-
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 -
International Journal of Infectious... Apr 2021Cutaneous secondary syphilis presents with various manifestations, including condyloma lata (confluented moist papules). This article reports an unusual case of oral...
Cutaneous secondary syphilis presents with various manifestations, including condyloma lata (confluented moist papules). This article reports an unusual case of oral condyloma lata. A 56-year-old man presented with a 2-month history of foreign body sensation and sore throat. Physical examination revealed a hypertrophic, reddish-brown, flat-topped, moist plaque in the right amygdaloid fossa. This raised clinical suspicion of lymphoma. However, further enquiry revealed that the patient had extramarital sexual history with a female sex worker. Rapid plasma regain and Treponema pallidum particle agglutination tests were both positive. The patient's wife was diagnosed with early latent syphilis. Both the patient and his wife were treated with penicillin G benzathine, and the lesion in the male patient disappeared in 2 weeks. To the authors' knowledge, a single condyloma lata in the amygdaloid fossa mimicking lymphoma has not been reported previously. Awareness of the usual manifestations of syphilis can avoid unnecessary biopsy, and early diagnosis and treatment may prevent irreversible complications. Partner notification is very important to reduce the risk of transmission, and persistent or recurrent infection.
Topics: Condylomata Acuminata; Female; Humans; Male; Middle Aged; Mouth Diseases; Penicillin G Benzathine; Sex Workers; Syphilis; Syphilis, Cutaneous
PubMed: 33607303
DOI: 10.1016/j.ijid.2021.02.051 -
Clinical Pharmacokinetics Jan 2023Piperacillin/tazobactam is one of the most frequently used antimicrobials in older adults. Using an opportunistic study design, we evaluated the pharmacokinetics of...
BACKGROUND AND OBJECTIVE
Piperacillin/tazobactam is one of the most frequently used antimicrobials in older adults. Using an opportunistic study design, we evaluated the pharmacokinetics of piperacillin/tazobactam as a probe drug to evaluate changes in antibacterial drug exposure and dosing requirements, including in older adults.
METHODS
A total of 121 adult patients were included. The population pharmacokinetic models that best characterized the observed plasma concentrations of piperacillin and tazobactam were one-compartment structural models with zero-order input and linear elimination.
RESULTS
Among all potential covariates, estimated creatinine clearance had the most substantial impact on the elimination clearance for both piperacillin and tazobactam. After accounting for renal function and body size, there was no remaining impact of frailty on the pharmacokinetics of piperacillin and tazobactam. Monte Carlo simulations indicated that renal function had a greater impact on the therapeutic target attainment than age, although these covariates were highly correlated. Frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale, was assessed in 60 patients who were ≥ 65 years of age.
CONCLUSIONS
The simulations suggested that adults ≤ 50 years of age infected with organisms with higher minimum inhibitory concentrations may benefit from continuous piperacillin/tazobactam infusions (12 g/day of piperacillin component) or extended infusions of 4 g every 8 hours. However, for a target of 50% fT + minimum inhibitory concentration, dosing based on renal function is generally preferable to dosing by age, and simulations suggested that patients with creatinine clearance ≥ 120 mL/min may benefit from infusions of 4 g every 8 hours for organisms with higher minimum inhibitory concentrations.
Topics: Humans; Aged; Longevity; Creatinine; Frailty; Penicillanic Acid; Canada; Piperacillin, Tazobactam Drug Combination; Anti-Bacterial Agents; Piperacillin; Tazobactam; Microbial Sensitivity Tests
PubMed: 36633812
DOI: 10.1007/s40262-022-01198-z -
BioMed Research International 2022This study was designed to identify from clinical mastitis of cattle and determine their antimicrobial resistance and virulence determinants to evaluate their potential...
This study was designed to identify from clinical mastitis of cattle and determine their antimicrobial resistance and virulence determinants to evaluate their potential public health significance. A total of 105 composite milk samples (80 from cattle with clinical mastitis and 25 from apparently healthy cattle) were analyzed. were isolated by culturing on enterococcal selective media and identified by PCR and sequencing. Antimicrobial resistance phenotype was elucidated by the disc diffusion method, and MIC was determined by broth microdilution method according to CLSI guidelines. Detection of antimicrobial resistance and virulence genes was done by PCR. were isolated from 11.25% (9/80) of the clinical mastitis and 4% (1/25) of the apparently healthy cattle milk samples. The disc diffusion test revealed 40% isolates as resistant to tetracycline and azithromycin, respectively. Among them, 20% (2/10) of isolates showed resistance to both tetracycline and azithromycin. Tetracycline-resistant isolates showed MIC ranging from ≥64 to >128 g/ml and carried tetracycline-resistant genes , , and in 25%, 25%, and 50% of the resistant isolates, respectively. On the other hand, all the isolates were sensitive to amoxicillin, ampicillin, bacitracin, chloramphenicol, gentamicin, penicillin, and vancomycin. In addition, the isolates carried at least one of the nine virulence genes screened with having the highest frequency, followed by , , , , , and genes. Positive correlations were evident between , , , and genes that are associated with the attachment and biofilm formation in isolated in this study carried antibiotic resistance and virulence determinants which explain their competence to be potential human pathogens.
Topics: Amoxicillin; Ampicillin; Animals; Anti-Bacterial Agents; Azithromycin; Bacitracin; Bangladesh; Cattle; Chloramphenicol; Drug Resistance, Bacterial; Enterococcus faecalis; Female; Gentamicins; Humans; Mastitis; Microbial Sensitivity Tests; Penicillins; Public Health; Tetracyclines; Vancomycin; Virulence; Virulence Factors
PubMed: 36203487
DOI: 10.1155/2022/8101866 -
BioMed Research International 2022To evaluate efficacy and adverse events of ceftolozane/tazobactam in complicated UTI including acute pyelonephritis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate efficacy and adverse events of ceftolozane/tazobactam in complicated UTI including acute pyelonephritis.
METHOD
Databases that include PubMed, Embase, Scopus, and TRIP were searched. All randomized controlled trials and cohort studies were considered for the study. Statistical analysis was done using a fixed effects model, and results were expressed in proportion for dichotomous data and risk ratio for continuous data with 95% confidence intervals (CI).
RESULTS
A clinical cure of ceftolozane/tazobactam was found to be 92% with 95% CI of 90-94 while that of piperacillin/tazobactam was only 78% (95% CI, 74-82) in patients with complicated UTI. Microbiological eradication was still higher in the ceftolozane/tazobactam group (83%, 95% CI 81-88) when compared with piperacillin/tazobactam (63% 95% CI, 58.77-65.2). Ceftolozane/tazobactam was more effective in the treatment of complicated urinary tract infections other than acute pyelonephritis as compared to piperacillin/tazobactam (RR = 1.21, 95% CI, 1.07-1.23). Serious adverse events were found comparable in both groups (RR = 1.15, 95% CI, 0.64-2.09).
CONCLUSION
The analysis showed that ceftolozane/tazobactam has better clinical outcomes including cure rates and low resistance for the treatment of complicated urinary tract infection.
Topics: Anti-Bacterial Agents; Cephalosporins; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pyelonephritis; Tazobactam; Urinary Tract Infections
PubMed: 35978637
DOI: 10.1155/2022/1639114 -
Medicine Sep 2022Here, we report the frequency of capsulated ampicillin-resistant Haemophilus influenzae strains isolated from children in Tunisia, particularly capsular serotype b, by...
BACKGROUND
Here, we report the frequency of capsulated ampicillin-resistant Haemophilus influenzae strains isolated from children in Tunisia, particularly capsular serotype b, by polymerase chain reaction (PCR) to determine the molecular mechanisms underlying ampicillin resistance.
METHODS
We considered 22 capsulated H influenzae strains selected from a series of 91 ampicillin-resistant H influenzae strains isolated from children between 2010 and 2011 in Tunisia. The capsular serotypes of these strains were identified by slide agglutination and PCR.
RESULTS
By PCR, 19 (20.88%) serotype b, 1 (1.1%) serotype a, 2 (2.2%) serotypes d and f and 69 (75.82%) non-typeable strains were found among the 91 ampicillin-resistant H influenzae strains. 100% of the assumption between the consequences of antigenic examinations and PCR was found. The serotype b strains showed biotypes I, II, III, IV, VI, and VIII. The other capsulated strains showed biotypes IV and VIII. Thirteen of the serotype b strains created β-lactamase (14.28%). The 19 serotype b ampicillin-resistant H influenzae strains were subdivided into 3 bunches as indicated: The gathering of the β-lactamase positive, ampicillin-resistant where 11 strains (57.89%) were β-lactamase positive blaTEM-1 (+) and ftsI (+). The second gathering of the β-lactamase negative, ampicillin-resistant strains, where 6 isolates (31.58%) were β-lactamase negative blaTEM-1 (-) and ftsI (-), and lastly, the gathering of the β-lactamase positive, amoxicillin-clavulanate resistant where 2 isolates (10.52%) were β-lactamase positive blaTEM-1 (+) and ftsI (-).
CONCLUSION
PCR should be used in our country because it may contribute to decreasing the probability of transmission of these strains, especially those showing the two mechanisms of resistance among children in Tunisia.
Topics: Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Ampicillin Resistance; Anti-Bacterial Agents; Child; Haemophilus Infections; Haemophilus influenzae; Humans; Microbial Sensitivity Tests; beta-Lactamases
PubMed: 36197170
DOI: 10.1097/MD.0000000000030713 -
European Journal of Pharmaceutical... Oct 2023This study aimed to assess the pharmacokinetic (PK) interactions of anaprazole, clarithromycin, and amoxicillin using physiologically based pharmacokinetic (PBPK) models.
Physiologically based pharmacokinetic modeling to assess the drug-drug interactions of anaprazole with clarithromycin and amoxicillin in patients undergoing eradication therapy of H. pylori infection.
OBJECTIVE
This study aimed to assess the pharmacokinetic (PK) interactions of anaprazole, clarithromycin, and amoxicillin using physiologically based pharmacokinetic (PBPK) models.
METHODS
The PBPK models for anaprazole, clarithromycin, and amoxicillin were constructed using the GastroPlus™ software (Version 9.7) based on the physicochemical data and PK parameters obtained from literature, then were optimized and validated in healthy subjects to predict the plasma concentration-time profiles of these three drugs and assess the predictive performance of each model. According to the analysis of the properties of each drug, the developed and validated models were applied to evaluate potential drug-drug interactions (DDIs) of anaprazole, clarithromycin, and amoxicillin.
RESULTS
The developed PBPK models properly described the pharmacokinetics of anaprazole, clarithromycin, and amoxicillin well, and all predicted PK parameters (C, AUC ratios were within 2.0-fold of the observed values. Furthermore, the application of these models to predict the anaprazole-clarithromycin and anaprazole-amoxicillin DDIs demonstrates their good performance, with the predicted DDI C ratios and DDI AUC ratios within 1.25-fold of the observed values, and all predicted DDI C, and AUC ratios within 2.0-fold. The simulated results show no need to adjust the dosage when co-administered with anaprazole in patients undergoing eradication therapy of H. pylori infection since the dose remained in the therapeutic range.
CONCLUSION
The whole-body PBPK models of anaprazole, clarithromycin, and amoxicillin were built and qualified, which can predict DDIs that are mediated by gastric pH change and inhibition of metabolic enzymes, providing a mechanistic understanding of the DDIs observed in the clinic of clarithromycin, amoxicillin with anaprazole.
Topics: Humans; Clarithromycin; Amoxicillin; Helicobacter pylori; Helicobacter Infections; Drug Interactions; Models, Biological
PubMed: 37480962
DOI: 10.1016/j.ejps.2023.106534 -
Proceedings of the National Academy of... Sep 2023Multidrug-resistant bacteria are one of the most serious threats to infection control. Few new antibiotics have been developed; however, the lack of an effective new...
Multidrug-resistant bacteria are one of the most serious threats to infection control. Few new antibiotics have been developed; however, the lack of an effective new mechanism of their action has worsened the situation. Photodynamic inactivation (PDI) can break antimicrobial resistance, since it potentiates the effect of antibiotics, and induces oxidative stress in microorganisms through the interaction of light with a photosensitizer. This paper addresses the application of PDI for increasing bacterial susceptibility to antibiotics and helping in bacterial persistence and virulence. The effect of photodynamic action on resistant bacteria collected from patients and bacteria cells with induced resistance in the laboratory was investigated. resistance breakdown levels for each antibiotic (amoxicillin, erythromycin, and gentamicin) from the photodynamic effect (10 µM curcumin, 10 J/cm) and its maintenance in descendant microorganisms were demonstrated within five cycles after PDI application. PDI showed an innovative feature for modifying the degree of bacterial sensitivity to antibiotics according to dosages, thus reducing resistance and persistence of microorganisms from standard and clinical strains. We hypothesize a reduction in the degree of antimicrobial resistance through photooxidative action combats antibiotic failures.
Topics: Humans; Anti-Bacterial Agents; Amoxicillin; Erythromycin; Gentamicins; Bacteria
PubMed: 37729197
DOI: 10.1073/pnas.2311667120 -
Virulence Dec 2023(GBS) is an important pathogenic bacteria that infected both aquatic animals and human beings, causing huge economic loss. The increasing cases of antibiotic-resistant...
(GBS) is an important pathogenic bacteria that infected both aquatic animals and human beings, causing huge economic loss. The increasing cases of antibiotic-resistant GBS impose challenges to treat such infection by antibiotics. Thus, it is highly demanded for the approach to tackle antibiotic resistance in GBS. In this study, we adopt a metabolomic approach to identify the metabolic signature of ampicillin-resistant GBS (AR-GBS) that ampicillin is the routine choice to treat infection by GBS. We find glycolysis is significantly repressed in AR-GBS, and fructose is the crucial biomarker. Exogenous fructose not only reverses ampicillin resistance in AR-GBS but also in clinic isolates including methicillin-resistant (MRSA) and NDM-1 expressing . The synergistic effect is confirmed in a zebrafish infection model. Furthermore, we demonstrate that the potentiation by fructose is dependent on glycolysis that enhances ampicillin uptake and the expression of penicillin-binding proteins, the ampicillin target. Our study demonstrates a novel approach to combat antibiotic resistance in GBS.
Topics: Animals; Humans; Anti-Bacterial Agents; Streptococcus agalactiae; Methicillin-Resistant Staphylococcus aureus; Zebrafish; Streptococcal Infections; Ampicillin; Escherichia coli; Microbial Sensitivity Tests
PubMed: 36803528
DOI: 10.1080/21505594.2023.2180938 -
Contrast Media & Molecular Imaging 2022This study aimed to compare the identification efficiency of metagenome next generation sequencing (mNGS) and traditional methods in detecting pathogens in patients with...
OBJECTIVE
This study aimed to compare the identification efficiency of metagenome next generation sequencing (mNGS) and traditional methods in detecting pathogens in patients with severe bacterial pneumonia (BP) and further analyze the drug resistance of common pathogens.
METHODS
A total of 180 patients with severe BP who were admitted to our hospital from June 2017 to July 2020 were selected as the research objects. Alveolar lavage fluid from the patients were collected, and pathogens were detected by the mNGS technology and traditional etiological detection technology. Common pathogens detected by mNGS were tested for the drug sensitivity test. The difference between mNGS and traditional detection method in the identification of pathogenic bacteria in severe BP patients was compared, and the distribution characteristics and drug resistance of pathogenic bacteria were analyzed.
RESULTS
The positive rate of mNGS detection was 92.22%, which was significantly higher than that of the traditional culture method (58.33%, < 0.05). 347 strains of pathogenic bacteria were detected by mNGS, including 256 strains of Gram-negative bacteria (G), 89 strains of Gram-positive bacteria (G), and 2 strains of fungi. Among G bacteria, had higher resistance to piperacillin/tazobactam, ceftazidime, imipenem, levofloxacin, amikacin, ciprofloxacin, gentamicin, and the lowest resistance to tigecycline. The resistance of to piperacillin/tazobactam and ceftazidime was higher. had low resistance to all the drugs. Escherichia coli had high drug resistance to most drugs, and the drug resistant rates to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, imipenem, and gentamicin were all more than 50.00%. G bacteria had high resistance to penicillin, azithromycin, amoxicillin and levofloxacin, and amoxicillin and levofloxacin had high resistance, up to 100.00%.
CONCLUSION
mNGS has high sensitivity for the identification of pathogenic bacteria in patients with BP. G bacteria were the main pathogens of BP, but both G and G bacteria had high resistance to a variety of antibacterial drugs.
Topics: Humans; Cefoperazone; Microbial Sensitivity Tests; Drug Resistance, Bacterial; Sulbactam; Ceftazidime; Levofloxacin; Tigecycline; Amikacin; Azithromycin; Gram-Negative Bacteria; Anti-Bacterial Agents; Imipenem; Intensive Care Units; Piperacillin, Tazobactam Drug Combination; Pneumonia, Bacterial; Amoxicillin; Gentamicins; Ciprofloxacin
PubMed: 36262997
DOI: 10.1155/2022/6980091