- Delayed Anaphylaxis with Methimazole: Nicolau Syndrome After Oxytocin Intramuscular Administration Anastrazole-Induced Autoimmune Hepatitis Amoxicillin- and Cephalexin-Induced Eosinophilic Colitis Docetaxel-Induced Supravenous Erythematous Eruption. [Journal Article]
- Hosp Pharm 2016 Jul; 51(7):520-3.
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers. Write to Dr. Mancano at ISMP, 200 Lakeside Drive, Suite 200, Horsham, PA 19044 (phone: 215-707-4936; e-mail: firstname.lastname@example.org). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices (ISMP) in cooperation with the FDA's MedWatch program and Temple University School of Pharmacy. ISMP is an FDA MedWatch partner.
- Resistance to oral antibiotics in 4569 Gram-negative rods isolated from urinary tract infection in children. [JOURNAL ARTICLE]
- Eur J Pediatr 2016 Aug 24.
To investigate antibiotic resistance among pathogens isolated from urines in a tertiary care children's hospital in Italy. Retrospective analysis of prospectively collected data on antibiotic susceptibility of Gram-negatives isolated from urines at the Istituto Giannina Gaslini, Genoa - Italy from 2007 to 2014. Antibiotic susceptibility was evaluated. By means of CLSI criteria from 2007 to 2010, while from 2011 EUCAST criteria were adopted. Data on susceptibility to amoxicillin-clavulanate, co-trimoxazole, cefuroxime, nitrofurantoin, fosfomycin and ciprofloxacin were evaluated for Escherichia coli, while for other Enterobacteriaceae data were collected for amoxicillin-clavulanate, co-trimoxazole and ciprofloxacin and for ciprofloxacin against Pseudomonas aeruginosa. Univariate and multivariable analyses were performed for risk factors associated with resistance. A total of 4596 Gram-negative strains were observed in 3364 patients. A significant increase in the proportion of resistant strains was observed for E.coli against amoxicillin-clavulanate, cefuroxime and ciprofloxacin and for others Enterobacteriaceae against co-trimoxazole and ciprofloxacin. Resistance to nitrofurantoin and fosfomycin was very infrequent in E.coli. Logistic regression analysis showed that repeated episode of urinary tract infections was a risk factor for E.coli resistance to amoxicillin-clavulanate, co-trimoxazole and cefuroxime, while admission in one of the Units usually managing children with urinary tract malformations was significantly associated to resistance to amoxicillin-clavulanate and cefuroxime.In conclusion the present study shows an increase in antibiotic resistance in pediatric bacteria isolated from urines in children, especially in presence of repeated episodes and/or urinary tract malformations. This resistance is worrisome for beta-lactams and cotrimoxazole, and start to increase also for fluoroquinolones while nitrofurantoin and fosfomycin still could represent useful drugs for oral treatment of these infections.• Infections are frequent in patients with urinary tract malformations • Antibiotic prophylaxis can select for resistant pathogens What is New: • The increase in the resistance to β-lactams, co-trimoxazole or fluoroquinolones in pathogens causing urinary tract infections cause a reduction of drugs with oral formulations available for therapy • Old drugs like nitrofurantoin and fosfomycin can represent attractive compounds for oral treatment of urinary tract infections in children presence of resistance to other drug classes.
- Skin-Sparing Débridement for Necrotizing Fasciitis in Children. [Journal Article]
- Plast Reconstr Surg 2016 Sep; 138(3):489e-97e.
Necrotizing fasciitis is a serious soft-tissue infection associated with sepsis and tissue destruction. Surgical management usually requires extensive débridement of necrotic fascia and overlying skin, with significant aesthetic and functional consequences. The authors review the outcome of all recent cases of necrotizing fasciitis treated with skin-sparing débridement at their institution.The authors conducted a retrospective review of all of their cases of necrotizing fasciitis treated with skin-sparing débridement. Medical records were evaluated with a standard form gathering relevant demographic and clinical data. All cases were confirmed as necrotizing fasciitis histologically.Ten patients were admitted with a diagnosis of necrotizing fasciitis. The median age of the patients was 4.9 years (range, 1.7 to 15.1 years). The majority of initial lesions were caused by chickenpox, mostly on the trunk. Interval from admission to surgery was 6 hours (range, 1 to 27.5 hours), with a median hospital stay of 11 days (range, 5 to 43 days). Median fasciectomy was 2.5 percent (range, 1 to 15 percent) of total body surface area, with a median skin excision of 0.25 percent of total body surface area (range, 0.1 to 3 percent). All patients received intravenous amoxicillin/clavulanic acid plus clindamycin. Delayed direct closure was possible for all patients. Median follow-up was 17 months (range, 3 to 79 months). There was no death in this series.This surgical management restricts skin excision to the area of definite skin necrosis, limiting skin excision to one-tenth of excised fascia, with long-term favorable cosmetic and functional results.Therapeutic, IV.
- Residue levels and discharge loads of antibiotics in wastewater treatment plants (WWTPs), hospital lagoons, and rivers within Lake Victoria Basin, Kenya. [Journal Article]
- Environ Monit Assess 2016 Sep; 188(9):532.
The detection of antibiotics in water systems has instigated great environmental concern due to the toxicological effects associated with these compounds. Their discharge into the environment results from the ubiquity of use in medical, veterinary, and agricultural practices. Some of the effects of antibiotics include development of antibiotic-resistant bacteria, making it difficult to treat diseases, variation in natural microbial communities, and enzyme activities. In this study, the first comprehensive survey of some frequently used antibiotics namely ampicillin (AMP), amoxicillin (AMX), sulfamethoxazole (SMX), chloramphenicol (CAP), and ciprofloxacin (CPF) within Lake Victoria Basin of Kenya is presented. Sludge and wastewater samples were collected from wastewater treatment plants (WWTPs) and hospital lagoons within the study area. Samples were extracted and cleaned by solid-phase extraction, and analysis was carried out using high-performance liquid chromatography (HPLC). All wastewater samples and sludge collected contained quantifiable levels of the selected antibiotics. The highest concentrations were recorded for AMP with WWTPs and hospitals having 0.36 ± 0.04 and 0.79 ± 0.07 μg/L, respectively. In sludge samples, SMX recorded the highest concentrations of 276 ± 12 ng/g. The high levels in sludge indicate the preferential partition of antibiotics onto solid phase, posing great danger to consumers of crops grown in biosolid-amended soils. The daily discharge loads of antibiotics from nine WWTPs ranged between 80.75 and 3044.9 mg day(-1) with a total discharge of 6395.85 mg day(-1), signifying a high potential of water resource pollution within the region. This report will aid in the assessment of the risks posed by antibiotics released into the environment.
- Characterization of invasive Neisseria meningitidis strains isolated at the Children's Hospital of Tunis, Tunisia. [Journal Article]
- East Mediterr Health J 2016 May; 22(5):343-9.
Neisseria meningitidis, a leading cause of bacterial meningitis and other serious infections, is responsible for approximately one-third of cases of bacterial meningitis in the Children's Hospital of Tunis. The serogroup distribution, antibiotic susceptibility and antigenic and molecular characteristics of N. meningitidis isolates were determined in patients aged 3 days-13 years between February 1998 and June 2013. In all 107 invasive strains of N. meningitidis were isolated. Reduced susceptibility to penicillin G was seen in 55.7% of isolates, with a low level of resistance in all cases; 28.4% showed a low level of resistance to amoxicillin. Serogroup B isolates were the most frequent (80.4%), followed by serogroups C (12.2%) and A (5.6%). Isolates of serogroup A had the same antigenic formula (A:4:P1.9), the same variable regions VR1, VR2 and VR3, and belonged to the same clonal complex (CC5). Isolates of serogroups B and C were more heterogeneous with several antigenic formulae. The most frequent clonal complex in these isolates was CC35. Serogroup B accounted for a large percentage of our isolates with marked diversity.
- Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia. [JOURNAL ARTICLE]
- Expert Rev Anti Infect Ther 2016 Aug 22.
In Zambia, antibiotics are categorized as prescription-only medicines. Antibiotics dispensed without a prescription pose a public health threat, which is a concern.Ascertain the extent of non-prescription sales and dispensing of antibiotics in community pharmacies in Zambia.The practice of non-prescription sale and dispensing were assessed in 73 randomly selected community retail pharmacies, using a structured interviewer-administered questionnaire with simulated case scenarios.Majority (97%) stated that clients frequently requested non-prescribed antibiotics. Interviewees usually asked clients' indications (94%), counselled on dosing (96%) and suggested changes to antibiotic choices (97%). All (100%) dispensed non-prescribed antibiotics. Commonly dispensed antibiotics included amoxicillin (52%), cotrimoxazole (25%) and metronidazole (23%). Non-prescription sale and dispensing of antibiotics was significantly associated with interviewees' professional qualification in four out of five simulations.Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement.
- Design and evaluation of an oral multiparticulate system for dual delivery of amoxicillin and Lactobacillus acidophilus. [JOURNAL ARTICLE]
- Future Microbiol 2016 Aug 22.
A delayed-release dual delivery system for amoxicillin and the probiotic Lactobacillus acidophilus was developed and evaluated.Statistical optimization of a cross-linked denatured ovalbumin protective matrix was first synthesized using a Box-Behnken experimental design prior to encapsulation with glyceryl monostereate. The encapsulated ovalbumin matrix was thereafter incorporated with amoxicillin in a gastro-resistant capsule. In vitro characterization and stability analysis of the ovalbumin and encapsulated components were also performed Results: Protection of L. acidophilus probiotic against the bactericidal effects of amoxicillin within the dual formulation was determined.The dual formulation in this study proved effective and provides insight into current microbiome research to identify, classify and use functional healthy bacteria to develop novel probiotic delivery technologies.
- Impact of anti-inflammatory drug consumption in peritonsillar abscesses: a retrospective cohort study. [Journal Article]
- BMC Infect Dis 2016; 16(1):432.
The experience of clinicians in charge of the in-hospital management of peritonsillar abscesses supports the association between severe forms and anti-inflammatory drug (AID) consumption. However, this observation is based on a limited number of clinical studies. Our objective was to assess the prevalence and impact of AID consumption in patients with peritonsillar abscesses.All patients referred to the ear, nose and throat surgery department for a peritonsillar abscess were included in a retrospective cohort study (2012-2014).Among the 216 included patients (male, 55 %; median age, 32 years [IQR, 26-40]), 127 had received AID (59 %), including corticosteroids (n = 67, 31 %) and/or non-steroidal AIDs (NSAIDs, n = 76, 35 %). 199 patients (92 %) benefit from a puncture and 5 (2 %) from a surgery under general anesthesia, associated with ceftriaxone/metronidazole (51 %) or amoxicillin/clavulanic acid (46 %). An iterative surgical procedure was required in 93 cases (43 %), including 19 % under general anesthesia. Bacteriological analysis (79 %) mainly disclosed streptococci (66 %) of A (18 %) and/or milleri (33 %) groups. The prevalence of anaerobes was higher in patients using AIDs (46 % versus 29 %, p = 0.034), regardless of prior antibiotic therapy. 65 patients benefited from a CT-scan; AID consumption was associated with larger abscesses (6.8 [IQR, 3.7-12.7] versus 2.9 [IQR, 0.9-7.8] cm(3); p = 0.005). AID consumption was not a risk factor of iterative surgical procedure.In comparison to the prescribing habits in uncomplicated upper respiratory tract infection, the high prevalence of AID consumption in patients with peritonsillar suppuration suggests a role of AIDs in promoting these complications.
- A randomized-controlled study comparing the efficacy of positive pressure nasal saline irrigation device versus syringe use in children with acute rhinosinusitis. [JOURNAL ARTICLE]
- Asian Pac J Allergy Immunol 2016 Aug 16.
To evaluate the efficacy of positive pressure nasal irrigation and the incidence of bacterial colonization found in the irrigation device utilized for nasal saline irrigation in children with acute sinusitis.We performed a randomized, prospective, controlled study of 80 children with acute sinusitis, aged 3-15 years. Each participant was randomized into one of two groups, one treated with a squeezable bottle and the other group treated with a syringe. A 5S-score and satisfactory score were then assessed. All patients utilized 1.25% buffered hypertonic solution for nasal irrigation twice daily for 2 weeks and received amoxicillin or amoxicillin-clavulanic acid. During this period, all participants recorded a 5S-score, a satisfaction score, resultant side effects and antihistamine use. Parents were instructed to clean the device with soap after each use. Nasal irrigation devices were sent to the microbiological laboratory for bacterial identification.At week two visits, both groups had improvement in their 5S-score and satisfaction score compared to baseline visits. Patients in the squeezable bottle group significantly improved in their 5S-score and satisfaction score compared to those in the syringe group. There were few complaints reported, and side effects were seen equally in both groups. The overall rate of bacterial contamination was found to be around 80%, but this did not translate into higher rates of infection amongst patients. Nasal irrigation with the use of a squeezable bottle was associated with improvement in 5S-score and satisfaction scores when compared to syringe use in children with acute sinusitis. There was no significant difference in bacterial contamination.
- Skin testing with β-lactam Antibiotics for Diagnosis of β-lactam Hypersensitivity in Children. [JOURNAL ARTICLE]
- Asian Pac J Allergy Immunol 2016 Aug 16.
Skin testing with penicilloyl-polylysine (PPL) and a minor determinant mixture (MDM) were previously recommended for evaluating β-lactam hypersensitivity. However, PPL and MDM have not been commercially available. This study was to determine the negative predictive value (NPV) of skin testing with β-lactam antibiotics for the diagnosis of β-lactam hypersensitivity.Patients age 1-18 years old with a history of β-lactam hypersensitivity were evaluated by skin tests (a skin prick test, an intradermal test) with penicillin G, ampicillin, amoxicillin-clavulanic acid, and the suspect β-lactam. The patients who had a negative skin test were performed with a drug provocation test (DPT) in a 3-dose-graded challenge. The hypersensitivity reactions were classified into immediate and non-immediate reactions.A total of 126 patients were evaluated for β-lactam hypersensitivity. Twenty two patients (17.4%) were confirmed with a β-lactam hypersensitivity. 12 (54.54 %) of them were confirmed by a skin test. There was no systemic reaction occurring after the skin tests. Ten patients (9.6%) from 104 patients with a negative skin test showed reactions after a DPT providing the NPV of the skin test with a 91.2% value.Among those children with a history of β-lactam hypersensitivity, skin testing with penicillin G, ampicillin, amoxicillin-clavulanic acid, and the suspect β-lactam was safe and provided a good NPV when PPL and MDM were unavailable. However, a skin test with β-lactam antibiotics alone did not provide a high sensitivity, thus a DPT procedure was necessary in order to confirm the diagnosis of β-lactam hypersensitivity.