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- Clinical Effectiveness of Co-trimoxazole vs. Amoxicillin in the Treatment of Non-Severe Pneumonia in Children in India: A Randomized Controlled Trial. [JOURNAL ARTICLE]
- Int J Prev Med 2013 Oct; 4(10):1162-1168.
Acute respiratory infection (ARI) in young children is responsible for an estimated 4.1 million deaths worldwide of which approximately 90% are due to pneumonia. To study the clinical effectiveness of co-trimoxazole versus amoxicillin in the treatment of non-severe pneumonia, as defined by WHO, in children in the age group of 02 months to 5 years. Randomized Control Trial study was conducted in out patient department of a large tertiary care hospital after taking consent from parents and ethical committee clearance.Children in study group were treated with amoxicillin (40 mg/kg/day in 3 divided doses) and those in control group were treated with co-trimoxazole (8 mg/kg/day of trimethoprim in 2 divided doses). All cases were reviewed on second and fifth day. The effectiveness and therapy failure were decided on the basis of clinical, radiological and complete blood count results.Two hundred and four cases of non severe pneumonia were studied. All cases were diagnosed on the basis of clinical criteria, as defined by WHO. Treatment failure was seen in 8.09% cases with amoxicillin and 39.05% cases with co-trimoxazole. Cost of one complete course with amoxicillin was 2.3 times higher than with co-trimoxazole. Compliance of therapy to co-trimoxazole (90.47%) was better than to amoxicillin (83.84%).The response to treatment with amoxicillin is faster, however, compliance is slightly poorer and cost of treatment high. In order to improve the compliance, better counseling and more studies are required to ascertain the efficacy of amoxicillin in higher dosage over a shorter period of time.
- Removal of emerging contaminants by simultaneous application of membrane ultrafiltration, activated carbon adsorption, and ultrasound irradiation. [JOURNAL ARTICLE]
- J Hazard Mater 2013 Nov 23.:342-349.
Advanced wastewater treatment is necessary to effectively remove emerging contaminants (ECs) with chronic toxicity, endocrine disrupting effects, and the capability to induce the proliferation of highly resistant microbial strains in the environment from before wastewater disposal or reuse. This paper investigates the efficiency of a novel hybrid process that applies membrane ultrafiltration, activated carbon adsorption, and ultrasound irradiation simultaneously to remove ECs. Diclofenac, carbamazepine, and amoxicillin are chosen for this investigation because of their assessed significant environmental risks. Removal mechanisms and enhancement effects are analysed in single and combined processes. The influence of adsorbent dose and ultrasonic frequency to EC removal are also investigated. Results suggest that adsorption is probably the main removal mechanism and is affected by the nature of ECs and the presence of other components in the mixture. Almost complete removals are achieved in the hybrid process for all ECs.
- Vancomycin decreases insulin sensitivity and is associated with alterations in intestinal microbiota and bile acid composition in obese subjects with metabolic syndrome. [JOURNAL ARTICLE]
- J Hepatol 2013 Dec 5.
Obesity has been associated with changes in the composition and function of the intestinal microbiota. Modulation of the microbiota by antibiotics also alters bile acid and glucose metabolism in mice. Hence, we hypothesized that short term administration of oral antibiotics in humans would affect fecal microbiota composition and subsequently bile acid and glucose metabolism.In this single blinded randomized controlled trial, 20 male obese subjects with metabolic syndrome were randomized to 7 days of amoxicillin 500mg t.i.d. or 7 days of vancomycin 500mg t.i.d. At baseline and after 1 week of therapy, fecal microbiota composition (Human Intestinal Tract Chip phylogenetic microarray), fecal and plasma bile acid concentrations as well as insulin sensitivity (hyperinsulinemic euglycemic clamp using [6,6-(2)H2]-glucose tracer) were measured.Vancomycin reduced fecal microbial diversity with a decrease of gram-positive bacteria (mainly Firmicutes) and a compensatory increase in gram-negative bacteria (mainly Proteobacteria). Concomitantly, vancomycin decreased fecal secondary bile acids with a simultaneous postprandial increase in primary bile acids in plasma (p<0.05). Moreover, changes in fecal bile acid concentrations were predominantly associated with altered Firmicutes. Finally, administration of vancomycin decreased peripheral insulin sensitivity (p<0.05). Amoxicillin did not affect any of these parameters.Oral administration of vancomycin significantly impacts host physiology by decreasing intestinal microbiota diversity, bile acid dehydroxylation and peripheral insulin sensitivity in subjects with metabolic syndrome. These data show that intestinal microbiota, particularly of the Firmicutes phylum contributes to bile acid and glucose metabolism in humans. This trial is registered at the Dutch Trial Register (NTR2566).
- Substitutions in Penicillin-Binding Protein 1 in Amoxicillin-Resistant Helicobacter pylori Strains Isolated from Korean Patients. [Journal Article]
- Gut Liver 2013 Nov; 7(6):655-60.
A worldwide increase in amoxicillin resistance in Helicobacter pylori is having an adverse effect on eradication therapy. In this study, we investigated the mechanism of the amoxicillin resistance of H. pylori in terms of amino acid substitutions in penicillin-binding protein 1 (PBP1).In total, 150 H. pylori strains were isolated from 144 patients with chronic gastritis, peptic ulcers, or stomach cancer. The minimum inhibitory concentrations (MICs) of the strains were determined with a serial 2-fold agar dilution method. The resistance breakpoint for amoxicillin was defined as >0.5 µg/mL.Nine of 150 H. pylori strains showed amoxicillin resistance (6%). The MIC values of the resistant strains ranged from 1 to 4 µg/mL. A PBP1 sequence analysis of the resistant strains revealed multiple amino acid substitutions: Val16→Ile, Val45→Ile, Ser414→Arg, Asn562→Tyr, Thr593→Ala, Gly595→Ser, and Ala599→Thr. The natural transformation of these mutated genes into amoxicillin-sensitive strains was performed in two separate pbp1 gene segments. A moderate increase in the amoxicillin MIC was observed in the segment that contained the penicillin-binding motif of the C-terminal portion, the transpeptidase domain.pbp1 mutation affects the amoxicillin resistance of H. pylori through the transfer of the penicillin-binding motif.
- Antibiogram pattern of oral microflora in periodontic children of age group 6 to 12 years: a clinicomicrobiological study. [Journal Article]
- J Contemp Dent Pract 2013; 14(4):595-600.
Aim:The study was carried out to see the diversity of oral microflora and its antibiotic sensitivity test in children of age group 6 to 12 years was carried. Materials and methods: Total 50 patients of age group 6 to 12 years were analyzed for their oral microflora and then checked for the antibiotic susceptibility test. The samples that were collected were incubated at 37°C for 48 hours. Once dispersed samples were taken and Gram staining was done, also they were spread on to a number of freshly prepared agar plates and incubated to allow cells to form microbial colony.
Results:The result showed microflora common in all types, Gram-positive facultative anaerobic rods and cocci. In normal children Gram-positive facultative anaerobic and fermenting cocci were predominant where as in children with caries growth of microbiota that were Gram-negative and positive, capnophilic, motile and anaerobic rods and cocci belonging to members of genera S. mutans and A. actinomycetemcomitans was seen.
Conclusion:By the present study it has been concluded that the number of bacteria determined by microscopic counts was twice as high in caries patients as in healthy sites, and also recommended that amoxicillin, ampicillin and amikacin are the most effective antibacterial drugs for the treatment of dental caries. Keywords: Microorganism, Antibiotics, Dental plaque, Pediatric patients, Sensitivity. How to cite this article: Fysal N, Jose S, Kulshrestha R, Arora D, Abdul Hafiz KA, Vasudevan S. Antibiogram Pattern of Oral Microflora in Periodontic Children of Age Group 6 to 12 Years: A Clinicomicrobiological Study. J Contemp Dent Pract 2013; 14(4):595-600. Source of support: Nil Conflict of interest: None declared.
- Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections. [REVIEW]
- Biomed Res Int 2013.:804391.
The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.
- Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department. [JOURNAL ARTICLE]
- Emerg Med Int 2013.:258517.
Background. Selection of empiric antibiotics for urinary tract infections (UTIs) has become more challenging because of the increasing rates of multidrug-resistant Enterobacteriaceae (MDRE) infections. Methods. This retrospective study was conducted to determine antibiotic resistance patterns, risk factors, and appropriate empiric antibiotic selection for MDRE UTIs. Adult patients seen in the Emergency Department (ED) with Enterobacteriaceae UTIs during 2008-2009 were identified from review of microbiology records. MDRE were defined as organisms resistant to at least 3 categories of antibiotics. Results. There were 431 eligible patients; 83 (19%) had MDRE UTIs. Resistance rates for individual antibiotics among MDRE UTIs were significantly greater than non-MDRE UTIs: levofloxacin, 72% versus 14%; TMP-SMX, 77% versus 12%; amoxicillin-clavulanate, 35% versus 4%; nitrofurantoin, 21% versus 12%, and ceftriaxone, 20% versus 0%. All Enterobacteriaceae isolates were susceptible to ertapenem (MIC ≤ 2 mg/L). Independent risk factors for MDRE UTI were prior fluoroquinolone use within 3 months (adjusted odds ratio (aOR) 3.64; P = 0.001), healthcare-associated risks (aOR 2.32; P = 0.009), and obstructive uropathy (aOR 2.22; P = 0.04). Conclusion. Our study suggests that once-daily intravenous or intramuscular ertapenem may be appropriate for outpatient treatment of ED patients with MDRE UTI.
- Treatment approaches and antibiotic use for emergency dental treatment in Turkey. [JOURNAL ARTICLE]
- Ther Clin Risk Manag 2013.:443-449.
The purpose of this study was to gather information about Turkish general dental practitioners' treatment approaches towards endodontic emergencies, antibiotic-prescribing habits, and their participation in lifelong learning programs. Questionnaires were given to dentists who attended the 16th National Congress organized by the Turkish Dental Association. From 1,400 questionnaires distributed, 589 (43%) were deemed usable in this study. This survey dealt with questions that were subdivided into two main topics: dental emergency treatment approaches, and antibiotic prescription and information on lifelong learning program participation. The statistical analysis was conducted with a χ (2) test at a significance level of P<0.05. For irreversible pulpitis cases in vital teeth, most of the dental practitioners (65.3%) preferred single-visit root canal treatments. For teeth presenting a periapical lesion, the preferred treatment approach was root canal treatment (91.5%). The rate of prescription of analgesics and antibiotics was 21.7% in untreated acute apical periodontitis cases and 41% in acute apical abscess cases. Frequently prescribed antibiotics were amoxicillin-clavulanate (61.8%) and amoxicillin (46.5%). There was a tendency for practitioners to attend congresses as their years of professional practice increased (P<0.0001). There have been discrepancies between taught and observed practice. Educational initiatives are needed to prevent inappropriate prescription of antibiotics.
- Low Helicobacter pylori primary resistance to clarithromycin in gastric biopsy specimens from dyspeptic patients of a city in the interior of Sao Paulo, Brazil. [JOURNAL ARTICLE]
- BMC Gastroenterol 2013 Dec 4; 13(1):164.
Clarithromycin, amoxicillin, and a pump proton inhibitor are the most common drugs recommended as first-line triple therapy for H.pylori treatment, which results in eradication rates close to 80%, varying regionally, principally due to emergency cases and increases of clarithromycin resistant strains. Nucleotide substitutions at the H. pylori domain V of the 23S rRNA fraction are involved in the macrolide resistance and the A2142G and A2143G mutations are predominant in clinical isolates worldwide including in Brazil. As H. pylori culture is fastidious, we investigated the primary occurrence of H. pylori A2142G and A2143G rDNA 23S mutations using a molecular approach directly on gastric biopsies of dyspeptic patients consecutively attended at Hospital das Clinicas of Marilia, Sao Paulo, Brazil.Biopsy specimens obtained from 1137 dyspeptic patients, were subjected to histopathology and H. pylori diagnosis by histology and PCR. PCR/RFLP assay was used to detect A2142G and A2143G point mutations at domain V of the H. pylori 23S rDNA associated with clarithromycin resistance. Through the developed assay, a 768 bp PCR amplicon corresponding to1728 to 2495 bp of the 23S H. pylori rDNA is restricted with MboII for A2142G mutation detection and with BsaI for A2143G mutation detection. Occurrence of 23S rDNA A2142G results in two DNA fragments (418 and 350 bp) and of 23S rDNA A2143G results in three DNA fragments (108, 310 and 350pb), due to a conserved BsaI restriction site.The PCR method used to diagnose H. pylori presented sensitivity, specificity and accuracy of 77,6%, 79,3% and 78,6%, respectively, compared to histology, the gold standard method for H. pylori diagnosis used in our routine. Prevalence of H.pylori with clarithromycin resistant genotypes was 2,46%, with predominance of A2143G 23S rDNA point mutation.The PCR/RFLP assay was a rapid and accurate H.pylori diagnostic and clarithromycin resistance determination method useful for routine practice. As prevalence of primary resistance of H.pylori to clarithromycin due to A2142G and A2143G mutations remains low in Marilia, the standard clarithromycin containing triple therapy is still valid.
- First observation in a non-endemic country (Togo) of Penicillium marneffei infection in a human immunodeficiency virus-infected patient: a case report. [JOURNAL ARTICLE]
- BMC Res Notes 2013 Dec 4; 6(1):506.
Infection with Penicillium marneffei is a common opportunistic infection in Southeast Asia where it is endemic. We report a case of Penicillium marneffei infection with fatal outcome in a Togolese woman infected with Human Immunodeficiency Virus (HIV).A 45-years-old patient, infected with Human Immunodeficiency Virus had consulted for ongoing febrile pneumonia since two weeks. Clinical examination revealed fever of 38.5[degree sign]C, dyspnea, pulmonary syndrome condensation and papulo-nodular of "molluscum contagiosum" like lesions located on the face, arms, neck and trunk. Sputum smear was negative for tuberculosis. The chest radiograph showed reticulonodular opacities in the right upper and middle lobes and two caves in the right hilar region. The CD4 count was 6 cells/mm3 after a year of antiretroviral treatment (Zidovudine-Lamivudine-Efavirenz). She was treated as smear negative pulmonary tuberculosis after a lack of gentamicin and amoxicillin plus clavulanic acid response. Culture of skin samples and sputum had revealed the presence of P. marneffei. A treatment with ketoconazole 600 mg per day was initiated. After two weeks of treatment, there was a decrease in the size and number of papules and nodules, without any new lesions. We noted disappearance of cough and fever. The chest X-ray showed a decrease of pulmonary lesions. There was no reactivation of P. marneffei infection but the patient died from AIDS after two years of follow up.We report a case of P. marneffei infection in a HIV-infected patient in a non-endemic country. Clinicians should think of P. marneffei infection in all HIV-infected patients with "molluscum contagiosum" like lesions.