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- Knowledge and Pattern of Antibiotic and Non Narcotic Analgesic Prescription for Pulpal and Periapical Pathologies- A Survey among Dentists. [Journal Article]
- J Clin Diagn Res 2014 Jul; 8(7):ZC10-4.
The objective was to assess the knowledge and pattern of antibiotic and non narcotic analgesic prescription for pulpal and periapical pathologies among dentists, registered with IDA, in and around Hyderabad.Cross-sectional survey was conducted from January 2014 to February 2014 in and around Hyderabad, Andhra Pradesh, India. A questionnaire for this cross-sectional survey was designed for evaluating the knowledge and patterns of antibiotic and non narcotic analgesic prescription for pulpal and periapical pathologies. It included some demographic information, questions regarding clinical and non clinical factors, type of antibiotics and non narcotics analgesics prescribed were recorded. Data was computed and analysed using SPSS software. Descriptive statistics was performed.The response rate for the study was 85%, 51.4% being males and 53.9% were pursuing post graduation. Of the respondents, 44.3% would prescribe medication with elevated body temperatures and evidence of systemic involvement, while 42.8% would prescribe medication for non clinical factors such as unsure of diagnosis. Necrotic pulp with acute apical periodontitis with swelling present and mod/severe preoperative symptoms was the most common condition identified for antibiotic therapy (56.4%). The first antibiotic of choice in patients with no medical allergies is amoxicillin, followed by amoxicillin and metronidazole. The first antibiotic of choice in case of allergic to penicillin was erythromycin. 55.1% and 37.3% would not prescribe antibiotic and analgesic after Root canal treatment respectively. The most commonly prescribed NSAID is Diclofenac (51.1%). Factors influencing the choice of analgesics among respondents is severity of pain (61.4%). 31.7% remained informed of current prophylactic practices through pharmaceutical companies followed by university training sessions and scientific societies (30.7%).The results of the present survey have demonstrated a lack of uniformity among the dental practitioners. All the clinicians should make themselves aware of the current guidelines available, to ensure highest degree of patient care.
- The use of poly(methacrylic acid) nanogel to control the release of amoxycillin with lower cytotoxicity. [JOURNAL ARTICLE]
- Mater Sci Eng C Mater Biol Appl 2014 Oct 1.:622-629.
In order to control the release of amoxycillin (AM) with lower cytotoxicity and higher activity, ethylene glycol dimethacrylate was used as the cross-linker, and a series of poly(methacrylic acid) (PMAA) nanogels were prepared to load the AM. Then, the morphology, size, in vitro release property, long-term antibacterial performance, cytotoxicity, stability and activity of this novel AM/PMAA nanogel were investigated. The results showed that the AM/PMAA nanogel sustainably released AM with long-term antibacterial activity. Moreover, the AM/PMAA nanogel could improve the stability of AM. More importantly, this AM/PMAA nanogel showed slighter cytotoxicity than AM alone, suggesting that the AM/PMAA nanogel was a more useful dosage form than AM for infectious diseases.
- Primary Brain Abscess Caused by Nocardia otitidiscaviarum. [Journal Article]
- Intern Med 2014; 53(17):2007-12.
Diagnosing primary cerebral nocardiosis is difficult. This case report describes a 79-year-old immunocompetent Japanese woman with a primary brain abscess caused by Nocardia otitidiscaviarum (IFM 11321) and reviews the findings of 11 previous patients with N. otitidiscaviarum-induced brain abscesses. Four patients survived, including ours. Beta-lactams were not effective in our patient, and the diagnosis required a pathologic analysis of the surgical specimen. Sulfamethoxazole/trimethoprim (ST) was administered to the patient. On antibiotic susceptibility testing, N. otitidiscaviarum (IFM11321) was found to be resistant to amoxicillin-clavulanic acid, ceftriaxone, cefotaxime, cefepime, imipenem and clarithromycin, but sensitive to amikacin, gentamicin, ST and linezolid. Antimicrobial susceptibility patterns differ among Nocardia species, making species identification important for treatment. Patients with suspected Nocardia infection should therefore be treated empirically with ST and/or amikacin and considered for surgical management.
- [Epidemiological study on antibiotic resistance among Helicobacter pylori in Taizhou district, Zhejiang, 2010-2013.] [JOURNAL ARTICLE]
- Zhonghua Liu Xing Bing Xue Za Zhi 2014 Jun; 35(6):704-707.
To study the infection status of Helicobacter pylori (H. pylori) and sensitivity to commonly used antibiotics in Taizhou district,Zhejiang province.39 099 cases aged between 5 and 95 years old (mean as 48.42 years) were involved during January 2010 to December, 2013 for this study. Sex ratio was 1 : 0.95. Yearly distribution of the number of cases were 5 031, 6 709, 11 902 and 15 457 in 2010, 2011, 2012 and 2013, respectively. Gastric mucosal specimens were collected and H. pylori strains were isolated and cultured in the same platform in Zhiyuan Medical Inspection Institute of Hangzhou. Resistance tests of all the H. pylori isolates were performed to 6 commonly used antibiotics:metronidazole, clarithromycin, amoxicillin, gentamicin, levofloxacin and furazolidone with the agar dilution method. The antibiotic resistance rates of H. pylori strains isolated during year 2010-2013 and the changing trends were analyzed.Resistance rates to levofloxacin and clarithromycin kept at higher level and the highest was in 2011 and then decreased in both 2012 and 2013 (P < 0.01). The resistance rates to both levofloxacin and clarithromycin reached the highest in 2011 (P < 0.01), and decreased thereafter, with no significant change in 2013 to 2012 (P > 0.05).Antibiotic resistance rate against metronidazole for HP isolate was highest. Resistance rate against amoxicillin and furazolidone, gentamicin was low. Clinical treatment should choose amoxicillin and furazolidone, gentamicin. The resistance rates to levofloxacin and clarithromycin had been seen at a significantly downwarding trend since 2011. However, the combined resistance rates to levofloxacin and clarithromycin did not seem to reduce since 2012.
- Recent Developments in Anti-dotes Against Anthrax. [JOURNAL ARTICLE]
- Recent Pat Antiinfect Drug Discov 2014 Aug 30.
The etiologic agent of disease anthrax, Bacillus anthracis, causes recurrent outbreaks among the livestock and intermittent infections in humans across the world. Controlling animal infections by vaccination can minimize the incidence of disease in humans. Prevention of anthrax in occupationally exposed personnel is achieved through vaccination with either live spores or precipitates of culture supernatants from attenuated strains of B. anthracis. However, anthrax vaccination of the large human population is impractical as well as inappropriate. Broad-range antibiotics like amoxicillin, ciprofloxacin, clindamycin, streptomycin, and penicillin G are recommended for the treatment of human anthrax infections, but the threat of antibiotic resistant strains always remains. Moreover, in absence of any specific symptom (s) during early infection, the diagnosis of anthrax is delayed causing elevated levels of anthrax toxin component which could be fatal. For these reasons, there is a need to develop new antimicrobial agents against virulent B. anthracis to effectively combat this fatal pathogen. Over the last two decade, extensive studies have been carried out to develop specific inhibitors against virulence factors of B. anthracis such as capsule, protective antigen, lethal factor and edema factor. Research has also been focused in developing inhibitors of anthrax toxin receptors (including the use of receptor decoys) and host furin endoproteases which are required for activation of toxin. This review highlights the recent progress made in developing the diverse countermeasures for anthrax infections targeting B. anthracis virulence factors and their counterparts in host.
- Antibiotic multi-resistance analysis of mesophilic and psychrotrophic Pseudomonas sp. isolated from goat and lamb slaughterhouse surfaces throughout meat chain production. [JOURNAL ARTICLE]
- Appl Environ Microbiol 2014 Aug 29.
The aim of this study was to investigate the phenotypic and genotypic antibiotic resistance profiles of pseudomonads isolated from surfaces of a goat and lamb slaughterhouse representative of the region as a possible source of meat contamination. Mesophilic (85 isolates) and psychrotrophic (37 isolates) pseudomonads identified at species level were generally resistant to sulfamethoxazole, erythromycin, amoxicillin, ampicillin, chloramphenicol, trimethoprim, rifampicin and ceftazidime (especially mesophiles), and colistin and tetracycline (especially psychrotrophes). However, theywere generally sensitive to ciprofloxacin, gentamicin, imipenem and kanamycin regardless the species identity. Worryingly, in the present study we found multidrug resistance (MDR) up to 13 antibiotics which was related with intrinsic and acquired resistance mechanisms. Furthermore, linkage between various antimicrobial resistance genes was shown for beta-lactams and tetracycline, trimethoprim or sulfonamides. The distribution and resistome-based analysis of MDR pseudomonads in different slaughterhouse zones indicated that the main sources of the identical or related pseudomonad strains were the animals (feet and wool) and the slaughterhouse environment, being disseminated from the beginning "Entrance" to the end of the meat processing production "Meat products". Those facts must be taken into consideration to avoid cross-contamination with subsequent flow of mobile resistance determinants throughout all slaughterhouse zones and then to human and the environment by the application of adequate practices of hygiene and disinfection measures including animal wool and feet and also the entrance environment.
- Simultaneous determination of most prescribed antibiotics in multiple urban wastewater by SPE-LC-MS/MS. [JOURNAL ARTICLE]
- J Chromatogr B Analyt Technol Biomed Life Sci 2014 Aug 12.:162-170.
A rapid analytical method was developed for the application of a long-term monitoring (>one year) of the most prescribed and often in hospitals used antibiotics in diverse wastewaters of an urban sewage treatment plant (STP). Additionally to the selected multi-class antibiotics amoxicillin, penicillin V and piperacillin (penicillins), cefotaxime and cefuroxime (cephalosporins), azithromycin, clarithromycin and roxithromycin (macrolids), ciprofloxacin and levofloxacin-ofloxacin (fluoroquinolones), clindamycin (lincosamide), doxycycline (tetracycline), sulfamethoxazole (sulfonamide) and trimethoprim (dihydrofolate reductase inhibitor), the bioactive metabolite clindamycin-sulfoxide, the reserve antibiotic vancomycin (glycopeptide) and as tracer of the STP the anticonvulsant carbamazepine and the antifungal fluconazole were involved. The analytical method combines a low-sample-volume solid phase extraction (SPE), followed by a chromatographic separation using a reversed phase (RP) and hydrophilic interaction liquid chromatography (HILIC) technique, respectively, coupled to a triple quadrupole mass spectrometer. Detection was performed with multiple reaction monitoring (MRM) measured with positive electrospray ionization (ESI+). The extraction efficiency of different SPE cartridges and optimized pH-values of the preparation procedure were tested. Finally, the extraction of antibiotics was realized with the Oasis HLB cartridge and a pH adjustment at 3.5. An external calibration curve in diluted blank urine was used for quality control of the sample set of daily composite samples of the STP for the duration of one year monitoring. The squared coefficient of determination (r(2)) in the concentration range (20-20,000ng/L or 100-100,000ng/L) of the calibration curves for the method was higher than 0.99 for all determined substances. The limit of quantification (LoQ) ranged between 0.8ng/L (azithromycin) and 245.1ng/L (vancomycin). Furthermore, a standard addition was used for quantification in wastewater samples. The process efficiencies ranged from 20% (doxycycline) to 134% (cefuroxime) in influent samples and from 31% (doxycycline) to 171% (cefuroxime) in effluent samples of the STP. All selected substances have been found in wastewater samples. Cefuroxime, doxycycline, levofloxacin, piperacillin, sulfamethoxazole and carbamazepine showed highest concentrations up to 6.2μg/L.
- Furazolidone-based triple and quadruple eradication therapy for Helicobacter pylori infection. [Journal Article]
- World J Gastroenterol 2014 Aug 28; 20(32):11415-21.
To evaluate the efficacy of furazolidone-based triple and quadruple therapy in eradicating Helicobacter pylori (H. pylori) in a multi-center randomized controlled trial.A total of 720 H. pylori positive patients with duodenal ulcer disease were enrolled at 10 different hospitals in Jiangxi province in China. The patients were randomly assigned to four treatment groups as follows: patients in Groups 1 and 3 received rabeprazole (10 mg), amoxicillin (1000 mg) and furazolidone (100 mg) twice daily for 7 and 10 d, respectively; patients in Groups 2 and 4 received rabeprazole (10 mg), bismuth (220 mg), amoxicillin (1000 mg) and furazolidone (100 mg) twice daily for 7 and 10 d, respectively. The primary outcome measure was H. pylori eradication rate 4 wk after treatment by intention-to-treat and per protocol analysis, while the secondary outcome measures were symptom and sign changes at the end of treatment and 4 wk after the end of treatment, as well as the proportion of patients who developed adverse events.The demographic data of the four groups were not significantly different. Overall, 666 patients completed the scheme and were re-assessed with the (13)C-urea breath test. The intention-to-treat analysis of the H. pylori eradication rates in Groups 1, 2, 3 and 4 were 74.44%, 82.78%, 78.89% and 86.11%, respectively. The H. pylori eradication rate in Group 4 was significantly higher than that in Group 1. According to the per protocol analysis, the H. pylori eradication rates in Groups 1, 2, 3 and 4 were 81.21%, 89.22%, 85.54% and 92.26%, respectively. The H. pylori eradication rate in Group 4 was significantly higher than that in Group 1. The number of adverse events was 15 (8.3%), 16 (8.9%), 15 (8.3%) and 17 (9.4%) in Groups 1, 2, 3 and 4, respectively, including dizziness, vomiting, diarrhea, nausea, skin rash, itchy skin, and malaise. The symptoms were relieved without special treatment in all of the patients.Both 7- and 10-d quadruple furazolidone-based therapies achieve satisfactory H. pylori eradication rates.
- The Influence of Urinary pH on Antibiotic Efficacy Against Bacterial Uropathogens. [Journal Article]
- Urology 2014 Sep; 84(3):731.e1-7.
To determine the effects of pH on the activity of clinically relevant antibiotics against bacterial uropathogens. Numerous factors affect antibiotic efficacy within the urinary tract including pH. Because human urine can substantially vary from acidic (pH 4.5) to alkaline (pH 8) conditions and can be easily clinically manipulated, it would be a great advantage to better understand the role of pH in antibiotic treatment of urinary tract infection.This in vitro study investigated the activity of 24 widely used antimicrobial agents against bacterial strains comprising 6 major uropathogenic species (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Staphylococcus saprophyticus, and Staphylococcus epidermidis) over the range of pH 5-8. Standard disk-diffusion and broth-microdilution assays were used. One-way analysis of variance was applied to determine significance (P <.05).For 18 of the 24 agents, pH was shown to play a significant role in overall inhibitory activity. Although most agents behaved similarly across most or all of the uropathogens tested, several only showed pH-dependent effects against certain organisms. The fluoroquinolones, co-trimoxazole, aminoglycosides, and macrolides all functioned optimally at alkaline pH, whereas the tetracyclines, nitrofurantoin, and many of the β-lactams tested exhibited their highest activity under more acidic conditions. Sulfamethoxazole, oxacillin, amoxicillin and clavulanic acid, vancomycin, imipenem, and clindamycin were largely unaffected by pH.Clinicians should consider the urinary pH of their patients when treating urinary tract infection, especially in complicated scenarios. Future clinical investigations examining urinary pH and antibiotic efficacy may result in the application of decreased antibiotic dosages and regimen durations, potentially reducing antibiotic resistance development.
- Antibiotic resistance and prevalence of class 1 and 2 integrons in Escherichia coli isolated from two wastewater treatment plants, and their receiving waters (Gulf of Gdansk, Baltic Sea, Poland). [JOURNAL ARTICLE]
- Environ Sci Pollut Res Int 2014 Aug 29.
In this study, antimicrobial-resistance patterns were analyzed in Escherichia coli isolates from raw (RW) and treated wastewater (TW) of two wastewater treatment plants (WWTPs), their marine outfalls (MOut), and mouth of the Vistula River (VR). Susceptibility of E. coli was tested against different classes of antibiotics. Isolates resistant to at least one antimicrobial agent were PCR tested for the presence of integrons. Ampicillin-resistant E. coli were the most frequent, followed by amoxicillin/clavulanate (up to 32 %), trimethoprim/sulfamethoxazole (up to 20 %), and fluoroquinolone (up to 15 %)-resistant isolates. Presence of class 1 and 2 integrons was detected among tested E. coli isolates with rate of 32.06 % (n = 84) and 3.05 % (n = 8), respectively. The presence of integrons was associated with increased frequency of resistance to fluoroquinolones, trimethoprim/sulfamethoxazole, amoxicillin/clavulanate, piperacillin/tazobactam, and presence of multidrug-resistance phenotype. Variable regions were detected in 48 class 1 and 5 class 2 integron-positive isolates. Nine different gene cassette arrays were confirmed among sequenced variable regions, with predominance of dfrA1-aadA1, dfrA17-aadA5, and aadA1 arrays. These findings illustrate the importance of WWTPs in spreading of resistance genes in the environment and the need for inclusion of at least monitoring efforts in the regular WWTP processes.