: Alkaline Phosphatase; Amoxicillin; Cell Differentiation; Chlorhexidine; Clindamycin; Humans; Osteoblasts
PubMed: 35476856
DOI: 10.11607/jomi.9253