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The Journal of Antimicrobial... May 2020Staphylococcus lugdunensis belongs to the CoNS group, but is regarded to be more virulent than most other CoNS. It is also remarkably susceptible to antibiotics,...
BACKGROUND
Staphylococcus lugdunensis belongs to the CoNS group, but is regarded to be more virulent than most other CoNS. It is also remarkably susceptible to antibiotics, including penicillin G.
OBJECTIVES
To evaluate different methods for penicillin susceptibility testing, to assess penicillin susceptibility rates among S. lugdunensis and to describe the clinical presentation including antibiotic treatment.
METHODS
Clinical isolates of S. lugdunensis were tested for penicillin susceptibility using disc diffusion according to CLSI (10 U disc) and EUCAST (1 U disc), assessment of zone-edge appearance, nitrocefin test and Etest for MIC determination. PCR of the blaZ gene was used as a reference method.
RESULTS
Of the 112 isolates included in the study, 67% were susceptible to penicillin G according to blaZ PCR. The EUCAST disc diffusion test had 100% sensitivity, whereas the CLSI method had one very major error with a false-susceptible isolate. When zone-edge appearance was included in the assessment, the false-susceptible isolate was correctly classified as resistant. Foreign-body infection was the most common focus of infection, affecting 49% of the participants. Only 4% of the patients were treated with penicillin G.
CONCLUSIONS
Penicillin susceptibility is common in S. lugdunensis and the disc diffusion method according to EUCAST had a higher sensitivity than that of CLSI. Assessment of zone-edge appearance could increase the sensitivity of the disc diffusion test. Penicillin susceptibility testing and treatment should be considered in S. lugdunensis infections.
Topics: Anti-Bacterial Agents; Disk Diffusion Antimicrobial Tests; Humans; Microbial Sensitivity Tests; Penicillin G; Penicillins; Staphylococcus lugdunensis
PubMed: 32016343
DOI: 10.1093/jac/dkaa004 -
The Journal of Antimicrobial... Sep 2023Pharmacokinetic (PK) data underlying paediatric penicillin dosing remain limited, especially in critical care.
The Neonatal and Paediatric Pharmacokinetics of Antimicrobials study (NAPPA): investigating amoxicillin, benzylpenicillin, flucloxacillin and piperacillin pharmacokinetics from birth to adolescence.
BACKGROUND
Pharmacokinetic (PK) data underlying paediatric penicillin dosing remain limited, especially in critical care.
OBJECTIVES
The primary objective of the Neonatal and Paediatric Pharmacokinetics of Antimicrobials study (NAPPA) was to characterize PK profiles of commonly used penicillins using data obtained during routine care, to further understanding of PK variability and inform future evidence-based dosing.
METHODS
NAPPA was a multicentre study of amoxicillin, co-amoxiclav, benzylpenicillin, flucloxacillin and piperacillin/tazobactam. Patients were recruited with informed consent. Antibiotic dosing followed standard of care. PK samples were obtained opportunistically or at optimal times, frozen and analysed using UPLC with tandem MS. Pharmacometric analysis was undertaken using NONMEM software (v7.3). Model-based simulations (n = 10 000) tested PTA with British National Formulary for Children (BNFC) and WHO dosing. The study had ethical approval.
RESULTS
For the combined IV PK model, 963 PK samples from 370 participants were analysed simultaneously incorporating amoxicillin, benzylpenicillin, flucloxacillin and piperacillin data. BNFC high-dose regimen simulations gave these PTA results (median fT>MIC at breakpoints of specified pathogens): amoxicillin 100% (Streptococcus pneumoniae); benzylpenicillin 100% (Group B Streptococcus); flucloxacillin 48% (MSSA); and piperacillin 100% (Pseudomonas aeruginosa). Oral population PK models for flucloxacillin and amoxicillin enabled estimation of first-order absorption rate constants (1.16 h-1 and 1.3 h-1) and bioavailability terms (62.7% and 58.7%, respectively).
CONCLUSIONS
NAPPA represents, to our knowledge, the largest prospective combined paediatric penicillin PK study undertaken to date, and the first paediatric flucloxacillin oral PK model. The PTA results provide evidence supportive of BNFC high-dose IV regimens for amoxicillin, benzylpenicillin and piperacillin.
Topics: Infant, Newborn; Humans; Child; Adolescent; Piperacillin; Floxacillin; Amoxicillin; Prospective Studies; Anti-Bacterial Agents; Penicillins; Microbial Sensitivity Tests
PubMed: 37531085
DOI: 10.1093/jac/dkad196 -
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 -
BMC Cardiovascular Disorders Feb 2022Ethiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary...
BACKGROUND
Ethiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This study describes the status of secondary RHD prevention.
METHODS
A multicenter, prospective study was performed on children aged 5-17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and ARF recurrence were evaluated.
RESULTS
A total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence.
CONCLUSION
Poor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence.
Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Child; Child, Preschool; Ethiopia; Female; Humans; Male; Medication Adherence; Penicillin G Benzathine; Prevalence; Prospective Studies; Recurrence; Rheumatic Heart Disease; Risk Assessment; Risk Factors; Secondary Prevention; Time Factors; Treatment Outcome
PubMed: 35109807
DOI: 10.1186/s12872-022-02473-4 -
Environmental Pollution (Barking, Essex... Dec 2022β-lactams are large group of antibiotics widely used to suppress the bacterial growth by inhibiting cell wall synthesis. Bacterial resistance against β-lactam...
Computational and data mining studies to understand the distribution and dynamics of Temoneria (TEM) β-lactamase and their interaction with β-lactam and β-lactamase inhibitors.
β-lactams are large group of antibiotics widely used to suppress the bacterial growth by inhibiting cell wall synthesis. Bacterial resistance against β-lactam antibiotics is primarily mediated through the production of Temoneria (TEM) β-lactamase (BLs), with almost 474 variants identified in Lactamase Engineering Database (LacED). The present study aims to develop a model to track the evolution of TEM BLs and their interactions with β-lactam and BLs inhibitors through data mining and computational approaches. Further, the model will be used to predict the effective combinations of β-lactam and BLs inhibitors to treat the bacterial infection harbouring emerging variants of β-lactamase. The molecular docking study results demonstrated that most TEM mutants recorded the least binding energy to penicillin and cephalosporin (I/II/III/IV/V generations) class of antibiotics. On the contrary, the same mutants recorded higher binding energy to carbapenem and Monobactam class of antibiotics. Among the BLs inhibitors, tazobactam recorded the least binding energy against most of the TEM mutants, indicating that it can lower the catalytic activity of TEM BLs, thereby potentiating antibiotic action. Similarly, data mining work has assisted us in creating a database of TEM mutants that has comprehensive data on mutations, bacterial diversity, Km, MIC, and IRT types. It has been noted that earlier released antibiotics like amoxicillin and ampicillin had lower Km and higher MIC values, which indicates the prevalence of bacterial resistance. By analysing the differential binding energy (ΔBE) of the selected TEM mutants against β-lactam and BLs inhibitors, the most effective combination of β-lactam (carbapenem and monobactam class of antibiotics) and BLs inhibitors (tazobactam) was identified, to cure bacterial diseases/infections and to prevent similar antibiotic resistance outbreaks. Therefore, our study opens a new avenue in developing strategies to manage antibiotic resistance in bacteria.
Topics: beta-Lactamase Inhibitors; beta-Lactams; beta-Lactamases; Molecular Docking Simulation; Penicillins; Cephalosporins; Anti-Bacterial Agents; Tazobactam; Ampicillin; Amoxicillin; Monobactams; Carbapenems; Data Mining
PubMed: 36180000
DOI: 10.1016/j.envpol.2022.120289 -
Journal of Endodontics Mar 2024Enterococcus faecalis is the most common enterococcal species associated with infective endocarditis and 1 of the most commonly detected bacteria in cases of... (Review)
Review
Antibiotic Resistance Profile of Clinical Strains of Enterococci from Secondary/Persistent Endodontic Infections: What do We Know? A Systematic Review of Clinical Studies.
INTRODUCTION
Enterococcus faecalis is the most common enterococcal species associated with infective endocarditis and 1 of the most commonly detected bacteria in cases of secondary/persistent endodontic infection (SPEI). Antimicrobial resistance is a global public health concern. This review aimed to answer the following research question: "Is there a change in the antibiotic resistance profile in clinical strains of E. faecalis over the years?". P (population) - patients with SPEI, I (intervention) -endodontic retreatment, C (comparison) -not included, O (outcome) - profile of Enterococci resistance and susceptibility to systemic antibiotics used.
METHODS
Two authors independently performed study selection, data extraction, and risk of bias assessment. The literature search was conducted using the following electronic databases: PubMed, Scopus, EMBASE, Web of Science, and Medline. Clinical studies in which Enterococci strains were isolated to assess their antimicrobial resistance were included.
RESULTS
Eleven clinical trials were included. Overall, E. faecalis isolated from teeth with SPEI presented an intermediate resistance to 16 antibiotics. In recent years, E. faecalis showed a little resistance to amoxicillin (without clavulanate) and benzylpenicillin. Erythromycin and rifampicin presented an increase in the intermediate-resistance status between the first and the last studies. E. faecium presented intermediate-resistance results.
CONCLUSION
The most effective drugs remain the combination of amoxicillin and clavulanate, followed by amoxicillin and benzylpenicillin. In patients allergic to penicillin derivatives, moxifloxacin and azithromycin may be indicated with caution. The antibiotics with the highest pattern of resistance against E. faecalis are clindamycin, gentamicin, metronidazole, and rifampicin and are therefore, contraindicated in cases of SPEI. Very few clinical studies using a microbiological approach in teeth with endodontic failure have been carried out to improve the efficacy of prophylactic regimens. However, as bacteria periodically develop resistance to the main drugs used, regular studies should be carried out on the action of these drugs in infection control.
Topics: Humans; Enterococcus; Rifampin; Anti-Bacterial Agents; Amoxicillin; Enterococcus faecalis; Penicillin G; Drug Resistance, Microbial; Clavulanic Acid; Microbial Sensitivity Tests; Enterococcus faecium
PubMed: 38171449
DOI: 10.1016/j.joen.2023.12.007 -
Environmental Science and Pollution... Dec 2022Farms utilizing sewage sludge and manure in their agronomic plant production are recognized as potential hotspots for environmental release of antibiotics and the...
Farms utilizing sewage sludge and manure in their agronomic plant production are recognized as potential hotspots for environmental release of antibiotics and the resulting promotion of antibiotic resistance. As part of the circular economy, the use of biogas digestates for soil fertilizing is steadily increasing, but their potential contribution to the spreading of pharmaceutical residues is largely unknown. Digestates can be produced from a variety of biowaste resources, including sewage sludge, manure, food waste, and fish ensilage. We developed a method for the detection of 17 antibiotics and 2 steroid hormones and applied the method to detect pharmaceutical residues in digestates from most municipal biogas plants in Norway, covering a variety of feedstocks. The detection frequency and measured levels were overall low for most compounds, except a few incidents which cause concern. Specifically, relatively high levels of amoxicillin, penicillin G, ciprofloxacin, and prednisolone were detected in different digestates. Further, ipronidazole was detected in four digestates, although no commercial pharmaceutical products containing ipronidazole are currently registered in Norway. A simplified risk assessment showed a high risk for soil microorganisms and indicates the tendency for antibiotic-resistant bacteria for penicillin G and amoxicillin. For prednisolone and ipronidazole; however, no toxicity data is available for reliable risk assessments.
Topics: Animals; Biofuels; Manure; Sewage; Anti-Bacterial Agents; Food; Ipronidazole; Refuse Disposal; Soil; Steroids; Amoxicillin; Prednisolone; Pharmaceutical Preparations; Anaerobiosis
PubMed: 35796924
DOI: 10.1007/s11356-022-21479-1 -
The Journal of Pediatrics Aug 2021
Topics: Adolescent; Anti-Bacterial Agents; Humans; Injections; Male; Nephrotic Syndrome; Penicillin G; Syphilis
PubMed: 33862026
DOI: 10.1016/j.jpeds.2021.04.009 -
Journal of Dental Research Sep 2019Dentists prescribe a large portion of all oral antibiotics, and these are associated with a risk of adverse drug reactions (ADRs). The aim of this study was to quantify...
Dentists prescribe a large portion of all oral antibiotics, and these are associated with a risk of adverse drug reactions (ADRs). The aim of this study was to quantify the risk of ADRs associated with oral antibiotics commonly prescribed by dentists. NHS Digital Prescribing data and Yellow Card Drug Analysis data for 2010 to 2017 were abstracted to quantify dental antibiotic prescribing in England, and the rate and types of ADRs associated with them. During the period of study, the mean number of actively practicing dentists in England was 23,624. Amoxicillin accounted for 64.8% of dental antibiotic prescribing and had the lowest reported rate of fatal ADRs (0.1/million prescriptions) and overall ADRs (21.5/million prescriptions). Indeed, amoxicillin was respectively 6 and 3 times less likely to cause an ADR than the other penicillins, penicillin V and amoxicillin + clavulanic acid, and appears to be very safe in patients with no history of penicillin allergy. In contrast, clindamycin, which is often used in patients with penicillin allergy, had the highest rate of fatal (2.9/million prescriptions) and overall (337.3/million prescriptions) ADRs, with (formerly ) infections pivotal to its ADR profile. Other amoxicillin alternatives, clarithromycin and metronidazole, while significantly worse than amoxicillin, were 3 and nearly 5 times less likely to cause an ADR than clindamycin. Ranked from least to most likely to cause an ADR, antibiotics most commonly prescribed were as follows: amoxicillin < cephalosporins < erythromycin < tetracyclines < azithromycin < metronidazole < amoxicillin + clavulanic acid < clarithromycin < penicillin V < clindamycin. This study confirmed the high level of safety associated with use of amoxicillin by dentists and the significantly worse rates of fatal and nonfatal ADRs associated with other penicillins and alternatives to amoxicillin for those who are penicillin allergic. In particular, clindamycin had the highest rate of fatal and nonfatal ADRs of any of the antibiotics commonly prescribed by dentists.
Topics: Administration, Oral; Adverse Drug Reaction Reporting Systems; Amoxicillin; Anti-Bacterial Agents; Clarithromycin; Clindamycin; Dentists; England; Humans; Metronidazole; Penicillins
PubMed: 31314998
DOI: 10.1177/0022034519863645 -
Journal of Advanced Nursing May 2021The aim of this study was to determine the effect of using three-dimensional videos with virtual reality glasses and distraction cards including optical illusion... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this study was to determine the effect of using three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures on patients' pain and satisfaction levels during intramuscular benzathine penicillin injection.
DESIGN
A randomized controlled trial.
METHOD
The study population consisted of 91 patients who were prescribed intramuscular benzathine penicillin medication. The participants were stratified by gender and assigned to three groups (control, virtual reality and distraction cards groups). The visual analogue scale was used to assess pain and patient satisfaction. A one-way analysis of variance and Dunnett's post hoc tests were used to compare the pain and satisfaction levels by group.
RESULTS
The mean pain was 6.67 (2.17) in the control group, 4.4 (2.71) in the distraction cards group and 4.93 (3.07) in the virtual reality group and the difference was statistically significant (F = 5.84, p ˂ .01). The average of the satisfaction levels in the groups was 3.57 (2.23) in the control group, 7.13 (2.86) in the distraction cards group and 8.07 (2.55) in the virtual reality group. The difference between the satisfaction levels was statistically significant (F = 25.77, p ˂ .01).
CONCLUSION
The three-dimensional videos with virtual reality glasses and distraction cards including optical illusion pictures were effective in reducing pain associated with intramuscular benzathine penicillin injection and increasing patient satisfaction.
IMPACT
The results of this study will contribute to evidence-based nursing practices for the pain associated with intramuscular benzathine penicillin injection.
CLINICAL TRIAL REGISTRY
NCT04420559.
Topics: Adult; Humans; Injections, Intramuscular; Pain; Pain Management; Penicillin G Benzathine; Virtual Reality
PubMed: 33608955
DOI: 10.1111/jan.14782