Treatment of Impetigo and Antimicrobial Resistance.

BACKGROUND: Impetigo is a contagious bacterial infection that affects the superficial skin layers. Increasing worldwide antimicrobial resistance (AMR) to existing topical agents commonly prescribed to treat impetigo is central to treatment failure. The Worldwide Health Organization developed a global action plan on AMR, but omitted information about AMR stewardship programs for topical antibiotics. OBJECTIVES: The review aims to provide information to clinicians and stakeholders regarding AMR and antimicrobial stewardship on topical antimicrobial drugs for impetigo treatment. METHODS: The literature searches reviewed the status of AMR to current topical antibiotics in impetigo, current therapeutic behavior, and concordance with antimicrobial stewardship principles. Two international panels convened to discuss the output of the searches, and the results of the panel discussions were used in the development of the manuscript. RESULTS: The literature search included clinical trials, research studies, clinical guidelines, consensus papers, and reviews (if they provided original data), published between January 2008 and May 2019. The articles were selected based on clinical relevancy of impetigo management, clinical efficacy, and safety of the treatment and antimicrobial resistance. The searches resulted in one-hundred and ninety-eight articles. After applying the eligibility criteria, nineteen articles met inclusion criteria and were considered in the present review. CONCLUSIONS: While published antimicrobial stewardship guidelines have focused on systemic antibiotics, few studies have attempted to evaluate topical antibiotic prescribing practices for impetigo treatment. Many of the topical impetigo treatments currently in use have developed resistance. The appropriate use of topical ozenoxacin can help eradicate impetigo while minimizing AMR.J Drugs Dermatol. 20(4):366-372. doi:10.36849/JDD.5795.

Efficacy of indacaterol in the treatment of patients with COPD.

Effective bronchodilation is an important part of the management of patients with chronic obstructive pulmonary disease (COPD) and can improve breathlessness and ability to undertake physical activities. Indacaterol is a new once-daily, long-acting inhaled bronchodilator for COPD. We review here the efficacy of indacaterol as a bronchodilator, including its impact upon symptoms and health status. The evidence reviewed comprises four placebo-controlled clinical studies of indacaterol treatment, three of which included treatment arms with one of the other long-acting inhaled bronchodilators (once-daily tiotropium or twice-daily salmeterol or formoterol), in 4,833 patients with moderate-to-severe COPD. Indacaterol had a bronchodilator effect significantly greater than formoterol and salmeterol, and similar to tiotropium. Its effect on symptoms and health status was similar or significantly greater than the other bronchodilators. The safety profile was similar to placebo. Once-daily indacaterol is an effective and beneficial maintenance bronchodilator treatment for patients with moderate-to-severe COPD.

Activity of elvitegravir, a once-daily integrase inhibitor, against resistant HIV Type 1: results of a phase 2, randomized, controlled, dose-ranging clinical trial.

BACKGROUND: This phase 2, randomized, active-controlled, 48-week study assessed the noninferiority of the human immunodeficiency virus (HIV) integrase inhibitor elvitegravir to comparator ritonavir-boosted protease inhibitor (CPI/r) in treatment-experienced subjects. METHODS: Subjects had HIV RNA levels 1000 copies/mL and 1 protease resistance mutation. Subjects received nucleoside or nucleotide reverse-transcriptase inhibitors (NRTIs) with or without T-20 and either CPI/r or once-daily elvitegravir at a dose of 20 mg, 50 mg, or 125 mg (blinded to dose) with ritonavir. After week 8, the independent data monitoring committee stopped the elvitegravir 20 mg arm and allowed subjects in the elvitegravir 50 mg and 125 mg arms to add protease inhibitors. The primary end point was the time-weighted average change from baseline in HIV RNA level through week 24 (DAVG(24)). RESULTS: A total of 278 subjects with a median of 11 protease and 3 thymidine analog mutations were randomized and treated. One-half of subjects received NRTIs without expected antiviral activity. Compared with the DAVG(24) for the CPI/r arm (-1.19 log(10) copies/mL), the elvitegravir 50 mg arm was noninferior (-1.44 log(10) copies/mL), and the elvitegravir 125 mg arm was superior (-1.66 log(10) copies/mL; P = .021). Efficacy was impacted by activity of background agents. There was no relationship between elvitegravir dosage and adverse events. CONCLUSIONS: Elvitegravir was well-tolerated and produced rapid virologic suppression that was durable with active background therapy. Trial registration. ClinicalTrials.gov identifier number: NCT00298350.

Determination of lomefloxacin in tablet preparations by liquid chromatography.

A sensitive, precise, and specific high-performance liquid chromatography (HPLC) method was developed for the assay of lomefloxacin (LFLX) in raw material and tablet preparations. The method validation parameters yielded good results and included the range, linearity, precision, accuracy, specificity, and recovery. It was also found that the excipients in the commercial tablet preparation did not interfere with the assay. The HPLC separation was performed on a reversed-phase Phenomenex C18 column (150 x 4.6 mm id, 5 microm particle size) with a mobile phase composed of 1% acetic acid-acetonitrile-methanol (70 + 15 + 15, v/v/v), pumped isocratically at a flow rate of 1.0 mL/min. The effluent was monitored at 280 nm. The calibration graph for LFLX was linear from 2.0 to 7.0 mg/mL. The interday and intraday precisions (relative standard deviation) were less than 1.0%. The method was applied for the quality control of commercial LFLX tablets to quantitate the drug.

Microbiological assay for enrofloxacin injection.

A simple, sensitive and specific agar diffusion bioassay for the antibacterial enrofloxacin was developed. Using a strain of Staphylococcus aureus ATCC 6538P as the test organism, enrofloxacin at concentrations ranging from 3.2 to 12.8 microg ml(-1) could be measured in injection. A prospective validation of the method showed that method was linear (r = 0.99998), precise (R.S.D. = 0.27) and accurate (it measured the added quantities). The method shows results that confirm its precision, not differing significantly the other method described in the literature. We conclude that microbiological assay is satisfactory for quantitation of in vitro antibacterial activity of enrofloxacin.

Efficacy of orally administered oxolinic acid and Vetoquinol, an oxolinic acid ester, for the treatment of furunculosis in Atlantic salmon Salmo salar held in seawater.

This study was performed to determine the efficacy of orally administered oxolinic acid and Vetoquinol, an oxolinic acid ester, in the treatment of experimental induced furunculosis in Atlantic salmon Salmo salar held in seawater. Two strains of the causative bacterium Aeromonas salmonicida subsp. salmonicida, 1 sensitive (VI-88/09/03175) and 1 resistant (3475/90) to oxolinic acid, were used. In 2 trials, cohabitational challenges were performed by introducing 8 fish challenged in advance by an intraperitoneal injection of 2.2 x 10(4) colony forming units of strain 3475/90 (Trial 1) or strain VI-88/09/03175 (Trial 2) to 10 aquaria each containing 40 healthy fish. The treatment groups in both trials consisted of 4 groups receiving either oxolinic acid (2 groups) or Vetoquinol (2 groups) and 1 control group. An unchallenged, unmedicated group was used to determine the natural mortality in the population. The recommended therapeutic dose of 25 mg oxolinic acid kg-1 fish at Days 1, 2, 4, 6, 8 and 10 following initiation of treatment was used. Oral medication initiated at Day 10 (Trial 1) or Day 11 (Trial 2) following challenge significantly (p < 0.05) lowered the specific mortality in all drug-treated groups compared to the untreated control groups. Mortality in Vetoquinol-treated groups was significantly (p < 0.05) lower than in oxolinic acid-treated groups in Trial 1 whereas no significant (p < 0.05) difference in survival rate was found between the medicated groups in Trial 2.

Efficacy of difloxacin in calves experimentally infected with Mannheimia haemolytica.

OBJECTIVE: To determine the efficacy of difloxacin, a novel fluoroquinolone antibiotic, in calves experimentally infected with Mannheimia haemolytica (formerly Pasteurella haemolytica). ANIMALS: Seventy-two 3-month-old Holstein calves. PROCEDURES: Calves were inoculated with M haemolytica intratracheally; after they developed clinical signs of pneumonic pasteurellosis, they were randomly assigned to 1 of 6 groups (n = 12/group). Calves in each group were treated with 10% difloxacin (2.5 or 5 mg/kg of body weight), 5% difloxacin (2.5 or 5 mg/kg), enrofloxacin (5 mg/kg), or saline (0.9% NaCl) solution (control group), once daily for 5 days, and clinical signs were scored daily. On day 15, calves were euthanatized, and the percentage of diseased lung tissue was calculated. Swab specimens of the lungs were submitted for bacterial culture. RESULTS: Mortality rate and percentage of diseased lung tissue were significantly higher and cure rate and average daily gain were significantly lower for control calves, compared with calves in the treatment groups; however, no significant differences were found among treatment groups. Mannheimia haemolytica was isolated from the lungs of 10 control calves and from at least 2 calves in each of the treatment groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that difloxacin and enrofloxacin were equally effective for treatment of calves with experimentally induced pneumonic pasteurellosis. However, treatment of infected calves with difloxacin or enrofloxacin may not eliminate the organism.

The use of ciprofloxacin in veterinary proprietary products of enrofloxacin.

A 3-mo chemical surveillance of 5 proprietary products of enrofloxacin for veterinary use was carried out. In all, 50 samples were analyzed by thin-layer chromatography and UV-Vis spectroscopy. Only the original brand of enrofloxacin (BAYTRIL) contained 5% of the drug while the 40 samples from the other 4 products contained 7.5% ciprofloxacin. A word of caution is given for the indiscriminate use of fluoroquinolones in veterinary medicine.

Determination of residues of enrofloxacin and its metabolite ciprofloxacin in chicken muscle by capillary electrophoresis using laser-induced fluorescence detection.

A method for the residue analysis of the veterinary antimicrobial agent enrofloxacin and its active desethyl metabolite ciprofloxacin in chicken muscle tissue has been developed and validated. The detection of the analytes was performed by laser-induced fluorescence (LIF) detection using a HeCd laser (lambda(ex) = 325 nm) providing an enhancement in sensitivity and selectivity compared to conventional UV detection. The assay has been validated with satisfying results. The limits of quantification for enrofloxacin and ciprofloxacin were 5 microg/kg and 20 microg/kg, respectively, with a fivefold preconcentration yielded by a sample clean-up with a simple liquid-liquid extraction procedure. Calibration graphs were linear from 5 to 1000 microg/kg for enrofloxacin and from 20 to 1000 microg/kg for ciprofloxacin. The assay allows the detection of contaminated muscle samples at the required maximum residue limit of the European Union, which is 100 microg/kg for the sum of enrofloxacin and ciprofloxacin.

Compositional analysis surveillance of eleven brands of enrofloxacin including Baytril for veterinary use.

Lack of consistency in clinical effectiveness of various commercial preparations of enrofloxacin prompted a compositional analysis surveillance of 11 trade marks of this fluoroquinolone using various physicochemical properties and high performance liquid chromatography (HPLC). Only one preparation resembled Baytril (Bayer of Mexico), the original brand of enrofloxacin. Variations in the concentration of enrofloxacin, use of different vehicles, substitution of this fluoroquinolone by ciprofloxacin and variations in pH were found. The use of ciprofloxacin in veterinary medicine is discussed.

Simple high-performance liquid chromatographic assay for the determination of ciprofloxacin in human plasma with ultraviolet detection.

A simple high-performance liquid chromatographic method is described for the quantitative analysis of ciprofloxacin in human plasma. Following protein precipitation from plasma by means of 6% perchloric acid, the upper layer which contains the analyte and the internal standard lomefloxacin, was analysed on a reverse phase column LiChrospher 60 RP-select B (5 microm) (EcoCART 125-3) with ultraviolet detection at 280 nm. The mobile phase was acetic acid 5%-methanol-acetonitrile (90:5:5, v/v/v). The assay was linear for ciprofloxacin over the concentration range of 0.050 to 6.00 microg ml(-1). The limit of quantification (LOQ) was 0.050 microg ml(-1). The method was successfully applied to a bioavailability study with five different ciprofloxacin formulations.

Las Quinolonas / The Quinolones

La continua lucha que el hombre libera contra gérmenes patógenos ha permitido obtener cada vez mejores y más eficaces antibióticos. Desde la década del sesenta el clínico dispone de un grupo de antimicrobianos que por sus características conforman un grupo especial: Las quinolonas. El entendimiento de su mecanismo de acción, actividad antimicrobiana, interacciones medicamentosas y otros aspectos son pilares básicos para que el médico comprenda y racionalice su uso. La inmensa gama de posibilidades de modificación en su molécula básica, indica que las quinolonas están llamadas a quedarse en el arsenal terapéutico durante varias décadas; de allí la importancia de revisar y actualizar los conceptos que hasta hoy rigen su uso clínico