ABSTRACT
We report a rare case of suppurative thrombophlebitis of the posterior neck caused by Streptococcus constellatus. A 69-year-old female patient was admitted to the hospital with neck pain and fever, which had persisted for 16 days prior to hospitalization. On day 1 (day of admission), blood cultures (later identifying S. constellatus) were performed, and ceftriaxone (CTRX) IV (2 g SID) was started. On day 3, suppurative thrombophlebitis of the posterior neck was diagnosed by CT scan. The antimicrobials were changed from CTRX to ampicillin/sulbactam IV (12 g QID) to guard against the possibility of complicated infection with Fusobacterium spp. or Prevotella spp. On day 17, a CT scan revealed that the thrombus remained. Therefore, oral edoxaban (30 mg SID) was started. On day 27, the patient was discharged after her medication was changed to oral amoxicillin/clavulanate (1500 mg/375 mg TID). On day 33, the amoxicillin/clavulanate was changed to oral cefaclor (1500 mg TID) and edoxaban was discontinued due to itching. On day 45, the course of cefaclor was completed. The patient went on to follow an uneventful course with no relapses or complications for two years since the conclusion of treatment. These results suggest that when a patient presents with persistent neck pain accompanied by fever, suppurative thrombophlebitis of the posterior neck should be considered. In antimicrobial therapy, the treatment could be switched from intravenous to oral. In addition, direct-acting oral anticoagulants may be an alternative to other forms of anticoagulants.
Subject(s)
Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Anti-Bacterial Agents/administration & dosage , Cefaclor/administration & dosage , Neck , Streptococcal Infections , Streptococcus constellatus/pathogenicity , Thrombophlebitis/drug therapy , Thrombophlebitis/microbiology , Administration, Oral , Aged , Ampicillin/administration & dosage , Deoxyuridine/administration & dosage , Deoxyuridine/adverse effects , Deoxyuridine/analogs & derivatives , Drug Substitution , Female , Humans , Infusions, Intravenous , Streptococcus constellatus/isolation & purification , Sulbactam/administration & dosage , Suppuration , Thrombophlebitis/diagnosis , Thrombophlebitis/pathology , Treatment OutcomeABSTRACT
Corona virus disease-2019 (COVID-19) emerged in Wuhan, China in December 2019 and was declared as a pandemic by the World Health Organization in March 2020. Although there is no complete treatment protocol for COVID-19, studies on this topic are ongoing, and it is known that broad-spectrum antibiotics such as cephalosporins are used for coinfections and symptoms in COVID-19 patients. Studies have shown that Staphylococcus aureus and Escherichia coli bacteria can cause symptoms such as diarrhea and coinfections accompanying COVID-19. Therefore, in this study, colon-targeted cefaclor monohydrate (CEF)-loaded poly(lactic-co-glycolic acid) (PLGA)-Eudragit S100 nanoparticles (NPs) were prepared using a nanoprecipitation technique. The particle sizes of the CEF-loaded NPs were between 171.4 and 198.8 nm. The encapsulation efficiency was in the range of 58.4%-81.2%. With dissolution studies, it has been concluded that formulations prepared with Eudragit S100 (E-coded) and Eudragit S100+PLGA (EP-coded) are pH-sensitive formulations and they are targetable to the colon, whereas the formulation prepared only with PLGA (P-coded) can release a higher CEF rate in the colon owing to the slow release properties of PLGA. The release kinetics were fitted to the Korsmeyer-Peppas and Weibull models. The antibacterial activity of E-, EP-, and P-coded formulations was 16-fold, 16-fold, and 2-fold higher than CEF, respectively, for S. aureus and E. coli according to the microdilution results. As a result of the time killing experiment, all formulations prepared were found to be more effective than the antibiotic itself for long periods. Consequently, all formulations prepared in this study hope to guide researchers/clinicians in treating both gram-positive and gram-negative bacteria-induced infections, as well as COVID-19 associated coinfections and symptoms.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/complications , Bacterial Infections/drug therapy , COVID-19/complications , Cefaclor/administration & dosage , Cefaclor/therapeutic use , Intestinal Diseases/complications , Intestinal Diseases/drug therapy , Anti-Bacterial Agents/pharmacology , Cefaclor/pharmacology , Coinfection , Drug Compounding , Escherichia coli/drug effects , Excipients , Kinetics , Microbial Sensitivity Tests , Nanoparticles , Particle Size , Polylactic Acid-Polyglycolic Acid Copolymer , Polymethacrylic Acids , Staphylococcus aureus/drug effectsSubject(s)
Antibodies, Antineutrophil Cytoplasmic/blood , Glomerulonephritis/diagnosis , Glomerulonephritis/microbiology , Osteomyelitis/diagnosis , Staphylococcal Infections/diagnosis , Anti-Bacterial Agents/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Cefaclor/administration & dosage , Cefazolin/administration & dosage , Child , Female , Glomerulonephritis/drug therapy , Glomerulonephritis/immunology , Humans , Magnetic Resonance Imaging , Osteomyelitis/drug therapy , Osteomyelitis/immunology , Osteomyelitis/microbiology , Peroxidase/blood , Peroxidase/immunology , Prednisolone/administration & dosage , Staphylococcal Infections/drug therapy , Staphylococcal Infections/immunology , Staphylococcus epidermidis/isolation & purification , Treatment OutcomeABSTRACT
To evaluate the clinical efficacy of azithromycin, cefaclor, and amoxicillin in treatment of pediatric tonsillitis, a total of 256 children with Group A ß-hemolytic streptococcus (GAS) tonsillitis were randomly divided into 3 groups. Only patients assessed with streptococcus-positive tonsillitis, considered to be compliant with treatment and complete clinical and microbiological evaluations at the end of therapy (day 14) and follow-up (day 30) were included in the efficacy analysis. Our study demonstrated that 96.4% of patients in the azithromycin group, 92.4% of patients in the cefaclor group, and 91.0% of patients in the amoxicillin group were recorded as clinical success at the end of therapy. Bacteriological eradication rates of the 3 groups at the end of therapy were 94.0%, 89.9%, and 88.5%, respectively. A pathogen recurrence rate was evaluated as 2.6%, 7.0%, and 5.9% at the follow-up. Treatment-stimulated adverse events occurred in 2.4% of patients in the azithromycin group, 11.3% in the cefaclor group, and 11.4% in the amoxicillin group. In summary, azithromycin showed an effective tendency for the treatment of pediatric tonsillitis with lower occurrence rate of adverse reactions, although there is no statistical significance for the clinical and bacteriological eradication efficacy between these 3 groups.
Subject(s)
Amoxicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Azithromycin/administration & dosage , Cefaclor/administration & dosage , Streptococcal Infections/drug therapy , Tonsillitis/drug therapy , Amoxicillin/adverse effects , Anti-Bacterial Agents/adverse effects , Azithromycin/adverse effects , Cefaclor/adverse effects , Child , Child, Preschool , Drug Administration Schedule , Female , Humans , Male , Streptococcal Infections/microbiology , Streptococcus pyogenes/isolation & purification , Tonsillitis/microbiology , Treatment OutcomeABSTRACT
Implant infections remain a major healthcare problem due to the prolonged hospitalisation period required to disrupt and treat bacterial biofilm formation, and the need for additional surgery to remove/replace the infected implant, which if not removed in a timely manner may lead to sepsis. Although localised drug administration, via an implanted scaffold, has shown promise in a clinical setting, the ideal scaffold cross-linking (to initially withstand the aggressive infection environment) and drug (to be effective against infection) have yet to be identified. In this work, in the first instance, the biochemical, biophysical, and biological properties of collagen sponges as a function of various concentrations (0.625%, 1.0%, 2.5%, 5.0%, and 10.0%) of hexamethylene diisocyanate were assessed. Data presented illustrate that hexamethylene diisocyanate at 0.625% concentration was able to effectively stabilise collagen scaffolds, as judged by the reduction in free amines, adequate resistance to collagenase digestion, reduction in swelling, increase in denaturation temperature, suitable mechanical properties, and appropriate cytocompatibility. Subsequently, collagen scaffolds stabilised with 0.625% hexamethylene diisocyanate were loaded with variable concentrations (0, 10, 100, and 500 µg ml-1) of Cefaclor and Ranalexin. Both drugs exhibited similar loading efficiency, release profile, and cytocompatibility. However, only collagen scaffolds loaded with 100 µg ml-1 Cefaclor exhibited adequate antibacterial properties against both 106 and 108 colony-forming units per ml of both Escherichia coli and Staphylococcus epidermidis.
Subject(s)
Antibiotic Prophylaxis/methods , Bacterial Physiological Phenomena/drug effects , Cefaclor/administration & dosage , Collagen/chemistry , Drug Implants/administration & dosage , Isocyanates/chemistry , Peptides, Cyclic/administration & dosage , Absorption, Physicochemical , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/chemistry , Cefaclor/chemistry , Cell Survival/drug effects , Cross-Linking Reagents/chemistry , Diffusion , Dose-Response Relationship, Drug , Drug Compounding/methods , Drug Implants/chemical synthesis , Peptides, Cyclic/chemistry , Porosity , Tissue ScaffoldsABSTRACT
This study aimed to compare existing dosing regimens of cefaclor with recommended pharmacokinetic/pharmacodynamic (PK/PD) parameters and to see if the proposed dosing regimen could have been the reason for development of bacterial resistance. PKs of cefaclor were determined after administrating the highest therapeutic dose of 750 mg in standard release (SF) and modified release form (MRF) in 12 volunteers. The study was performed on clinical isolates of the most frequent causative agents in urinary and respiratory infections. Minimum inhibitory concentration (MIC), postantibiotic effect, and PK/PD efficacy indices were determined. Peak plasma concentrations of 23.142 ± 5.67 (SF) and 8.7 ± 2.09 µg/mL (MRF) were observed after 40-60 min and 3.04 ± 0.75 h, respectively. MIC for investigated bacterial strains ranged from 1 to 4 mg/L. Postantibiotic effect lasted from 2.10-2.18 ± 0.2 h for Gram-positive to 0.58-0.90 ± 0.05 h for Gram-negative bacteria. PK/PD indices (t > MIC) ranged from 27.08 ± 5.93% to 43.23 ± 6.54% of 8-h dosing interval (SF) and 22.57 ± 8.93% to 49.65 ± 1.95% of 12-h dosing interval (MRF). Plasma levels were below MIC for more than 50% of the dosing interval even for the most sensitive pathogens (MIC = 1 mg/L). During both dosing intervals the total "antibacterial activity" was not longer than 6 h for Gram-positive and 5 h for Gram-negative bacteria for SF and 9 h for Gram-positive and 5 h for Gram-negative bacteria for MRF.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacterial Infections/drug therapy , Cefaclor/administration & dosage , Gram-Negative Bacteria/drug effects , Adult , Drug Resistance, Bacterial/drug effects , Female , Humans , Male , Microbial Sensitivity Tests/methods , Middle Aged , Respiratory Tract Infections/drug therapy , Urinary Tract Infections/drug therapy , Young AdultABSTRACT
The determination of cefaclor in a new, complex chocolate matrix was performed by using a simple sample preparation (dispersion in dilute hydrochloric acid at 80 degrees C, centrifugation, washing with cyclohexane), followed by ion pair HPLC on a Kinetex pentafluorophenyl core-shell stationary phase with UV detection at 265 nm. We obtained good linearity (R2 = 0.9976) and precision (average RSD 0.86%) for the relevant concentration range. The preparations, although hand-made in this pilot phase, showed good uniformity of content. After being stored for four weeks in a refrigerator the preparation did not contain recognizable amounts of decomposition products.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cacao , Capsules , Cefaclor/administration & dosage , Chemistry, Pharmaceutical , Chromatography, High Pressure Liquid , Dosage Forms , Gelatin , Reference Standards , Reproducibility of Results , Spectrophotometry, UltravioletABSTRACT
AIM: To present two case reports describing the treatment of immature teeth with necrotic pulps using concentrated platelet-rich plasma (cPRP) with 12-month clinical and radiographic follow-up. SUMMARY: Root canal revascularization was performed on immature permanent teeth clinically and radiographically diagnosed as requiring root canal treatment. Following disinfection of the canal space with triple antibiotic paste (1 : 1 : 1: ciprofloxacin, metronidazole and cefaclor), a tissue scaffold was created with cPRP prepared using 2-step centrifugation. The final restoration was completed with white mineral trioxide aggregate and composite resin. The patients were recalled for clinical and radiographic evaluations every 3 months. At the 12-month follow-up apical closure by narrowing of the apical foramen and convergence of the apical walls in the treated teeth was observed.
Subject(s)
Dental Pulp Cavity/blood supply , Neovascularization, Physiologic , Platelet-Rich Plasma , Anti-Bacterial Agents/administration & dosage , Cefaclor/administration & dosage , Child , Ciprofloxacin/administration & dosage , Disinfection , Humans , Male , Metronidazole/administration & dosageABSTRACT
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.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Pneumonia/drug therapy , Technology Assessment, Biomedical , Cefaclor/administration & dosage , Cefuroxime/administration & dosage , Cephalosporins/administration & dosage , Treatment Outcome , Colombia , Community-Acquired InfectionsABSTRACT
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.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cariostatic Agents/chemistry , Dental Atraumatic Restorative Treatment/methods , Dental Caries/therapy , Dental Cavity Lining , Dentin/pathology , Glass Ionomer Cements/therapeutic use , Cariostatic Agents/therapeutic use , Cefaclor/administration & dosage , Chi-Square Distribution , Child , Child, Preschool , Ciprofloxacin/administration & dosage , Dentin/microbiology , Double-Blind Method , Female , Glass Ionomer Cements/chemistry , Humans , Male , Metronidazole/administration & dosage , Tooth, DeciduousABSTRACT
The aim of the present study was to develop and characterize coated chitosan-alginate beads containing cefaclor as a controlled release delivery system. Coated cefaclor beads were prepared by solvent evaporation techniques. Beads were found to be intact and spherical in shape. Their size range was 1.05 to 2.06. The loading efficiency showed maximum value when the concentration of cefaclor, chitosan and PEG 400 was 10 % (m/V), 0.5 % (m/V) and 2 % (V/V), respectively. Best retardation of cefaclor release from chitosan-alginate beads was achieved by coating with 15 % of shellac in formula F19. A significant antimicrobial activity (p < 0.05) against Staphylococcus aureus and Klebsiella pneumoniae was observed for formula F19 compared to the standard antibiotic disc. Furthermore, the simulated plasma profile showed the superiority of F19 in sustaining drug release for more than 12 h. Therefore, shellac coated chitosan-alginate beads could be considered a successful controlled release oral cefaclor dosage form.
Subject(s)
Cefaclor/administration & dosage , Cefaclor/chemistry , Delayed-Action Preparations/chemistry , Administration, Oral , Alginates/chemistry , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/chemistry , Chemistry, Pharmaceutical/methods , Chitosan/chemistry , Dosage Forms , Drug Carriers/chemistry , Drug Delivery Systems/methods , Glucuronic Acid/chemistry , Hexuronic Acids/chemistry , Kinetics , Klebsiella pneumoniae/drug effects , Particle Size , Polyethylene Glycols/chemistry , Solvents/chemistry , Staphylococcus aureus/drug effectsABSTRACT
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.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Anti-Bacterial Agents/administration & dosage , Cariostatic Agents/chemistry , Dental Cavity Lining , Dental Atraumatic Restorative Treatment/methods , Dental Caries/therapy , Dentin/pathology , Glass Ionomer Cements/therapeutic use , Chi-Square Distribution , Cariostatic Agents/therapeutic use , Cefaclor/administration & dosage , Ciprofloxacin/administration & dosage , Double-Blind Method , Dentin/microbiology , Glass Ionomer Cements/chemistry , Metronidazole/administration & dosage , Tooth, DeciduousABSTRACT
INTRODUCTION: Regenerative endodontic procedures are an alternative treatment for immature teeth with necrotic pulps. Typically, intracanal medicaments such as triple antibiotic paste (TAP) or double antibiotic paste (DAP) and calcium hydroxide (Ca[OH](2)) are used for disinfection. However, their effect on human stem cells of the apical papilla (SCAPs) is unknown. We hypothesized that intracanal medicaments at high concentrations are toxic to SCAPs. To test this hypothesis, a cell culture assay was used. METHODS: Briefly, SCAPs were cultured and subjected to either no drug treatment or various concentrations including TAP, DAP, modified TAP (ciprofloxacin, metronidazole and cefaclor), Augmentin (Champs Pharmacy, San Antonio, TX), or Ca(OH)(2). Viable stem cells counts were obtained using an automated method of detecting trypan blue dye at 3 days after treatment. RESULTS: All 4 antibiotics significantly reduced SCAP survival in a concentration-dependent fashion. Interestingly, Ca(OH)(2) was conducive with SCAP survival at all concentrations. CONCLUSIONS: Collectively, our data show that high concentrations of antibiotics have a detrimental effect on SCAP survival, whereas lower concentrations as well as Ca(OH)(2) at all tested concentrations are conducive with SCAP survival and proliferation. These studies highlight the clinically important point that intracanal medicaments must be used at concentrations that are bactericidal while having minimal effects on stem cell viability.
Subject(s)
Anti-Bacterial Agents/toxicity , Cell Survival/drug effects , Dental Papilla/drug effects , Root Canal Irrigants/toxicity , Stem Cells/drug effects , Adolescent , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Amoxicillin-Potassium Clavulanate Combination/toxicity , Anti-Bacterial Agents/administration & dosage , Calcium Hydroxide/administration & dosage , Calcium Hydroxide/toxicity , Cefaclor/administration & dosage , Cefaclor/toxicity , Cells, Cultured , Ciprofloxacin/administration & dosage , Ciprofloxacin/toxicity , Dental Papilla/cytology , Dose-Response Relationship, Drug , Female , Humans , Metronidazole/administration & dosage , Metronidazole/toxicity , Molar, Third/cytology , Root Canal Irrigants/administration & dosage , Statistics, NonparametricABSTRACT
AIM: The duration of therapy represents a fundamental aspect in the compliance to the therapy of child pathologies, such as pharyngotonsillitis, treated with oral therapy. Although penicillin and amoxicillin are the first choice antibiotics in the case of a child suffering from pharyngotonsillitis with the proven presence of Group A ß-hemolytic Streptococcus (GAS), the number of orally administered doses and 10 days of therapy, considerably lower the compliance. METHODS: An open phase IV randomized multicenter clinical trial was conducted in parallel groups, involving 49 family pediatrician (FP), distributed over the entire national territory, enrolling 435 children suffering from GAS-FT. 210 children received Cefaclor, 50 mg/kg/day, administered twice daily for five days, whilst 213 children received amoxicillin/clavulanate 40 mg/kg/day administered twice daily for 10 days. RESULTS: The results showed percentages of eradication of 88.4% for the Cefaclor group and 94.3% for the amoxicillin/clavulanate group, and a positive clinical judgement of 92.3% for the Cefaclor group and 96.6% for the amoxicillin/clavulanate group. The two arms of the study did not have any significant statistical differences, neither for the eradication, nor for the clinical judgement nor for the reduction of the Milano Score between the beginning and the end of treatment, with a P=0.042 for amoxicillin/clavulanate for eradication. CONCLUSION: This study confirms that the administration of Cefaclor for five days during GAS-FT has the same efficacy as a 10-day therapy with amoxicillin/clavulanate, with a clearly different compliance.
Subject(s)
Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Cefaclor/therapeutic use , Pharyngitis/drug therapy , Streptococcal Infections/drug therapy , Streptococcus pyogenes , Adolescent , Algorithms , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Anti-Bacterial Agents/administration & dosage , Cefaclor/administration & dosage , Child , Child, Preschool , Drug Administration Schedule , Female , Humans , Male , Pharyngitis/microbiology , Sicily , Streptococcal Infections/complications , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/isolation & purification , Time Factors , Treatment OutcomeABSTRACT
An open-label, single-dose, randomized, crossover study was carried out in 20 Chinese healthy male subjects to compare the pharmacokinetics of 2 cefaclor (CAS 53994-73-3) formulations after administration of a single 250 mg dose of each drug with a 1-week wash-out period. Blood samples were collected before and with 6 h after drug administration. Plasma concentrations were determined by high-performance liquid chromatography (HPLC) with UV detector. 2 formulations were evaluated using the following pharmacokinetic parameters: AUC0-t, Cmax and tmax was analyzed nonparametrically. The 90% confidence interval (CI) of the ratios (teat/reference) of log-transformed AUC0-t and Cmax fell within the bioequivalence acceptance range of 80-125%. The results showed that the 90% CI of the ratios of AUC0-t and Cmax were 105.1% (101.0-109.4%) and 92.4% (82.5-103.4%), respectively, which therefore could conclude 2 oral cefaclor capsule formulations of cefaclor are bioequivalent. Both treatments showed similar tolerability and safety.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacokinetics , Cefaclor/administration & dosage , Cefaclor/pharmacokinetics , Anti-Bacterial Agents/chemistry , Area Under Curve , Asian People , Capsules , Cefaclor/chemistry , Chemistry, Pharmaceutical , Chromatography, High Pressure Liquid , Cross-Over Studies , Half-Life , Humans , Liquid-Liquid Extraction , Therapeutic EquivalencyABSTRACT
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 2nd, 7th and 14th 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 1mg/ml respectively. During the normal use of Ceclor, Midocef, and Forticef the loss of activity and the degradation were less than 5% on the 14th 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 <0.05). Significant effects were observed between (4oC and 37°C) and (25°C and 37°C) for all except Ceclor. Multiple comparisons between days of storage showed non significant mean difference values at 4°C except Cefabac. However significant results between days were found at 25°C and 37°C except for Midocef between (7th and 14th day). It was found that the pediatric suspensions of Cefaclor in the Jordanian market were stable and contained the amount of active ingredient specified by the United States pharmacopoeias specification (USP) and the British Pharmacopoeias specifications (BP).
Subject(s)
Anti-Bacterial Agents/chemistry , Anti-Bacterial Agents/pharmacology , Cefaclor/chemistry , Cefaclor/pharmacology , Chromatography, Reverse-Phase/methods , Disk Diffusion Antimicrobial Tests/methods , Administration, Oral , Anti-Bacterial Agents/administration & dosage , Cefaclor/administration & dosage , Drug Stability , Drug Storage/statistics & numerical data , In Vitro Techniques , Limit of Detection , Suspensions , Temperature , Time FactorsABSTRACT
BACKGROUND AND AIMS: In rodents, cephalosporin antibiotics can mimic peptones and stimulate release of cholecystokinin (CCK), a hormone that slows gastric emptying. The rate of gastric emptying is a major determinant of postprandial blood glucose and insulin concentrations. We therefore evaluated the effect of orally administered cefaclor on plasma CCK and gastric emptying, as well as postprandial glycemic and insulinemic responses, in healthy humans. MATERIALS AND METHODS: We studied 8 healthy subjects on two days in double-blind, randomized order. On each day, subjects consumed 1000 mg cefaclor or placebo 30 min before a mashed potato meal labeled with (13)C octanoic acid. Blood and breath samples were collected for 4h after the meal. RESULTS: Blood glucose, serum insulin and plasma CCK increased in response to the carbohydrate meal on both study days, and cefaclor had no effect on these responses. Similarly, the gastric half-emptying time (measured by breath test) did not differ (placebo: 137.5+/-6.0 min vs. cefaclor: 143.1+/-8.0 min). CONCLUSION: Cefaclor, when given before a meal in the form of a capsule, does not stimulate CCK release or slow gastric emptying in healthy humans.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Blood Glucose/metabolism , Cefaclor/administration & dosage , Cholecystokinin/blood , Gastric Emptying/drug effects , Insulin/blood , Adult , Caprylates/pharmacology , Carbon Isotopes/pharmacology , Double-Blind Method , Female , Humans , Male , Peptones/metabolism , Solanum tuberosumABSTRACT
Soluble mucus glycoprotein (S-mucin) processed from the small intestines (ileal region) of freshly slaughtered pigs via homogenization, dialysis, centrifugation and lyophilization and their admixtures with type B gelatin were used to prepare cefaclor-loaded microspheres by the emulsification-crosslinking method. The microspheres were evaluated for the in vitro delivery of cefaclor in both simulated intestinal fluid (SIF) without pancreatin (pH 7.4) and simulated gastric fluid (SGF) without pepsin (pH 1.2). Results obtained indicated that the microspheres formulated were highly mucoadhesive and that release of cefaclor in both release media was non-Fickian and was much higher and more rapid in SGF than in SIF and from microspheres based on gelatin alone when compared to those based on gelatin-procine mucin admixtures. The mean area under the plasma level versus time curves (AUC) was shown to be dependent on the formulation with values of 172.3 mug.h/ml for the control, 278.5 mug.h/ml for microspheres based on gelatin only and 353.0 mug.h/ml for microspheres formulated with equal parts of gelatin and mucin indicating that the rectal route may provide a therapeutically viable alternative to the oral route for the delivery of cefaclor. Further indications also emerged of a possibility of site-specific delivery of cefaclor to the small intestine through a careful selection of gelatin type and porcine mucin admixtures prior to formulation of the microspheres. On the whole, the inclusion of S-mucin in the composition of the microspheres had an enhancer effect on the release and rectal bioavailability of cefaclor which may be exploited in the design of a rectal delivery system of the drug.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cefaclor/administration & dosage , Drug Carriers , Gelatin , Microspheres , Mucins , Administration, Rectal , Animals , Anti-Bacterial Agents/pharmacokinetics , Area Under Curve , Biological Availability , Cefaclor/pharmacokinetics , Gastric Juice , In Vitro Techniques , Intestine, Small , Rats , Rats, Wistar , SwineABSTRACT
The purpose of this report is to present the case of a patient wherein revascularization of the necrotic infected pulp space of an immature permanent maxillary central incisor tooth was induced in vivo by stimulation of a blood clot from the periapical tissues into the canal space. This was achieved after disinfecting the canal space with a topical antibiotic paste followed by inducing a blood clot scaffold from the periapical tissues. This treatment approach offers great potential to avoid the need for traditional apexification with calcium hydroxide or the need to achieve an artificial apical barrier with mineral trioxide aggregate. Furthermore, this treatment approach can help rescue infected immature teeth by physiologically strengthening the root walls.
Subject(s)
Dental Pulp Necrosis/therapy , Incisor/pathology , Neovascularization, Physiologic/physiology , Periapical Abscess/therapy , Aluminum Compounds/therapeutic use , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/therapeutic use , Blood Coagulation/physiology , Calcium Compounds/therapeutic use , Cefaclor/administration & dosage , Child , Ciprofloxacin/administration & dosage , Dental Pulp Cavity/pathology , Drug Combinations , Follow-Up Studies , Humans , Incisor/blood supply , Male , Maxilla , Metronidazole/administration & dosage , Oxides/therapeutic use , Periapical Tissue/pathology , Root Canal Filling Materials/therapeutic use , Root Canal Irrigants/therapeutic use , Root Canal Therapy/methods , Silicates/therapeutic use , Sodium Hypochlorite/therapeutic use , Tooth Apex/pathologyABSTRACT
Cranberry juice consumption is often recommended along with low-dose oral antibiotics for prophylaxis for recurrent urinary tract infection (UTI). Because multiple membrane transporters are involved in the intestinal absorption and renal excretion of beta-lactam antibiotics, we evaluated the potential risk of pharmacokinetic interactions between cranberry juice and the beta-lactams amoxicillin (amoxicilline) and cefaclor. The amoxicillin-cranberry juice interaction was investigated in 18 healthy women who received on four separate occasions a single oral test dose of amoxicillin at 500 mg and 2 g with or without cranberry juice cocktail (8 oz) according to a crossover design. A parallel cefaclor-cranberry juice interaction study was also conducted in which 500 mg cefaclor was administered with or without cranberry juice cocktail (12 oz). Data were analyzed by noncompartmental methods and nonlinear mixed-effects compartmental modeling. We conclude that the concurrent use of cranberry juice has no significant effect on the extent of oral absorption or the renal clearance of amoxicillin and cefaclor. However, delays in the absorption of amoxicillin and cefaclor were observed. These results suggest that the use of cranberry juice at usual quantities as prophylaxis for UTI is not likely to alter the pharmacokinetics of these two oral antibiotics.