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1.
Wiad Lek ; 77(1): 171-177, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38431823

RESUMO

We reported the case of tonsillitis treatment in a 17-years-old boy with use of chemical non-antibiotic preparations, plant derived products and antibiotic benzathine phenoxymethylpenicillin. The antimicrobial agents for treatment were selected on the basis of their activity against a disease agent, the group A ß-hemolytic strain Streptococcus pyogenes BS1 isolated from a patient. The bacterium was susceptible in vitro to ß-lactams, with largest zones conditioned by penicillin G and benzathine phenoxymethylpenicillin discs, to fluoroquinolones and to cephems, with exception of cefazolin. Lincosamide clindamycin, macrolide spiramycin, aminoglycoside gentamicin, erythromycin, tetracycline and combination of sulfamethoxazole and trimethoprim were inactive against this bacterium. The Streptococcus pyogenes BS1 demonstrated intermediate susceptibility to the cephalosporin cephalexin, fluoroquinolone lomefloxacin and glycopeptide vancomycin. Non-antibiotic preparations were evaluated against Streptococcus pyogenes BS1 also. Among them "Stomatidin", "Chlorophyllipt", and phages of "Pyofag" were more effective than "Decatylen", "Decasan" and "Furadonin" in vitro. The antimicrobial applications of "Stomatidin", "Chlorophyllipt" and phages of "Pyofag" in the patient were less effective compared to the result of antibiotic benzathine phenoxymethylpenicillin treatment. Complete recovery of the patient was achieved with use of this antibiotic and Calendula flower extract as an local anti-inflammatory agent.


Assuntos
Anti-Infecciosos , Etilenodiaminas , Tonsilite , Adolescente , Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Penicilina V/farmacologia , Streptococcus pyogenes , Tonsilite/tratamento farmacológico
2.
Anal Methods ; 16(4): 558-565, 2024 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-38189092

RESUMO

Background: The optimization of antimicrobial dosing plays a crucial role in improving the likelihood of achieving therapeutic success while reducing the risks associated with toxicity and antimicrobial resistance. Probenecid has shown significant potential in enhancing the serum exposure of phenoxymethylpenicillin, thereby allowing for lower doses of phenoxymethylpenicillin to achieve similar pharmacokinetic/pharmacodynamic (PK/PD) targets. We developed a triple quadrupole liquid chromatography mass spectrometry (TQ LC/MS) analysis of, phenoxymethylpenicillin, benzylpenicillin and probenecid using benzylpenicillin-d7 and probenecid-d14 as IS in single low-volumes of human serum, with improved limit of quantification to support therapeutic drug monitoring. Methods: Sample clean-up was performed by protein precipitation using acetonitrile. Reverse phase chromatography was performed using TQ LC/MS. The mobile phase consisted of 55% methanol in water + 0.1% formic acid, with a flow rate of 0.4 mL min-1. Antibiotic stability was assessed at different temperatures. Results: Chromatographic separation was achieved within 2 minutes, allowing simultaneous measurement of phenoxymethylpenicillin, benzylpenicillin and probenecid in a single 15 µL blood sample. Validation indicated linearity over the range 0.0015-10 mg L-1, with accuracy of 96-102% and a LLOQ of 0.01 mg L-1. All drugs demonstrated good stability under different storage conditions. Conclusion: The developed method is simple, rapid, accurate and clinically applicable for the quantification of phenoxymethylpenicillin, benzylpenicillin and probenecid in tandem.


Assuntos
Penicilina V , Probenecid , Humanos , Probenecid/farmacologia , Espectrometria de Massas em Tandem/métodos , Antibacterianos/farmacologia , Penicilina G
3.
Plant Mol Biol ; 114(1): 7, 2024 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-38265485

RESUMO

KEY MESSAGE: Plant U-box E3 ligases PUB20 and PUB21 are flg22-triggered signaling components and negatively regulate immune responses. Plant U-box proteins (PUBs) constitute a class of E3 ligases that are associated with various stress responses. Among the class IV PUBs featuring C-terminal Armadillo (ARM) repeats, PUB20 and PUB21 are closely related homologs. Here, we show that both PUB20 and PUB21 negatively regulate innate immunity in plants. Loss of PUB20 and PUB21 function leads to enhanced resistance to surface inoculation with the virulent bacterium Pseudomonas syringae pv. tomato DC3000 (Pst DC3000). However, the resistance levels remain unaffected after infiltration inoculation, suggesting that PUB20 and PUB21 primarily function during the early defense stages. The enhanced resistance to Pst DC3000 in PUB mutant plants (pub20-1, pub21-1, and pub20-1/pub21-1) correlates with extensive flg22-triggered reactive oxygen production, strong MPK3 activation, and enhanced transcriptional activation of early immune response genes. Additionally, PUB mutant plants (except pub21-1) exhibit constitutive stomatal closure after Pst DC3000 inoculation, implying the significant role of PUB20 in stomatal immunity. Comparative analyses of flg22 responses between PUB mutants and wild-type plants reveals that the robust activation of the pattern-induced immune responses may enhance resistance against Pst DC3000. Notably, the hypersensitivity responses triggered by RPM1/avrRpm1 and RPS2/avrRpt2 are independent of PUB20 and PUB21. These results suggest that PUB20 and PUB21 knockout mutations affect bacterial invasion, likely during the early stages, acting as negative regulators of plant immunity.


Assuntos
Arabidopsis , Reconhecimento da Imunidade Inata , Imunidade Inata , Proteínas de Plantas , Penicilina V , Ligases
4.
Acta Obstet Gynecol Scand ; 103(3): 531-539, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38108616

RESUMO

INTRODUCTION: Antibiotics are often prescribed during pregnancy. Assessing the current state of prenatal antibiotic use is therefore imperative for optimizing prescribing and identifying emerging research priorities. The study aimed to describe recent trends and patterns in antibiotic use during pregnancy among women who gave birth in Sweden, including user characteristics. MATERIAL AND METHODS: Population-based descriptive study using linked nationwide registers. All pregnancies delivered in Sweden from 2007 to 2019 were included. Prevalence of use was defined as the percentage of pregnancies during which at least one prescription forantibiotics was filled. Temporal trends in the prevalence of antibiotic use by calendar year, trimester and weeks of gestation were assessed from time series graphs. RESULTS: Prescriptions for systemic antibiotics were filled in 20.7% of 1 434 431 pregnancies overall, decreasing from 24.7% in 2007 to 18.0% in 2019. Phenoxymethylpenicillin (8.5%), pivmecillinam (6.5%), nitrofurantoin (4.7%), amoxicillin (1.6%) and cefadroxil (1.5%) use were the most prevalent. Their use decreased over the 13-year period, except for pivmecillinam, which increased from 4.0% to 7.4%. Prevalence of use was highest in the second trimester (9.5%), with weekly trends peaking at 13 and 34 weeks of gestation. Compared with non-users, antibiotic users more often belonged to the youngest and oldest age strata, carried multipleton pregnancies, had delivered before, had attained a lower education level and smoked in early pregnancy. A higher body mass index, asthma, chronic renal disease and diabetes mellitus were more prevalent among antibiotic users than among non-users. CONCLUSIONS: Although outpatient antibiotic use during pregnancy in Sweden has been declining, one in five pregnancies was exposed to systemic antibiotics.


Assuntos
Andinocilina Pivoxil , Antibacterianos , Gravidez , Feminino , Humanos , Antibacterianos/uso terapêutico , Suécia/epidemiologia , Amoxicilina , Penicilina V
5.
Turk J Pediatr ; 65(3): 351-361, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37395955

RESUMO

BACKGROUND: Acute otitis media (AOM) is the inflammation of the middle ear. It constitutes one of the most frequent infections which affects children and usually occurs between 6 to 24 months of age. AOM can emerge due to viruses and/or bacteria. The aim of the current systematic review is to assess in children between 6 months and 12 years of age with AOM, the efficacy of any antimicrobial agent or placebo compared with amoxicillinclavulanate, to measure the resolution of AOM or symptoms. METHODS: The medical databases PubMed (MEDLINE) and Web of Science were used. Data extraction and analysis were performed by two independent reviewers. Eligibility criteria were set, and only randomised control trials (RCTs) were included. Critical appraisal of the eligible studies was performed. Pooled analysis was conducted using the Review Manager v. 5.4.1 software (RevMan). RESULTS: Twelve RCTs were totally included. Three (25.0%) RCTs studied the impact of azithromycin, two (16.7%) investigated the impact of cefdinir, two (16.7%) investigated placebo, three (25.0%) studied quinolones, one (8.3%) investigated cefaclor and one (8.3%) studied penicillin V, compared to amoxicillin-clavulanate. In five (41.7%) RCTs, amoxicillin-clavulanate proved to be superior to azithromycin, cefdinir, placebo, cefaclor and penicillin V, while in seven (58.3%) RCTs its efficacy was comparable with other antimicrobials or placebo. The rates of AOM relapse after treatment with amoxicillin-clavulanate were comparable to those of other antimicrobials or placebo. However, amoxicillin-clavulanate was more effective in eradicating Streptococcus pneumoniae from the culture, when compared to cefdinir. The results of the meta-analysis were not evaluated due to substantial heterogeneity between studies. CONCLUSIONS: Amoxicillin-clavulanate should be the treatment of choice for children between 6 months and 12 years of age with AOM.


Assuntos
Anti-Infecciosos , Otite Média , Criança , Humanos , Lactente , Doença Aguda , Amoxicilina/uso terapêutico , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Azitromicina/uso terapêutico , Cefaclor/uso terapêutico , Cefdinir/uso terapêutico , Otite Média/tratamento farmacológico , Otite Média/microbiologia , Penicilina V/uso terapêutico , Resultado do Tratamento
6.
J Clin Nurs ; 32(21-22): 7783-7790, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37485967

RESUMO

BACKGROUND: Increasing number of nurse prescribers could be part of a solution to the shortage of physicians, improve access to treatment and curb the rise in healthcare costs; however, readmissions after nurse prescribers' appointments are under-researched. AIMS: To describe and compare clients' initial appointments with nurse prescribers and physicians. In addition, client readmissions within 60 days in the target organisation after nurse prescribers' and physicians' appointments were investigated. DESIGN: Retrospective register-based follow-up study. METHODS: Data included client appointments (n = 3986) with nurse prescribers and physicians, and clients' readmissions (n = 9038) from 1 January 2018 to 31 December 2019 from one hospital district in Finland. Data were analysed statistically using frequencies, percentages, rate ratios and cross-tabulation. STROBE checklist was used. RESULTS: Initial appointments including trimethoprim, pivmecillinam, phenoxymethyl penicillin, chloramphenicol, fusidic acid and cephalexin prescriptions with nurse prescribers (n = 36) were 2131, and physicians (n = 140) 1855. On average, client readmissions (within 60 days) per initial appointment were 2.10 after appointments with nurse prescribers and 2.46 after physicians. After initial appointments, including phenoxymethyl penicillin prescriptions, with nurse prescribers, clients had more readmissions in all age groups than after initial appointments with physicians. However, in all, after initial appointments with physicians, clients had a higher proportion of readmissions. CONCLUSION: Clients have fewer readmissions after appointments with nurse prescribers than physicians, including the same prescriptions. Nurse prescribers' skills may not have been fully utilised. Physicians treated many patients whose diseases nurse prescribers might have been able to treat based on the nurse prescribers' rights. However, physician clients may have more demanding service requirements.


Assuntos
Readmissão do Paciente , Penicilina V , Humanos , Estudos Retrospectivos , Seguimentos , Prescrições de Medicamentos
7.
J Laryngol Otol ; 137(9): 992-996, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37194922

RESUMO

BACKGROUND: Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess. METHODS: A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole. RESULTS: Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects. CONCLUSION: Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.


Assuntos
Abscesso Peritonsilar , Humanos , Abscesso Peritonsilar/terapia , Metronidazol/uso terapêutico , Penicilinas/uso terapêutico , Penicilina V/uso terapêutico , Drenagem , Antibacterianos/uso terapêutico
8.
Res Social Adm Pharm ; 19(8): 1193-1201, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37183105

RESUMO

Antimicrobial resistance (AMR) is a global healthcare challenge that governments and health systems are tackling primarily through antimicrobial stewardship (AMS). This should, improve antibiotic use, avoid inappropriate prescribing, reduce prescription numbers, aligning with national/international AMS targets. In primary care in the United Kingdom (UK) antibiotics are mainly prescribed for patients with urinary and respiratory symptoms (22.7% and 46% of all antibiotic prescriptions respectively). This study aimed to capture the time-series trends (2014-2022) for commonly prescribed antibiotics for respiratory and urinary tract infections in primary care in England. Trends for Amoxicillin, Amoxicillin sodium, Trimethoprim, Clarithromycin, Erythromycin, Erythromycin ethylsuccinate, Erythromycin stearate, Doxycycline hyclate, Doxycycline monohydrate and Phenoxymethylpenicillin (Penicillin V) were determined. In doing so providing evidence regarding meeting UK antibiotic prescribing rate objectives (a 15% reduction in human antibiotic use 2019-2024). Time series trend analysis of 62,949,272 antibiotic prescriptions from 6,370 General Practices in England extracted from the National Health Service (NHS) Business Services Authority web portal were explored. With additional investigation of prescribing rate trends by quintiles of the Index of Multiple Deprivation (IMD). Overall, there is a downwards trend in antibiotic prescribing for those explored. There is an association between IMD, geographical location, and higher antibiotic prescribing levels (prescribing hot spots). England has a well-documented North-South divide of health inequalities, this is reflected in antibiotic prescribing. The corona virus pandemic (COVID-19) impacted on AMS, with a rise in doxycycline and trimethoprim prescriptions notable in higher IMD areas. Since then, prescribing appears to have returned to pre-pandemic levels in all IMDs and continued to decline. AMS efforts are being adhered to in primary care in England. This study provides further evidence of the link between locality and poorer health outcomes (reflected in higher antibiotic prescribing). Further work is required to address antibiotic use in hot spot areas.


Assuntos
Antibacterianos , COVID-19 , Humanos , Antibacterianos/uso terapêutico , Medicina Estatal , Amoxicilina , Doxiciclina/uso terapêutico , Prescrição Inadequada , Penicilina V , Trimetoprima , Eritromicina , Atenção Primária à Saúde , Padrões de Prática Médica
9.
Scand J Prim Health Care ; 41(1): 91-97, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36880344

RESUMO

OBJECTIVE: The aim was to compare rapid antigen detection test (RADT) and throat culture for group A streptococci (GAS) among patients recently treated with penicillin V for GAS pharyngotonsillitis. DESIGN AND SETTING: The study was a secondary analysis within a randomized controlled trial comparing 5 versus 10 days of penicillin V for GAS pharyngotonsillitis. Patients were recruited at 17 primary health care centres in Sweden. SUBJECTS: We included 316 patients ≥ 6 years of age, having 3-4 Centor criteria, a positive RADT and a positive throat culture for GAS at inclusion, and also having a RADT and throat culture for GAS taken at a follow-up visit within 21 days. MAIN OUTCOME MEASURES: RADT and conventional throat culture for GAS. RESULTS: This prospective study showed 91% agreement between RADT and culture at follow-up within 21 days. Only 3/316 participants had negative RADT with a positive throat culture for GAS at follow-up, and 27/316 patients with positive RADT had a negative culture for GAS. Log rank test did not reveal any difference in the decline over time of positive tests between RADT and throat culture (p = 0.24). Agreement between RADT and throat culture for GAS at the follow-up was not associated with treatment duration, number of days from inclusion until follow-up, throat symptoms at follow-up, gender, or age. CONCLUSION: RADT and culture for GAS agreed to a high extent also after recent penicillin V treatment. RADT for GAS means a low risk for missing the presence of GAS.KEY POINTSTesting for group A streptococci (GAS) before antibiotic treatment can reduce antibiotic prescription for pharyngotonsillitis. It has been proposed that rapid antigen detection tests (RADT) for group A streptococci after recent penicillin V treatment may be falsely positive due to possible persisting antigens from non-viable bacteria.The decline of the presence of GAS was similar between RADT and conventional throat culture in patients who had recently completed penicillin V treatment for GAS pharyngotonsillitisRADT for GAS is useful in identifying the presence of GAS after recent penicillin V treatment.


Assuntos
Faringite , Infecções Estreptocócicas , Humanos , Recém-Nascido , Penicilina V , Faringite/diagnóstico , Faringite/tratamento farmacológico , Faringite/microbiologia , Estudos Prospectivos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , Antibacterianos/uso terapêutico , Atenção Primária à Saúde
10.
Curr Opin Infect Dis ; 36(2): 95-101, 2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-36853755

RESUMO

PURPOSE OF REVIEW: Recurrent cellulitis is a challenging clinical condition affecting up to 47% of patients after the first episode, especially those with predisposing risk factors. The purpose of this review is to describe the state of the art of literature evidence and to highlight recent developments in its management. RECENT FINDINGS: Recurrent cellulitis can occur after successful treatment of cellulitis. Conditions that commonly increase the risk of cellulitis include local and systemic modifiable and nonmodifiable factors. A rigorous approach to the management of risk factors and treatment of acute infection is important as the risk of recurrence rises with repeated episodes. Risk factors, if present, need to be targeted in association with antibiotic prophylaxis. Penicillin V is the preferred antibiotic for prevention but other antibiotics and new drugs can be considered in cases of ß-lactam allergy, intolerance, or failure. SUMMARY: Recurrent cellulitis is associated with short term and long-term morbidity as well as significant healthcare costs. Management of underlying predisposing conditions is crucial to prevent recurrence in addition with evaluation of pharmacological measures, but specialized and multidisciplinary skills are needed. More efforts are needed to prevent and treat this underestimated problem.


Assuntos
Antibacterianos , Celulite (Flegmão) , Humanos , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/prevenção & controle , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Penicilina V/uso terapêutico , Prevenção Secundária , Doença Crônica , Recidiva
11.
Br Dent J ; 234(1): 11-12, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36639456
12.
Acta Odontol Scand ; 81(2): 143-150, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35802705

RESUMO

OBJECTIVE: To study the influence of demographic and organizational factors to antibiotic utilization in dental implant surgery in Sweden. MATERIAL AND METHODS: Descriptive statistics regarding antibiotic prescription between 2009 and 2019 was retrieved from two national registers, the Swedish Prescribed Drug Register and the Dental Health register, both administered by the National Board of Health and Welfare. RESULTS: During the years 2009-2019 a significant decrease of the proportion of prescriptions of systemic antibiotics in conjunction with implant surgical procedures occurred in all patient groups where the most common procedure was the insertion of a single implant. The proportion of dental visits when implant surgical treatment was performed which resulted in a prescription of antibiotics decreased significantly from 1/3 to approximately 1/5. However, comparing Public and Private dental care providers, the reduction was significantly greater in Public dental care. Patients with low level of education in urban regions, treated in Private dental clinics were more likely to receive antibiotics in conjunction to implant surgery compared to other groups. Phenoxymethylpenicillin is the most widely used substance in conjunction with implant surgery. CONCLUSION: There is still room for improvement in reduction of antibiotic prescriptions in conjunction to implant surgical procedures in Sweden.


Assuntos
Antibacterianos , Implantes Dentários , Humanos , Antibacterianos/uso terapêutico , Implantes Dentários/efeitos adversos , Suécia , Antibioticoprofilaxia/métodos , Penicilina V
13.
J Am Soc Mass Spectrom ; 34(1): 109-118, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36515652

RESUMO

Enzyme kinetics is normally assessed by performing individual kinetic measurements using batch-type reactors (test tubes, microtiter plates), in which enzymes are mixed with different substrates. Some drawbacks of conventional methods are the large amounts of experimental materials, long analysis times, and limitations of spectrophotometry. Therefore, we have developed a method for facile determination of enzyme kinetics using online flow-based mass spectrometry. A concentration ramp of substrate or product was created by dynamically adjusting flow rates of pumps delivering stock solution of substrate and diluent. Precise kinetic measurements were performed by reaction product quantification and initial rate calculation. In the presence of ascending substrate concentrations, the rate of a target enzyme (penicillinase)-catalyzed hydrolysis was varied. By measuring the reaction product continuously, Michaelis constants (KM) could be calculated. The enzyme kinetic measurements for hydrolysis of penicillins were conducted based on this simple, rapid, and low sample consumption online flow device. In the homogeneous reaction, the KM values for amoxicillin, ampicillin, penicillin G, and penicillin V were 254.9 ± 14.5, 29.2 ± 0.3, 2.6 ± 0.1, and 5.4 ± 0.1 µM, respectively. In the heterogeneous reaction, the KM values for amoxicillin, ampicillin, penicillin G, and penicillin V were 408.9 ± 75.1, 114.4 ± 8.0, 21.8 ± 0.7, and 83.3 ± 4.8 µM, respectively. Apart from enzyme assay, the showcased method for the generation of temporal concentration ramps can be utilized to perform rapid quantity calibrations for mass spectrometric analyses.


Assuntos
Ampicilina , Penicilina V , Cinética , Penicilina G , Amoxicilina , Espectrometria de Massas
14.
BMC Infect Dis ; 22(1): 840, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368940

RESUMO

BACKGROUND: Sore throat is a common reason for prescribing antibiotics in primary care, and 10 days of treatment is recommended for patients with pharyngotonsillitis with group A streptococcus (GAS). Our group recently showed that penicillin V (PcV) four times daily for 5 days was non-inferior in clinical outcome to PcV three times daily for 10 days. This study compares duration, intensity of symptoms, and side effects in patients with a Centor Score (CS) of 3 or 4 respectively, after treatment with PcV for 5 or 10 days and evaluates whether all patients with pharyngotonsillitis with a CS of 3 or 4 should be treated for 5 days or if severity of symptoms or CS suggest a longer treatment period. METHOD: Data on symptoms and recovery from patient diaries from 433 patients included in a RCT comparing PcV 800 mg × 4 for 5 days or PcV 1 g × 3 for 10 days was used. Patients six years and older with CS-3 or CS-4 and positive rapid antigen detection test for GAS-infection were grouped based on CS and randomized treatment. Comparisons for categorical variables were made with Pearson's chi-squared test or Fisher's exact test. Continuous variables were compared with the Mann-Whitney U test. RESULTS: Patients with CS-3 as well as patients with CS-4 who received PcV 800 mg × 4 for 5 days self-reported that they recovered earlier compared to patients with CS-3 or CS-4 who received treatment with PcV 1 g × 3 for 10 days. In addition, the throat pain as single symptom was relieved 1 day earlier in patients with CS-4 and 5 days of treatment compared to patients with CS-4 and 10 days of treatment. No differences in side effects between the groups were found. CONCLUSION: Intense treatment with PcV four times a day for 5 days seems clinically beneficial and strengthens the suggestion that the 4-dose regimen with 800 mg PcV for 5 days may be the future treatment strategy for GAS positive pharyngotonsillitis irrespectively of CS-3 or CS-4. Trail registration ClinicalTrials.gov ID: NCT02712307 (3 April 2016).


Assuntos
Faringite , Infecções Estreptocócicas , Tonsilite , Humanos , Penicilina V/uso terapêutico , Faringite/tratamento farmacológico , Atenção Primária à Saúde , Estudos Prospectivos , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Tonsilite/tratamento farmacológico
15.
Chemosphere ; 309(Pt 1): 136606, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36174729

RESUMO

Bacterial communities are crucial for processing and degrading contaminants in hyporheic zones (HZ). However, the effects of antibiotics on HZ bacterial communities have seldom been addressed. Here, using MiSeq 16S amplicon sequencing technology, the effects of acute exposure to Enrofloxacin, Sulfathiazole, Tetracycline hydrochloride, and Penicillin V potassium on HZ bacterial communities were investigated. Results revealed that HZ sediment communities responded differently to different classes of antibiotics, reflecting the distinct selection stress of antibiotics on HZ bacterial communities. Besides, HZ communities from the locations with more severe antibiotic contamination backgrounds (∼150 µg kg-1) were more resistant towards antibiotic treatment. Compared with small/non-significant changes in HZ community diversity and composition treated with ng L-1∼ug L-1 level antibiotics compared to the control group, treatments with antibiotics over mg L-1 level significantly reduced the diversity and changed the structures of HZ bacterial communities, and enhanced the resistance of the community to antibiotics by enriching antibiotic resistant bacteria. The exposure to mg L-1 level antibiotics also changed community functions by restricting the growth of functional bacteria, such as ammonia oxidizing bacteria (AOB) Nitrosomonas, resulting in ammonia accumulation in sediments. The results implied that at field-relevant concentrations, there was no or minor effect of antibiotics on HZ bacterial community structure and functions, and only those areas with high antibiotic concentrations would have effects.


Assuntos
Amônia , Antibacterianos , Amônia/química , Antibacterianos/farmacologia , Sedimentos Geológicos/microbiologia , Tetraciclina , Penicilina V , Enrofloxacina , Bactérias , Sulfatiazóis
16.
Environ Sci Pollut Res Int ; 29(44): 67026-67045, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35513617

RESUMO

Although antibiotic exposure in the general population has been well documented by a biomonitoring approach, epidemiologic data on the relationships between urinary antibiotic burden in the elderly with blood pressure (BP) are still lacking. The current study revealed thirty-four antibiotics in urine specimens from 990 elderly patients in Lu'an City, China, with detection frequencies ranging from 0.2 to 35.5%. Among the elderly, the prevalence of hypertension was 72.0%, and 12 antibiotics were detected in more than 10% of individuals with hypertension. The elderly with hypertension had the maximum daily exposure (5450.45 µg/kg/day) to fluoroquinolones (FQs). Multiple linear regression analyses revealed significant associations of BP and pulse pressure (PP) with exposure to specific antibiotics. The estimated ß values (95% confidence interval) of associations with systolic blood pressure (SBP) in the right arm were 4.42 (1.15, 7.69) for FQs, 4.26 (0.52, 8.01) for the preferred as human antibiotics (PHAs), and 3.48 (0.20, 6.77) for the mixtures (FQs + tetracyclines [TCs] (tertile 3 vs. tertile 1)), respectively. Increased concentrations of TCs were associated with decreased diastolic BP (DBP; tertile 3: -1.75 [-3.39, -0.12]) for the right arm. Higher levels of FQs (tertile 3: 4.28 [1.02, 7.54]), PHAs (tertile 3: 4.25 [0.49, 8.01]), and FQs + TCs (tertile 3: 3.99 [0.71, 7.26]) were associated with increased SBP, and an increase in DBP for FQs (tertile 3: 1.82 [0.22, 3.42]) was shown in the left arm. Also, higher urinary concentrations of FQs (tertile 3: 3.18 [0.53, 5.82]), PHAs (tertile 3: 3.42 [0.40, 6.45]), and FQs + TCs (tertile 3: 3.06 [0.40, 5.72]) were related to increased PP, whereas a decline in PP for TCs (tertile 2: -2.93 [-5.60, -0.25]) in the right arm. And increased concentrations of penicillin V (tertile 3: 5.31 [1.53, 9.10]) and FQs + TCs (tertile 3: 2.84 [0.19, 5.49]) were related to higher PP in the left arm. By utilizing restricted cubic splines, our current study revealed a potential nonlinear dose-response association between FQ exposure and hypertension risk. In conclusion, this investigation is the first to present antibiotic exposure using a biomonitoring approach, and informs understanding of impacts of antibiotic residues, as emerging hazardous pollutants, on the hypertension risk in the elderly.


Assuntos
Antibacterianos , Hipertensão , Idoso , Pressão Sanguínea , Fluoroquinolonas , Humanos , Hipertensão/epidemiologia , Penicilina V , Tetraciclinas
17.
Basic Clin Pharmacol Toxicol ; 130(1): 151-157, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34747101

RESUMO

BACKGROUND: Discrepancies exist in Danish guidelines for the treatment of bacterial community-acquired pneumonia (CAP). This study aimed to investigate how general practitioners (GPs) treat adults with CAP and explore associations between GP characteristics and treatment duration. METHODS: In autumn 2020, GPs in the North Denmark Region were asked to complete an electronic questionnaire on antibiotic prescribing for CAP. Information about GP gender, age, experience and type of practice was obtained. Multivariable logistic regression was used to analyse the association between GP characteristics and treatment duration. RESULTS: A total of 298 GPs were invited to participate of whom 108 completed the survey. Penicillin V was used as first line treatment for CAP by all participants. Treatment duration varied from 5 (54.6%) to 10 days (8.3%). A 5-day course of penicillin was less likely to be prescribed by male GPs (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13-0.94) and more likely to be prescribed by GPs with 5-9 years of experience in general practice (OR 5.03, 95% CI 1.09-23.21) compared to those with 10-19 years of experience. CONCLUSION: Variation in antibiotic treatment of CAP emphasises the importance of generating solid evidence about the optimal duration regarding both effectiveness and safety.


Assuntos
Antibacterianos/administração & dosagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Dinamarca , Esquema de Medicação , Feminino , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Penicilina V/administração & dosagem
19.
Enzyme Microb Technol ; 149: 109819, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34311875

RESUMO

The recognition and interaction of FEZ-1 from Legionella (FEZ-1) with penicillin V(PV) and cefoxitin(CFX) were investigated using fluorescence spectra in combination with molecular dynamics simulation (MD). The results revealed that the CFX bind with FEZ-1 in stronger interaction and induced larger conformational change than PV, despite all being forced by the electrostatic interaction and along with the changing in an environment of amino acid residues as well as the polypeptide skeleton inside the FEZ-1. Moreover, only the loop1, loop2, and N-terminal were observed locating near the binding pocket of FEZ-1, consisting of a flexible "gate-like" zone with better adaptability that controlled the entrance of antibiotic into the pocket by allowing the newly introduced antibiotic to match the pocket better through the conformational changes of these three substructures in the binding procedure. The current study may provide some valuable information on the antibiotic hydrolytic process by metallo-beta-lactamase and thus the references for the development of new antibiotics for super bacteria.


Assuntos
Cefoxitina , Legionella , Penicilina V , beta-Lactamases , Cefoxitina/farmacologia , Legionella/metabolismo , Simulação de Dinâmica Molecular , Penicilina V/farmacologia , beta-Lactamases/metabolismo
20.
Pediatr. aten. prim ; 23(90): 155-162, abr.- jun. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-222758

RESUMO

Objetivo: evaluar si una intervención farmacéutica formativa permite mejorar la utilización de antibióticos en las faringoamigdalitis agudas (FAA) pediátricas. Material y métodos: estudio de intervención antes-después. Se analizaron las prescripciones de antibióticos (J01) asociadas a los códigos CIAP faringitis-amigdalitis estreptocócica (FAE) (R72), faringitis aguda (R74) y amigdalitis aguda (R76) antes y después de una intervención farmacéutica formativa sobre pediatras de Atención Primaria (AP). Se calculó el porcentaje de prescripciones de antibióticos de primera elección (penicilina V, penicilina G o amoxicilina) asociadas al código CIAP R72 y CIAP R74-R76. La intervención farmacéutica consistió en un taller formativo y sesiones clínicas. Resultados: la prescripción de antibióticos sistémicos disminuyó de forma significativa en el periodo posintervención respecto al preintervención (44,1% frente a 46,2% (p = 0,014)). Se observó un aumento significativo del porcentaje de prescripciones de antibióticos de primera elección asociadas al código CIAP R72 (84,3% frente a 57,6%; p <0,001) y una disminución de las prescripciones de amoxicilina/clavulánico (13,6% frente a 22,9%; p <0,001) y de azitromicina (1,0% frente a 11,3%; p <0,001) asociadas al código CIAP R72. Conclusiones: las prescripciones de antibióticos de los pediatras de AP disminuyeron, optimizándose el uso de antibióticos de primera elección en las FAE (AU)


Objective: to assess whether a pharmaceutical education intervention achieved a reduction and improvement in the prescription of antibiotics for management of paediatric acute pharyngitis (PAP).Material and methods: we conducted a pre-post intervention study. We analysed the prescription of systemic antibiotics (J01) associated with diagnoses corresponding to CIAP codes for streptococcal pharyngitis-tonsillitis (R72), acute pharyngitis (R74) and acute tonsillitis (R76) before and after a pharmaceutical education intervention on primary care (PC) paediatricians. We calculated the percentage of antibiotic prescriptions corresponding to first-line antibiotics (penicillin V, penicillin G or amoxicillin) associated with CIAP code R72 and CIAP codes R74-R76. The pharmaceutical education intervention consisted of a training workshop and clinical sessions.Results: the prescription of systemic antibiotics decreased significantly in the post-intervention period compared to the pre-intervention period (44.1% versus 46.2%; p = 0.014). There was a significant increase in the percentage of first-line antibiotic prescriptions out of the total prescriptions associated with CIAP code R72 (84.3% versus 57.6%; p = 0.000) and a decrease in the proportion of prescriptions of amoxicillin-clavulanic acid (13.6% versus 22.9%; p <0.001) and azithromycin (1.0% versus 11.3%; p <0.001) over the total prescriptions associated with CIAP code R72.Conclusions: there was a decrease in antibiotic prescription by PC paediatricians with improvement in the prescription of first-line agents for PAP. (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Gestão de Antimicrobianos , Infecções Estreptocócicas/tratamento farmacológico , Faringite/tratamento farmacológico , Tonsilite/tratamento farmacológico , Antibacterianos/administração & dosagem , Penicilina V/administração & dosagem , Penicilina G/administração & dosagem , Amoxicilina/administração & dosagem , Doença Aguda
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