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Masoudi M, Mashreghi M, Zenhari A, Mashreghi A. Combinational antimicrobial activity of biogenic TiO 2 NP/ZnO NPs nanoantibiotics and amoxicillin-clavulanic acid against MDR-pathogens. Int J Pharm 2024; 652:123821. [PMID: 38242259 DOI: 10.1016/j.ijpharm.2024.123821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
The development of effective strategies against multidrug-resistant (MDR) pathogens is an urgent need in modern medicine. Nanoantibiotics (nABs) offer a new hope in countering the surge of MDR-pathogens. The aim of the current study was to evaluate the antibacterial activity of two attractive nABs, TiO2 NPs and ZnO NPs, and their performance in improving the antimicrobial activity of defined antibiotics (amoxicillin-clavulanic acid, amox-clav) against MDR-pathogens. The nABs were synthesized using a green method. The physicochemical characteristics of the synthesized nanoparticles were determined using standard methods. The results showed the formation of pure anatase TiO2 NPs and hexagonal ZnO NPs with an average particle size of 38.65 nm and 57.87 nm, respectively. The values of zeta potential indicated the high stability of the samples. At 8 mg/mL, both nABs exhibited 100 % antioxidant activity, while ZnO showed significantly higher activity at lower concentrations. The antibiofilm assay showed that both nABs could inhibit the formation of biofilms of Acinetobacter baumannii 80 and Escherichia coli 27G (MDR-isolates). However, ZnO NPs showed superior antibiofilm activity (100 %) against E. coli 27G. The MIC values were determined to be 8 (1), 2 (2), and 4 (4) mg/mL for amox-clav, TiO2 NPs, and ZnO NPs against A. baumannii 80 (E. coli 27G), respectively. The results showed that both nABs had synergistically enhanced antibacterial performance in combination with amox-clav. Specifically, an 8-fold reduction in MIC values of antibiotics was observed when they were combined with nABs. These findings highlight the potential of TiO2 NPs and ZnO NPs as effective nanoantibiotics against MDR-pathogens. The synergistic effect observed when combining nABs with antibiotics suggests a promising approach for combating antibiotic resistance. Further research and development in this area could lead to the development of more effective treatment strategies against MDR infections.
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Affiliation(s)
- Mina Masoudi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran; Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mansour Mashreghi
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran; Industrial Biotechnology Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran; Nano Research Center, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Alireza Zenhari
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Amirala Mashreghi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Scahill K, Jessen LR, Prior C, Singleton D, Foroutan F, Ferran AA, Arenas C, Bjørnvad CR, Lavy E, Allerton F, Weese JS, Allenspach K, Guardabassi L, Unterer S, Bodnárová T, Windahl U, Brennan ML, Werner M. Efficacy of antimicrobial and nutraceutical treatment for canine acute diarrhoea: A systematic review and meta-analysis for European Network for Optimization of Antimicrobial Therapy (ENOVAT) guidelines. Vet J 2024; 303:106054. [PMID: 38049062 DOI: 10.1016/j.tvjl.2023.106054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/02/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
Systemic antimicrobial treatments are commonly prescribed to dogs with acute diarrhoea, while nutraceuticals (prebiotics, probiotics, and synbiotics) are frequently administered as an alternative treatment. The aim of this systematic review and meta-analysis was to assess the effectiveness of antimicrobials and nutraceutical preparations for treatment of canine acute diarrhoea (CAD). The results of this study will be used to create evidence-based treatment guidelines. PICOs (population, intervention, comparator, and outcome) were generated by a multidisciplinary expert panel taking into account opinions from stakeholders (general practitioners and dog owners). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to evaluate the certainty of the evidence. The systematic search yielded six randomised controlled trials (RCT) for antimicrobial treatment and six RCTs for nutraceutical treatment meeting the eligibility criteria. Categories of disease severity (mild, moderate, and severe) were created based on the presence of systemic signs and response to fluid therapy. Outcomes included duration of diarrhoea, duration of hospitalization, progression of disease, mortality, and adverse effects. High certainty evidence showed that antimicrobial treatment did not have a clinically relevant effect on any outcome in dogs with mild or moderate disease. Certainty of evidence was low for dogs with severe disease. Nutraceutical products did not show a clinically significant effect in shortening the duration of diarrhoea (based on very low to moderate certainty evidence). No adverse effects were reported in any of the studies.
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Affiliation(s)
- K Scahill
- University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh EH16 4SB, UK; Evidensia Södra Djursjukhuset Kungens Kurva, Månskärarvägen 13, Kungens Kurva 14175, Sweden.
| | - L R Jessen
- Department of Veterinary Clinical Science, University of Copenhagen, 1870 Frederiksberg C, Denmark
| | - C Prior
- Willows Veterinary Centre and Referral Centre, Solihull B90 4NH, United Kingdom
| | - D Singleton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, CH64 7TE, UK
| | - F Foroutan
- Faculty of Health Sciences, McMasters University, ON L8S 4L8, Canada
| | - A A Ferran
- INTHERES, Université de Toulouse, INRAE, ENVT, Toulouse 31076, France
| | - C Arenas
- Internal Medicine Service, AniCura Valencia Sur Hospital Veterinario, Valencia 46460, Spain; VetCT Teleconsulting, Cambridge CB3 0FA, UK
| | - C R Bjørnvad
- Department of Veterinary Clinical Science, University of Copenhagen, 1870 Frederiksberg C, Denmark
| | - E Lavy
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - F Allerton
- Willows Veterinary Centre and Referral Centre, Solihull B90 4NH, United Kingdom
| | - J S Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G2W1, Canada
| | - K Allenspach
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames 50010, IA, USA
| | - L Guardabassi
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark
| | - S Unterer
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich 8057, Switzerland
| | - T Bodnárová
- Veterinary Clinic Podebrady, Poděbrady 29001, Czech Republic
| | - U Windahl
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), SE-75189 Uppsala, Sweden
| | - M L Brennan
- Centre for Evidence-based Veterinary Medicine, The University of Nottingham, NG7 2QL, UK
| | - M Werner
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich 8057, Switzerland
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Somprasong N, Hagen JP, Sahl JW, Webb JR, Hall CM, Currie BJ, Wagner DM, Keim P, Schweizer HP. A conserved active site PenA β-lactamase Ambler motif specific for Burkholderia pseudomallei/B. mallei is likely responsible for intrinsic amoxicillin-clavulanic acid sensitivity and facilitates a simple diagnostic PCR assay for melioidosis. Int J Antimicrob Agents 2023; 61:106714. [PMID: 36640845 DOI: 10.1016/j.ijantimicag.2023.106714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/23/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023]
Abstract
Burkholderia pseudomallei is a soil- and water-dwelling Gram-negative bacterium that causes melioidosis in humans and animals. Amoxicillin-clavulanic acid (AMC) susceptibility has been hailed as an integral part of the screening algorithm for identification of B. pseudomallei, but the molecular basis for the inherent AMC susceptibility of this bacterium remains undefined. This study showed that B. pseudomallei (and the closely-related B. mallei) wild-type strains are the only Burkholderia spp. that contain a 70STSK73 PenA Ambler motif. This motif was present in >99.5% of 1820 analysed B. pseudomallei strains and 100% of 83 analysed B. mallei strains, and is proposed as the likely cause for their inherent AMC sensitivity. The authors developed a polymerase chain reaction (PCR) assay that specifically amplifies the penA70ST(S/F)K73-containing region from B. pseudomallei and B. mallei, but not from the remaining B. pseudomallei complex species or the 70STFK73 region from the closely-related penB of B. cepacia complex species. The abundance and purity of the 193-bp PCR fragment from putative B. pseudomallei isolates from clinical and environmental samples is likely sufficient for reliable confirmation of the presence of B. pseudomallei. The PCR assay is designed to be especially suited for use in resource-constrained areas. While not further explored in this study, the assay may allow diagnosis of putative B. mallei in culture isolates from animal and human samples.
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Affiliation(s)
- Nawarat Somprasong
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr. Flagstaff, AZ 86001-4073, USA
| | - Johannah P Hagen
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr. Flagstaff, AZ 86001-4073, USA
| | - Jason W Sahl
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr. Flagstaff, AZ 86001-4073, USA; Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jessica R Webb
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Carina M Hall
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr. Flagstaff, AZ 86001-4073, USA
| | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Department of Infectious Diseases and Northern Territory Medical Programme, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - David M Wagner
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr. Flagstaff, AZ 86001-4073, USA; Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Paul Keim
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr. Flagstaff, AZ 86001-4073, USA; Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Herbert P Schweizer
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr. Flagstaff, AZ 86001-4073, USA; Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona, USA.
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Meszaros EP, Stancu C, Costanza A, Besson M, Sarasin F, Bondolfi G, Ambrosetti J. Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately. BMC Psychiatry 2021; 21:399. [PMID: 34380446 PMCID: PMC8359544 DOI: 10.1186/s12888-021-03397-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 07/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Antibiomania is a rare but recognized side effect with yet unclear definite pathogenesis although multiple hypotheses have been proposed. The novelty of this case is the suspected pharmacodynamic drug-drug interaction between clarithromycin and amoxicillin-clavulanic acid. CASE PRESENTATION We present the occurrence of a brief manic episode concerning a 50-year-old man with no psychiatric history, first started on amoxicillin-clavulanic acid therapy and then switched to clarithromycin for left basal pneumonia. Shortly after the antibiotic prescription, he presented psychiatric symptomatology (logorrhea, elevated mood, irritability, increase in physical activity and delusions). The antibiotic was stopped and the patient received lorazepam (2.5 mg p.o.) to treat psychomotor agitation. Approximately 12 h after clarithromycin cessation, amelioration was already observed, supporting the diagnosis of a clarithromycin-induced manic episode. Amoxicillin-clavulanic acid was then reintroduced because of the pneumonia and psychiatric symptoms reemerged. This second antibiotic was also stopped, and 1 week later, the patient was symptom-free. CONCLUSION The emergence of psychiatric side effects related to antibiotherapy, which is a common treatment, can greatly impact a patient's quality of life. Early recognition and intervention could substantially influence the administered medical care and recovery. Moreover, given the widespread use of antibiotics including in combination, we thought our case report might be clinically useful as a clinical reminder relevant to the use of antibiotic combinations.
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Affiliation(s)
- Edith Paula Meszaros
- Departments of Emergency and Psychiatry, Emergency Psychiatric Unit (UAUP), Geneva University Hospitals (HUG), Geneva, Switzerland.
| | - Catheline Stancu
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Alessandra Costanza
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Marie Besson
- grid.150338.c0000 0001 0721 9812Unit of Psychopharmacology, Department of Pharmacology and Toxicology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - François Sarasin
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Department of Emergency, Emergency Medicine Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Guido Bondolfi
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Julia Ambrosetti
- grid.150338.c0000 0001 0721 9812Departments of Emergency and Psychiatry, Emergency Psychiatric Unit (UAUP), Geneva University Hospitals (HUG), Geneva, Switzerland
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Mohammed SO, A Shuaibu SD, Gaya SA, Rabiu A. The efficacy of two doses versus 7 days' course of prophylactic antibiotics following cesarean section: An experience from Aminu Kano Teaching Hospital. Ann Afr Med 2020; 19:103-112. [PMID: 32499466 PMCID: PMC7453943 DOI: 10.4103/aam.aam_39_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Postcesarean wound infection is a leading cause of prolonged hospital stay. Considerable debates still exist regarding choice of antibiotics, dose, and duration of use. Objectives: The objective is to compare the efficacy of 2 doses of amoxicillin-clavulanic acid versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole as prophylactic antibiotics following cesarean section (CS). Methodology: It was a randomized controlled trial that was conducted among 160 women undergoing CS at Aminu Kano Teaching Hospital. Women were randomized into two groups. Group I (study group) received 2 doses of 1.2 g amoxicillin-clavulanic acid. Group II (control group) received a 7 days course of amoxicillin-clavulanic acid and metronidazole. The data obtained were analyzed using SPSS version 17. Categorical (qualitative) variables were analyzed using Ch-square test and Fisher’s exact test as appropriate while continuous (quantitative) variables were analyzed using independent sample t-test. P < 0.05 was considered statistically significant. Results: There was no statistically significant association in the occurrence of fever (12.8% vs. 15.8%, P = 0.6), wound infection (6.4% vs. 10.5%, P = 0.36), endometritis (7.7% vs. 11.8%, P = 0.38), UTI (6.4% vs. 5.3%, P = 1.00), mean duration of hospital stay (129.7 vs. 134.2 h, P = 0.48), and neonatal outcomes between the two groups. There was statistically significant difference in the mean cost of antibiotics (₦2883/US$9.5 vs. ₦7040/US$23.1, P < 0.001) and maternal side effects (10.3% vs. 26.3%, P < 0.001) between the study and the control groups, respectively. Conclusion: This study found no statistically significant difference in infectious morbidity, duration of hospital stay, and neonatal outcomes when two doses of amoxicillin-clavulanic acid was compared with a 7 days course of prophylactic antibiotic following CS. The use of two doses of amoxicillin-clavulanic acid has the advantages of reduced cost and some maternal side effects. The two doses were cheaper with minimal side effects.
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Affiliation(s)
| | - Samaila Danjuma A Shuaibu
- Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sule Abdullahi Gaya
- Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ayyuba Rabiu
- Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
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Hamanaka R, Hashimoto T, Mizukami E, Okutsu Y, Masutomo K, Komiya K, Nureki SI, Shimoda K, Hiramatsu K. A case report of primary sternal osteomyelitis caused by polymicrobial bacteria, including Actinomyces israelii. IDCases 2020; 21:e00922. [PMID: 32775208 DOI: 10.1016/j.idcr.2020.e00922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/21/2022] Open
Abstract
Actinomyces species colonize the human oropharynx, gastrointestinal tract, and urogenital tract. Primary sternal osteomyelitis is very rare, especially caused by Actinomyces israelii. Actinomycosis requires long-term antibiotic treatment. A. israelii should be included in the differential diagnosis as a causative pathogen of osteomyelitis.
We herein report a case of primary sternal osteomyelitis caused by polymicrobial bacteria, including Actinomyces israelii. A 72-year-old man presented with a fever and precordial pain. Chest computed tomography (CT) revealed peristernal fluid associated with an osteolytic lesion and a peripheral nodule in the right upper lobe. We suspected sternal osteomyelitis, and an incision and drainage were performed. Culture of the drainage fluid and bone tissue yielded A. israelii, Fusobacterium necrophorum, and Streptococcus constellatus. Treatment with benzylpenicillin potassium (PCG) was administered. A subsequent chest CT scan showed that the peripheral nodule decreased in size after antimicrobial therapy. We therefore presumed the peripheral nodule as septic pulmonary embolism(SPE). Antimicrobial agents were administered for a total of 6 months. To our knowledge, this is the first case report of primary sternal osteomyelitis associated with presumed SPE caused by polymicrobial bacteria, including A. israelii. It is important to identify the causative pathogen in osteomyelitis, which requires long-term antibiotic treatment.
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Viloria-Alebesque A, Povar-Echeverría M, Bruscas-Alijarde MJ, Gracia-Gutiérrez A, Royo-Trallero L, Al-Cheikh-Felices P. Myoclonus induced by amoxicillin-clavulanic acid. Epilepsy Behav Rep 2020; 14:100367. [PMID: 32529182 PMCID: PMC7283096 DOI: 10.1016/j.ebr.2020.100367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/10/2020] [Accepted: 04/05/2020] [Indexed: 12/14/2022] Open
Abstract
We present a patient in whom myoclonus appeared after initiation of treatment with amoxicillin-clavulanic acid. Myoclonus and EEG abnormalities disappeared after discontinuation of antibiotic treatment. This possible adverse effect should be considered to avoid performing aggressive therapeutic maneuvers.
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Affiliation(s)
- Alejandro Viloria-Alebesque
- Neurology Service, Hospital General de la Defensa, Vía Ibérica 1, 50009 Zaragoza, Spain.,Aragón Health Research Institute, Aragón Biomedical Research Center, Avenida San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Marina Povar-Echeverría
- Internal Medicine Service, Hospital General de la Defensa, Vía Ibérica 1, 50009 Zaragoza, Spain
| | | | - Anyuli Gracia-Gutiérrez
- Internal Medicine Service, Hospital General de la Defensa, Vía Ibérica 1, 50009 Zaragoza, Spain
| | - Leticia Royo-Trallero
- Internal Medicine Service, Hospital General de la Defensa, Vía Ibérica 1, 50009 Zaragoza, Spain
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Korppi M. Review shows paediatric protracted bacterial bronchitis needs an accurate diagnosis and strictly targeted extended antibiotics. Acta Paediatr 2019; 108:823-827. [PMID: 30580451 DOI: 10.1111/apa.14705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
Abstract
AIM In 2017, the European Respiratory Society task force stated that protracted bacterial bronchitis (PBB) was a distinct clinical entity and outlined the diagnostic criteria and principles for treatment. However, this guidance was based on data from Australia and the USA. This mini review evaluated the data and addressed the lack of research-based data from Europe. METHODS We supplemented the 2017 report by conducting a nonsystematic review of the literature on prolonged wet or productive cough and on PBB in children up to September 2018. RESULTS Our review confirmed the lack of European data on PBB. Based on the available literature, and the 2017 European guidance, PBB is a wet or productive cough that lasts for four or more weeks, with no signs or symptoms, known as specific cough pointers, which suggest an underlying illness. PBB usually recovers with appropriate antibiotics for two weeks. Failing that radiological investigations or lung function measurements are needed. If PBB occurs three times over 12 months, then computerised tomography can diagnose bronchiectasis and determine other permanent changes. CONCLUSION More data are needed on PBB, especially in Europe. The implementation of PBB may help clinicians to prescribe antibiotics more effectively and reduce their inappropriate use.
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Affiliation(s)
- Matti Korppi
- Center for Child Health Research Tampere University and University Hospital Tampere Finland
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9
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Kaliyaperumal K, Grove JI, Delahay RM, Griffiths WJH, Duckworth A, Aithal GP. Pharmacogenomics of drug-induced liver injury (DILI): Molecular biology to clinical applications. J Hepatol 2018; 69:948-957. [PMID: 29792895 DOI: 10.1016/j.jhep.2018.05.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
A 21-year old woman was admitted to hospital with a two-week history of painless jaundice, fatigue and anorexia having previously been fit and well. One month prior to presentation, the patient had taken a five-day course of amoxicillin-clavulanic acid for an infected skin cyst. Otherwise, she was only on the oral contraceptive pill and reported minimal alcohol intake. On examination, she was deeply jaundiced, but alert and oriented with no asterixis. She had no stigmata of chronic liver disease, but hepatomegaly extending 3 cm from below the right subcostal margin was evident. Investigations showed: white cell count 13.4 × 109/L (normal 3.6-9.3), haemoglobin 11.8 g/dl (normal 11-15), platelet count 356 × 109/L (normal 170-420), sodium 138 mmol/L (normal 134-144), potassium 3.5 mmol/L (normal 3.5-5.0), creatinine 32 µmol/L (normal 40-75), albumin 30 g/L (normal 35-48), alanine aminotransferase 707 IU/L (normal 15-54), alkaline phosphatase 151 IU/L (normal 30-130), bilirubin 384 µmol/L (normal 7-31) and prothrombin time 27.2 s (normal 11.7-14). Screening for hepatitis A, B, C, E, Epstein-Barr virus, cytomegalovirus and autoimmune hepatitis was negative. Tests for anti-smooth muscle, antinuclear, and anti-liver-kidney microsomal-1 antibodies were negative; immunoglobulin levels and ceruloplasmin levels were normal. Liver ultrasonography demonstrated a liver of normal contour with no biliary dilatation, a normal spleen size and patent vessels. Liver biopsy revealed severe portal interface hepatitis with lobular inflammation and scant plasma cells. Her clinical condition deteriorated in the following days with prothrombin time and bilirubin rising to 56.6 s and 470 µmol/L, respectively. At follow-up after 11 days, her alanine aminotransferase level was 1,931 IU/L. She developed grade 2 hepatic encephalopathy 14 days after presentation, and was listed for a super-urgent liver transplant. Human leucocyte antigen (HLA) typing was performed as a part of preparatory investigations and showed the patient carried the HLA haplotype HLA-DRB1∗15:02-DQB1∗06:01. Following orthotopic transplantation of a deceased donor graft her explant histology revealed severe ongoing hepatitis with multi-acinar necrosis (Fig. 1A and B). This case raised a number of important questions about the diagnosis of drug-induced liver injury and tools available for clinicians to make the best decisions for patient care: In this Grand Rounds article, we will explore these questions, describing the pathophysiology, diagnostic and prognostic biomarkers, and clinical management of drug-induced liver injury. We will also discuss ongoing areas of uncertainty.
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Affiliation(s)
- Kalaiyarasi Kaliyaperumal
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Jane I Grove
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Robin M Delahay
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | | | - Adam Duckworth
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK.
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10
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Popper M, Gancarčíková S, Maďar M, Mudroňová D, Hrčková G, Nemcová R. Amoxicillin-clavulanic acid and ciprofloxacin-treated SPF mice as gnotobiotic model. Appl Microbiol Biotechnol 2016; 100:9671-9682. [PMID: 27695915 DOI: 10.1007/s00253-016-7855-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/25/2016] [Accepted: 09/13/2016] [Indexed: 12/22/2022]
Abstract
The experiment was carried out on 24 SPF BALB/c female mice and lasted for 15 days with a 5-day antibiotic (ATB) treatment and then 10 days without ATB treatment. The aim of our study was to acquire an animal model with reduced and controlled microflora and, at the same time, to ensure that the good health of these animals is maintained. Per oral administration of amoxicillin and clavulanate potassium in Amoksiklav (Sandoz, Slovenia) at a dose of 387.11 mg/kg body weight (0.2 ml of dilution per mouse) and subcutaneous administration of ciprofloxacin in Ciloxan (Alcon, Spain) at a dose of 18.87 mg/kg body weight (0.1 ml of dilution per mouse) were performed every 12 h during first 5 days of experiment. Five-day treatment with ATB led to a reduced survivability of microorganisms in faeces (28.33 ± 0.43 % on day 2) and caecum content (28.10 ± 1.56 %), where no cultivable microorganisms in faeces were present. Ten-day convalescence of decontaminated animals under gnotobiotic conditions prevented recovery of species diversity in mice gut microflora. This was reduced to two detectable cultivable species, namely Escherichia coli (GenBank KX086704) and Enterococcus sp. (GenBank KX086705) which were capable to restore its metabolic (CRL 2012) and morphological potential (Baratta et al. Histochem Cell Biol 131:713-726, 2009) within physiological range. Animals obtained under this procedure can be used in further studies. As a result, we created a mouse gnoto model with reduced and controlled microflora without alteration of the overall health status of the respective animals.
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Affiliation(s)
- Miroslav Popper
- Department of Microbiology and Immunology, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovakia.
| | - Soňa Gancarčíková
- Department of Microbiology and Immunology, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovakia
| | - Marián Maďar
- Department of Microbiology and Immunology, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovakia
| | - Dagmar Mudroňová
- Department of Microbiology and Immunology, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovakia
| | - Gabriela Hrčková
- Institute of Parasitology, Slovak Academy of Sciences, Košice, Slovakia
| | - Radomíra Nemcová
- Department of Microbiology and Immunology, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovakia
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