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CMAJ : Canadian Medical Association... Feb 2022
Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Blister; Child, Preschool; Diagnosis, Differential; Female; Foot Dermatoses; Humans; Staphylococcal Infections; Staphylococcus aureus
PubMed: 35131755
DOI: 10.1503/cmaj.210685 -
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 -
Journal of Clinical Pharmacology Jul 2021This clinical trial was conducted to evaluate the pharmacokinetics and pharmacodynamics of tegoprazan when coadministered with amoxicillin/clarithromycin in healthy... (Randomized Controlled Trial)
Randomized Controlled Trial
This clinical trial was conducted to evaluate the pharmacokinetics and pharmacodynamics of tegoprazan when coadministered with amoxicillin/clarithromycin in healthy subjects. Cohort 1 was an open-label, randomized multiple-dose study to evaluate the mutual interaction of tegoprazan and amoxicillin/clarithromycin on the disposition of 3 tested drugs including tegoprazan M1 metabolite and 14-hydroxyclarithromycin (14-OH-clarithromycin). Cohort 2 was an open-label, randomized, active-controlled, parallel multiple-dose study to compare the intragastric pH profile after multiple oral doses of 50 or 100 mg tegoprazan coadministered with amoxicillin/clarithromycin 1000/500 mg for 7 days and pantoprazole-based triple therapy as the comparator arm. The coadministration of tegoprazan with amoxicillin/clarithromycin increased C (2.2-fold) and AUC (2.7-fold) of tegoprazan and M1 (2.1- and 2.2-fold for C and AUC , respectively) compared with administration of tegoprazan alone. The C and AUC of 14-OH-clarithromycin increased by 1.7- and 1.8-fold, respectively; the disposition of amoxicillin and clarithromycin were not significantly changed. On days 1 and 7 of treatment, tegoprazan-based therapies (both 50- and 100-mg therapies) maintained pH above 6 for more than 88% of the 24-hour period, which was significantly longer compared with pantoprazole-based therapy. Tegoprazan either alone or in combination with amoxicillin/clarithromycin was well tolerated in healthy subjects. In conclusion, the exposure of tegoprazan was increased after coadministration of amoxicillin/clarithromycin, which led to increase pharmacodynamic response measured by intragastric pH compared with tegoprazan alone. Therefore, tegoprazan-based triple therapy would be effective therapeutic regimen to manage intragastric pH in terms of gastric or duodenal ulcers healing, treatment of gastroesophageal reflux disease, and Helicobacter pylori eradication.
Topics: Adult; Amoxicillin; Area Under Curve; Benzene Derivatives; Clarithromycin; Dose-Response Relationship, Drug; Drug Combinations; Gastrointestinal Agents; Healthy Volunteers; Humans; Hydrogen-Ion Concentration; Imidazoles; Male; Metabolic Clearance Rate; Middle Aged
PubMed: 33341955
DOI: 10.1002/jcph.1805 -
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 -
Benchmarking of Outpatient Pediatric Antibiotic Prescribing: Results of a Multicenter Collaborative.Journal of the Pediatric Infectious... Jun 2023Most antibiotic use occurs in ambulatory settings. No benchmarks exist for pediatric institutions to assess their outpatient antibiotic use and compare prescribing rates...
BACKGROUND
Most antibiotic use occurs in ambulatory settings. No benchmarks exist for pediatric institutions to assess their outpatient antibiotic use and compare prescribing rates to peers. We aimed to share pediatric outpatient antibiotic use reports and benchmarking metrics nationally.
METHODS
We invited institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient (SHARPS-OP) Collaborative to contribute quarterly aggregate reports on antibiotic use from January 2019 to June 2022. Outpatient settings included emergency departments (ED), urgent care centers (UCC), primary care clinics (PCC) and telehealth encounters. Benchmarking metrics included the percentage of: (1) all acute encounters resulting in antibiotic prescriptions; (2) acute respiratory infection (ARI) encounters resulting in antibiotic prescriptions; and among ARI encounters receiving antibiotics, (3) the percentage receiving amoxicillin ("Amoxicillin index"); and (4) the percentage receiving azithromycin ("Azithromycin index"). We collected rates of antibiotic prescriptions with durations ≤7 days and >10 days from institutions able to provide validated duration data.
RESULTS
Twenty-one institutions submitted aggregate reports. Percent ARI encounters receiving antibiotics were highest in the UCC (40.2%), and lowest in telehealth (19.1%). Amoxicillin index was highest for the ED (76.2%), and lowest for telehealth (55.8%), while the azithromycin index was similar for ED, UCC, and PCC (3.8%, 3.7%, and 5.0% respectively). Antibiotic duration of ≤7 days varied substantially (46.4% for ED, 27.8% UCC, 23.7% telehealth, and 16.4% PCC).
CONCLUSIONS
We developed a benchmarking platform for key pediatric outpatient antibiotic use metrics drawing data from multiple pediatric institutions nationally. These data may serve as a baseline measurement for future improvement work.
Topics: Humans; Child; Anti-Bacterial Agents; Azithromycin; Benchmarking; Outpatients; Practice Patterns, Physicians'; Amoxicillin; Respiratory Tract Infections; Inappropriate Prescribing
PubMed: 37262431
DOI: 10.1093/jpids/piad039 -
Frontiers in Immunology 2022We previously reported that vonoprazan-amoxicillin (VA) dual therapy for 7 or 10 days is not satisfactorily efficacious for () eradication. We aimed to explore the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND AIM
We previously reported that vonoprazan-amoxicillin (VA) dual therapy for 7 or 10 days is not satisfactorily efficacious for () eradication. We aimed to explore the efficacy of VA dual therapy for 14 days as a first-line treatment for infection.
METHODS
This was a single center, prospective, open-labeled, randomized non-inferiority clinical study conducted in China. Treatment naïve infected patients were randomized into two groups: 20 mg vonoprazan (VPZ) b.i.d. in combination with low-dose (1000 mg b.i.d.) or high-dose (1000 mg t.i.d) amoxicillin for 14 days. C-urea breath tests were used to access the cure rate at least 4 weeks after treatment.
RESULTS
A total of 154 patients were assessed and 110 subjects were randomized. The eradication rate of VPZ with b.i.d. amoxicillin or t.i.d. amoxicillin for 14 days was 89.1% and 87.3% by intention-to-treat analysis, respectively, and 94.1% and 95.9% by per-protocol analysis, respectively. The eradication rate and incidence of adverse events were not different between the two groups.
CONCLUSION
VPZ with b.i.d. or t.i.d. amoxicillin for 14 days provides satisfactory efficacy as a first-line treatment for infection in China.
Topics: Humans; Amoxicillin; Anti-Bacterial Agents; Clarithromycin; Helicobacter Infections; Helicobacter pylori; Prospective Studies; Proton Pump Inhibitors
PubMed: 36726990
DOI: 10.3389/fimmu.2022.1049908 -
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 -
European Journal of Medical Research Aug 2023To evaluate the efficacy and safety of vonoprazan-amoxicillin (VA) dual therapy for radically eradicating Helicobacter pylori (H. pylori). (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the efficacy and safety of vonoprazan-amoxicillin (VA) dual therapy for radically eradicating Helicobacter pylori (H. pylori).
METHODS
The PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched up to July 7, 2022, to identify clinical trials comparing the efficacy of VA dual therapy and triple therapy for H. pylori eradication. After evaluating the quality of the included studies, random effects models were conducted, and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to estimate the efficacy and safety of each approach.
RESULTS
Six publications (including four randomized controlled trials) involving 2019 patients were included in this meta-analysis. Overall, the eradication rate for VA dual therapy was 89.9%, while it was 85.2% for triple therapy based on other acid inhibitors. The eradication rate of H. pylori in the VA dual regimen group was higher than that in the PPI-based (omeprazole or lansoprazole) triple therapy group (RR = 1.15, 95% CI 1.07-1.23, p < 0.0001). However, the efficacy of VA dual therapy was comparable with VA-Clarithromycin (VAC) triple therapy (RR = 0.97, 95% CI 0.93-1.02). Besides, the incidence of adverse reactions in VA dual therapy was also lower than that in triple therapy (RR = 0.80, 95% CI 0.70-0.91, p = 0.0009).
CONCLUSION
Compared with PPI-based triple therapy, VA dual therapy showed a better therapeutic effect, safety and patient compliance rate for eradicating H. pylori, which should be used as a novel curative strategy in the future.
Topics: Humans; Amoxicillin; Helicobacter pylori; Anti-Bacterial Agents; Helicobacter Infections; Proton Pump Inhibitors; Drug Therapy, Combination; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37550781
DOI: 10.1186/s40001-023-01249-6 -
Minerva Pediatrics Apr 2023Black tongue (BT) is a benign, self-limiting black discoloration of the lingual mucosa due to different factors. Only a few pediatric cases of BT related to drug intake... (Review)
Review
Black tongue (BT) is a benign, self-limiting black discoloration of the lingual mucosa due to different factors. Only a few pediatric cases of BT related to drug intake are described. We report a child with BT developed after amoxicillin/clavulanic acid intake and also made a review of the pediatric cases of black tongue reported in literature after drugs. The child underwent allergy work-up with in-vivo and in-vitro tests, showing a positive lymphocyte transformation test (LTT) for amoxicillin and amoxicillin/clavulanic acid. For the first time, BT was proved to be a hypersensitivity reaction to drugs, suggesting a possible role of a T-cell mediated mechanism. Even if already reported as a mild side effect, according to our results, allergy investigations are essential to make a confident diagnosis and to give further indications to patients about the discontinuation of the culprit drug.
Topics: Humans; Child; Skin Tests; Immunoglobulin E; Drug Hypersensitivity; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Hypersensitivity
PubMed: 36322020
DOI: 10.23736/S2724-5276.22.07044-6