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Geraldes C, Tavares L, Gil S, Oliveira M. Biocides in the Hospital Environment: Application and Tolerance Development. Microb Drug Resist 2023; 29:456-476. [PMID: 37643289 DOI: 10.1089/mdr.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Hospital-acquired infections are a rising problem with consequences for patients, hospitals, and health care workers. Biocides can be employed to prevent these infections, contributing to eliminate or reduce microorganisms' concentrations at the hospital environment. These antimicrobials belong to several groups, each with distinct characteristics that need to be taken into account in their selection for specific applications. Moreover, their activity is influenced by many factors, such as compound concentration and the presence of organic matter. This article aims to review some of the chemical biocides available for hospital infection control, as well as the main factors that influence their efficacy and promote susceptibility decreases, with the purpose to contribute for reducing misusage and consequently for preventing the development of resistance to these antimicrobials.
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Affiliation(s)
- Catarina Geraldes
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
| | - Luís Tavares
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
| | - Solange Gil
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
- Department of Animal Health, Biological Isolation and Containment Unit (BICU), Veterinary Hospital, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
| | - Manuela Oliveira
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
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Peyneau M, de Chaisemartin L, Gigant N, Chollet-Martin S, Kerdine-Römer S. Quaternary ammonium compounds in hypersensitivity reactions. FRONTIERS IN TOXICOLOGY 2022; 4:973680. [PMID: 36211198 PMCID: PMC9534575 DOI: 10.3389/ftox.2022.973680] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Quaternary ammonium compounds (QAC) are commonly used disinfectants, antiseptics, preservatives, and detergents due to their antibacterial property and represent the first used biocides before phenolic or nitrogen products. Their common structure consists of one or more quaternary ammonium bound with four lateral substituents. Their amphiphilic structure allows them to intercalate into microorganism surfaces which induces an unstable and porous membrane that explains their antimicrobial activity towards bacteria, fungi, and viruses. QAC are thus found in many areas, such as household products, medicines, hygiene products, cosmetics, agriculture, or industrial products but are also used in medical practice as disinfectants and antiseptics and in health care facilities where they are used for cleaning floors and walls. QAC exposure has already been involved in occupational asthma in healthcare workers or professional cleaners by many authors. They also have been suggested to play a role in contact dermatitis (CD) and urticaria in workers using cosmetics such as hairdressers or healthcare workers, inciting reglementary agencies to make recommendations regarding those products. However, distinguishing the irritant or sensitizing properties of chemicals is complex and as a result, the sensitizing property of QAC is still controverted. Moreover, the precise mechanisms underlying the possible sensitization effect are still under investigation, and to date, only a few studies have documented an immunological mechanism. Besides, QAC have been suggested to be responsible for neuromuscular blocking agents (NMBA) sensitization by cross-reactivity. This hypothesis is supported by a higher prevalence of quaternary ammonium (QA)-specific IgE in the professionally exposed populations, such as hairdressers, cleaners, or healthcare workers, suggesting that the sensitization happens with structurally similar compounds present in the environment. This review summarizes the newest knowledge about QAC and their role in hypersensitivities. After describing the different QAC, their structure and use, the most relevant studies about the effects of QAC on the immune system will be reviewed and discussed.
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Affiliation(s)
- Marine Peyneau
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
- *Correspondence: Marine Peyneau,
| | - Luc de Chaisemartin
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
| | - Nicolas Gigant
- CNRS, BioCIS, Université Paris-Saclay, Châtenay-Malabry, France
| | - Sylvie Chollet-Martin
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
| | - Saadia Kerdine-Römer
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
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Stjepanovic AN, Todorovic NB, Tesic TZ, Komazec ZS, Canji-Panic JM, Lalic-Popovic MN. Pharmaceutical excipients with potential to cause adverse effects in paediatric nasal medicines. Regul Toxicol Pharmacol 2022; 133:105225. [PMID: 35817211 DOI: 10.1016/j.yrtph.2022.105225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
Some pharmaceutical excipients may cause adverse reactions, excipient-related interactions and/or contraindications. Due to the unique characteristics of the paediatric population, adverse effects may occur to substances generally thought safe. The proportion of topical nasal medicines approved for paediatric use and the prevalence and labelling of excipients with known effect (EKE) in these products were compared in Serbia as a non-EU country and Croatia and Slovenia as EU countries. The study was designed as a post-authorization safety study and safety of excipients was considered in accordance with recommendations of the European Medicines Agency (EMA). More than 90% of topical nasal medicines registered in the three countries were approved for paediatric use and more than half of these paediatric medicines contained EKE that may cause adverse effects. Benzalkonium chloride was found in 52.38%, 55.81% and 59.09% of these products in Serbia, Croatia and Slovenia, respectively. Propylene glycol, benzyl alcohol, ethanol, methyl paraben, propyl paraben and boric acid were also present in a few analysed preparations. A significant number of EKE labelling deficiencies were detected in all three countries, hindering healthcare professionals' access to information needed for adequate patient counselling. A revision of the nasal paediatric medicines' PLs and SmPCs is recommended.
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Affiliation(s)
- Ana N Stjepanovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia
| | - Nemanja B Todorovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia
| | - Tamara Z Tesic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Otorhinolaryngology, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Ear, Nose and Throath Diseases, Novi Sad, Serbia
| | - Zoran S Komazec
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Otorhinolaryngology, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Ear, Nose and Throath Diseases, Novi Sad, Serbia
| | - Jelena M Canji-Panic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia
| | - Mladena N Lalic-Popovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine Novi Sad, Centre for Medical and Pharmaceutical Investigations and Quality Control (CEMPhIC), Novi Sad, Serbia.
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New Challenges in Drug Allergy: the Resurgence of Excipients. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:273-291. [PMID: 35910462 PMCID: PMC9308858 DOI: 10.1007/s40521-022-00313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 10/28/2022]
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Wallace CK, Bell SE, LaTourette PC, Miedel EM, Carty AJ, Philips BH. Suspected Anaphylactic Reaction to Ketamine in 3 Yucatan Swine ( Sus scrofa). Comp Med 2019; 69:419-424. [PMID: 31585552 DOI: 10.30802/aalas-cm-18-000148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This case series describes the clinical courses of 3 juvenile Yucatan miniature swine (Sus scrofa) that experienced a suspected anaphylactic reaction to ketamine hydrochloride during premedication for protocol-related surgery. All 3 swine rapidly developed diffuse erythema shortly after injection with ketamine-containing drug combinations. Clinical signs ranged from tachycardia and erythema alone to tachycardia and erythema followed by respiratory and cardiac arrest. Ketamine was considered the most likely cause of these reactions because it was the only agent in the premedication sedation combination that was used in all 3 swine. Subsequent intradermal skin testing confirmed this suspicion. With supportive care measures and standard medical interventions for anaphylaxis, all 3 animals recovered well and went on to be successful experimental subjects when an alternative anesthetic regimen that did not contain ketamine was used. To our knowledge, this report is the first description of a suspected adverse ketamine reaction of this type in swine despite the widespread use of the drug in this species. Ketamine anaphylaxis is rare in people, but the few cases described presented with symptoms similar to the clinical signs seen in the pigs in this report. In addition to highlighting a potential adverse drug reaction to ketamine in swine, this case series demonstrates the value of emergency preparedness for even the most routine of procedures.
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Affiliation(s)
- Chelsea K Wallace
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania:,
| | - Sara E Bell
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
| | - Philip C LaTourette
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
| | - Emily M Miedel
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania: Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania: Department of Comparative Medicine, University of South Florida, Tampa, Florida
| | - Anthony J Carty
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Blythe H Philips
- University Laboratory Animal Resources, University of Pennsylvania, Philadelphia, Pennsylvania
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Aerts O, Goossens A. Preservatives. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_85-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Palm J, Fuchs K, Stammer H, Schumacher‐Stimpfl A, Milde J. Efficacy and safety of a triple active sore throat lozenge in the treatment of patients with acute pharyngitis: Results of a multi-centre, randomised, placebo-controlled, double-blind, parallel-group trial (DoriPha). Int J Clin Pract 2018; 72:e13272. [PMID: 30329199 PMCID: PMC6282512 DOI: 10.1111/ijcp.13272] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/15/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this multi-centre, randomised, double-blind, placebo-controlled trial was to compare the efficacy and safety of the fixed combination of 0.5 mg tyrothricin, 1.0 mg benzalkonium chloride, and 1.5 mg benzocaine (study drug marketed as Dorithricin® ) in repeat dosing for 3 days to match placebo lozenges in the treatment of acute pharyngitis in adults. METHODS Patients (pts, aged ≥18 years) with acute pharyngitis, ie, non-streptococcal sore throat and moderate-to-severe pain (intensity NRS ≥ 7; VAS ≥ 50) were assigned to study drug (n = 160) or matching placebo (n = 161). Efficacy was assessed by investigator for 2 hours post initial dose (p.i.d.), and 3 days later (Visit 2). Primary efficacy endpoint was the complete resolution of throat pain and difficulty in swallowing at Visit 2 (3 days p.i.d.). Safety and local tolerability were also assessed. RESULTS Seventy-two hours (p.i.d.), complete resolution of throat pain and difficulty in swallowing were achieved by 44.6% patients on study drug compared with 27.2% patients on placebo (difference 17.4% (CI [5.8%; 29.7%]; 64% improvement [GEE, P = 0.0022]). Until 2 hours p.i.d., reduction in symptoms was better with study drug (P < 0.005). Treatment satisfaction was higher with study drug (patients'/investigators' assessment (78.9%/78.9% vs 55.0%/55.6% for placebo) and was well tolerated, overall safety profile was comparable to placebo. CONCLUSION The strength of this randomised controlled trial lies in the endpoint of complete remission after 3 days p.i.d., especially in the light of other trials addressing acute pharyngitis. The results of this study show a significant benefit of the study drug over placebo in the treatment of acute pharyngitis. Local treatment with the fixed combination (0.5 mg tyrothricin, 1.0 mg benzalkonium chloride, and 1.5 mg benzocaine) provides a rapid analgesic effect and is effective in relieving both severe throat pain as well as difficulty in swallowing associated with acute pharyngitis leading to a 64% improved complete remission within 72 hours. The triple active combination is a suitable treatment option for patients in the self-management of acute pharyngitis and sore throat. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03323528.
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Affiliation(s)
| | - Katharina Fuchs
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
| | - Holger Stammer
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
| | | | - Jens Milde
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
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Abstract
PURPOSE OF REVIEW This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings. RECENT FINDINGS Multiple new and elusive causes of anaphylaxis have been described over the past 35 years. Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.
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Haldar R, Bajwa SS, Kaur J. Xylometazoline nasal drops induced anaphylaxis: An atypical perioperative complication. J Anaesthesiol Clin Pharmacol 2017; 33:399-401. [PMID: 29109644 PMCID: PMC5672530 DOI: 10.4103/0970-9185.173331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Xylometazoline nasal drops used for nasal decongestion can have side-effect in the form of palpitation, hypertension, headache, and tremors. Anaphylaxis to xylometazoline nasal drops is a relatively unrecognized complication. We encountered a patient posted for tonsillectomy who developed serious anaphylaxis upon administration of a commercially available preparation of xylometazoline nasal drops and required aggressive management for stabilization. Further evaluation and literature search indicated toward the preservative (benzylalkonium chloride) as the cause of this adverse event.
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Affiliation(s)
| | | | - Jasleen Kaur
- Department of Anaesthesia, Gian Sagar Medical College, Banur, Patiala, Punjab, India
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Qureshi AA, Nilssen E. Alternatives to Benzalkonium Chloride containing nasal preparations. Clin Otolaryngol 2016; 40:400-1. [PMID: 26179693 DOI: 10.1111/coa.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - E Nilssen
- Queen Alexandra Hospital, Portsmouth, UK
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Melin VE, Melin TE, Dessify BJ, Nguyen CT, Shea CS, Hrubec TC. Quaternary ammonium disinfectants cause subfertility in mice by targeting both male and female reproductive processes. Reprod Toxicol 2015; 59:159-66. [PMID: 26582257 DOI: 10.1016/j.reprotox.2015.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 10/01/2015] [Accepted: 10/09/2015] [Indexed: 01/26/2023]
Abstract
Alkyl dimethyl benzyl ammonium chloride (ADBAC) and didecyl dimethyl ammonium chloride (DDAC) are common ingredients in household bathroom and kitchen cleaning sprays. ADBAC+DDAC cause reproductive toxicity in mice. The aim of the present study was to investigate gender-specific reproductive effects from ADBAC+DDAC. Female reproduction was assessed through ovulation, oocyte implantation, and estrus cycling. Male reproductive function was assessed by sperm concentration, motility, and viability. Numbers of corpora lutea were not different after 2 weeks, but decreased after 8 weeks of ADBAC+DDAC exposure. Dams exposed for 5 weeks to ADBAC+DDAC spent significantly less time in estrus. ADBAC+DDAC exposed males exhibited declines in both sperm concentration and motility, but not sperm viability. Subfertility in mice from ADBAC+DDAC exposure is, therefore, mediated through reproductive disturbances in both females and males. While the effect of ADBAC+DDAC exposure on human health is unclear, widespread exposure necessitates further consideration of their potential reproductive toxicity.
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Affiliation(s)
- Vanessa E Melin
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine, VA Tech, Blacksburg, VA 24061, USA
| | - Travis E Melin
- Department of Biomedical Science, E. Via College of Osteopathic Medicine - Virginia Campus, Blacksburg, VA 24060, USA
| | - Brian J Dessify
- Department of Biomedical Science, E. Via College of Osteopathic Medicine - Virginia Campus, Blacksburg, VA 24060, USA
| | - Christina T Nguyen
- Department of Biomedical Science, E. Via College of Osteopathic Medicine - Virginia Campus, Blacksburg, VA 24060, USA
| | - Caroline S Shea
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine, VA Tech, Blacksburg, VA 24061, USA
| | - Terry C Hrubec
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine, VA Tech, Blacksburg, VA 24061, USA; Department of Biomedical Science, E. Via College of Osteopathic Medicine - Virginia Campus, Blacksburg, VA 24060, USA.
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