Drug-induced chronic bullous disease of childhood in a two-year-old Filipino male triggered by cefaclor or cefuroxime: A case report

Introduction@#Chronic bullous disease of childhood (CBDC) is a rare immune-mediated subepidermal vesiculobullous eruption, characterized by linear IgA deposition along the basement membrane zone of the skin. Although mostly idiopathic, CBDC may be triggered by factors such as infection, and drugs. Clinical and immunohistopathological features of drug-induced cases are heterogeneous and indistinguishable from the idiopathic form.@*Case report@#A two-year-old Filipino male presented with pruritic vesicles and bullae on the back several days after finishing a course of cefuroxime, and cefaclor. Examination revealed multiple tense vesicles and bullae, some coalescing into a rosette pattern with central crusts on the perioral, scalp, neck, back, perineal, and perianal areas. Histopathology showed a subepidermal split with neutrophilic and eosinophilic infiltrates. Direct immunofluorescence revealed strong linear deposition of IgA, and granular deposits of C3 and IgM at the basement membrane zone, thus confirming the di- agnosis of CBDC. Dapsone at 2mg/kg/day was started, with oral prednisolone (1.3mg/kg/day), and cloxacillin syrup (40mg/kg/day). Topical care with betamethasone dipropionate and mupirocin ointment was included. After eight weeks, patient showed significant im- provement with few vesicles and resolved lesions healing with post-inflammatory hyperpigmentation.@*Conclusion@#We report a case of a two-year-old male presenting with vesiculobullous lesions after a course of cefuroxime, and cefaclor. As both were given and withdrawn in a period of close proximity, it is difficult to determine the probable culprit drug. Spontaneous resolution upon withdrawal of the suspected drug is variable. Systemic therapy such as dapsone may be necessary for treatment.

Cytotoxicity of intracanal dressings on apical papilla cells differ upon activation with E. faecalis LTA

Abstract Objective The aim of this study was to investigate the cytotoxic effects of modified triple antibiotic paste and an experimental composition using calcium hydroxide on lipoteichoic acid (LTA)-primed apical papilla cells (APC). Material and Methods Human APC were tested for in vitro cytotoxicity of modified Triple Antibiotic Paste (mTAP - Ciprofloxacin, Metronidazole and Cefaclor at 1:1:1) and of a paste of Ciprofloxacin, Metronidazole and Calcium hydroxide (CMC - 1:1:2) and modified CMC (mCMC - 2:2:1) by using MTT assay. The substances were reconstituted in DMEM at 1,000 µg/mL and » serially diluted before being kept in contact with cells for 1, 3, 5 and 7 days. Further, cells were primed with 1 µg/mL of Enterococcus faecalis LTA for 7 days prior to the viability test with 1,000 µg/mL of each substance. Statistical analysis was performed using one-way analysis of variance (ANOVA) and two-way ANOVA respectively followed by Tukey's post-test. Significance levels were set at p<0.05. Results In the first assay, the higher cytotoxic rates were reached by mTAP for all experimental periods. CMC was found toxic for APC at 5 and 7 days, whereas mCMC did not affect the cell viability. Only CMC and mCMC were able to induce some cellular proliferation. In the second assay, when considering the condition with medium only, LTA-primed cells significantly proliferated in comparison to LTA-untreated ones. At this context, mTAP and CMC showed similar cytotoxicity than the observed for LTA-untreated cells, while mCMC was shown cytotoxic at 7 days only for LTA-primed APC. Comparing the medications, mTAP was more cytotoxic than CMC and mCMC. Conclusion mTAP showed higher cytotoxicity than CMC and mCMC and the effect of topic antimicrobials might differ when tested against apical papilla cells under physiological or activated conditions.

Root canal dressings for revascularization influence in vitro mineralization of apical papilla cells

Abstract Endodontic revascularization is based on cell recruitment into the necrotic root canal of immature teeth after chemical disinfection. The clinical outcome depends on the ability of surviving cells from the apical tissue to differentiate and promote hard tissue deposition inside the dentinal walls. Objective To investigate the effect of calcium hydroxide (CH) and modified triple antibiotic paste (mTAP - ciprofloxacin, metronidazole and cefaclor) on the viability and mineralization potential of apical papilla cells (APC) in vitro . Material and Methods APC cultures were kept in contact with CH or mTAP (250-1000 µg/mL) for 5 days, after which cell viability was assessed using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Next, APCs were subjected to CH or mTAP at 250 µg/mL for 5 days before inducing the differentiation assay. After 14 and 21 days, calcium deposition was assessed by the Alizarin Red S staining method, followed by elution and quantification using spectrophotometry. Data were analyzed using ANOVA followed by Tukey post hoc test. Results CH induced cell proliferation, whereas mTAP showed significant cytotoxicity at all concentrations tested. APC treated with CH demonstrated improved mineralization capacity at 14 days, while, for mTAP, significant reduction on the mineralization rate was observed for both experimental periods (14 and 21 days). Conclusion Our findings showed that CH induces cell proliferation and improves early mineralization, whereas mTAP was found cytotoxic and reduced the mineralization potential in vitro of APCs.

Outcome of Regenerative Endodontic Treatment for an Avulsed Immature Permanent Tooth: A Case Report / 대한소아치과학회지

Dental avulsion, defined as the complete displacement of a tooth from the alveolar bone with consequent loss of the blood and nerve supply, was reported as one of the most severe dental injuries. Avulsion can cause tissue ischemia, which leads to pulp necrosis.Apexification is a conventional treatment method that induces an apical calcified barrier in immature roots with pulp necrosis. However, root development characterized by an increase in the root thickness and length cannot be achieved by apexification.The purpose of this case report was to describe the radiographic and clinical outcomes of regenerative endodontic treatment for the avulsed and necrosed permanent tooth with an immature root after replantation in a 5-year-old girl; the treatment was performed using a mixture of ciprofloxacin, metronidazole and cefaclor, CollaTape and Biodentine.

Proper Cut-off Levels of Serum Specific IgE to Cefaclor for Patients with Cefaclor Allergy

PURPOSE: Cefaclor, a second-generation oral cephalosporin, is known to cause IgE-mediated hypersensitivity. Assays of serum-specific IgE (sIgE) to cefaclor are commercially available via the ImmunoCAP system (Thermo Fisher Scientific). While serum levels of sIgE >0.35 kU/L are considered indicative of an allergy, some patients with cefaclor allergy show low serum IgE levels. This study aimed to evaluate the proper cut-off levels of sIgE in the diagnosis of immediate hypersensitivity to cefaclor. MATERIALS AND METHODS: A total of 269 patients with drug allergy history, who underwent assays of sIgE to cefaclor at Ajou University hospital and Dong-A University Hospital, were reviewed retrospectively. Among them, 193 patients exhibited cefaclor-induced immediate hypersensitivity with certain or probable causality of an adverse drug reaction according to the WHO-UMC (the World Health Organization-the Uppsala Monitoring Centre) algorithm, and 76 controls showed delayed hypersensitivity reactions to non-antibiotics. RESULTS: In total, 126 of the 193 patients (65.3%) experienced anaphylaxis; they had higher serum sIgE levels than patients with immediate hypersensitivity who did not experience anaphylaxis (6.36±12.39 kU/L vs. 4.28±13.61 kU/L, p < 0.001). The best cut-off value for cefaclor-induced immediate hypersensitivity was 0.11 kU/L, with sensitivity of 80.2% and specificity of 81.6%. A cut-off value of 0.44 kU/L showed the best sensitivity (75.4%) and specificity (65.7%) for differentiating anaphylaxis from immediate hypersensitivity reactions. CONCLUSION: Patients with cefaclor anaphylaxis exhibit high serum IgE levels. A cut-off value of 0.11 kU/L of sIgE to cefaclor is proper for identifying patients with cefaclor allergy, and 0.44 kU/L may be useful to detect anaphylaxis.

Clinical Features of Serious Adverse Drug Reactions in a Tertiary Care Hospital in Korea / 대한내과학회지

BACKGROUND/AIMS: Several studies have reported on the clinical aspects of adverse drug reactions (ADRs). To date, no study has evaluated serious adverse drug reactions (SADRs) in Korea. The current study evaluates the clinical expression of SADRs in a Korean hospital. METHODS: We reviewed a total of 3,386 cases of SADR occurring between March 2012 and November 2015 in a single tertiary care institution (Regional Pharmacovigilance Center). RESULTS: When classified by organ system, the most common SADRs were white cell and reticuloendothelial system disorders (n = 511). Skin/appendage (n = 296) and gastrointestinal (n = 216) disorders were the fourth- and eighth-most common SADRs, respectively. The three most common single symptoms were leukopenia (n = 499 events), hypotension (n = 444) and anaphylaxis (n = 215). Leukopenia was mainly caused by anti-tumor drugs, followed by piperacilin/tazobactam (n = 28), vancomycin (n = 10) and methimazole (n = 6). Hypotension was most often caused by propacetamol injection (n = 145), while anaphylaxis was mainly caused by cefaclor (n = 19), ranitidine (n = 12), iopamidol (n = 10) and multi-vitamin infusion (n = 9). CONCLUSIONS: Significant differences were noted in the clinical aspects of ADRs and SADRs. Additional studies are warranted to further assess SADRs in response to frequently used causative drugs.

Immunologic Evaluation of Immediate Hypersensitivity to Cefaclor

PURPOSE: Cefaclor is widely prescribed for various infectious diseases. As its consumption increases, the number of hypersensitivity reactions to cefaclor has increased. This study aimed to evaluate the immunologic findings of immediate hypersensitivity to cefaclor. MATERIALS AND METHODS: We enrolled 47 patients with immediate hypersensitivity to cefaclor from Ajou University Hospital and Asan Medical Center. Serum specific IgE, IgG1, and IgG4 antibodies to cefaclor-human serum albumin (HSA) conjugate were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The most common phenotype was anaphylaxis (Group I, 78.7%), followed by urticaria (Group II, 21.3%). The detection of specific IgE, IgG1, and IgG4 to cefaclor-HSA conjugate by ELISA tended to be higher in Group I (40.5%, 41.7%, 21.6%) than in Group II (20.0%, 20.0%, 0%) with no statistical significance. Significant associations were found between specific IgE and IgG1 or IgG4 (p<0.001, p=0.019). ELISA inhibition tests showed significant inhibitions by both free cefaclor and cefaclor-HSA conjugate. For basophil activation tests in patients having no specific IgE antibody, the CD63 expression level on basophils increased with incubations of free cefaclor. CONCLUSION: The most common manifestation of immediate hypersensitivity to cefaclor was anaphylaxis, most of which was mediated by IgE; however, a non-IgE mediated direct basophil activation mechanism was suggested in a subset of anaphylaxis patients.

Evaluación de efectividad y seguridad de cefaclor, cefprozil y cefuroxim a como primera línea para neumonía adquirida en la comunidad en menores de 5 años / Evaluation of effectiveness and safety of cefaclor, cefprozil and cefuroxim a as first line for community-acquired pneumonia in children under 5 years

Antecedentes: Descripción de la condición de salud de interés (indicación): La Neumonía Adquirida en la Comunidad (NAC), e s una enfermedad resultante de la inflamación del parénquima pulmonar generada por un agente infeccioso fuera del ambiente hospitalario. El cuadro clínico se caracteriza por tos, fiebre y signos de consolidación al examen físico, pero puede ser muy variable y mostrar otros síntomas locales como disnea, dolor torácico, expectoración, taquipnea, o generales como fiebre, escalofríos confusión y taquicardia. Información de la tecnología: La cefuroxima es muy activa frente a la mayoría de las bacterias gram-positivas (incluyendo las cepas productoras de penicilinasa) como los estafilococos (S. aureus, S. epidermis), estreptococos (a excepción de los enterococos) y algunas bacterias gram-positivas anaerobias. Entre las bacterias gram-negativas sensibles a la cefuroxima se encuentran los E.coli, Klebsiella, H.influenzae, Proteus mirabilis, N.meningitidis, y N.gonorrhoeae, incluyendo las cepas que son productoras de beta-lactamasas. Otros gérmenes sensibles son la Pasteurella multocida, Citrobacter, Salmonella, Shigella, y Yersinia. La cefuroxima tiene poca actividad frente a especies de Providencia, P. vulgaris, Serratia, o Pseudomonas. Tampoco es efectiva frente a la Listeria meningitis. Evaluación de efectividad y seguridad: ¿Cuál es la efectividad y seguridad de cefaclor, cefprozil y cefuroxima comparados con amoxicilina, amoxicilina/ácido clavulánico, eritromicina, claritromicina o azitromicina, como monoterapia ambulatoria de primera línea para NAC no complicada en niños menores de 5 años? La pregunta de evaluación fue refinada y validada con base en: autorización de mercadeo de las tecnologías para la indicación de interés (registro sanitario INVIMA), listado de medic\r\namentos vitales no disponibles, cobertura de las tecnologías en el Plan Obligatorio de Salud (POS) \r\n(Acuerdo 029 de 2011), revisión de grupos terapéuticos (clasificación ATC: Anatomical, Therapeutic, Chemical classification system), recomendaciones de guías de práctica clínica actualizadas, disponibilidad de evidencia sobre efectividad y seguridad (reportes de evaluación de tecnologías y revisiones sistemáticas de la literatura), uso de las tecnologías (listas nacionales de recobro, estadísticas de prescripc\r\nión, etc), estudios de carga de enfermedad. Población: Personas con diagnóstico de Neumonía Adquirida en la comunidad. Tecnología de interés: Amoxicilina, amoxicilina/ácido clavulánico, eritromicina, claritromicina o azitromicina. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónica.Conclusiones: No existen diferencias estadísticamente significativas en cuanto a efectividad al comparar tasas de curación de cefuroxima con amoxicilina. No existen diferencias estadísticamente significativas en cuanto a efectividad al comparar tasas de curación de cefuroxima con claritromicina. No se encontraron comparaciones entre cefaclor, cefprozil con amoxicilina, amoxicilina/ácido, clavulánico, eritromicina, claritromicina y azitromicina. La revisión sistemática es de alta calidad, pero hacen falta estudios que permitan aclarar las diferencias entre cefuroxima y amoxicilina/ácido clavulánico, eritromicina, y azitromicina.

Use of glass ionomer cement containing antibiotics to seal off infected dentin: a randomized clinical trial

Dental materials with antibacterial properties can prevent the harmful effects caused by oral cariogenic bacteria. This double-blind controlled clinical trial evaluated the performance of a glass ionomer cement (GIC) added with antibiotics for sealing infected dentin in atraumatic restorations of primary molars. The study enrolled 45 children (45 teeth) between 5 and 8 years of age, of both genders, divided into two groups: GC (n=22), where cavities were lined with a conventional GIC (Vidrion F) and GA (n=23), with cavities lined with Vidrion F added with 1% each of metronidazole, ciprofloxacin and cefaclor antibiotic. Both groups were restored with Ketac Molar Easymix. Molars with carious lesions on the inner half of dentin without clinical or radiographic pulp damage were selected. Patients were evaluated clinically (pain, fistulas or mobility) and radiographically (area of caries, periapical region and furcation) after 1, 3, 6 and 12 months. For statistical analysis, chi-squared or Fisher's exact tests were used with a 5% significance level. GA (82.6-95.7%) had better results than GC (12.5-36.4%) in all evaluations (p<0.05) and the difference in the success rate was 46.2-72.5% higher for GA. The use of the antibiotic-containing GIC liner on infected dentin proved satisfactory when applied in deciduous teeth.

Os materiais dentários com propriedades antibacterianas podem proteger os efeitos nocivos causados por bactérias cariogênicas. Este ensaio clínico controlado duplo-cego avaliou o desempenho do cimento de ionômero de vidro (CIV) associado à antibióticos no selamento da dentina infectada em restaurações atraumáticas de molares decíduos. O estudo envolveu 45 crianças (45 dentes) entre 5 e 8 anos de idade, de ambos os sexos, divididos em dois grupos: GC (n=22), onde as cavidades foram forradas com CIV convencional (Vidrion F) e GA (n=23), onde as cavidades foram forradas com Vidrion F contendo 1% de cada um dos antibióticos metronidazole, ciprofloxacina e cefaclor. Ambos os grupos foram restaurados com Ketac Molar Easymix. Molares com lesões de cárie na metade interna da dentina, sem danos pulpares clínicos ou radiográficos foram selecionados. Os pacientes foram avaliados clinicamente (presença de dor, fístulas ou mobilidade) e radiograficamente (área de cárie, região periapical e de furca dos dentes), após 1, 3, 6 e 12 meses. Para a análise estatística o Qui-quadrado ou Exato de Fisher foram utilizados com 5,0% de significância. GA (82,6-95,7%) obteve melhores resultados do que GC (12,5-36,4%) em todas as avaliações (p<0,05) e a diferença na taxa de sucesso foi de 46,2-72,5% maior para GA. O uso do CIV com antibióticos no forramento da dentina infectada foi satisfatório em dentes decíduos.

Nasopharyngeal Colonization of Moraxella catarrhalis in Young Korean Children / 감염과화학요법

BACKGROUND: Nasopharyngeal bacterial flora can cause respiratory tract diseases as well as invasive bacterial diseases. Moraxella catarrhalis colonizing in the nasopharynx is considered an important potential pathogen with an increasing production of beta-lactamase. This study examined the nasopharyngeal colonization rate of M. catarrhalis and the antibiotic susceptibility of M. catarrhalis. MATERIALS AND METHODS: Healthy children who visited one of the three University hospitals in the Republic of Korea or attended a day-care center around the participating hospitals were enrolled in this study. The nasopharyngeal samples were obtained by nasopharyngeal washing with normal saline and M. catarrhalis was isolated. The nasopharyngeal colonization rate of M. catarrhalis was investigated and the minimal inhibitory concentrations (MICs) were measured for commonly used oral antibiotics (amoxicillin, amoxicillin/clavulanate, cefaclor, cefixime, cefdinir, cefditoren, erythromycin and trimethoprim). RESULTS: Three hundred and seventy-nine children aged between 6 months and 5 years were enrolled, and the nasopharyngeal colonization rate of M. catarrhalis was 33% (124 children). All isolated M. catarrhalis produced beta-lactamase. The MIC90 of the antibiotics were as follows: amoxicillin, >16 mg/L; amoxicillin/clavulanate, 0.5 mg/L; cefaclor, 8 mg/L ; cefixime, 0.125 mg/L; cefdinir, 0.25 mg/L; cefditoren, 0.25 mg/L; erythromycin, 0.5 mg/L; and trimethoprim, >16 mg/L. CONCLUSIONS: M. catarrhalis was colonized in 33% of the children aged 6 months to 5 years, and showed low MICs for amoxicillin/clavulanate and oral 2nd and 3rd generation cephalosporins.

Evaluation of cefaclor oral suspensions stability using reversed phase high performance liquid chromatography and antimicrobial diffusion methods

The effect of temperature stresses on Cefaclor suspensions under different storage conditions for a duration of 14 days was tested. The degradation of Cefaclor was determined on the 2[nd], 7[th] and 14[th] day after reconstitution using a sensitive and precise Reversed phase High Performance Liquid Chromatographic [RP-HPLC] method. The RSD values for Forticef, Midocef, Ceclor, Cefabac and Cloracef, indicated a good precision of the RP-HPLC method. The limit of detection [LOD] and the limit of quantification [LOQ] were found 0.008 mg/ml and 0.03mg/ml respectively. The antimicrobial effect of Cefaclor suspension was also tested against pathogenic bacteria using the cylinder diffusion method. The RSD values range of the antimicrobial assay for all the Cefaclor compounds were 1.47-3.7%. The LOD and LOQ were 0.2mg/ml and Img/ml respectively. During the normal use of Ceclor, Midocef, and Forticef the loss of activity and the degradation were less than 5% on the 14[th] day of preservation at 4°C. However, the percentage of degradation for Cefabac and Cloracef on the 14th day reached 5 and 6%, respectively. Statistical multiple comparison between the effect of 4°C and 25°C indicated non significant mean differences [P >/= 0.05] for Forticef, Cefabac, Ceclor and Cloraf and significant effect for Midocef [P

Prevalence and Risk Factors for Extended Spectrum Beta-Lactamase-Producing Uropathogens in Patients with Urinary Tract Infection

PURPOSE: The aim of this study was to determine the prevalence and risk factors of extended spectrum beta-lactamase (ESBL)-producing microorganisms in urinary tract infection. MATERIALS AND METHODS: total of 2,312 patients older than 25 years and diagnosed from January 2007 to December 2009 as having urinary tract infection were studied. The prevalence of ESBL-producing microorganisms including Escherichia coli and the antimicrobial susceptibility of E. coli were examined. Univariate analyses were performed with gender, age, inpatient status, previous hospitalization, recent history of urinary catheterization, recent exposure to specific antibiotics, and past history of urogenital organ operation as risk factors for the emergence of ESBL-producing microorganisms. Then, multivariate analysis was performed with all significant variables. RESULTS: In outpatient urinary tract infection, the antimicrobial susceptibility of E. coli to each of the third-generation cephalosporins, cefotaxime, ceftazidime, and ceftriaxone, was 87.6%, 93.4%, and 87.7%, respectively, and the prevalence of ESBL-producing E. coli was 12.1%. In inpatient urinary tract infection, the susceptibility of E. coli was 78%, 84.5%, and 76.9%, respectively, and the prevalence was 23.1%. CONCLUSIONS: The overall prevalence of ESBL-producing microorganism was 12.6% and the risk appeared to be increased in cases with a previous hospitalization, a recent history of urinary catheterization, inpatient status, cefaclor medication, cefminox administration, and female gender.

Prevalence and Risk Factors for Extended Spectrum Beta-Lactamase-Producing Uropathogens in Patients with Urinary Tract Infection

PURPOSE: The aim of this study was to determine the prevalence and risk factors of extended spectrum beta-lactamase (ESBL)-producing microorganisms in urinary tract infection. MATERIALS AND METHODS: total of 2,312 patients older than 25 years and diagnosed from January 2007 to December 2009 as having urinary tract infection were studied. The prevalence of ESBL-producing microorganisms including Escherichia coli and the antimicrobial susceptibility of E. coli were examined. Univariate analyses were performed with gender, age, inpatient status, previous hospitalization, recent history of urinary catheterization, recent exposure to specific antibiotics, and past history of urogenital organ operation as risk factors for the emergence of ESBL-producing microorganisms. Then, multivariate analysis was performed with all significant variables. RESULTS: In outpatient urinary tract infection, the antimicrobial susceptibility of E. coli to each of the third-generation cephalosporins, cefotaxime, ceftazidime, and ceftriaxone, was 87.6%, 93.4%, and 87.7%, respectively, and the prevalence of ESBL-producing E. coli was 12.1%. In inpatient urinary tract infection, the susceptibility of E. coli was 78%, 84.5%, and 76.9%, respectively, and the prevalence was 23.1%. CONCLUSIONS: The overall prevalence of ESBL-producing microorganism was 12.6% and the risk appeared to be increased in cases with a previous hospitalization, a recent history of urinary catheterization, inpatient status, cefaclor medication, cefminox administration, and female gender.

A Case of Cutaneous Mycobacterium abscessus Infection / 대한피부과학회지

We report a case of cutaneous Mycobacterium (M.) abscessus infection in a 32-year-old woman who presented with a red infiltrated plaque on her left shin. No history of prior trauma was reported, but she had a history of habitual leg shaving. Skin biopsy specimen showed neutrophilic abscesses with poorly defined granulomas in the lower dermis and subcutaneous tissue, as well as some acid-fast bacilli. The microorganism was identified as M. abscessus by tissue culture and PCR-restriction fragment length polymorphism (PCR-RFLP) analysis. The patient was treated with clarithromycin and cefaclor for 4 months, and there was no evidence of recurrence at 6 month follow-up.

Avaliação in vitro de propriedades físico-químicas de cimentos de ionômero de vidro convencionais, após adição de própolis e antibióticos / Evaluation in vitro of properties physicist-chemistries of glass-ionomer cements, after

O objetivo deste estudo foi avaliar o desgaste pela perda de massa após escovação simulada, a liberação de flúor e a resistência à compressão de dois cimentos de ionômero de vidro, um indicado para restaurações convencionais e outro indicado para a técnica de restaurações atraumáticas (ART), com a adição de antibióticos e própolis. Foram confeccionados corpos-de-prova em cimentos de ionômero de vidro (Vidrion R e Vitro Molar), adicionando-se antibióticos (cefaclor, ciprofloxacina e metronidazol) ou suspensão de própolis (30% em álcool de cereais) aos mesmos. A seguir observou-se perda de massa por escovação simulada (n=48), resistência à compressão (n=90) e liberação de flúor (n=60) dos corpos-de-prova. Os dados obtidos foram analisados estatisticamente pelo teste de variância ANOVA e Tukey com nível de significância p < 00,5. Analisando-se os resultados obtidos, verificou-se maior perda de massa após escovação simulada para o cimento de ionômero de vidro (Vidrion) adicionado de antibiótico, em relação ao Vidrion (grupo controle), com diferença estatisticamente significativa. Ocorreu maior liberação de fluoretos no cimento de ionômero de vidro (Vitro Molar) adicionado de antibióticos em relação ao Vitro Molar, com diferença estatisticamente significativa. A resistência à compressão foi menor, com diferença estatísticamente significativa, para o cimento de ionômero de vidro (Vidrion) adicionado de antibióticos e de propolis em relação Vidrion. Ocorreu também, diferença estatística na resistência à compressão entre os cimentos de ionômero de vidro Vidrion e Vitro Molar, com superioridade para o primeiro.

[ vitro anti-staphylococcus aureus activity of Nigella sativa L., seed oil extract, compared with CXM, CEC, MAN and CAZ antibiotics]

The anti-microbial effect of plants has been suggested from old years. New researches in this field confirm such property of applications. In this study, anti-microbial effects of Nigella sativa seed oil cold extract against two strains of Staphylococcus aureus was evaluated, and the minimum inhibitory concentration [MIC] of Nigella sativa L. [NS] was compared with relevant antibiotics. Detection of mic in ns oil cold extract was performed using broth dilution method. The original extract was prepared in 0.5%, 0.25%, 0.06% and 0.03% concentrations by serial dilution. S. Aureus strains [ATCC 1112 and 2572] were grown in TSB media to 0.5 mc farland standard concentrations and each 0.01 dilution of microorganism suspension above was transferred to the drug dilution. Tubes were incubated overnight at 35 °C. The sensitivity of the bacteria was defined by disk diffusion [kirby-bauer] Method and Antibiogram disks made by Difco Inc. The obtained values were compared with the effects of the extract. MIC for S. Aureus ATCC-2572 and S. aureus ATCC-1112 were found 1/16 and 1/10, respectively. It was revealed by performing in vitro sensitivity tests for the two strains that NS oil can affect the bacterial pure form in 0.125% and 0.26% concentrations. It is suggested that the anti-microbial effect of NS oil extract is comparable with antibiotics such as CXM, CEC, MAN, CAZ. We recommend experimental use of Nigella sativa L. to control some of bacterial infections

Susceptibility tests of oral antibiotics including cefixime against Escherichia coli, isolated from pediatric patients with community acquired urinary tract infections / 소아과

PURPOSE: Urinary tract infection(UTI) is one of the most frequent infections in children. E. coli is the most frequent etiological micropathogen in pediatric community UTI, and E. coli has developed resistance to many antibiotics, highlighting the need for regular surveys of this organism resistant patterns in the community. The aim of this study was to determine the oral antibiotic susceptibility patterns of E. coli, isolated from pediatric patients with uncomplicated community acquired UTI. METHODS: E. coli isolates, obtained from pediatric patients with uncomplicated community acquired UTI between October in 2004 to September in 2005. And minimal inhibitory concentrations(MICs) of oral aminopenicillins and beta-lactamase inhibnitors(ampicillin, amoxacillin, ampicillin-sulbactam), oral cephalosporins(cefaclor, cefixime) and sulfa drug(trimethoprime-sulfamethoxazole) were performed according to the National Committee for Clinical Laboratory Standards(NCCLS) guide line. RESULTS: Total 211 organisms were isolated from pediatric out-patients with community UTI. E. coli was the most common organism(89 percent), followed by E. fecalis, Proteus species, S. aureus, M. morganii, and P. aeruginosa. The resistant rates of aminopenicillins and beta-lactamase inhibitors, cefaclor and sulfa drug to E. coli were very high. But, the resistant rate of cefixime was markedly low, and ESBL strains were isolated with small rates. CONCLUSION: Our study results suggest that aminopenicillins, cefaclor and sulfa drug may not be useful as first line empirical antibiotics to treat pediatric patients with community UTI in Korea. But, 3rd generation cephalosporin such as cefixime can be used as effective second line antibiotics after primary treatment failure, also may be useful as an empirical first line antibiotic. Finally, we conclude that a continuous surveillance study to monitor susceptibility patterns of E. coli in community UTI will be needed for the standard guide lines of empirical oral antibiotic treatment.

Comparative efficacy and safety evaluation of cefaclor vs amoxycillin + clavulanate in children with Acute Otitis Media (AOM).

Acute Otitis Media (AOM) is the most frequent respiratory tract infection of infancy and childhood that is treated with antimicrobial agents. The most common causative pathogens include Streptococcus pneumoniae, Hemophilus influenzae and Moxarella catarrhalis, and therefore antibacterial management should target against these isolates. Cefaclor, a congener of cephalexin monohydrate, is a semisynthetic cephalosporin antibiotic. It is an orally active cephalosporin which has demonstrated activity against a wide range of organisms in vitro. Present study is designed as a multicentric prospective trial to study and compare the efficacy and safety of cefaclor versus amoxicillin + clav in children with acute otitis media. One hundred and sixty seven patients were evaluated for efficacy endpoints in the cefaclor arm comprised of 104 males and 63 females with a mean age of 5.74+/-2.80 years and 185 patients in the amoxy-clav group comprised of 118 males and 67 females with a mean age of 4.93+/-2.92 years. Both cefaclor and amoxy-clav caused a significant improvement in all the signs and symptoms after a 10-day treatment period. However, between-the-group comparisons showed that the reduction in most of the symptoms was significantly more in cefaclor arm as compared to amoxicillin-clav arm. The clinical success (clinical cure + improvement) at the end of therapy was significantly more in cefaclor arm: 98% with cefaclor versus 85% with amoxicillin + clav, p<0.05 Table 3. Failure cases were prescribed other antibiotics according to the culture sensitivity reports, as rescue medication. Bacterial eradication rates were largely consistent with clinical responses. Bacteriological eradication was seen in 95% of patients in cefaclor group and 78% of patients in amoxicillin + clav group. In conclusion, cefaclor is a well tolerated and effective antibacterial option for acute otitis media in children and it is superior to the combination of amoxicillin + clav in efficacy and tolerability in acute AOM. Moreover, its expanded spectrum of activity, ability to achieve adequate concentrations in tissues, suitability for twice-daily dosing, and proven tolerability suggest that it is a good alternative to agents traditionally used in acute otitis media.

In Vitro Activities of Cefatrizine-Clavulanic Acid against Gram-Negative Bacilli Isolated from Community-acquired Urinary Track Infection / 대한진단검사의학회지

BACKGROUND: A high proportion of currently isolated gram-negative bacilli are resistant to beta-lactams by producing beta-lactamases. beta-lactam and beta-lactamase inhibitor combinations have been successfully used to overcome the resistance. In this study, in vitro antimicrobial activity of a new combination, cefatrizine-clavulanic acid, was determined against gram-negative bacilli isolated from community-acquired urinary track infections. METHODS: Nonduplicate strains of Enterobacteriaceae, isolated in 2003 from urine specimens of outpatients and inpatients of less than 3 hospital days at Severance Hospital, were tested by the NCCLS agar dilution method. RESULTS: Of a total of 204 isolates, 144 (71%) were Escherichia coli and 30 (15%) were Klebsiella spp. MIC50 and MIC90 of cefatrizine for E. coli were 2 microgram/mL and 16 microgram/mL, respectively. MIC90s of both cefaclor and cefoxitin were also 16 g/mL. MIC50 and MIC90 of cefatrizine-clavulanic acid for E. coli were 1 microgram/mL and 4 microgram/mL, respectively, which were 1/2-1/4 of those of cefaclor and cefoxitin. For Klebsiella spp., MIC90 of cefatrizine was 4 microgram/mL with an MIC range of 1->128 microgram/mL, whereas that of cefatrizine-clavulanic acid was 2 microgram/mL with an MIC range of 0.5-32 microgram/mL. In vitro activity of cefatrizine-clavulanic acid was higher than that of cefatrizine. CONCLUSIONS: Improved in vitro activity of cefatrizine-clavulanic acid against isolates of E. coli and Klebsiella spp. from community-acquired urinary track infection suggested that the combination is useful for an empirical treatment of the infection.

Evaluation of the clinical efficacy of Qingqiao capsule in treating patients with secretory otitis media / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the clinical efficacy of Qingqiao Capsule (QQC) in treating patients with secretory otitis media (SOM).</p><p><b>METHODS</b>A total of 90 patients were randomly assigned into the treated group (n = 45) and the control group (n = 45). Patients in the treated group were administrated with QQC, 5 capsules each time, 3 times a day for totally 10-14 days, and those in the control group were given per os cefaclor capsules 0.5 g each time for adult, 3 times a day, or 20 mg/(kg.d) for children, for 10-14 days. The therapeutic efficacy of treatment on the patients was observed and compared after treatment and followed up for 3-6 months.</p><p><b>RESULTS</b>(1) The clinical efficacy in the treated group was superior to that in the control group with significant statistical difference (P < 0.01); (2) Comparison of the efficacies in patients of three different TCM syndrome types (the external pathogenic wind invasion caused auditory orifice stuffiness type, the Gan-Dan damp-heat steaming up auditory orifice type and the Pi-deficiency dysfunction induced dirty dampness blocking ear type) showed no statistically significant difference (P > 0.05); (3) The vanishing rate and time needed of the main symptoms and signs in the treated group were superior to those in the control group on ear muffle, tinnitus, hearing impairment, hydrotypanum, pure tone threshold and abnormal tongue figure, and the difference was statistically significant (P < 0.05 or P < 0.01), only those of earache, otopiesis and abnormal pulse figure were insignificantly different between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>QQC is an effective Chinese composite medicine on patients with SOM, and shows no obvious adverse reaction.</p>