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Gayawan E, Cameron E, Okitika T, Egbon OA, Gething P. A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria. PLoS One 2024; 19:e0303963. [PMID: 38776302 PMCID: PMC11111079 DOI: 10.1371/journal.pone.0303963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/04/2024] [Indexed: 05/24/2024] Open
Abstract
We assess progress towards improved case management of childhood diarrhea in Nigeria over a period of targeted health systems reform from 2013 to 2018. Individual and community data from three Demographic and Health Survey rounds are leveraged in a geospatial model designed for stratified estimation by venue of treatment seeking and State. Our analysis reveals a highly regionalised health system undergoing rapid change. Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44-0.69; 95% CI] in 2008; 0.70 [0.54-0.83] in 2018) or chemist/pharmacy (0.28 [0.17-0.42] in 2008; 0.48 [0.31-0.64] in 2018). Yet State-level variations in venue attendance and performance by venue have conspired to hold the overall proportion receiving this potentially life-saving therapy (0.45 [0.35-0.55] in 2018) to well-below ideal coverage levels. High performing states that have demonstrated significant improvements include Kano, Jigawa and Borno, while under-performing states that have suffered declines in coverage include Kaduna and Taraba. The use of antibiotics is not recommended for mild cases of childhood diarrhea yet remains concerningly high nationally (0.27 [0.19-0.36] in 2018) with negligible variation between venues. Antibiotic use rates are particularly high in Enugu, Kaduna, Taraba, Kano, Niger and Kebbi, yet welcome reductions were identified in Jigawa, Adamawa and Osun. These results support the conclusions of previous studies and build the strength of evidence that urgent action is needed throughout the multi-tiered health system to improve the quality and equity of care for common childhood illnesses in Nigeria.
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Affiliation(s)
- Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Ewan Cameron
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Tolu Okitika
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Osafu Augustine Egbon
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Peter Gething
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
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Alnezary FS, Alamri AR, Alrehaili RD, Alnizari DS, Alzahrani F, Mahmoud M, Almutairi MS, Kurdi A, Godman B. Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR. Front Pediatr 2024; 12:1342493. [PMID: 38562134 PMCID: PMC10982503 DOI: 10.3389/fped.2024.1342493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Diarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care. Method Simulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists' practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists' practice was categorized into adequate, less adequate, and poor. Results 182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription. Conclusion A high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists' practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.
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Affiliation(s)
- Faris S. Alnezary
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Amira R. Alamri
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Rafa D. Alrehaili
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Dina S. Alnizari
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Fahad Alzahrani
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Mansour Mahmoud
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Masaad S. Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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In Vitro Selective Combinatory Effect of Ciprofloxacin with Nitroxoline, Sanguinarine, and Zinc Pyrithione against Diarrhea-Causing and Gut Beneficial Bacteria. Microbiol Spectr 2022; 10:e0106322. [PMID: 35972279 PMCID: PMC9603368 DOI: 10.1128/spectrum.01063-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Antibiotic resistance in diarrhea-causing bacteria and its disruption of gut microbiota composition are health problems worldwide. The development of combinatory agents that increase the selective inhibitory effect (synergism) against diarrheagenic pathogens and, simultaneously, have a lowered impact (antagonism) or no negative action on the gut microbiota is therefore proposed as a new strategy efficient for chemotherapy against diarrheal conditions. In this study, the in vitro selective combinatory effect of ciprofloxacin with nitroxoline, sanguinarine, and zinc pyrithione, representing various classes of alkaloid-related compounds (nitroquinolines, benzylisoquinolines and metal-pyridine derivative complexes) against selected standard diarrhea-causing (Bacillus cereus, Enterococcus faecalis, Listeria monocytogenes, Shigella flexneri, and Vibrio parahaemolyticus) and gut-beneficial (Bifidobacterium adolescentis, Bifidobacterium animalis subsp. lactis, Bifidobacterium breve, Lactobacillus casei, and Lactobacillus rhamnosus) bacteria, was evaluated according to the sum of fractional inhibitory concentration indices (FICIs) obtained by the checkerboard method. The results showed that the individual combination of ciprofloxacin with nitroxoline, sanguinarine, and zinc pyrithione produced a synergistic effect against the pathogenic bacteria, with FICI values ranging from 0.071 to 0.5, whereas their antagonistic interaction toward the Bifidobacterium strains (with FICI values ranging from 4.012 to 8.023) was observed. Ciprofloxacin-zinc pyrithione produced significant synergistic action against S. flexneri, whereas a strong antagonistic interaction was observed toward B. breve for the ciprofloxacin-nitroxoline combination. These findings suggest that certain combinations of agents tested in this study can be used for the development of antidiarrheal therapeutic agents with reduced harmful action on the gastrointestinal microbiome. However, further studies focused on their pharmacological efficacy and safety are needed before they are considered for clinical trials. IMPORTANCE Diarrheal infections, which are commonly treated by antibiotics, are still responsible for over 4 to 5 million cases of human deaths annually. Moreover, the rising incidence of antibiotic resistance and its negative effect on beneficial bacteria (e.g., Bifidobacteria) of the gut microbial community are another problem. Thus, the development of selective agents able to inhibit diarrheal bacteria and, simultaneously, that have no negative impact on the gut microbiota, is important. Our results showed that individual combinations of ciprofloxacin with nitroxoline, sanguinarine, and zinc pyrithione produced synergism against the pathogenic bacteria, whereas their antagonistic interaction toward the beneficial strains was observed. The antagonism can be considered a positive effect contributing to the safety of the therapeutic agents, whereas their synergism against diarrheal bacteria significantly potentiates total antimicrobial efficacy. The certain combinations tested in this study can be used for the development of antidiarrheal agents with reduced harmful action on the gastrointestinal microbiome.
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Treatment with Distinct Antibiotic Classes Causes Different Pulmonary Outcomes on Allergic Airway Inflammation Associated with Modulation of Symbiotic Microbiota. J Immunol Res 2022; 2022:1466011. [PMID: 35785028 PMCID: PMC9242750 DOI: 10.1155/2022/1466011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Asthma is a chronic pulmonary disease that affects about 300 million people worldwide. Previous studies have associated antimicrobial use with allergies, but the real impact of antibiotics on asthma is still elusive. We investigated the potential impact of amoxicillin (Amox), trimethoprim/sulfamethoxazole (TMP/SMX), and metronidazole (Metro) in a murine model of OVA-induced allergic airway inflammation. Methods BALB/c mice received three cycles of 7 days of antibiotics in drinking water followed by 7 days washout and were sensitized i.p. with OVA/Alum at days 0 and 14. After the end of the last antibiotic washout, the mice were challenged with aerosolized OVA. Pulmonary parameters were evaluated, and serum, BAL, and feces were collected for analysis. Results Amox- and TMP/SMX-treated animals displayed more severe allergic airway inflammation parameters with increased airway hyperresponsiveness, reduced lung alveolar volume, and increased levels in BAL of IL-4 and IL-6. In contrast, Metro-treated mice showed preserved FEV-50, decreased lung inflammation, and higher levels of butyrate and propionate in their feces. Metro treatment was associated with increased OVA-specific IgA in serum. BAL microbiota was abundant in allergic groups but not in nonallergic controls with the Amox-treated group displaying the increased frequency of Proteobacteria, while Metro and TMP/SMX showed increased levels of Firmicutes. In the gut, we observed the enrichment of Akkermansia muciniphila associated with reduced airway inflammation phenotype in the Metro group, even after the recovery period. Conclusion Our data suggest that different antibiotic treatments may impact the course of experimental allergic airway inflammation in diverse ways by several mechanisms, including modulation of short-chain fat acids production by intestinal microbiota.
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Kudera T, Fiserova B, Korytakova M, Doskocil I, Salmonova H, Tulin EE, Nguon S, Bande MM, Kokoska L. In Vitro Selective Antibacterial and Antiproliferative Effects of Ethanolic Extracts from Cambodian and Philippine Plants Used in Folk Medicine for Diarrhea Treatment. Front Pharmacol 2021; 12:746808. [PMID: 34899301 PMCID: PMC8661004 DOI: 10.3389/fphar.2021.746808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
Bacterial diarrhea remains a global health problem, especially in developing tropical countries. Moreover, dysbiosis caused by diarrheagenic bacteria and inappropriate antimicrobial treatment has been associated with intestinal carcinogenesis. Despite the rich tradition of the use of herbs for the treatment of gastrointestinal disorders in Cambodian and Philippine folk medicine, many of them have not yet been systematically studied for their in vitro selective inhibitory effects on intestinal bacteria and cells. In the present study, in vitro inhibitory activities of 35 ethanolic extracts derived from 32 Cambodian and Philippine medicinal plants were determined by broth microdilution method against 12 pathogenic bacteria. Furthermore, cytotoxicity against intestinal cancer cells (Caco-2 and HT-29) using thiazolyl blue tetrazolium bromide cytotoxicity assay and safety to six beneficial intestinal bacteria (bifidobacteria and lactobacilli) and intestinal normal cells (FHs 74 Int) were determined for the antimicrobially active extracts. Selectivity indices (SIs) were calculated among the averages of minimum inhibitory concentrations (MICs), half-maximal inhibitory concentrations (IC50), and 80% inhibitory concentrations of proliferation (IC80) for each type of the tested agents. The extracts of Artocarpus blancoi (Elmer) Merr. (Moraceae), Ancistrocladus tectorius (Lour.) Merr. (Ancistrocladaceae), and Pentacme siamensis (Miq.) Kurz (Dipterocarpaceae) produced significant growth-inhibitory effects (MICs = 32-512 μg/ml) against intestinal pathogenic bacteria at the concentrations nontoxic to normal intestinal cells (IC80 values >512 μg/ml; SIs = 0.11-0.2). Moreover, the extract of P. siamensis (Miq.) Kurz was relatively safe to beneficial bacteria (MICs ≥512 μg/ml; SI = 0.1), and together with A. blancoi (Elmer) Merr., they selectively inhibited intestinal cancer cells (IC50 values ≥51.98 ± 19.79 μg/ml; SIs = 0.3 and 0.6). Finally, a strong selective antiproliferative effect on cancer cells (IC50 values 37.89 ± 2.68 to 130.89 ± 13.99 μg/ml; SIs = 0.5) was exerted by Ehretia microphylla Lam. (Boraginaceae), Lagerstroemia cochinchinensis Pierre ex Gagnep. (Lythraceae), and Melastoma saigonense (Kuntze) Merr. (Melastomataceae) (leaves with flower buds). The results suggest that the above-mentioned species are promising materials for the development of new selective antibacterial and antiproliferative agents for the treatment of infectious diarrhea and associated intestinal cancer diseases. However, further research is needed regarding the isolation and identification of their active constituents.
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Affiliation(s)
- Tomas Kudera
- Laboratory of Ethnobotany and Ethnopharmacology, Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Prague, Czechia
| | - Barbora Fiserova
- Laboratory of Ethnobotany and Ethnopharmacology, Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Prague, Czechia
| | - Marie Korytakova
- Laboratory of Ethnobotany and Ethnopharmacology, Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Prague, Czechia
| | - Ivo Doskocil
- Faculty of Agrobiology, Food and Natural Resources, Department of Microbiology, Nutrition and Dietetics, Czech University of Life Sciences Prague, Prague, Czechia
| | - Hana Salmonova
- Faculty of Agrobiology, Food and Natural Resources, Department of Microbiology, Nutrition and Dietetics, Czech University of Life Sciences Prague, Prague, Czechia
| | | | - Samnang Nguon
- Graduate School, Royal University of Agriculture, Phnom Penh, Cambodia
| | - Marlito M. Bande
- Institute of Tropical Ecology and Environmental Management, Visayas State University, Baybay, Philippines
| | - Ladislav Kokoska
- Laboratory of Ethnobotany and Ethnopharmacology, Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Prague, Czechia
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Qureshi S, Resham S, Hashmi M, Naveed AB, Haq Z, Ali SA. A retrospective review on antibiotic use in acute watery diarrhea in children in a tertiary care hospital of Karachi, Pakistan. PLoS One 2021; 16:e0253712. [PMID: 34264965 PMCID: PMC8282082 DOI: 10.1371/journal.pone.0253712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Responsible for at least one in nine pediatric deaths, diarrheal diseases are the leading, global cause of death. Further abetted by improper antibiotic use in a hospital setting, children with acute watery diarrhea can see prolonged hospital stays, and unwanted adverse effects such as antibiotic resistance. Hence, this study is aimed to identify the association between antibiotic usage for the treatment of acute watery diarrhea in children, and the impact this line of management has on the duration of their hospital stay. METHODS A retrospective review was conducted at the department of Pediatric of Aga Khan University Hospital (AKUH) in Karachi. A total of 305 records of children aged 6 months to 5 years who were admitted with a diagnosis of acute watery diarrhea from June 2017 -December 2018 was screened, of which 175 fulfilled the eligibility criteria. A predesigned questionnaire was used to collect demographic information, comorbidities, and clinical features, severity of dehydration, clinical examination, treatment received, and laboratory investigations. The primary outcome of this study was the length of hospital stay measured against the number of hours a child stayed in hospital for treatment of acute watery diarrhea. The statistical analysis was carried out using STATA version 14 to reach conclusive results. RESULTS 175 patients presented with acute watery diarrhea, out of which 106 (60.6%) did not receive antibiotics. The median (IQR) age of the group that did not receive antibiotics was 12.0 (12.0) months compared to 15.0 (12.0) months for the group that did receive antibiotics. In both groups, there were more males than females, less than 15% of the patients were severely malnourished (WHZ score -3SD) and less than 10% of the patients were severely dehydrated. The median (IQR) length of hospital stay (hours) was 32.0 (19.0) respectively for the group that did not receive antibiotic and 41.0 (32.0) for the group that did receive antibiotic therapy. The expected length of hospital stay for the group that received antibiotic therapy was 0.22 hours higher than the group that did not. Finally, as compared to females, hospital stay for males was longer by 0.25 hours. CONCLUSION In conclusion, antibiotic use was associated with a prolonged hospital stay in children with acute watery diarrhea as compared to children who did not receive antibiotics. Large scale robust prospective studies are needed to establish this association using this observational data.
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Affiliation(s)
- Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahzadi Resham
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mariam Hashmi
- Graduate Medical Student, Aga Khan University, Karachi, Pakistan
| | | | - Zoya Haq
- Medical Student, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Lanyero H, Ocan M, Obua C, Stålsby Lundborg C, Nanzigu S, Katureebe A, N Kalyango J, Eriksen J. Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study. BMC Public Health 2021; 21:1254. [PMID: 34187421 PMCID: PMC8244156 DOI: 10.1186/s12889-021-11254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diarrhea is the second leading cause of mortality in children under 5 years of age globally, and the risk of death increases with practices such as restriction of fluid intake and inappropriate use of antibiotics. We determined the prevalence of antibiotic use in managing diarrhea in children under 5 years of age in rural communities of Gulu district, northern Uganda. Method A cross-sectional study among children under 5 years with diarrhea, from households selected using multi-stage sampling. A researcher administered questionnaire was used to obtain data from caregivers of these children. Results Of the 856 children recruited, 318 (37.1%, 318/856) had experienced diarrhea, where 263 (82.7%, 263/318) had diarrhea with acute respiratory infections (ARIs), and 55 (17.3%, 55/318) had diarrhea without ARIs. The majority (89.6%, 285/318) of the children had non-bloody diarrhea. A high proportion (82.8%) of the children with non-bloody diarrhea also had ARIs. Bloody diarrhea was reported for 33 (10.4%) children including those with ARIs, and only 6 of these (18.2%) children had bloody diarrhea without ARIs. Of the 318 children with diarrhea, over half (52%, CI: 46–57) were administered antibiotics. Of the 55 children who had diarrhea without ARIs, over a third (38%, CI: 26–51) were administered antibiotics. Similarly, of the 263 children with diarrhea and ARIs, 54% (CI: 48–60) were treated with antibiotics. The determinants of antibiotic use included; children living in peri-urban settings (AOR: 3.41, CI: 1.65–7.08, P = 0.001), getting treatment from health facility (AOR: 1.76, CI: 1.06–2.93, P = 0.029), and having diarrhea with ARIs (AOR: 3.09, CI: 1.49–6.42, P = 0.003). Conclusion Antibiotic use is common among children under 5 years with diarrhea in rural communities of northern Uganda.
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Affiliation(s)
- Hindum Lanyero
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Sarah Nanzigu
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Joan N Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda.,Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Department of infectious diseases, South General Hospital, 118 83, Stockholm, Sweden
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Mohebi S, Nave HH, Javadi K, Amanati A, Kholdi S, Hadadi M, Hashemizadeh Z, Motamedifar M. Evaluate the distribution of virulence genes and to investigate antibiotic resistance pattern among Shigella species isolated from children with shigellosis in Iran. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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David EE, Igwenyi IO, Iroha IR, David CN, Mbah PC, Okpala OF, Ukeh NU, Ogbaji O, Ugwurauma CE, Chukwuma GC. Trends in Empirical Treatment of Hospitalized Children with Acute Gastroenteritis in Nigeria. RECENT ADVANCES IN ANTI-INFECTIVE DRUG DISCOVERY 2021; 16:237-244. [PMID: 34719369 DOI: 10.2174/2772434416666211022155438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/30/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Acute gastroenteritis is a common infectious disease with a high rate of morbidity and mortality in children below five years of age. Appropriate empirical treatment is therefore vital for reducing the incidence of the disease. OBJECTIVE This study aimed at determining the trends in the empirical treatment of hospitalized children with acute gastroenteritis. METHODS The study involved the data analysis of 88 medical folders of children who were diagnosed with gastroenteritis from January to February 2020 (a period of gastroenteritis yearly outbreak) in Mile 4 Hospital Abakaliki, Ebonyi State, Nigeria. Socio-demographic data and administered antibiotics data were collected. RESULTS Out of the 88 children, a total of 54 (61%) children were males, while 34 (39%) were females. The ages of the children ranged between 1-51 months, while the mean age was seen at 14 months. About 58 (66%) were diagnosed with acute gastroenteritis alone, with children aged 7-12 months recording higher numbers [25 (28%)]. Severe dehydration was seen as the most common morbidity of children with acute gastroenteritis. The guardians/parents of these children stayed at home for an average of 3 days (1-6 days) before visiting the hospital. The children were treated for an average of 5 days (2-9 days) in the hospital. The most singly used antibiotics was ciprofloxacin [31 (35%)] followed by a combination of ciprofloxacin and ceftriaxone [21 (24%)]. About 12 (14%) of the children were treated using a single dose of the antimalarial drug while 10 (11%) were treated in double combination therapy. The lowest duration in hospitalization (4 days) was seen in the use of a single dose regimen, while the highest hospitalization time (6 days) was seen in the use of a triple dose regimen. CONCLUSION The best empirical treatment of acute gastroenteritis may involve the use of ciprofloxacin alone and its combination with ceftriaxone. The severity of gastroenteritis may also be exacerbated with malaria.
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Affiliation(s)
- Ebuka E David
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Ikechuku O Igwenyi
- Department of Biochemistry, Ebonyi State University, Ebonyi State,Nigeria
| | | | - Chidinma N David
- Department of Microbiology, Ebonyi State University, Ebonyi State,Nigeria
| | - Precious C Mbah
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Ogochukwu F Okpala
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Nkemdirim U Ukeh
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Oluchukwu Ogbaji
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Chinecherem E Ugwurauma
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Goodness C Chukwuma
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
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Kudera T, Doskocil I, Salmonova H, Petrtyl M, Skrivanova E, Kokoska L. In Vitro Selective Growth-Inhibitory Activities of Phytochemicals, Synthetic Phytochemical Analogs, and Antibiotics against Diarrheagenic/Probiotic Bacteria and Cancer/Normal Intestinal Cells. Pharmaceuticals (Basel) 2020; 13:E233. [PMID: 32899218 PMCID: PMC7558399 DOI: 10.3390/ph13090233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
A desirable attribute of novel antimicrobial agents for bacterial diarrhea is decreased toxicity toward host intestinal microbiota. In addition, gut dysbiosis is associated with an increased risk of developing intestinal cancer. In this study, the selective growth-inhibitory activities of ten phytochemicals and their synthetic analogs (berberine, bismuth subsalicylate, ferron, 8-hydroxyquinoline, chloroxine, nitroxoline, salicylic acid, sanguinarine, tannic acid, and zinc pyrithione), as well as those of six commercial antibiotics (ceftriaxone, ciprofloxacin, chloramphenicol, metronidazole, tetracycline, and vancomycin) against 21 intestinal pathogenic/probiotic (e.g., Salmonella spp. and bifidobacteria) bacterial strains and three intestinal cancer/normal (Caco-2, HT29, and FHs 74 Int) cell lines were examined in vitro using the broth microdilution method and thiazolyl blue tetrazolium bromide assay. Chloroxine, ciprofloxacin, nitroxoline, tetracycline, and zinc pyrithione exhibited the most potent selective growth-inhibitory activity against pathogens, whereas 8-hydroxyquinoline, chloroxine, nitroxoline, sanguinarine, and zinc pyrithione exhibited the highest cytotoxic activity against cancer cells. None of the tested antibiotics were cytotoxic to normal cells, whereas 8-hydroxyquinoline and sanguinarine exhibited selective antiproliferative activity against cancer cells. These findings indicate that 8-hydroxyquinoline alkaloids and metal-pyridine derivative complexes are chemical structures derived from plants with potential bioactive properties in terms of selective antibacterial and anticancer activities against diarrheagenic bacteria and intestinal cancer cells.
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Affiliation(s)
- Tomas Kudera
- Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Kamycka 129, 16500 Praha-Suchdol, Czech Republic;
| | - Ivo Doskocil
- Department of Microbiology, Nutrition and Dietetics, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, Kamycka 129, 16500 Praha-Suchdol, Czech Republic; (I.D.); (H.S.); (E.S.)
| | - Hana Salmonova
- Department of Microbiology, Nutrition and Dietetics, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, Kamycka 129, 16500 Praha-Suchdol, Czech Republic; (I.D.); (H.S.); (E.S.)
| | - Miloslav Petrtyl
- Department of Zoology and Fisheries, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, Kamycka 129, 16500 Praha-Suchdol, Czech Republic;
| | - Eva Skrivanova
- Department of Microbiology, Nutrition and Dietetics, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, Kamycka 129, 16500 Praha-Suchdol, Czech Republic; (I.D.); (H.S.); (E.S.)
| | - Ladislav Kokoska
- Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Kamycka 129, 16500 Praha-Suchdol, Czech Republic;
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Tsige AG, Nedi T, Bacha T. Assessment of the Management of Diarrhoea Among Children Under Five in Addis Ababa, Ethiopia. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:135-143. [PMID: 32440249 PMCID: PMC7213891 DOI: 10.2147/phmt.s243513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/01/2020] [Indexed: 12/23/2022]
Abstract
Purpose Irrational antibiotic use is a worldwide problem. One of the main reasons for excessive use of antibiotics is the failure to follow the clinical guidelines. Inappropriate use of antibiotics for infectious diarrhea is associated with the risk of increasing the development of antimicrobial resistance and the cost of health care. We therefore pursued to assess the appropriateness of the management of diarrhea in children in Addis Ababa. Materials and Methods A retrospective cross-sectional study was conducted in the health centers of Addis Ababa, Ethiopia, between September 2014 and February 2015. Demographic characteristics, signs of dehydration, stool characteristics, drug types and other relevant information have been collected. Data analysis was performed using version 20 of the SPSS. Logistic regression was used to examine the association between dependent and independent variables. Indicators for the appropriateness of diarrhoea management have been established on the basis of the Standard Treatment Guideline and the guidelines of the World Health Organization. Results A total of 803 medical records of children have been checked. Of this, 54.4% had received inappropriate management. At least one antimicrobial was prescribed to 73.2% of the children who visited the health centres. Oral rehydration solution (ORS) and zinc were prescribed only in 66.7% and 47.5%, respectively. Appropriate management among children diagnosed with dysentery was found to be 6.38 times higher adjusted odds ratios (AOR=6.38 (3.11, 13.63)) than children with watery diarrhea. Although antibiotics are prescribed inappropriately for most children, it is appropriate when the diarrhea is bloody. Appropriate management of diarrhoea among infants aged 2-11 months was 54% less compared to children aged 12-59 months (AOR=0.46 (0.24, 0.90)). Conclusion The magnitude of inadequate antibiotic prescription while managing diarrhoea in our setting was high. On the contrary, a low prescribing rate of ORS and zinc was observed. Our result highlights the need for urgent action to prevent the development of antibiotic-resistant microorganisms. Health-care professionals should have clear information on the risks of inadequate diarrhoea treatment in children under five.
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Affiliation(s)
- Arega Gashaw Tsige
- Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Teshome Nedi
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tigist Bacha
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mekonnen GK, Mengistie B, Sahilu G, Kloos H, Mulat W. Etiologies of diarrhea and drug susceptibility patterns of bacterial isolates among under-five year children in refugee camps in Gambella Region, Ethiopia: a case control study. BMC Infect Dis 2019; 19:1008. [PMID: 31779589 PMCID: PMC6883563 DOI: 10.1186/s12879-019-4599-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/28/2019] [Indexed: 01/20/2023] Open
Abstract
Background Despite substantial global effort and updated clinical management guidelines, diarrhea continues to be among leading worldwide causes of morbidity and mortality in children. Infectious diarrhea, the most common form of diarrhea causes substantial morbidity and mortality among children in developing countries, and the muddled use of antibiotics needs caution due to potential problems of drug-resistance. The aim of this study is to identify etiologies of diarrhea and drug susceptibility patterns of bacterial isolates in under-five children in refugee camps in Gambella Region, Ethiopia. Methods An institution- based matched case control study was conducted using a questionnaire-based interview from June to December 2017 in Pugnido and Teirkidi refugee camps. Stool samples were collected and parasites causing diarrhea were identified by wet mount microscopy. Conventional culture supplemented with API 20E identification kit was used to identify Salmonella and Shigella species. Antibiotic susceptibility of bacterial isolates was investigated by using the disk diffusion method. The association between etiologies and diarrhea was analyzed using McNemar test or Fisher exact test with 95% confidence interval at a level of significance of P < 0.05. Results The overall prevalence of enteric pathogens were 55 (41.0%) in diarrhea cases and 18 (13.4%) in healthy controls. The detected etiologies include Giardia lambia (28), Shigella spp. (16), E. hystolyotica/dispar (13), Ascaris lumbricoides (10), Salmonella spp. (6), Cryptosporidium parvum (6), Hymenolepis nana (4) and Isospora belli (3). All isolates were sensitive to kanamycine and ceftazidime. The high resistance rate was observed against ampicillin (100%), amoxicillin (100%), erythromycin (52%), chloramphenicol (47.5%), tetracycline (40.5%), cotrimoxazole (34.8%) and amoxicillin-clavulanic acid (33%). The majorities of the isolates had a low rate of resistance to ciprofloxacin (8.7%), naldxic acid (8.7%) and amikacin (13%). Conclusions Giardia lamblia, E. Hystolytica/dispar, and Shigella spp are the common etiologies of diarrhea in children in the studied refugee camps. The study also showed that significant numbers of bacterial isolates were resistant to the commonly used antimicrobial drugs. Therefore, improving clinical laboratory services and promoting evidence-based drug prescription may reinforce proper use of antibiotics and reduce the emergence of microbial resistance.
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Affiliation(s)
- Getachew Kabew Mekonnen
- Addis Ababa University, Ethiopian Institute of Water Resources, PO. BOX 150461, Addis Ababa, Ethiopia. .,Addis Ababa City Administration, PO. Box 8470, Addis Ababa, Ethiopia. .,Haramaya University, College of Health and Medical Sciences, PO. Box 1570, Harar, Ethiopia.
| | - Bezatu Mengistie
- Haramaya University, College of Health and Medical Sciences, PO. Box 1570, Harar, Ethiopia
| | - Geremew Sahilu
- Addis Ababa University, Ethiopian Institute of Water Resources, PO. BOX 150461, Addis Ababa, Ethiopia
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Worku Mulat
- Wello University, College of Medicine and Health Sciences, Desse, Ethiopia
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Assefa A, Girma M. Prevalence and antimicrobial susceptibility patterns of Salmonella and Shigella isolates among children aged below five years with diarrhea attending Robe General Hospital and Goba Referral Hospital, South East Ethiopia. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:19. [PMID: 31832223 PMCID: PMC6864936 DOI: 10.1186/s40794-019-0096-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022]
Abstract
Background Diarrheal diseases are responsible for high level of morbidity and mortality, particularly in children below 5 years. Salmonella and Shigella spp. are pathogenic microbes responsible for the major diarrheal associated mortality. The purpose of this study was to determine the prevalence, factors associated with Salmonella and Shigella isolates infections and their antimicrobial susceptibility patterns among diarrheic children aged below 5 years attending BRGH and GRH, Ethiopia. Methods A health institution based cross-sectional study was conducted from April to July 2016. One stool samples was collected from 422 diarrheic children under the ages of five and were cultured on to Hektoen Enteric (HE) and Salmonella-Shigella agar. Isolation identification of the Salmonella and Shigella isolates were conducted using standard bacteriological methods. Antibiotic susceptibility was done by Kirby–Bauer disk diffusion method. The isolates were defined as multidrug resistant if it was resistant to two or more antimicrobial agents. Descriptive statistics were employed and logistic regression models were constructed to determine factors associated with Shigella/Salmonella prevalence. Results The prevalence of Salmonella and Shigella isolates were 6.9 and 4.3%, respectively. Children aged between 1 to 3 years were significantly associated with Salmonella infection [AOR = 19.08, 95% CI (2.68–135.86)]. The odd of prevalence of Salmonella/Shigella isolates was significantly associated with absence of latrine, absence of hand washing after latrine, and in unimmunized children in adjusted odd ratio. Unimproved water sources and hand washing before meal had also higher odd of prevalence although the difference was not significant. All Salmonella and Shigella isolates were resistant to amoxicillin (100%). In addition, all Shigella isolates were completely resistant to chloramphenicol, and tetracycline, and were multidrug resistant. However, all Salmonella and Shigella isolates were susceptible to ciprofloxacin and ceftriaxone. Conclusion There was a relatively low prevalence of Salmonella and Shigella species in the study areas and were significantly associated with lack of personal hygiene and environmental sanitation. There were also higher drug resistance and multidrug resistant pattern. Personal hygiene and environmental sanitation, including access to latrine and supply of safe drinking water are suggested. Checking susceptibilities of Shigella and Salmonella isolates causing diarrhea is also suggested.
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Affiliation(s)
- Addisu Assefa
- Department of Biology, Madda Walabu University, P.O.B.247, Bale Robe, Ethiopia
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Auta A, Ogbonna BO, Adewuyi EO, Adeloye D, Strickland-Hodge B. Prevalence and factors associated with the use of antibiotics in non-bloody diarrhoea in children under 5 years of age in sub-Saharan Africa. Arch Dis Child 2019; 104:518-521. [PMID: 29555724 DOI: 10.1136/archdischild-2017-314228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate the prevalence and determine the factors associated with the use of antibiotics in the management of non-bloody diarrhoea in children under 5 years of age in sub-Saharan Africa (SSA). METHODS We conducted a meta-analysis of demographic and health survey data sets from 30 countries in SSA. Pooled prevalence estimates were calculated using random effects model. Χ2 tests were employed to determine the factors associated with the antibiotic use. RESULTS The pooled prevalence of antibiotic use among cases of non-bloody diarrhoea in children under 5 years of age was 23.1% (95% CI 19.5 to 26.7). The use of antibiotics in children with non-bloody diarrhoea in SSA was associated with (p<0.05) the source of care, place of residence, wealth index, maternal education and breastfeeding status. CONCLUSION We found an unacceptably high use of antibiotics to treat episodes of non-bloody diarrhoea in children under the age of 5 in SSA.
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Affiliation(s)
- Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Brian O Ogbonna
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Emmanuel O Adewuyi
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Davies Adeloye
- Nigerian Urban Reproductive Health Initiative, Abuja, Nigeria.,Johns Hopkins Centre for Communication Programs, Baltimore, Maryland, USA
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Mohamed-Salem R, Rodríguez Fernández C, Nieto-Pelegrín E, Conde-Valentín B, Rumbero A, Martinez-Quiles N. Aqueous extract of Hibiscus sabdariffa inhibits pedestal induction by enteropathogenic E. coli and promotes bacterial filamentation in vitro. PLoS One 2019; 14:e0213580. [PMID: 30849110 PMCID: PMC6407759 DOI: 10.1371/journal.pone.0213580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
Diarrheic diseases account for the annual death of approximately 1.9 million children under the age of 5 years, and it is a major cause of work absenteeism in developed countries. As diarrheagenic bacteria, enteropathogenic Escherichia coli (EPEC) attach to cells in the small intestine, causing local disappearance of microvilli and inducing the formation of actin-rich pedestals that disrupt the intestinal barrier and help EPEC adhere to and infect intestinal cells. Antibiotics and other bioactive compounds can often be found by analyzing traditional medicines. Here a crude aqueous extract of Hibiscus sabdariffa, which typically grows in subtropical and tropical areas and is a popular medicinal tisane in many countries, was analyzed for antibacterial activity against EPEC. In standard microdilution assays, the extract showed a minimum inhibitory concentration of 6.5 mg/ml against EPEC growth. Time-kill kinetics assays demonstrated significant 24 h bactericidal activity at 25 mg/ml. The extract is able to impede pedestal induction. Not only did the extract inhibit preformed pedestals but it prevented pedestal induction as well. Remarkably, it also promoted the formation of EPEC filaments, as observed with other antibiotics. Our results in vitro support the potential of Hibiscus sabdariffa as an antimicrobial agent against EPEC.
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Affiliation(s)
- Reda Mohamed-Salem
- Department of Microbiology and Parasitology, Pharmacy School, Complutense University, Madrid, Spain
| | | | - Elvira Nieto-Pelegrín
- Department of Microbiology and Parasitology, Pharmacy School, Complutense University, Madrid, Spain
| | - Beatriz Conde-Valentín
- Department of Microbiology and Parasitology, Pharmacy School, Complutense University, Madrid, Spain
- Pharmaceutics and Food Technology Department, Complutense University, Madrid, Spain
| | - Angel Rumbero
- Organic Chemistry Department, Autonóma University, Madrid, Spain
| | - Narcisa Martinez-Quiles
- Department of Microbiology and Parasitology, Pharmacy School, Complutense University, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University and Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
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Gebreegziabher G, Asrat D, W/Amanuel Y, Hagos T. Isolation and Antimicrobial Susceptibility Profile of Shigella and Salmonella Species from Children with Acute Diarrhoea in Mekelle Hospital and Semen Health Center, Ethiopia. Ethiop J Health Sci 2018; 28:197-206. [PMID: 29983517 PMCID: PMC6016337 DOI: 10.4314/ejhs.v28i2.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Salmonella and Shigella remain the major contributors to acute enteric infections and diarrhoea. Hence, the objective of this study was to isolate and determine the antimicrobial susceptibility pattern of Shigella and Salmonella species from children with acute diarrhoea in Mekelle Hospital and Semen Health Center. Methods A cross sectional study was conducted among 260 children with acute diarrhoea from November 2011 to March 2012 in Mekelle, Ethiopia. Stool specimen was collected from all study participants who presented with acute diarrhoea. Microscopy, culture and confirmatory identification were done by the pattern of biochemical reactions using a standard bacterial identification system (API 20E, BioMerieux, Marcy-l'Etoile, France) and polyvalent (Poly O and H) antiseras for Salmonella species and Vi for S.typhi. Isolated colonies were assessed for antimicrobial susceptibility profile using disk diffusion method. Data was entered and analyzed using SPSS version 16.0 software. Results Out of the 260 study participants, 145(55.8%) were males while 115(44.2%) were females. The majority of the patients (44.2%) were of children under five years old. A total of 120 enteropathogens were isolated. The frequency of isolation was 19(7.3%), 18(6.9%) and 83(31.9%) for Salmonella species, Shigella species and intestinal parasites respectively. Most of the Shigella isolates were resistant to ampicillin (88.9%), Tetracycline (77.8), cotrimoxazole (55.6%) and chloramphenicol (55.6%). Among the Salmonella isolates, the highest resistance was observed to ampicillin (89.5%), Tetracycline (89.5%), chloramphenicol (78.9%) and cotrimoxazole (57.9%). Multi-drug resistance was noted in 19(100%) and 16(88.9%) of Salmonella and Shigella species respectively. Conclusions Shigella and Salmonella are still challenging pathogens in children < 5 years of age. High antibiotic resistance was observed among both isolates to ampicillin, tetracycline, chloramphenicol and cotrimoxazole.
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Affiliation(s)
- Gebremichael Gebreegziabher
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Daniel Asrat
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Yimtubezinash W/Amanuel
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Tesfalem Hagos
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University
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Antidiarrheal Activity of 80% Methanolic Leaf Extract of Justicia schimperiana. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018. [PMID: 29541140 PMCID: PMC5818970 DOI: 10.1155/2018/3037120] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Diarrhea is one of the leading causes of preventable death in developing countries and mainly affects children and infants. It has been reported that the leaf of Justicia schimperiana is used as an antidiarrheal agent in Libo Kemekem district, northwest Ethiopia. Method The 80% methanolic leaf extract of J. schimperiana was evaluated for its activity against castor oil-induced diarrhea, enteropooling, and gastrointestinal motility in mice. Results Significant reduction (p < 0.001) in the total defecation and diarrheal drops was produced by all the test doses of the extract. Percentage inhibition of wet feces was 42.58, 65.07, and 74.96% at 100, 200, and 400 mg/kg doses of the extract, respectively. The extract also significantly inhibited castor oil-induced enteropooling at all test doses. The percent reduction in mean weight of intestinal contents was 66.96, 67.83, and 76.52% at 100, 200, and 400 mg/kg doses of the extract, respectively. The extract significantly reduced gastrointestinal movement of charcoal meal as well at 200 (p < 0.01) and 400 mg/kg (p < 0.001) doses. Conclusion In conclusion, the methanolic leaf extract of J. schimperiana has an antidiarrheal activity and this supports the use of this plant in the treatment of diarrhea in the traditional settings.
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Quraishi F, Shaheen S, Memon Z, Fatima G. Culture and Sensitivity Patterns of Various Antibiotics Used for the Treatment of Pediatric Infectious Diarrhea in Children under 5 Years of Age: A Tertiary Care Experience from Karachi. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ijcm.2018.99057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abu-Saied MA, Taha TH, El-Deeb NM, Hafez EE. Polyvinyl alcohol/Sodium alginate integrated silver nanoparticles as probable solution for decontamination of microbes contaminated water. Int J Biol Macromol 2017; 107:1773-1781. [PMID: 29030192 DOI: 10.1016/j.ijbiomac.2017.10.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/18/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Abstract
It is well known that the pathogenic multidrug resistant microbes are highly distributed and transferred to human through contaminated food and water. Advanced technologies have been developed for controlling these microbes using synthesized nanoparticles. In this study, biosynthesized silver nanoparticles were prepared, characterized and integrated with two synthetic and natural polymers. The polymers-silver nanoparticles were characterized using SEM, FTIR and mechanical properties of the membrane synthesized from either polymers with/without nanosilver. Both of pathogenic bacteria and yeast were tested for their resistance against 10 different antibiotics. The pathogens showed high resistance against 9 antibiotics and only one was recorded as potent. The cytotoxicity of nanosilver integrated polymers were tested against Hamster kidney cells and Human skin fibroblast cells, and the non-cytotoxic dose was checked for its antimicrobial activity against the selected pathogens. The obtained results in this study confirm that the using of the nanomaterials in safe doses could be a good substitution for biogenic antibiotics and chemicals used in water treatment. Moreover, the beads which were used in this study could be lasts for long period in water treatment station with high antibacterial capacity, in addition, it can be gathered easily at the end of the run.
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Affiliation(s)
- M A Abu-Saied
- Polymer Materials Research Department, Advanced Technology and New Materials Research Institute, City of Scientific Research and Technology Applications (SRTA-CITY), New Borg El-Arab City, 21934, Alexandria, Egypt.
| | - Tarek H Taha
- Environmental Biotechnology Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), City of Scientific Research and Technology Applications (SRTA-CITY), New Borg El-Arab City, 21934, Alexandria, Egypt.
| | - Nehal M El-Deeb
- Department of Biopharmaceutical Product Research, Genetic Engineering and Biotechnology Research Institute (GEBRI), City of Scientific Research and Technology Applications (SRTA-CITY), New Borg El-Arab City, 21934, Alexandria, Egypt
| | - Elsayed E Hafez
- Plant Protection and Biomolecular Diagnosis Department, Arid Lands Cultivation Research Institute (ALCRI), City of Scientific Research and Technology Applications (SRTA-CITY), New Borg El-Arab City, 21934, Alexandria, Egypt
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Moustafa MF, Taha TH, Helal M, Alrumman SA. Differential-display reverse transcription-PCR (DDRT-PCR): a new technology for molecular detection and studying one of the antagonistic factors of Bacillus endophyticus strain SA against Staphylococcus aureus (MRSA). 3 Biotech 2016; 6:121. [PMID: 28330192 PMCID: PMC4909024 DOI: 10.1007/s13205-016-0439-1] [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] [Received: 12/01/2015] [Accepted: 05/25/2016] [Indexed: 10/25/2022] Open
Abstract
Differential Display (DDRT-PCR) is a powerful technique for analyzing differences in gene expression. In-vivo expression technologies and differential display RT-PCR are providing new approaches to further examine a microbe's response to experimental conditions which more closely resemble natural microbial associations and habitats. In this study, Bacillus endophyticus strain SA isolated from the inner tissue of the stem of the cultivated plant (Salvadora persica, Asir, Kingdom of Saudi Arabia) produces an antagonistic factor. This factor has a broad spectrum of activity against Gram-positive and specifically against Staphylococcus aureus (MRSA). The antagonistic factor was isolated from the bacterial culture medium and purified by thin layer chromatography technique, then analyzed by GC-MS analysis. Identification of the producer strain was performed using the partial nucleotide sequence of 16S rRNA gene, which indicated that this strain is identical to B. endophyticus with 99 % similarity. The sequence of this strain was deposited at NCBI GenBank under accession number KF011545. Application of differential display RT-PCR revealed that the isolate was able to up-regulate a gene with serine protease like protein. The protein is well known as antimicrobial agent and was reported to be produced by plants, animals and insects. Serine protease is also known to be produced by bacteria for purposes oth er than bacterial-bacterial antagonistic effect, which has been confirmed by this study.
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Rogawski ET, Meshnick SR, Becker-Dreps S, Adair LS, Sandler RS, Sarkar R, Kattula D, Ward HD, Kang G, Westreich DJ. Reduction in diarrhoeal rates through interventions that prevent unnecessary antibiotic exposure early in life in an observational birth cohort. J Epidemiol Community Health 2015; 70:500-5. [PMID: 26621194 DOI: 10.1136/jech-2015-206635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/09/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Antibiotic treatment early in life is often not needed and has been associated with increased rates of subsequent diarrhoea. We estimated the impact of realistic interventions, which would prevent unnecessary antibiotic exposures before 6 months of age, on reducing childhood diarrhoeal rates. METHODS In data from a prospective observational cohort study conducted in Vellore, India, we used the parametric g-formula to model diarrhoeal incidence rate differences contrasting the observed incidence of diarrhoea to the incidence expected under hypothetical interventions. The interventions prevented unnecessary antibiotic treatments for non-bloody diarrhoea, vomiting and upper respiratory infections before 6 months of age. We also modelled targeted interventions, in which unnecessary antibiotic use was prevented only among children who had already stopped exclusive breast feeding. RESULTS More than half of all antibiotic exposures before 6 months (58.9%) were likely unnecessary. The incidence rate difference associated with removing unnecessary antibiotic use before 6 months of age was -0.28 (95% CI -0.46 to -0.08) episodes per 30 child-months. This implies that preventing unnecessary antibiotic exposures in just 4 children would reduce the incidence of diarrhoea by 1 from 6 months to 3 years of age. CONCLUSIONS Interventions to reduce unnecessary antibiotic use among young children could result in an important reduction in diarrhoeal rates. This work provides an example application of statistical methods which can further the aim of presenting epidemiological findings that are relevant to public health practice.
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Affiliation(s)
| | - Steven R Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sylvia Becker-Dreps
- Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda S Adair
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert S Sandler
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA Department of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rajiv Sarkar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepthi Kattula
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Honorine D Ward
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Daniel J Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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Medina AM, Rivera FP, Pons MJ, Riveros M, Gomes C, Bernal M, Meza R, Maves RC, Huicho L, Chea-Woo E, Lanata CF, Gil AI, Ochoa TJ, Ruiz J. Comparative analysis of antimicrobial resistance in enterotoxigenic Escherichia coli isolates from two paediatric cohort studies in Lima, Peru. Trans R Soc Trop Med Hyg 2015; 109:493-502. [PMID: 26175267 PMCID: PMC4592336 DOI: 10.1093/trstmh/trv054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/29/2015] [Accepted: 06/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibiotic resistance is increasing worldwide, being of special concern in low- and middle-income countries. The aim of this study was to determine the antimicrobial susceptibility and mechanisms of resistance in 205 enterotoxigenic Escherichia coli (ETEC) isolates from two cohort studies in children <24 months in Lima, Peru. METHODS ETEC were identified by an in-house multiplex real-time PCR. Susceptibility to 13 antimicrobial agents was tested by disk diffusion; mechanisms of resistance were evaluated by PCR. RESULTS ETEC isolates were resistant to ampicillin (64%), cotrimoxazole (52%), tetracycline (37%); 39% of the isolates were multidrug-resistant. Heat-stable toxin producing (ETEC-st) (48%) and heat-labile toxin producing ETEC (ETEC-lt) (40%) had higher rates of multidrug resistance than isolates producing both toxins (ETEC-lt-st) (21%), p<0.05. Only 10% of isolates were resistant to nalidixic acid and none to ciprofloxacin or cefotaxime. Ampicillin and sulfamethoxazole resistance were most often associated with blaTEM (69%) and sul2 genes (68%), respectively. Tetracycline resistance was associated with tet(A) (49%) and tet(B) (39%) genes. Azithromycin inhibitory diameters were ≤15 mm in 36% of isolates, with 5% of those presenting the mph(A) gene. CONCLUSIONS ETEC from Peruvian children are often resistant to older, inexpensive antibiotics, while remaining susceptible to ciprofloxacin, cephalosporins and furazolidone. Fluoroquinolones and azithromycin remain the drugs of choice for ETEC infections in Peru. However, further development of resistance should be closely monitored.
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Affiliation(s)
- Anicia M Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fulton P Rivera
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria J Pons
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain Universidad Peruana de Ciencias Aplicadas Lima, Peru
| | - Maribel Riveros
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cláudia Gomes
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - María Bernal
- Department of Bacteriology, U.S. Naval Medical Research Unit No. 6, Callao, Peru
| | - Rina Meza
- Department of Bacteriology, U.S. Naval Medical Research Unit No. 6, Callao, Peru
| | - Ryan C Maves
- Department of Bacteriology, U.S. Naval Medical Research Unit No. 6, Callao, Peru Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California, USA
| | - Luis Huicho
- Universidad Peruana Cayetano Heredia, Lima, Peru Universidad Nacional Mayor de San Marcos, Lima, Peru Instituto Nacional de Salud del Niño, Lima, Peru Instituto de Investigación Nutricional, Lima, Peru
| | | | | | - Ana I Gil
- Instituto de Investigación Nutricional, Lima, Peru
| | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru Universidad Peruana Cayetano Heredia, Lima, Peru Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas, USA
| | - Joaquim Ruiz
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Abstract
BACKGROUND Antibiotic treatment of childhood illnesses is common in India. In addition to contributing to antimicrobial resistance, antibiotics might result in increased susceptibility to diarrhea through interactions with the gastrointestinal microbiota. Breast milk, which enriches the microbiota early in life, may increase the resilience of the microbiota against perturbations by antibiotics. METHODS In a prospective observational cohort study, we assessed whether antibiotic exposures from birth to 6 months affected rates of diarrhea up to age 3 years among 465 children from Vellore, India. Adjusting for treatment indicators, we modeled diarrheal rates among children exposed and unexposed to antibiotics using negative binomial regression. We further assessed whether the effect of antibiotics on diarrheal rates was modified by exclusive breastfeeding at 6 months. RESULTS More than half of the children (n = 267, 57.4%) were given at least one course of antibiotics in the first 6 months of life. The adjusted relative incidence rate of diarrhea was 33% higher among children who received antibiotics under 6 months of age compared with those who did not (incidence rate ratio: 1.33, 95% confidence interval: 1.12, 1.57). Children who were exclusively breastfed until 6 months of age did not have increased diarrheal rates following antibiotic use. CONCLUSIONS Antibiotic exposures early in life were associated with increased rates of diarrhea in early childhood. Exclusive breastfeeding might protect against this negative impact.
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Rogawski ET, Westreich DJ, Becker-Dreps S, Adair LS, Sandler RS, Sarkar R, Kattula D, Ward HD, Meshnick SR, Kang G. Antibiotic treatment of diarrhoea is associated with decreased time to the next diarrhoea episode among young children in Vellore, India. Int J Epidemiol 2015; 44:978-87. [PMID: 25929259 DOI: 10.1093/ije/dyv040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antibiotics are commonly given for the treatment of childhood diarrhoea, but are not indicated in most cases. Antibiotics modify the gastrointestinal microbiota, which may have unanticipated effects on the risk of subsequent diarrhoea. METHODS In a prospective observational cohort study, we assessed the effect of caregiver-reported antibiotic treatment for diarrhoea on the timing of a child's next episode among 434 children followed from birth to 3 years of age in Vellore, India. We estimated median time differences and time ratios from inverse probability of exposure-weighted Kaplan-Meier curves for the time to next diarrhoea episode, comparing children who did and did not receive antibiotics for the previous episode. RESULTS Study children had more than five diarrhoea episodes on average in the first 3 years of life, and more than a quarter of all episodes were treated with antibiotics. Children who received antibiotics for their first diarrhoea episode had their second episode on average 8 weeks earlier (median time difference: -8, 95% confidence interval: -10, -3) than children who did not receive antibiotics. The effects of antibiotics on subsequent diarrhoea were greatest at earlier episodes and younger ages, and cefixime had a slightly larger effect compared with cotrimoxazole. CONCLUSIONS Antibiotic treatment of diarrhoea was associated with reduced time to a subsequent diarrhoea episode, especially among younger infants. Whereas rational use of antibiotics has been advocated to reduce antimicrobial resistance in populations, we show that overuse of antibiotics may also have a direct adverse effect on individual patients.
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Affiliation(s)
| | | | | | | | - Robert S Sandler
- Department of Epidemiology, Department of Medicine, University of North Carolina - Chapel Hill, NC, USA
| | - Rajiv Sarkar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India and
| | - Deepthi Kattula
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India and
| | - Honorine D Ward
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India and Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | | | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India and
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25
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Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, Laxminarayan R. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. THE LANCET. INFECTIOUS DISEASES 2014; 14:742-750. [PMID: 25022435 DOI: 10.1016/s1473-3099(14)70780-7] [Citation(s) in RCA: 1294] [Impact Index Per Article: 129.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Antibiotic drug consumption is a major driver of antibiotic resistance. Variations in antibiotic resistance across countries are attributable, in part, to different volumes and patterns for antibiotic consumption. We aimed to assess variations in consumption to assist monitoring of the rise of resistance and development of rational-use policies and to provide a baseline for future assessment. METHODS With use of sales data for retail and hospital pharmacies from the IMS Health MIDAS database, we reviewed trends for consumption of standard units of antibiotics between 2000 and 2010 for 71 countries. We used compound annual growth rates to assess temporal differences in consumption for each country and Fourier series and regression methods to assess seasonal differences in consumption in 63 of the countries. FINDINGS Between 2000 and 2010, consumption of antibiotic drugs increased by 36% (from 54 083 964 813 standard units to 73 620 748 816 standard units). Brazil, Russia, India, China, and South Africa accounted for 76% of this increase. In most countries, antibiotic consumption varied significantly with season. There was increased consumption of carbapenems (45%) and polymixins (13%), two last-resort classes of antibiotic drugs. INTERPRETATION The rise of antibiotic consumption and the increase in use of last-resort antibiotic drugs raises serious concerns for public health. Appropriate use of antibiotics in developing countries should be encouraged. However, to prevent a striking rise in resistance in low-income and middle-income countries with large populations and to preserve antibiotic efficacy worldwide, programmes that promote rational use through coordinated efforts by the international community should be a priority. FUNDING US Department of Homeland Security, Bill & Melinda Gates Foundation, US National Institutes of Health, Princeton Grand Challenges Program.
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Affiliation(s)
- Thomas P Van Boeckel
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Sumanth Gandra
- Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA
| | - Ashvin Ashok
- Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA
| | - Quentin Caudron
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Princeton Environmental Institute, Princeton, NJ, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Simon A Levin
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Princeton Environmental Institute, Princeton, NJ, USA; Beijer Institute of Ecological Economics, Stockholm, Sweden
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India.
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Njume C, Goduka NI. Treatment of diarrhoea in rural African communities: an overview of measures to maximise the medicinal potentials of indigenous plants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:3911-33. [PMID: 23202823 PMCID: PMC3524604 DOI: 10.3390/ijerph9113911] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/05/2012] [Accepted: 09/14/2012] [Indexed: 01/10/2023]
Abstract
Diarrhoea is a major cause of morbidity and mortality in rural communities in Africa, particularly in children under the age of five. This calls for the development of cost effective alternative strategies such as the use of herbal drugs in the treatment of diarrhoea in these communities. Expenses associated with the use of orthodox medicines have generated renewed interest and reliance on indigenous medicinal plants in the treatment and management of diarrhoeal infections in rural communities. The properties of many phenolic constituents of medicinal plants such as their ability to inhibit enteropooling and delay gastrointestinal transit are very useful in the control of diarrhoea, but problems such as scarcity of valuable medicinal plants, lack of standardization of methods of preparation, poor storage conditions and incertitude in some traditional health practitioners are issues that affect the efficacy and the practice of traditional medicine in rural African communities. This review appraises the current strategies used in the treatment of diarrhoea according to the Western orthodox and indigenous African health-care systems and points out major areas that could be targeted by health-promotion efforts as a means to improve management and alleviate suffering associated with diarrhoea in rural areas of the developing world. Community education and research with indigenous knowledge holders on ways to maximise the medicinal potentials in indigenous plants could improve diarrhoea management in African rural communities.
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Affiliation(s)
- Collise Njume
- Department of Medical Microbiology, Walter Sisulu University, Mthatha 5117, South Africa
- Centre for Rural Development, Enkululekweni, Walter Sisulu University, Mthatha 5117, South Africa;
| | - Nomalungelo I. Goduka
- Centre for Rural Development, Enkululekweni, Walter Sisulu University, Mthatha 5117, South Africa;
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27
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Nakhjavani FA, Emaneini M, Hosseini H, Iman-Eini H, Aligholi M, Jabalameli F, Haghi-Ashtiani MT, Taherikalani M, Mirsalehian A. Molecular analysis of typical and atypical enteropathogenic Escherichia coli (EPEC) isolated from children with diarrhoea. J Med Microbiol 2012; 62:191-195. [PMID: 23065543 DOI: 10.1099/jmm.0.046516-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Diarrhoea continues to be one of the most common causes of morbidity and mortality among infants and children in developing countries. To investigate the incidence, antimicrobial resistance and genetic relationships of enteropathogenic Escherichia coli (EPEC) in children with diarrhoea, a total of 612 stool specimens were collected in Tehran, Iran, and cultured to isolate strains of EPEC. The disc diffusion method was used to determine the susceptibility of the isolates according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The presence of eae, stx and bfp-A genes was determined by PCR. The genetic relationships between EPEC isolates were determined by pulsed-field gel electrophoresis (PFGE). Out of the 412 strains of E. coli obtained from 612 diarrhoeal stool specimens, 23 (5.6 %) were identified as EPEC, of which seven (30.4 %) were classified as typical strains of EPEC and 16 (69.6 %) were classified as atypical. Out of the 23 EPEC isolates, 69.5 % were resistant to ampicillin, 39.1 % were resistant to tetracycline and cotrimoxazole, 30.4 % were resistant to cefpodoxime, ceftazidime, ceftriaxone and aztreonam, and 26.1 % were resistant to imipenem. The isolates were classified into 21 pulsotypes by PFGE profiles. The present study shows that typical and atypical EPEC isolates displayed considerable heterogeneity in PFGE profiles and EPEC infections were only sporadic in Tehran. Overall 69 % of isolates were resistant to at least one of the antibiotics tested.
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Affiliation(s)
- Farrokh Akbari Nakhjavani
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, PO Box 14155-6447, Tehran 14174, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, PO Box 14155-6447, Tehran 14174, Iran
| | - Hossein Hosseini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, PO Box 14155-6447, Tehran 14174, Iran
| | - Hossein Iman-Eini
- School of ECE, College of Engineering, University of Tehran, PO Box 11365-4563, Tehran 14174, Iran
| | - Marzieh Aligholi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, PO Box 14155-6447, Tehran 14174, Iran
| | - Fereshteh Jabalameli
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, PO Box 14155-6447, Tehran 14174, Iran
| | - Mohammad Taghi Haghi-Ashtiani
- Department of Pathology, Children's Medical Center, School of Medicine, Tehran University of Medical Sciences, PO Box 14155-6447, Tehran 14174, Iran
| | - Morovat Taherikalani
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam 69315, Iran
| | - Akbar Mirsalehian
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, PO Box 14155-6447, Tehran 14174, Iran
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28
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Mass distribution of azithromycin for trachoma control is associated with short-term reduction in risk of acute lower respiratory infection in young children. Pediatr Infect Dis J 2012; 31:341-6. [PMID: 22173140 DOI: 10.1097/inf.0b013e31824155c9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated the effect of a single mass distribution of azithromycin for trachoma on the risk of acute lower respiratory infection (ALRI) during a 6-month period among young children living in 8 communities in rural Tanzania. METHODS In 8 communities, a cohort of randomly selected children (n = 1036) was followed for incidence of ALRI episodes. Mass treatment for trachoma using a single dose of oral azithromycin was provided in 4 of the 8 communities where trachoma prevalence was .10%. All children were followed with biweekly surveillance at home for 6 months. Incidence of ALRI episodes was calculated for 0 to 1 month, 1 to 3 months, and 3 to 6 months posttreatment and in comparable time points in the nontreated villages. RESULTS In the multivariate analysis, living in a MDA village was associated with a 38% (rate ratio 5 0.62, 95% confidence interval [CI] = 0.43-0.91) decreased risk of ALRI in the 0- to 1-month follow-up period as compared with those in the untreated communities after adjusting for covariates and clustering. There were no significant differences in ALRI incidence by exposure status in the 1- to 3-month (rate ratio = 0.91, 95% CI = 0.69-1.20) and in the 3- to 6-month (rate ratio = 1.00, 95% CI = 0.76-1.30) follow-up periods. CONCLUSIONS Mass distribution of a single dose of oral azithromycin for trachoma is associated with a significant short-term reduction in ALRI morbidity among young children.
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29
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Coles CL, Seidman JC, Levens J, Mkocha H, Munoz B, West S. Association of mass treatment with azithromycin in trachoma-endemic communities with short-term reduced risk of diarrhea in young children. Am J Trop Med Hyg 2011; 85:691-6. [PMID: 21976574 DOI: 10.4269/ajtmh.2011.11-0046] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A cohort study was designed to assess the impact of mass distribution of azithromycin (MDA) for trachoma control on incidence over six months of pediatric diarrhea in eight communities in rural Tanzania. A single dose of azithromycin was offered to all residents in four communities, where trachoma prevalence was ≥ 10%. Four geographically matched communities had trachoma prevalences < 10% and did not receive MDA. All randomly selected children (n = 1036) were followed-up for six months post-MDA with bi-weekly surveillance at home. In the 0-1-month and 1-3-month periods, MDA exposure was associated with a 39% (rate ratio = 0.61, 95% confidence interval = 0.39-0.95) and 24% (rate ratio = 0.76, 95% confidence interval = 0.54-1.07) lower risk of diarrhea, respectively, compared with those unexposed, after adjustment for clustering and covariates. By the 3-6-month period, diarrhea incidence was comparable between groups. Thus, MDA was associated with a short-term reduction in diarrheal morbidity in children.
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Affiliation(s)
- Christian L Coles
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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30
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Nunes MDRCM, Magalhães PP, Macêdo ADS, Franco RT, Penna FJ, Mendes EN. Attaching and effacing Escherichia coli and Shiga toxin-producing E. coli in children with acute diarrhoea and controls in Teresina/PI, Brazil. Trans R Soc Trop Med Hyg 2011; 106:43-7. [PMID: 22099006 DOI: 10.1016/j.trstmh.2011.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 09/30/2011] [Accepted: 09/30/2011] [Indexed: 10/15/2022] Open
Abstract
This 3.5-year prospective study was conducted to ascertain the level of attaching and effacing Escherichia coli (AEEC) associated diarrhoea in children from Teresina, a northeastern state of Brazil. Passed faecal specimens from 400 patients (250 with and 150 without diarrhoea) up to 60 months of age attending from 2004 to 2007 at two public hospitals were investigated. Conventional microbiology methods and PCR were employed. Escherichia coli was isolated from 390 children, 240 of them with diarrhoea. A total of 117 AEEC strains were cultivated from specimens from 63 children, 37 with and 26 without diarrhoea. No association between AEEC and diarrhoea was observed. Atypical enteropathogenic E. coli (a-EPEC) (79.4%) was more commonly found than typical EPEC (t-EPEC). Association between EPEC and EPEC subtypes and diarrhoea was not detected. Mixed infection by t-EPEC and a-EPEC and infection by Shiga toxin-producing E. coli (STEC) were rare. Enteropathogenic E. coli was more common in males and in children aged less than 12 months. Correlation between serotyping and PCR results was 0.19. High resistance rates of AEEC to ampicillin, cephalotin, and trimethoprim-sulfamethoxazole were found. In conclusion, EPEC is very common in children with diarrhoea and controls in the population we studied, with a-EPEC predominating. This diarrhoeagenic E. coli (DEC) pathotype is more common in infant males and is resistant to drugs frequently used in clinical practice.
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Affiliation(s)
- Maria do Rosário Conceição Moura Nunes
- Departamento de Propedêutica Complementar, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, 30130-100, Belo Horizonte, MG, Brazil
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Kolahi AA, Rastegarpour A, Abadi A, Gachkar L. An unexpectedly high incidence of acute childhood diarrhea in Koot-Abdollah, Ahwaz, Iran. Int J Infect Dis 2010; 14:e618-21. [PMID: 20116314 DOI: 10.1016/j.ijid.2009.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 10/13/2009] [Accepted: 10/15/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Koot-Abdollah is a neighborhood in Ahwaz, in the southeast of Iran, susceptible to public health hazards due to a number of factors, including a low level of personal hygiene, inappropriate community sanitation, and a high level of environmental and water pollution. This study was designed to measure the incidence of acute childhood diarrhea in this neighborhood. METHODS This was a descriptive population-based study. Via multistage sampling, data were collected by interviewing the mothers in their homes. Reported 95% confidence intervals included a finite population correction factor and accounted for the cluster sampling design. RESULTS The study included 2016 children aged 6 to 60 months. Overall, 725 (36.0%) of the children studied had experienced an episode of acute diarrhea during the previous two weeks. In other words, the children demonstrated a rate of diarrhea per 100 person-years of 936 for the studied period, which was a time period expected to reveal the lowest possible incidence of diarrhea. CONCLUSIONS The incidence of diarrhea per two weeks in Koot-Abdollah is exceptionally high. The limitation of available drinking water, warm weather, illiteracy, poverty, and low incomes, in addition to the low level of sanitation and personal hygiene and extreme environmental pollution contribute to this high incidence.
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Affiliation(s)
- Ali-Asghar Kolahi
- Department of Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Evin, PO Box 193954719, Tehran, Iran.
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Mohsin M, Haque A, Ali A, Sarwar Y, Bashir S, Tariq A, Afzal A, Iftikhar T, Saeed MA. Effects of Ampicillin, Gentamicin, and Cefotaxime on the Release of Shiga Toxins from Shiga Toxin–ProducingEscherichia coliIsolated During a Diarrhea Episode in Faisalabad, Pakistan. Foodborne Pathog Dis 2010; 7:85-90. [DOI: 10.1089/fpd.2009.0311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mashkoor Mohsin
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Abdul Haque
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Aamir Ali
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Yasra Sarwar
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Saira Bashir
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Ayesha Tariq
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Amna Afzal
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Tayyaba Iftikhar
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
| | - Muhammad Azeem Saeed
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
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