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- Single-dose compared to multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, non-inferiority trial. [JOURNAL ARTICLE]
- Acta Obstet Gynecol Scand 2014 Sep 29.
To investigate the efficacy of a single prophylactic dose of ampicillin combined with metronidazole to prevent post-cesarean section infections compared with a multiple day regimen in low-resource settings. Design An evaluator-blinded randomized, controlled, non-inferiority trial.Two rural hospitals in Tanzania.Of 181 enrolled eligible women with an indication for cesarean section, information on 176 was analyzed by intention-to-treat.The women were randomly assigned to either the intervention group who received a single dose of ampicillin and metronidazole, or to the control group who received a multiple day regimen of ampicillin/amoxicillin and metronidazole.The primary outcome was maternal post-cesarean infection. Secondary outcomes were severity of these infections, other maternal complications, and the duration of hospital stay. Results: In the intervention group (n = 89), six women (6.7%) developed a wound infection compared to nine (10.3%) in the control group (n = 87) (difference 3.60; 95% CI -4.65 to 11.85) (p = 0.40).A single dose of prophylactic ampicillin and metronidazole is equally effective as a multiple day regimen in preventing post-cesarean wound infections in low-resource settings, therefore it can be considered as a good strategy in low-resource settings. The reduced quantity of prophylactic antibiotics will reduce costs without increasing the risk of maternal infection. This article is protected by copyright. All rights reserved.
- Modulatory effect of three antibiotics on uterus bovine contractility in vitro and likely therapeutic approaches in reproduction. [JOURNAL ARTICLE]
- Theriogenology 2014 Aug 29.
This in vitro study investigates the modulatory effect of three antibiotics (amoxicillin, enrofloxacin, and rifaximin) on contractility of the bovine uterine tissue in follicular and luteal phases. The effects of these antibiotics at three single doses (10(-6), 10(-5), and 10(-4) M) on their basal contractility were evaluated in isolated organ bath. The functionality of the strip throughout the experiment was evaluated by a dose of carbachol (10(-5) M); the obtained effect had to be repeatable (difference of ≤20%) that is comparable to that induced by the previous administration of the same substance. The results demonstrate the different modulatory activities of these antibiotics on uterine contractility in follicular and luteal phases. The effects induced by amoxicillin and enrofloxacin are opposite: the first relaxes and the second increases the uterine contractility in both cycle phases. Instead, the activity of rifaximin varies depending on the phase of estrous cycle: it increases in the follicular phase and relaxes in the luteal phase. The obtained data provide the hypothesis of possible implications of these drugs in the pharmacologic modulation of uterine contractions. Their action at this level, associated with their specific antimicrobial effects, could suggest using these antibiotics for the treatment of diseases related to postpartum or infections that may occur in pregnant cattle, by virtue of their effects on myometrial contractility too.
- Bloodstream infections at a tertiary referral hospital in Yangon, Myanmar. [JOURNAL ARTICLE]
- Trans R Soc Trop Med Hyg 2014 Sep 23.
Data regarding characteristics of bloodstream infections in Myanmar are limited.Blood culture results from all outpatients and inpatients were extracted from records of the Clinical Microbiology Laboratory, Yangon General Hospital, for the period 2005 through 2013.Of 3865 blood cultures performed, 449 (11.6%) were positive for a pathogenic organism. Gram-negative bacteria was the most common organism group, accounting for 246 (55.5%) of 449 isolations. Staphylococcus aureus was the most common isolate, from 171 (38.1%) of 449 blood cultures. From 2005-2008 to 2009-2013 the proportion of all pathogenic isolates that were Gram-positive declined from 52.8% (167/316) to 20.3% (27/133) (p<0.001), whereas the proportion of Gram-negative bacteria rose from 45.6% (144/316) to 78.9% (105/133) (p<0.001), with non-fermentative bacilli accounting for much of this increase. Antimicrobial susceptibility testing demonstrated a high prevalence resistance of S. aureus to first-line antimicrobials such as erythromycin, penicillin and oxacillin. More than half of tested Escherichia coli and Citrobacter species showed resistance to amoxicillin-clavulanic acid, ceftriaxone or gentamicin.Bloodstream infections are common among patients receiving blood culture at a tertiary hospital in Yangon, Myanmar. Our findings suggest that antimicrobial resistance among invasive bacteria is common, similar to patterns described elsewhere in the region, and highlight the need for locally adapted antimicrobial guidelines for sepsis management.
- Dog and Cat Bites. [JOURNAL ARTICLE]
- Am Fam Physician 2014 Aug 15; 90(4):239-243.
Animal bites account for 1% of all emergency department visits in the United States and more than $50 million in health care costs per year. Most animal bites are from a dog, usually one known to the victim. Most dog bite victims are children. Bite wounds should be cleaned, copiously irrigated with normal saline using a 20-mL or larger syringe or a 20-gauge catheter attached to the syringe. The wound should be explored for tendon or bone involvement and possible foreign bodies. Wounds may be closed if cosmetically favorable, such as wounds on the face or gaping wounds. Antibiotic prophylaxis should be considered, especially if there is a high risk of infection, such as with cat bites, with puncture wounds, with wounds to the hand, and in persons who are immunosuppressed. Amoxicillin/clavulanate is the first-line prophylactic antibiotic. The need for rabies prophylaxis should be addressed with any animal bite because even domestic animals are often unvaccinated. Postexposure rabies prophylaxis consists of immune globulin at presentation and vaccination on days 0, 3, 7, and 14. Counseling patients and families about animal safety may help decrease animal bites. In most states, physicians are required by law to report animal bites.
- Impetigo: diagnosis and treatment. [Journal Article]
- Am Fam Physician 2014 Aug 15; 90(4):229-35.
Impetigo is the most common bacterial skin infection in children two to five years of age. There are two principal types: nonbullous (70% of cases) and bullous (30% of cases). Nonbullous impetigo, or impetigo contagiosa, is caused by Staphylococcus aureus or Streptococcus pyogenes, and is characterized by honey-colored crusts on the face and extremities. Impetigo primarily affects the skin or secondarily infects insect bites, eczema, or herpetic lesions. Bullous impetigo, which is caused exclusively by S. aureus, results in large, flaccid bullae and is more likely to affect intertriginous areas. Both types usually resolve within two to three weeks without scarring, and complications are rare, with the most serious being poststreptococcal glomerulonephritis. Treatment includes topical antibiotics such as mupirocin, retapamulin, and fusidic acid. Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical. Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options, but penicillin is not. Natural therapies such as tea tree oil; olive, garlic, and coconut oils; and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options. Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone. Topical disinfectants are inferior to antibiotics and should not be used. Empiric treatment considerations have changed with the increasing prevalence of antibiotic-resistant bacteria, with methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus all documented. Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections. Clindamycin proves helpful in suspected methicillin-resistant S. aureus infections. Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection.
- Antibiotic treatment failure in four common infections in UK primary care 1991-2012: longitudinal analysis. [Journal Article]
- BMJ 2014.:g5493.
To characterise failure of antibiotic treatment in primary care in the United Kingdom in four common infection classes from 1991 to 2012.Longitudinal analysis of failure rates for first line antibiotic monotherapies associated with diagnoses for upper and lower respiratory tract infections, skin and soft tissue infections, and acute otitis media.Routine primary care data from the UK Clinical Practice Research Datalink (CPRD).Adjusted rates of treatment failure defined by standardised criteria and indexed to year 1 (1991=100).From 58 million antibiotic prescriptions in CPRD, we analysed 10 967 607 monotherapy episodes for the four indications: 4 236 574 (38.6%) for upper respiratory tract infections; 3 148 947 (28.7%) for lower respiratory tract infections; 2 568 230 (23.4%) for skin and soft tissue infections; and 1 013 856 (9.2%) for acute otitis media. In 1991, the overall failure rate was 13.9% (12.0% for upper respiratory tract infections; 16.9% for lower respiratory tract infections; 12.8% for skin and soft tissue infections; and 13.9% for acute otitis media). By 2012, the overall failure rate was 15.4%, representing an increase of 12% compared with 1991 (adjusted value indexed to first year (1991) 112, 95% confidence interval 112 to 113). The highest rate was seen in lower respiratory tract infections (135, 134 to 136). While failure rates were below 20% for most commonly prescribed antibiotics (amoxicillin, phenoxymethylpenicillin (penicillin-V), and flucloxacillin), notable increases were seen for trimethoprim in the treatment of upper respiratory tract infections (from 29.2% in 1991-95 to 70.1% in 2008-12) and for ciprofloxacin (from 22.3% in 1991-95 to 30.8% in 2008-12) and cefalexin (from 22.0% in 1991-95 to 30.8% in 2008-12) in the treatment of lower respiratory tract infections. Failure rates for broad spectrum penicillins, macrolides, and flucloxacillin remained largely stable.From 1991 to 2012, more than one in 10 first line antibiotic monotherapies for the selected infections were associated with treatment failure. Overall failure rates increased by 12% over this period, with most of the increase occurring in more recent years, when antibiotic prescribing in primary care plateaued and then increased.
- Oligomerization of esculin improves its antibacterial activity and modulates antibiotic resistance. [JOURNAL ARTICLE]
- J Antibiot (Tokyo) 2014 Sep 24.
In this particular study, the antibacterial activity of esculin and oligomer fractions was assessed. MIC values of esculin and its oligomer fractions as well as of some antibiotics against Gram-positive and Gram-negative strains and against Escherichia coli multiresistant variants were determined by the standard broth microdilution method. Both esculin and oligoesculin fractions exhibited antibacterial effect against reference strains; Staphylococcus aureus, Enterococcus faecalis, Salmonella enteritidis and Salmonella typhimurium. It appears that E3 oligomer fraction had the greatest antibacterial activity against these reference strains. Besides, as E2 and E3 revealed the best antibacterial effect against multiresistant variants of E. coli, we decided to test the effect of each, combined to the antibiotic against which the variants were resistant. In the interaction study, E2 and E3 oligoesculin fractions were found to be effective in reducing the resistance of E. coli 6574 to ofloxacin and the resistance of E. coli 6228 to amoxicillin. Only E3 oligoesculin fraction showed a synergetic interaction with amoxicillin and tetracyclin against E. coli 6708, but no interaction was found either with E2 or E3 fractions against E. coli 6234. Our study allowed us to conclude that oligomerization of esculin increases its antibacterial potential, according to the degree of polymerization.The Journal of Antibiotics advance online publication, 24 September 2014; doi:10.1038/ja.2014.127.
- Clarithromycin-Based Standard Triple Therapy Can Still Be Effective for Helicobacter pylori Eradication in Some Parts of the Korea. [Journal Article]
- J Korean Med Sci 2014 Sep; 29(9):1240-6.
We evaluated the antibiotic resistance rates and eradication rates of clarithromycin based triple therapy from 2005 to 2010 retrospectively. In addition, we investigated the mechanism of clarithromycin resistance in Helicobacter pylori strains isolated from Korean patients. Two hundred and twelve strains of H. pylori were isolated from 204 patients. H. pylori ATCC 43504 was used as the standard strain. The eradication rates of H. pylori from 2005 to 2010 were 89.3%, 82.6%, 86.3%, 87.7%, 81.8%, and 84.2%, respectively. Total eradication rate was 84.9%. DNA sequences of the 23S RNA gene in clarithromycin-resistant strains were determined. The resistance rates of H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, moxifloxacin, and levofloxacin were 9.0%, 8.5%, 36.3%, 0%, 14.2%, 14.2%, and 14.2%, respectively. The multidrug resistance rate of H. pylori was 16.5%. Sequence analysis of clarithromycin-resistant strains showed an A2144G mutation in 8 of 14 strains (57.1%), a T2183C mutation in 5 of 14 strains (35.7%), and double mutations of both A2144G and T2183C in 1 of 14 strains (7.1%). In the present study, triple therapy may still be an effective eradication therapy for H. pylori infections in Korea. The A2144G and T2183C mutations are mainly present in clarithromycin-resistant isolates.
- Pulmonary actinomycosis and Hodgkin's disease: when FDG-PET may be misleading. [Journal Article]
- BMJ Case Rep 2014.
We present a patient with advanced Hodgkin's disease treated with escalated BEACOPP chemotherapy. The result from the interim fluorodeoxyglucose positron emission tomography with CT (PET-CT) after two cycles of chemotherapy is crucial for treatment guidance for the clinical trial HD18 from the German Hodgkin Study Group. An increase in size and standard uptake value (SUV) of a pulmonary lesion suggesting refractory Hodgkin's disease was documented. Since all other manifestations of the lymphoma responded well to the treatment, the discordant behaviour was suspicious for another reason for this progressive pulmonary lesion. Bronchoscopy revealed Actinomyces species in cultures from bronchial washings. Specific treatment was initiated and consisted of 2 weeks of intravenous penicillin followed by ceftriaxone intravenous for another 4 weeks and subsequent oral amoxicillin to complete 12 months of antibiotic therapy. For the Hodgkin's lymphoma, complete remission was documented after a total of six cycles of escalated BEACOPP.
- Selective Antibacterial Activity of Patchouli Alcohol Against Helicobacter pylori Based on Inhibition of Urease. [JOURNAL ARTICLE]
- Phytother Res 2014 Sep 22.
The aim of this study is to evaluate the antibacterial activity and urease inhibitory effects of patchouli alcohol (PA), the bioactive ingredient isolated from Pogostemonis Herba, which has been widely used for the treatment of gastrointestinal disorders. The activities of PA against selected bacteria and fungi were determined by agar dilution method. It was demonstrated that PA exhibited selective antibacterial activity against Helicobacter pylori, without influencing the major normal gastrointestinal bacteria. Noticeably, the antibacterial activity of PA was superior to that of amoxicillin, with minimal inhibition concentration value of 78 µg/mL. On the other hand, PA inhibited ureases from H. pylori and jack bean in concentration-dependent fashion with IC50 values of 2.67 ± 0.79 mM and 2.99 ± 0.41 mM, respectively. Lineweaver-Burk plots indicated that the type of inhibition was non-competitive against H. pylori urease whereas uncompetitive against jack bean urease. Reactivation of PA-inactivated urease assay showed DL-dithiothreitol, the thiol reagent, synergistically inactivated urease with PA instead of enzymatic activity recovery. In conclusion, the selective H. pylori antibacterial activity along with urease inhibitory potential of PA could make it a possible drug candidate for the treatment of H. pylori infection. Copyright © 2014 John Wiley & Sons, Ltd.