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Expert Opinion on Pharmacotherapy Feb 2022causes dyspepsia, peptic ulcer, and gastric malignancies. Treatments for are mostly empirical depending on regional antibiotic resistances and the patient's history...
INTRODUCTION
causes dyspepsia, peptic ulcer, and gastric malignancies. Treatments for are mostly empirical depending on regional antibiotic resistances and the patient's history and less frequently susceptibility guided. has a low resistance to rifabutin and has been proposed as an alternative for third-line treatment and beyond but recently has also gained attention for use as first- and second-line treatment.
AREAS COVERED
In this review, the authors systematically searched medical databases in order to present the current eradication rates for any treatment based on the two antibiotics, rifabutin and amoxicillin with a potent acid inhibitor. They also assessed the safety and tolerance of all the relative regimens.
EXPERT OPINION
Treatment with a rifabutin- and amoxicillin-containing regimen is a valuable option when treating difficult to eradicate Helicobacter pylori infections. Its efficacy is overall 71.4%, and it is not influenced by previous antibiotics, gender, smoking habits, and age. Its results were better when used as a first- or second-line treatment. In third-line therapy and beyond, eradication rates are lower. Adverse effects of all rifabutin regimens occurred in 23% of patients and were mostly mild with bone marrow suppression being very low and reversible.
Topics: Adult; Amoxicillin; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Rifabutin
PubMed: 34595999
DOI: 10.1080/14656566.2021.1982894 -
Inflammopharmacology Dec 2022Acute diverticulitis disease is associated with inflammation and infection in the colon diverticula and may lead to severe morbidity. This study aimed to evaluate and...
Acute diverticulitis disease is associated with inflammation and infection in the colon diverticula and may lead to severe morbidity. This study aimed to evaluate and compare the protective effects of amoxicillin antibiotic, either alone or in combination with probiotics (Lactobacillus acidophilus and Bifidobacterium lactis), in a rat model of acute diverticulitis disease. Acute diverticulitis was induced, in albino rats, by adding 3% weight/volume of dextran sulfate sodium (DSS) to the rats' drinking water; daily for 7 days, in addition to injecting lipopolysaccharide (LPS) enema (4 mg/kg). The impact of treatments was assessed by measuring the physiological and immunological parameters and evaluating colon macroscopic and microscopic lesions. The results showed that both treatments (especially probiotics with amoxicillin) alleviated the adverse effects of DSS and LPS. This was obvious through the modulation of the rats' body weight and the colon weight-to-length ratio. Also, there was a significant (p < 0.001) decrease in the colon macroscopic lesion score. The pro-inflammatory cytokines [(TNF)-α, (IL)-1β, (IFN)-γ, and (IL)-18]; in the colon tissue; were significantly (p < 0.001) decreased. Also, both treatments significantly ameliorated the elevation of myeloperoxidase activity and C-reactive protein levels, in addition to improving the histopathological alterations in the colon tissue. In conclusion, amoxicillin and probiotics-amoxicillin were effective in preventing the development of experimentally induced acute diverticulitis, through their anti-inflammatory and immunomodulatory effects. Furthermore, this study has explored the role of probiotics in preventing DSS/LPS-induced acute diverticulitis, so it can be applied as a promising treatment option for acute diverticulitis disease.
Topics: Animals; Amoxicillin; Colitis; Colon; Cytokines; Dextran Sulfate; Disease Models, Animal; Diverticulitis; Lipopolysaccharides; Models, Theoretical; Probiotics; Tumor Necrosis Factor-alpha; Rats
PubMed: 36318434
DOI: 10.1007/s10787-022-01093-w -
Molecules (Basel, Switzerland) Jul 2022() is a global health threat, and the World Health Organization has included among 12 bacterial species that require high priority future strategies for the...
() is a global health threat, and the World Health Organization has included among 12 bacterial species that require high priority future strategies for the development of new antibiotics due mainly to its high rates of resistance. Metallic nanoparticles are known for their antimicrobial properties. The FDA (Food and Drug Administration) has approved zinc oxide nanoparticles (ZnONPs) as biocompatible antimicrobials. Green synthesis of ZnONPs was performed based on galls extract (OGE) and was characterized by UV, IR, DLS, TEM, and SEM measurements. In addition, LC-MS/MS was used for the identification of OGE constituents. A checkerboard assay was used to evaluate the activity of synthesized Qi-ZnONPs and OGE against , and their synergistic effects with amoxicillin were evaluated. LC-MS/MS analyses identified 20 compounds as major gallic acid conjugates. The ZnONPs had average particle sizes of 5.5 nm (DLS) and 7.99 nm (TEM). Both OGE and Qi-ZnONPs exhibited moderate activity against . Amoxicillin and Qi-ZnONPs combinations (1:2 and 1:4 amoxicillin:/Qi-ZnONPs) significantly decreased the MIC by two-fold and four-fold, respectively, and FIC values for the combinations were more significant than with OGE alone. OGE is rich in phenolics. The synergism between Qi-ZnONPs and amoxicillin can provide an alternative safe agent of low cost to combat infections.
Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Chromatography, Liquid; Helicobacter pylori; Metal Nanoparticles; Nanoparticles; Plant Extracts; Quercus; Tandem Mass Spectrometry; Zinc Oxide
PubMed: 35889432
DOI: 10.3390/molecules27144559 -
PloS One 2022Polypharmacy may be considered as the customary practice to provide optimum care services to patients but inter resulted in augmented probability of multiple drug... (Randomized Controlled Trial)
Randomized Controlled Trial
Polypharmacy may be considered as the customary practice to provide optimum care services to patients but inter resulted in augmented probability of multiple drug interaction. Keeping in view the importance of drug interaction possibility, this study was designed to evaluate the effect of ranitidine on pharmacokinetics of amoxicillin in the local population of Karachi, Pakistan. Amoxicillin and ranitidine are the most commonly prescribed drugs to treat duodenal ulcer caused by Helicobacter pylori. The current investigation was carried out as a single center, open label, two phase, single dose, randomized way in cross over manner to evaluate the potential of pharmacokinetic interaction among amoxicillin formulation and ranitidine in adult healthy male volunteers. Post dosing blood samples were collected at multiple time points that are 0.5, 1, 1.5, 2, 3, 4, 6, 8 and 10 hours after administering amoxicillin 250mg capsule with and without ranitidine. For estimation of amoxicillin concentration in plasma, an HPLC method was developed and validated. The solvent system consisted of 0.025M phosphate buffer: acetonitrile (94:6 v/v). C18 column was employed with a flow rate of 1.0 ml/minute and at 230nm. A linear pattern with a correlation coefficient of 0.999 in the concentration ranges of 25μg/mL to 0.097μg/mL for amoxicillin and 25μg/mL to 0.048μg/mL for ranitidine was observed. Amoxicillin retention time was about 8 minutes and ranitidine retention time was around 12 minutes. Amoxicillin levels were computed and the concentrations were applied to calculate the pharmacokinetic parameters. Pharmacokinetic parameters were estimated by Kinetica TM 4.4.1 (Thermo Electron Corp. USA). The analysis of variance (two way) and t test (two one sided) were applied on log transformed pharmacokinetic parameters of amoxicillin. The Tmax was determined between amoxicillin alone and amoxicillin with ranitidine by Friedman test. The 90% confidence interval values for Cmax(calc) (0.687-0.743) and Tmax(calc) (1.148-1.742) for amoxicillin with or without ranitidine were not found within the FDA acceptable limits of 0.8-1.25. Study demonstrated the significant reduction in peak plasma levels of amoxicillin in presence of ranitidine. It is advisable to administer both drugs with time interval to avoid such interactions and increases in the bactericidal efficacy of amoxicillin.
Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Healthy Volunteers; Helicobacter Infections; Helicobacter pylori; Humans; Male; Pakistan; Ranitidine
PubMed: 35609024
DOI: 10.1371/journal.pone.0267791 -
Ecotoxicology and Environmental Safety Apr 2020Many studies have been conducted on the evaluation and monitoring of micropollutants and by-products in wastewater treatment plants. Considering the increase in the...
Many studies have been conducted on the evaluation and monitoring of micropollutants and by-products in wastewater treatment plants. Considering the increase in the production and consumption of emerging contaminants, such as drugs, personal care products, and plasticisers, it is necessary to conduct studies that support the elaboration of laws and regulations that promote the environmentally sustainable use of sludge and effluents. In this work, the biological degradation of amoxicillin was studied under two anaerobic conditions: i) using a 6 L reactor operated under semi-continuous flow; and ii) a batch system with 100 mL sealed glass syringes. According to the statistical analysis, amoxicillin was completely removed from the systems, but biogas production inhibition was observed (p < 0.05). Liquid chromatography-high-resolution mass spectrometry analysis identified amoxicillin penicilloic acid, amoxilloic acid, amoxicillin diketopiperazine and phenol hydroxypyrazine as by-products under anaerobic conditions. Ecotoxicity tests on effluent treated under the batch conditions showed that the addition of higher amounts of amoxicillin inhibited the target species Aliivibrio fischeri and Raphidocelis subcaptata, causing functional decreases of 28.5% and 22.2% when the antibiotic concentration was 2500 μg L. A. fischeri was the most sensitive organism to effluent treated under semi-continuous flow conditions; a continuous reduction in bioluminescence of up to 88.8% was observed after 39 days of feeding, which was associated with by-products accumulation due to unbalanced conditions during anaerobic digestion. Changes in the physico-chemical characteristics of the effluent caused the accumulation and removal of AMX-DKP IV and modified the toxicity to Lactuca sativa and R. subcapitata.
Topics: Aliivibrio fischeri; Amoxicillin; Anaerobiosis; Anti-Bacterial Agents; Biofuels; Ecotoxicology; Waste Disposal, Fluid; Wastewater; Water Pollutants, Chemical
PubMed: 32032860
DOI: 10.1016/j.ecoenv.2020.110207 -
Scientific Reports Nov 2019The effects of antibiotics on the intestinal flora can create potential drug-drug interactions. The combination of amoxicillin and aspirin is high and there is a high...
The effects of antibiotics on the intestinal flora can create potential drug-drug interactions. The combination of amoxicillin and aspirin is high and there is a high probability of interaction. We used 16S rRNA, incubation experiments and liquid chromatography-tandem mass spectrometry to analyze rat biological samples to characterize the effect of amoxicillin on the pharmacokinetics of aspirin metabolites. We first discovered that amoxicillin reduced the species and number of intestinal flora in rats, such as reducing the abundance of Helicobacter pylori and Prevotella_copri. After 12, 24, and 36 hours of incubation, the remaining amount of aspirin in the aspirin and amoxicillin treatment groups decreased, and salicylic acid production increased, suggesting that aspirin is metabolized by the intestinal flora, and the main metabolite is salicylic acid. As the incubation time prolonged, the reduction of aspirin and the production of salicylic acid in the amoxicillin treatment group were slower. It is indicated that the metabolic activity of aspirin through the intestinal flora is slowed down after administration of amoxicillin. The pharmacokinetic experiments showed that after administration of amoxicillin, the area under the salicylic acid curve increased by 91.38%, the peak concentration increased by 60.43%, and the clearance rate decreased by 43.55%.The results demonstrated that amoxicillin affected the pharmacokinetics of aspirin active metabolite salicylic acid by slowing down the metabolic activity of intestinal flora on aspirin. The interaction between amoxicillin and aspirin mediated by the intestinal flora may affect the efficacy of aspirin and cause more significant adverse effects.
Topics: Amoxicillin; Animals; Aspirin; Drug Interactions; Gastrointestinal Microbiome; Helicobacter pylori; Prevotella; Rats; Rats, Wistar
PubMed: 31700098
DOI: 10.1038/s41598-019-52632-5 -
The New England Journal of Medicine Jul 2020The World Health Organization (WHO) recommends oral amoxicillin for patients who have pneumonia with tachypnea, yet trial data indicate that not using amoxicillin to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The World Health Organization (WHO) recommends oral amoxicillin for patients who have pneumonia with tachypnea, yet trial data indicate that not using amoxicillin to treat this condition may be noninferior to using amoxicillin.
METHODS
We conducted a double-blind, randomized, placebo-controlled noninferiority trial involving children at primary health care centers in low-income communities in Karachi, Pakistan. Children who were 2 to 59 months of age and who met WHO criteria for nonsevere pneumonia with tachypnea were randomly assigned to a 3-day course of a suspension of amoxicillin (the active control) of 50 mg per milliliter or matched volume of placebo (the test regimen), according to WHO weight bands (500 mg every 12 hours for a weight of 4 to <10 kg, 1000 mg every 12 hours for a weight of 10 to <14 kg, or 1500 mg every 12 hours for a weight of 14 to <20 kg). The primary outcome was treatment failure during the 3-day course of amoxicillin or placebo. The prespecified noninferiority margin was 1.75 percentage points.
RESULTS
From November 9, 2014, through November 30, 2017, a total of 4002 children underwent randomization (1999 in the placebo group and 2003 in the amoxicillin group). In the per-protocol analysis, the incidence of treatment failure was 4.9% among placebo recipients (95 of 1927 children) and 2.6% among amoxicillin recipients (51 of 1929 children) (between-group difference, 2.3 percentage points; 95% confidence interval [CI], 0.9 to 3.7). Results were similar in the intention-to-treat analysis. The presence of fever and wheeze predicted treatment failure. The number needed to treat to prevent one treatment failure was 44 (95% CI, 31 to 80). One patient (<0.1%) in each group died. Relapse occurred in 40 children (2.2%) in the placebo group and in 58 children (3.1%) in the amoxicillin group.
CONCLUSIONS
Among children younger than 5 years of age with nonsevere pneumonia, the frequency of treatment failure was higher in the placebo group than in the amoxicillin group, a difference that did not meet the noninferiority margin for placebo. (Funded by the Joint Global Health Trials Scheme [of the Department for International Development, Medical Research Council, and Wellcome] and others; RETAPP ClinicalTrials.gov number, NCT02372461.).
Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Child, Preschool; Double-Blind Method; Duration of Therapy; Female; Humans; Infant; Male; Pakistan; Placebos; Pneumonia; Recurrence; Tachypnea; Treatment Failure
PubMed: 32609980
DOI: 10.1056/NEJMoa1911998 -
International Journal of Clinical... Dec 2021Background For amoxicillin-clavulanic acid and meropenem to be effective, concentrations must exceed the minimum inhibitory concentration of infecting pathogens....
Background For amoxicillin-clavulanic acid and meropenem to be effective, concentrations must exceed the minimum inhibitory concentration of infecting pathogens. Objective To retrospectively evaluate time windows between both scheduled prescription and administration and reconstitution-preparation and end of administration of intravenous amoxicillin-clavulanic acid and meropenem prescriptions. Setting 37 hospital wards at a tertiary hospital, Belgium. Method All adult hospital stays with at least one amoxicillin-clavulanic acid or meropenem administration in 2018 were reviewed. Time windows were deemed acceptable if < 30 min between prescription and administration and < 90 or < 150 min between reconstitution-preparation and end of administration for amoxicillin-clavulanic acid and meropenem, respectively. Main outcome measure Time windows between prescription and administration and between reconstitution-preparation and administration. Results For 50 273 administered prescriptions, both time windows were acceptable in 53.7% of first dose and 56.4% of follow-up dose administrations. 43.7% of first doses did not respect the time window between reconstitution-preparation and administration (2.8%) or between prescription and administration (40.9%). These discrepancies equalled 11.1% and 26.3% for follow-up doses, respectively. Large variation across hospital wards was observed. After the first five consecutive administrations, 93.1% of patients had not received their antibiotics within the time windows allowed. The most striking predictor of timely administration with respect to both prescription and reconstitution-preparation time was prescription synchronisation with nursing administration rounds. Conclusion For amoxicillin-clavulanic acid and meropenem, timeliness of reconstitution-preparation and administration was appropriate in approximately half of administrations. Evaluating and safeguarding the timeliness of antibiotic administration should be considered an important aspect of antibiotic stewardship.
Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clavulanic Acid; Humans; Meropenem; Retrospective Studies; Tertiary Care Centers
PubMed: 34138408
DOI: 10.1007/s11096-021-01297-0 -
Journal of Medical Microbiology Nov 2023is the leading cause of peptic ulcers and gastric cancer. The most common treatment regimens use combinations of two or three antibiotics and a proton pump inhibitor...
is the leading cause of peptic ulcers and gastric cancer. The most common treatment regimens use combinations of two or three antibiotics and a proton pump inhibitor (PPI) to suppress stomach acid. The World Health Organization designated clarithromycin-resistant as a high priority pathogen for drug development, due to increasing antibiotic resistance globally. There is no routine surveillance of primary antimicrobial sensitivities in the UK, and published data are lacking. This study aimed to characterize antimicrobial sensitivities of isolates collected in Nottingham, UK, between 2001 and 2018. Gastric biopsy samples were collected, with informed written consent and ethics approval, from 162 patients attending the Queen's Medical Centre in Nottingham for an upper GI tract endoscopy. Antibiotic sensitivity was assessed using E-Tests and a more cost-effective disc diffusion test. The clarithromycin, amoxicillin and levofloxacin disc diffusion tests provided identical results to E-Tests on a subset of 30 isolates. Disparities were observed in the metronidazole test results, however. In total, 241 isolates from 162 patients were tested using at least one method. Of all isolates, 28 % were resistant to clarithromycin, 62 % to metronidazole and 3 % to amoxicillin, which are used in first-line therapies. For those antibiotics used in second- and third-line therapies, 4 % were resistant to levofloxacin and none of the isolates were resistant to tetracycline. Resistance to more than one antibiotic was found in 27 % of isolates. The frequency of patients with a clarithromycin-resistant strain increased dramatically over time: from 16 % between 2001 and 2005 to 40 % between 2011 and 2018 (=0.011). For the same time periods, there was also an increase in those with a metronidazole-resistant strain (from 58 to 78 %; =0.05). The frequencies of clarithromycin and metronidazole resistance were higher in isolates from patients who had previously received eradication therapy, compared to those who had not (40 % versus 77 %, and 80 % versus 92 %, respectively). Of 79 pairs of isolates from the antrum and corpus regions of the same patient's stomach, only six had differences in their antimicrobial susceptibility profiles. Although there was high and increasing resistance to clarithromycin and metronidazole, there was no resistance to tetracycline and the frequencies of amoxicillin and levofloxacin resistance were very low.
Topics: Humans; Clarithromycin; Metronidazole; Helicobacter pylori; Levofloxacin; Helicobacter Infections; Incidence; Microbial Sensitivity Tests; Anti-Bacterial Agents; Amoxicillin; Tetracycline; Drug Resistance, Microbial; United Kingdom
PubMed: 37962209
DOI: 10.1099/jmm.0.001776 -
Biomedical Chromatography : BMC Dec 2021In the management of cystic fibrosis, treatments against Staphylococcus aureus and Haemophilus influenzae such as amoxicillin or cotrimoxazole have to be prescribed and...
In the management of cystic fibrosis, treatments against Staphylococcus aureus and Haemophilus influenzae such as amoxicillin or cotrimoxazole have to be prescribed and the antibiotherapy's efficacy may be linked to the concentration that reaches the infected site. As cystic fibrosis patients present disturbed pharmacokinetics parameters, drug monitoring would be relevant to assess the lung distribution of antibiotics and to optimize dosing regimens. In this context, the aim of the study was to develop and validate HPLC-based methods for the determination of both antibiotics in bronchial sputum from cystic fibrosis patients, in order to assess the distribution of the drugs into the lungs. Plasma proteins were precipitated by acetonitrile and amoxicillin concentrations in sputum were determined by HPLC coupled with tandem-mass spectrometry. Following liquid extraction with ethyl acetate, cotrimoxazole was quantified by HPLC using ultraviolet detection. Both methods were rapid, specific, accurate and reproducible. The method was applied to patient samples. In three treated patients, concentrations of amoxicillin in sputum were similar and below the lower limit of quantification (0.1 μg/g) and in six patients, sputum concentrations up to 11.1 and 6.4 μg/g were measured for sulfamethoxazole and trimethoprim, respectively.
Topics: Amoxicillin; Chromatography, High Pressure Liquid; Cystic Fibrosis; Drug Monitoring; Humans; Limit of Detection; Linear Models; Reproducibility of Results; Sputum; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 34212399
DOI: 10.1002/bmc.5208