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- Antibiotic susceptibility of Clostridium difficile is similar worldwide over two decades despite widespread use of broad-spectrum antibiotics: an analysis done at the University Hospital of Zurich. [JOURNAL ARTICLE]
- BMC Infect Dis 2014 Nov 26; 14(1):607.
Background Clostridium difficile infection (CDI) remains a major health problem worldwide. Antibiotic use, in general, and clindamycin and ciprofloxacin, in particular, have been implicated in the pathogenesis of CDI. Here, we hypothesized that antibiotics that are highly active in vitro against C. difficile are less frequently associated with CDI than others. The primary goals of our study were to determine if antibiotic susceptibility and CDI are associated and whether the antimicrobial susceptibility of C. difficile changed over the years.Methods and resultsWe examined a large panel of C. difficile strains collected in 2006¿2008 at the University Hospital of Zurich. We found that the antimicrobial susceptibilities to amoxicillin/clavulanate, piperacillin/tazobactam, meropenem, clindamycin, ciprofloxacin, ceftriaxone, metronidazole and vancomycin were similar to those reported in the literature and that they are similar to those reported in other populations over the last two decades. Antibiotic activity did not prevent CDI. For example, thre use of meropenem, which is highly active against all strains tested, was a clear risk factor for CDI. Most of the antibiotics tested also showed a higher minimum inhibitory concentration distribution than that of EUCAST. All strains were susceptible to metronidazole. One strain was resistant to vancomycin.ConclusionsAntibiotic susceptibilities of the collection of C. difficile from the University Hospital of Zurich are similar to those reported by others since the 1980. Patients treated with carbapenems and cephalosporins had the highest risk of developing CDI irrespective of the antimicrobial activity of carbapenems.
- [Ten Day Concomitant Therapy Is Superior to Ten Day Sequential Therapy for Helicobacter pylori Eradication]. [English Abstract, Journal Article]
- Korean J Gastroenterol 2014 Nov 25; 64(5):260-7.
Because the efficacy of standard triple therapy for Helicobacter pylori eradication has declined, new regimens such as sequential therapy (ST) and concomitant therapy (CoCTx) have been introduced. The aim of this study was to compare the efficacy of 10-day ST and 10-day CoCTx for H. pylori eradication.We retrospectively reviewed the medical records of 316 patients with proven H. pylori infection. They were assigned to one of 2 regimens; ST (n=191) consisted of, lansoprazole 30 mg and amoxicillin 1 g for 5 days followed by lansoprazole 30 mg, metronidazole 500 mg, and clarithromycin 500 mg for 5 days, and CoCTx (n=125) consisted of lansoprazole 30 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg for 10 days. All drugs were administered twice a day. Bacterial eradication was checked by using a (13)C-urea breath test at least 4 weeks after completion of treatment.The mean age and male to female ratio was 51.74 and 1.03, respectively. Baseline characteristics were not different in both groups. Ten day CoCTx group (94.4%, 118/125) showed better eradication rate than ST group (82.2%, 157/191) (p=0.002). Drug compliances were not statistically different between the two groups (p=0.19). Side effects were more frequently reported in the CoCTx group than in the ST group (p=0.03).Ten-day CoCTx was superior to ST in terms of eradicating H. pylori infection. Although the CoCTx producing more side effects than ST, CoCTx can be thought to be a promising alternative to ST as a treatment regimen for H. pylori eradication. (Korean J Gastroenterol 2014;64:260-267).
- Comparison of bleaching efficacy of two bleaching agents on teeth discoloured by different antibiotic combinations used in revascularization. [JOURNAL ARTICLE]
- Clin Oral Investig 2014 Nov 22.
To investigate the whitening effects of different bleaching agents on teeth discoloured by different antibiotic combinations of ciprofloxacin and metronidazole with minocycline, doxycycline, amoxicillin or cefaclor.Forty extracted bovine incisors were collected and discoloured with triple antibiotic pastes (TAP) with minocycline, doxycycline, amoxicillin and cefaclor throughout 30 days. The specimens were then randomly divided into two subgroups and each group received different bleaching materials: 35 % hydrogen peroxide and sodium perborate. Spectrophotometric measurements were obtained on the buccal surfaces of the crown, firstly in the beginning, then on the 4th, 8th and 12th days after the placement of the bleaching materials. The acceptability threshold was set to 3.5. The ∆E values were calculated and the data was analysed using the repeated measures analysis of variance (P = .05).All the test groups induced colour changes exceeding the acceptability threshold 30 days after the antibiotic pastes were placed. The 35 % hydrogen peroxide was more effective than sodium perborate in the whitening of discoloured teeth by antibiotic pastes (P = .001). The whitening effect after the 8th and 12th days was significantly more than after 4 days of treatment (P <.001). The discolouration caused by the TAP with minocycline and cefaclor showed greater whitening compared to the TAP with doxycycline and amoxicillin groups (P <.05).The whitening treatment effect of 35 % hydrogen peroxide on teeth discoloured by antibiotic pastes seems to have significantly outperformed the sodium perborate treatment. Both bleaching agents were allowed to bleach the teeth gradually each day and the effects on the 8th and 12th days were superior to the one on the 4th day.The use of 35 % hydrogen peroxide could be advantageous to bleach the teeth discoloured with antibiotic pastes compared to sodium perborate.
- Differential Benefits of Amoxicillin-Metronidazole in Different Phases of Periodontal Therapy Randomized Controlled Crossover Clinical Trial. [JOURNAL ARTICLE]
- J Periodontol 2014 Nov 21.:1-13.
Background: The specific advantage of administering systemic antibiotics during initial, non-surgical therapy, or in the context of periodontal surgery is unclear. This study assessed the differential outcomes of periodontal therapy supplemented with amoxicillin-metronidazole during either the non-surgical or the surgical treatment phase. Methods: Single center, randomized placebo controlled crossover clinical trial with a one-year follow-up. Eighty participants with Aggregatibacter actinomycetemcomitans-associated moderate to advanced periodontitis were randomized into two treatment groups. A: Antibiotics (3/d 500 mg metronidazole plus 375 mg amoxicillin for 7 days) during the first, non-surgical phase of periodontal therapy (T1), and placebo during the second, surgical phase (T2). B: Placebo during T1, and antibiotics during T2. Number of sites with PD >4 mm and BOP per patient was the primary outcome. Results: 11212 sites were clinically monitored on 1870 teeth. T1 with antibiotics decreased the number of sites with PD >4 mm and BOP per patient significantly more than without (A: from 34.5 to 5.7, 84%; B: from 28.7 to 8.7, 70%, p<0.01). Twenty patients treated with antibiotics, but only 8 treated with placebo, achieved a tenfold reduction of diseased sites (p=0.007). Consequently, fewer patients of group A needed further therapy, the mean number of surgical interventions was lower and treatment time in T2 was shorter. Six months after T2 the mean number of residual pockets (A: 2.8±5.2, B: 2.2±5.0) was not significantly different and was sustained over 12 months in both groups. Conclusion: Giving the antibiotics during the first or second phase yielded similar long term outcomes, however, antibiotics in T1 resolved the disease quicker, and thus reduced the need for additional surgical intervention.
- Examining the Risks of Cardiac Arrhythmia and Mortality among New-Generation Macrolides, Fluoroquinolones, and Beta-Lactam/Beta-Lactamase Inhibitor: A Nationwide Study. [JOURNAL ARTICLE]
- Clin Infect Dis 2014 Nov 18.
Previous studies have demonstrated increased cardiovascular mortality related to azithromycin and levofloxacin. Risks associated with alternative drugs in the same class, including clarithromycin and moxifloxacin, were unknown. We used the Taiwan National Health Insurance Database to perform a nationwide, population-based study that compares the risks of ventricular arrhythmia and cardiovascular death among these antibiotics. A total of 10,684,100 patients prescribed oral azithromycin, clarithromycin, moxifloxacin, levofloxacin, ciprofloxacin, or amoxicillin/clavulanate at outpatient visit between January 2001 and November 2011. A logistic regression model adjusted for propensity score was used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for adverse cardiac outcomes occurring within 7 days after the initiation of antibiotic treatment. Compared with amoxicillin-clavulanate treatment, the use of azithromycin and moxifloxacin were associated with significant increases in the risks of ventricular arrhythmia and cardiovascular death. The adjusted ORs (95% CI) for ventricular arrhythmia were 4.32 (2.95-6.33) for azithromycin, 3.30 (2.07-5.25) for moxifloxacin, and 1.41 (0.91-2.18) for levofloxacin. For cardiovascular death, the adjusted ORs (95% CI) for azithromycin, moxifloxacin, and levofloxacin were 2.62 (1.69-4.06), 2.31 (1.39-3.84), and 1.77 (1.22-2.59), respectively. No association was noted between clarithromycin or ciprofloxacin and adverse cardiac outcomes. Healthcare professionals should consider the small but significant increased risk of ventricular arrhythmia and cardiovascular death when prescribing azithromycin and moxifloxacin. Additional research is needed to determine whether the increased risk of mortality is caused by the drugs, or related to the severity of infection or the pathogens themselves.
- Acute Generalized Exanthematous Pustulosis Caused by Dihydrocodeine Phosphate in a Patient With Psoriasis Vulgaris and a Heterozygous IL36RN Mutation. [JOURNAL ARTICLE]
- JAMA Dermatol 2014 Nov 19.
Acute generalized exanthematous pustulosis (AGEP) is a rare and severe type of drug eruption. Dihydrocodeine phosphate is a semisynthetic opioid analgesic. Recently, recessive mutations in IL36RN have been identified in generalized pustular psoriasis (GPP). To date, 4 cases of AGEP and IL36RN mutation without previous history of psoriasis vulgaris (PV) have been reported.A woman in her 60s with PV presented with diffuse erythema, nonfollicular pustules, and fever. She had been treated with dextromethorphan hydrobromide hydrate, amoxicillin hydrate, clarithromycin, dihydrocodeine phosphate, tipepidine hibenzate, and tulobuterol tape for a cough and common cold. Based on histopathologic results and a positive result in a drug provocation test with dihydrocodeine phosphate, she was diagnosed with AGEP. A heterozygous IL36RN mutation c.28C>T (p.Arg10X) was also confirmed by mutation analysis.This is the first report of dihydrocodeine phosphate-induced AGEP. In this case, helper T cells, type 17, might have been activated because of morphine and underlying PV, followed by increased production of interleukin (IL) 36. However, because of the IL36RN mutation, IL-36 signaling was uncontrolled, which might have resulted in the occurrence of AGEP. An IL36RN mutation might underlie several different pustular skin eruptions, including AGEP and GPP, and further accumulation of patient data is required.
- Replacement of clarithromycin with azithromycin in triple therapy regimens for the eradication of helicobacter pylori: A randomized clinical trial. [Journal Article]
- J Med Life 2014 Jun 15; 7(2):254-9.
Eradication of helicobacter pylori is important for treatment of GU but an ideal regimen is not available. HP is resistant to metronidazole and clarithromycin. Clarithromycin is expensive and is not available in under developing countries. This study aimed to compare two regimens containing clarithromycin or azithromycin.Totally, seventy-eight patients with GU (confirmed with endoscopy) and infection of HP (Confirmed by Rapid Urease Test (RUT)) were allocated to one of the groups of study (35 participants in each group). Two weeks regimen of Clarithromycin (2×500 mg) + Amoxicillin (2×1 gr) + omeprazole (2×20 mg) was administered for group A of patients while group B got a 10 days regimen of Azithromycin (1×250 mg) + 14 days Amoxicillin (2×1 gr) + omeprazole (2×20 mg). At the end of the treatment course, the patients were evaluated according to the side effects of the drugs. In addition, two months after the end of therapy, patients underwent endoscopy and biopsy to evaluate HP eradication.After two weeks, the side effects of the drug were: Nausea 8 patients in group A and 7 patients in group B, Diarrhea 2 patients in group A, 3 patients in group B and vomiting 2 patients in group A, 3 patients in group B. There were no serious side effects in any group. Eradication rate in group A was 82.9% (based on per protocol analysis (PPA)) and 84.6 % (intention to treat (ITT)). In group B, eradication rate was 77.1 % (PPA) and 79.5 % (ITT) (P=0.55).Based on our study results, azithromycin can be used in HP eradication regimen because of its similar efficacy to clarithromycin but also have lower cost, side effects and resistance.
- Development of aminoglycoside and β-lactamase resistance among intestinal microbiota of swine treated with lincomycin, chlortetracycline, and amoxicillin. [JOURNAL ARTICLE]
- Front Microbiol 2014.:580.
Lincomycin, chlortetracycline, and amoxicillin are commonly used antimicrobials for growth promotion and infectious disease prophylaxis in swine production. In this study, we investigated the shifts and resistance development among intestinal microbiota in pregnant sows before and after lincomycin, chlortetracycline, and amoxicillin treatment by using phylogenetic analysis, bacterial enumeration, and PCR. After the antimicrobial treatment, shifts in microbial community, an increased proportion of resistant bacteria, and genes related to antimicrobial resistance as compared to the day before antimicrobial administration (day 0) were observed. Importantly, a positive correlation between antimicrobial resistance gene expression in different categories, especially those encoding aminoglycoside and β-lactamase and antimicrobial resistance, was observed. These findings demonstrate an important role of antimicrobial usage in animals in the development of antimicrobial resistance, and support the notion that prudent use of antimicrobials in swine is needed to reduce the risk of the emergence of multi-drug resistant zoonotic pathogens.
- Prevalence of salmonella infection in dogs in maiduguri, northeastern Nigeria. [Journal Article]
- Int J Microbiol 2014.:392548.
The prevalence and antimicrobial sensitivity of Salmonella from dogs in Maiduguri Metropolis were determined using standard bacteriological methods to assess the risk of possible transmission of Salmonella infection from dogs to humans. Of 119 samples, Salmonella was isolated from 52 (43.7%). Males had higher prevalence of 50.0% compared with 34.7% in females (P < 0.05). Dogs older than 24 months had higher prevalence of 61.0% and the lowest was seen in dogs aged 13-24 months (P < 0.05). The prevalence of 31.8%, 41.2%, and 58.8% was observed in dogs aged 3-6, 10-12, and 7-9 months, respectively. High prevalence of 49.5% was observed in Mongrels, while Terrier and Alsatian breeds had 30.0% and 8.3%, respectively. Salmonella isolates from Alsatian and Terrier breeds showed about 100% susceptibility to all the tested antimicrobials. Higher percentage of the Salmonella isolates from Mongrels also showed susceptibility to ciprofloxacin (89.7%), amoxicillin (87.6%), vancomycin (86.6%), and chloramphenicol (84.5%). However about 50% of these isolates showed resistance to ofloxacin. The carrier status of Salmonella is high among dogs especially Mongrels. Therefore good environmental hygiene, discouraging straying coupled with feeding of dogs with properly cooked and uncontaminated feeds was recommended to mitigate risk of human salmonellosis.
- Race, Otitis Media, and Antibiotic Selection. [JOURNAL ARTICLE]
- Pediatrics 2014 Nov 17.
Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally.We examined OM visit rates during 2008 to 2010 for children ≤14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrow-spectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM.The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86).Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.