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Acta Gastro-enterologica Belgica 2022An 18 mth old boy was sent to the Emergency Room of the Jessa Hospital (Hasselt, Belgium) because of persistent vomiting. The clinical examination was without...
CASE REPORT
An 18 mth old boy was sent to the Emergency Room of the Jessa Hospital (Hasselt, Belgium) because of persistent vomiting. The clinical examination was without particularities, except for a runny nose. The diagnosis of indigestion or (viral) gastritis was made. Patient was sent home. He was represented at the ER five days later. He stopped vomiting for 3 consecutive days after his first hospital visit, but started to vomit again the last 2 days, the last night even two times with bilious vomiting. His appetite was decreased since one week. The infant was not comfortable during abdominal palpation. This finding led to the decision for further investigations. An abdominal ultrasound showed air superposition in the epi- and mesogastrium. There were no signs of intussusception. An abdominal X-ray was performed (fig 1).
ANSWER AND DISCUSSION
The abdominal X-ray showed a corpus alienum, presumably magnets, in the mesogastrium and free air under the right diaphragm (fig. 1). An abdominal CT-scan could not visualise whether the magnets were situated in- or outside the intestinal lumen. At laparoscopy, clitted small intestinal loops with multiple perforation sites were detected as well as a purulent peritonitis in the left fossa iliaca (fig. 2). Magnets were removed. Perforations were sutured. Postoperatively augmentin was given. Patient recovered completly. can attract each other through the intestinal wall, get stuck and pinch the digestive tract causing major and sometimes life-threatening intestinal perforation (1). Endoscopical or surgical removal can be performed, based on location and complications (2,3).
Topics: Amoxicillin-Potassium Clavulanate Combination; Dyspepsia; Gastritis; Humans; Intestinal Perforation; Male; Vomiting
PubMed: 36198301
DOI: 10.51821/85.3.10286 -
Journal of Veterinary Internal Medicine Mar 2021Little is known about effects of factors such as kidney disease, affecting ampicillin pharmacokinetics in dogs.
BACKGROUND
Little is known about effects of factors such as kidney disease, affecting ampicillin pharmacokinetics in dogs.
OBJECTIVES
Determine the pharmacokinetics of ampicillin after a single intravenous dose in healthy and azotemic dogs.
ANIMALS
Nine dogs presenting with acute kidney injury and 10 healthy dogs.
METHODS
This was a prospective study. An ampicillin dose of 22.2 mg/kg (mean dose) was administered once intravenously. Blood samples were obtained at timed intervals (just before administration, 1, 2, 4, 12, and 24 hours), analyzed using high-pressure liquid chromatography followed by pharmacokinetic analysis of the plasma drug concentrations.
RESULTS
Peak ampicillin concentration (mcg/mL; 97.07 (36.1) vs 21.3 (50.26)), P<.001 (geometric mean (coefficient of variation, CV%)), half-life (hours; 5.86 (56.55) vs 0.97 (115.3)), P<.001) and AUC (h × mcg/mL; 731.04 (83.75) vs 33.57 (53.68)), P<.001) were greater in azotemic dogs than in healthy dogs. Azotemic dogs also had significantly lower clearance (30.06 (84.19) vs 655.03 (53.67); mL/kg h, P < .001) and volume of distribution (253.95 (30.14) vs 916.93 (135.24); mL/kg, P <.001) compared to healthy dogs.
CONCLUSION AND CLINICAL IMPORTANCE
Increased drug concentrations and slower clearance of ampicillin in azotemic dogs could have clinical importance in contributing to antibiotic associated morbidity requiring indicating the need to adjust ampicillin dosing in dogs with decreased kidney function.
Topics: Administration, Oral; Ampicillin; Animals; Anti-Bacterial Agents; Area Under Curve; Chromatography, High Pressure Liquid; Dogs; Half-Life; Prospective Studies
PubMed: 33474795
DOI: 10.1111/jvim.16026 -
Comparative Medicine Jun 2021Over the last decade, interest in the role of the microbiome in health and disease has increased. The use of germ-free animals and depletion of the microbial flora using...
Over the last decade, interest in the role of the microbiome in health and disease has increased. The use of germ-free animals and depletion of the microbial flora using antimicrobials are 2 methods commonly used to study the microbiome in laboratory mice. Germ-free mice are born, raised, and studied in isolators in the absence of any known microbes; however, the equipment, supplies, and training required for the use of these mice can be costly and time-consuming. The use of antibiotics to decrease the microbial flora does not require special equipment, can be used for any mouse strain, and is relatively inexpensive; however, mice treated in this manner still retain microbes and they do not live in a germ-free environment. One commonly used antibiotic cocktail regimen uses ampicillin, neomycin, metronidazole, and vancomycin in the drinking water for 2 to 4 wk. We found that the palatability of this mixture is low, resulting in weight loss and leading to removal of mice from the study. The addition of sucralose to the medicated water and making wet food (mash) with the medicated water improved intake; however, the low palatability still resulted in a high number of mice requiring removal. The current study evaluated a new combination of antibiotics designed to reduce the gut microbiota while maintaining body weights. C57BL/6NCrl mice were placed on one of the following drinking water regimens: ampicillin/neomycin/metronidazole/vancomycin water ( = 16), enrofloxacin/ampicillin water ( = 12), or standard reverse osmosis deionized water (RODI) ( = 11). During an 8 day regimen, mice were weighed and water consumption was measured. Feces were collected before and after 8 d of treatment. Quantitative real-time PCR (real-time qPCR) for 16S bacterial ribosome was performed on each sample, and values were compared among groups. The combination of enrofloxacin and ampicillin improved water intake, together with a greater reduction in gut flora.
Topics: Ampicillin; Animals; Anti-Bacterial Agents; Feces; Female; Gastrointestinal Microbiome; Mice; Mice, Inbred C57BL
PubMed: 34088363
DOI: 10.30802/AALAS-CM-21-000023 -
BMC Infectious Diseases Oct 2021Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically...
BACKGROUND
Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically significant hypersensitivity. Few patients undergo evaluation, which leads to overuse of broad-spectrum antibiotics. The objective of this study was to monitor prevalence and implement screening and testing of hospitalized patients.
METHODS
All patients admitted to the medical department in a local hospital in Oslo, Norway, with a self-reported penicillin allergy were screened using an interview algorithm to categorize the reported allergy as high-risk or low-risk. Patients with a history of low-risk allergy underwent a direct graded oral amoxicillin challenge to verify absence of a true IgE-type allergy.
RESULTS
257 of 5529 inpatients (4.6%) reported a penicillin allergy. 191 (74%) of these patients underwent screening, of which 86 (45%) had an allergy categorized as low-risk. 54 (63%) of the low-risk patients consented to an oral test. 98% of these did not have an immediate reaction to the amoxicillin challenge, and their penicillin allergy label could thus be removed. 42% of the patients under treatment with antibiotics during inclusion could switch to treatment with penicillins immediately after testing, in line with the national recommendations for antibiotic use.
CONCLUSIONS
The prevalence of self-reported penicillin allergy was lower in this Norwegian population, than reported in other studies. Screening and testing of hospitalized patients with self-reported penicillin allergy is a feasible and easy measure to de-label a large proportion of patients, resulting in immediate clinical and environmental benefit. Our findings suggest that non-allergist physicians can safely undertake clinically impactful allergy evaluations.
Topics: Amoxicillin; Drug Hypersensitivity; Humans; Penicillins; Pilot Projects; Skin Tests
PubMed: 34670500
DOI: 10.1186/s12879-021-06794-1 -
The Journal of Antimicrobial... Nov 2022
Topics: Infant; Infant, Newborn; Humans; Mezlocillin; Bacterial Infections; Kinetics
PubMed: 36101504
DOI: 10.1093/jac/dkac305 -
The Pan African Medical Journal 2023inappropriate use of antimicrobials is a cause for concern and contributes to the global antimicrobial resistance crises especially in Africa. This review aims to... (Review)
Review
INTRODUCTION
inappropriate use of antimicrobials is a cause for concern and contributes to the global antimicrobial resistance crises especially in Africa. This review aims to summarize the available evidence on the point prevalence and pattern of antimicrobial and/or antibiotic prescription in Africa.
METHODS
this review was carried out between April and September 2021 and identified published studies up until March 2021 on the point prevalence of antibiotic and/or antimicrobial use in Africa. Sources searched were OVID, PubMed, EMBASE, CINAHL, Web of Science, Google Scholar, Google, and African Journal Online (AJOL). Observational studies that reported prevalence published in English language were included. Covidence systematic review software was used for this review. A form for data extraction using domains culled from the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) was developed on Covidence. Screening of studies for eligibility was done independently by two reviewers. Critical Appraisal tool for use in Joanna Briggs Institute (JBI) Systematic Reviews for prevalence studies was used for quality appraisal.
RESULTS
a total of 17 studies that met the inclusion criteria were included in the review. The overall prevalence of antimicrobial/antibiotic use among inpatients in these studies ranged from 40.7% to 97.6%. The median antimicrobial/antibiotic use was 61.3 [IQR= 45.5-72.1]. The highest use of antimicrobials was reported among studies from Nigeria with a prevalence of 97.6%. The most prescribed antibiotics were the beta-lactam penicillin (Amoxicillin, clavulanic acid) (86.9%), and third generation cephalosporins (55.0%). There was general preference for parenteral route of administration of the antimicrobial agents (40-70%). Use for community acquired infections (28.0-79.5%) was the main reason for use. Majority of the prophylactic use of antimicrobial agents were for surgical prophylaxis. the high prevalence of antimicrobial use in Africa reinforces the need for continued surveillance and concerted efforts to institutionalize and support antimicrobial stewardship for prescribers in health institutions in the African region.
Topics: Humans; Prevalence; Anti-Infective Agents; Anti-Bacterial Agents; Nigeria; Amoxicillin
PubMed: 37637407
DOI: 10.11604/pamj.2023.45.67.36191 -
The Journal of Applied Laboratory... Sep 2021The class of antibiotics known as β-lactams are a commonly used due to their effectiveness and safety. Therapeutic drug monitoring has been proposed but requires an...
BACKGROUND
The class of antibiotics known as β-lactams are a commonly used due to their effectiveness and safety. Therapeutic drug monitoring has been proposed but requires an accurate assay along with well-characterized preanalytic stability, as β-lactams are known to be relatively unstable.
METHODS
A high-throughput LC-MS/MS assay validation and stability study was performed for cefepime, meropenem, and piperacillin and tazobactam in serum. Patient samples, standards, and QCs were crashed with acetonitrile containing internal standard. Following centrifugation, an aliquot of the supernatant was diluted with clinical laboratory reagent water and analyzed by LC-MS/MS.
RESULTS
The assay showed linearity between 0.5 and 60 µg/mL for each analyte. The intra- and interassay reproducibility at 3 different concentrations (approximately 2, 25, and 40 µg/mL) was <5% for each analyte. Accuracy studies for each analyte were compared using linear regression and demonstrated: slope = 1.0 ± 0.1; r2 ≥ 0.980; and y intercept 95% CI that included zero. Minimal ion suppression or enhancement was observed, and no significant carryover was observed up to 500 µg/mL of each analyte. Stability studies demonstrated significant loss in serum for each analyte at ambient and refrigerated temperatures (2-8 °C) and at -20 °C over days or weeks. In contrast, when stored at -80 °C, no significant loss was observed.
CONCLUSIONS
The LC-MS/MS assay showed acceptable performance characteristics for quantitation of β-lactams. With well-characterized stability, this assay can be used with residual specimens for pharmacokinetic modeling, which may lead to individualized dosing and improved patient care.
Topics: Cefepime; Chromatography, Liquid; Humans; Meropenem; Piperacillin; Reproducibility of Results; Tandem Mass Spectrometry; Tazobactam
PubMed: 34086904
DOI: 10.1093/jalm/jfab036 -
Journal of Biological Inorganic... Dec 2022Determination of the toxicity of compounds toward cancer cells is a frequent procedure in drug discovery. For metal complexes, which are often reactive prodrugs, care...
Determination of the toxicity of compounds toward cancer cells is a frequent procedure in drug discovery. For metal complexes, which are often reactive prodrugs, care has to be taken to consider reactions with components of the cell culture medium that might change the speciation of the metal complex before it is taken up by the cells. Here, we consider possible reactions between the clinical platinum drugs cisplatin and oxaliplatin with penicillin G, an antibiotic added routinely to cell culture media to prevent bacterial contamination. Platinum has a high affinity for ligands with sulfur donors. Penicillin G is an unstable thioether that degrades in a range of pathways. Nuclear magnetic resonance (NMR) and UV-Vis absorption spectroscopic studies show that reactions with cisplatin can occur within minutes to hours at 310 K, but more slowly with oxaliplatin. The identities of the Pt- adducts were investigated by mass spectrometry. The marked effect on cytotoxicity of co-incubation of cisplatin with penicillin G was demonstrated for the HeLa human cervical cancer cell line. These studies highlight the possibility that reactions with penicillin G might influence the cytotoxic activity of metal complexes determined in culture media.
Topics: Humans; Cisplatin; Oxaliplatin; Platinum; Coordination Complexes; Organoplatinum Compounds; Antineoplastic Agents; Penicillin G
PubMed: 36153767
DOI: 10.1007/s00775-022-01958-z -
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 -
Saudi Journal of Gastroenterology :... 2023Vonoprazan-amoxicillin (VA) dual therapy has recently been proposed to eradicate Helicobacter pylori (H. pylori) with controversial results. We, therefore, conducted a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vonoprazan-amoxicillin (VA) dual therapy has recently been proposed to eradicate Helicobacter pylori (H. pylori) with controversial results. We, therefore, conducted a meta-analysis to assess the effect of this therapy for H. pylori eradication.
METHODS
We searched PubMed, Embase, Cochrane Library, and Web of Science database from inception until November 2022, collecting randomized controlled trials (RCTs) comparing VA dual therapy with other regimens for H. pylori eradication. Pooled relative risks (RRs) were calculated using random effects model.
RESULTS
Five RCTs were ultimately included. Compared with the vonoprazan-amoxicillin-clarithromycin (VAC) triple therapy, the eradication rate of VA dual therapy was lower in intention-to-treat (ITT) analysis (n = 3 RCTs, RR = 0.94, 95% CI: 0.88-0.99, P = 0.03), but there was no significant difference between them in the per-protocol (PP) analysis (RR = 0.96, 95% CI: 0.91-1.01, P = 0.11). For clarithromycin-resistant H. pylori strains, the eradication rate of VA dual therapy was significantly higher than that of the VAC triple therapy (n = 2 RCTs, RR = 1.20, 95% CI: 1.03-1.39, P = 0.02). Compared with the PPI-based triple therapy (PAC), VA dual therapy had a superior eradication rate (n = 2 RCTs, ITT analysis: RR = 1.13, 95% CI: 1.04-1.23, P = 0.003; PP analysis: pooled RR = 1.14, 95% CI: 1.06-1.22, P = 0.0004). Compared with VAC or PAC triple therapy, VA dual therapy has a similar incidence of total adverse events and compliance.
CONCLUSIONS
VA dual therapy had a similar effect compared to VAC triple therapy and was superior to PAC triple therapy. Future RCTs are needed to ascertain the optimal dosage and duration of vonoprazan and amoxicillin, and the effect of VA dual therapy compared with the mainstream regimens recommended by current guidelines.
Topics: Humans; Amoxicillin; Clarithromycin; Anti-Bacterial Agents; Helicobacter pylori; Helicobacter Infections; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Drug Therapy, Combination; Treatment Outcome
PubMed: 37602635
DOI: 10.4103/sjg.sjg_153_23