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2.
Medicine (Baltimore) ; 98(49): e18267, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804363

RESUMO

RATIONALE: Rhizobium radiobacter is a Gram-negative pathogen present in soil and plants. Cases of R radiobacter infection in immunocompromised hosts have been sporadically reported. However, septic shock caused by R radiobacter is rarely seen. PATIENT CONCERNS: Here, we describe an elderly patient with a rapid progression of watery diarrhea, anorexia, fever, weakness, oliguria, and shock. Blood results showed increased total white blood cell count and C-reactive protein. Arterial blood gas results showed hypoxia and elevated lactate level. The Sequential Organ Failure Assessment score was 11. Blood culture at admission showed Gram-negative bacteria, which were later confirmed as R radiobacter. DIAGNOSIS: Septic shock caused by R Radiobacter. INTERVENTIONS: The patient was treated with intravenous cefoperazone/sulbactam and sequential oral levofloxacin. OUTCOMES: The patient recovered completely. CONCLUSION: R radiobacter may be considered as a potential opportunistic pathogen that may cause severe sepsis in elderly patients, especially those with multiple underlying diseases.


Assuntos
Agrobacterium tumefaciens/isolamento & purificação , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Cefoperazona/uso terapêutico , Progressão da Doença , Quimioterapia Combinada , Feminino , Humanos , Levofloxacino/uso terapêutico , Sulbactam/uso terapêutico
3.
Arq Gastroenterol ; 56(4): 361-366, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721972

RESUMO

BACKGROUND: Helicobacter pylori infection in Chile remains as a public and private health-care system's challenge, with a prevalence of the infection over 70%. Nowadays, antibiotic treatment of the infection is mandatory to prevent the arising of severe associated diseases but failures in the eradication therapy mainly due to clarithromycin resistance has been observed worldwide and first line eradication therapy seems to be not effective anymore in several geographical areas. Thus, health-care systems are committed to maintain an epidemiological surveillance upon the evolution of the antibiotic resistance of this priority 2 pathogen. OBJECTIVE: This work reports a 10 years surveillance of the primary antibiotic resistance of H. pylori clinical isolates at the Biobío region-Chile, and the evolution of resistance toward amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline among the species. METHODS: H. pylori strains were investigated during the periods 2005-2007 (1435 patients analysed) and 2015-2017 (220 patients analysed) by inoculating a saline homogenate biopsy onto the surface of Columbia agar (Oxoid, Basingstoke, UK) - supplemented with 7% horse red blood cells plus DENT inhibitor (Oxoid, Basingstoke, UK) - following by incubation at 37ºC under 10% CO2 atmosphere for five days. Antibiotic resistance pattern of the isolates was assessed using the disk diffusion test in Müeller-Hinton agar supplemented with 7% horse red blood cells followed by incubation for further three days under 10% CO2 atmosphere. Statistical analysis was done using the SPSS v22 software and P values <0.05 were considered statistically significant. RESULTS: A total of 41% of 1435 patients were detected to be infected with H. pylori by bacteriological culture in 2005-2007 period, meanwhile 32.7% from 220 patients were also infected in 2015-2017 period. The clinical isolates of H. pylori are mostly susceptible to amoxicillin and tetracycline (both over 98% of strains), but less susceptible to levofloxacin in both periods analysed (over 79% of the strains). On the other hand, metronidazole continuous showing the highest score of resistant isolates (over 40% of resistant strains), although an 18% fewer resistant strains were observed in 2015-2017 period. Clarithromycin, the key antibiotic in eradication therapies, has an increased frequency of resistant strain isolated in the decade (22.5% in 2005-2007 and 29.2% in 2015-2017). Multidrug resistant strains (two, three and four antibiotics) were also detected in both periods with the highest scores for simultaneous resistance to clarithromycin-metronidazole (18%) and clarithromycin-metronidazole-levofloxacin (12.5%) resistant strains. According to gender, the isolates resistant to amoxicillin, clarithromycin and metronidazole were more frequent in female, with a specific increment in amoxicillin and clarithromycin resistance. CONCLUSION: The frequency of clarithromycin resistance (29.2%) detected in 2015-2017 suggests that conventional triple therapy is no longer effective in this region.


Assuntos
Antibacterianos/farmacologia , Helicobacter pylori/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/farmacologia , Chile , Claritromicina/farmacologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Bacteriana Múltipla , Feminino , Infecções por Helicobacter/microbiologia , Humanos , Levofloxacino/farmacologia , Masculino , Metronidazol/farmacologia , Pessoa de Meia-Idade , Vigilância da População , Tetraciclina/farmacologia , Adulto Jovem
4.
BMC Infect Dis ; 19(1): 916, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664927

RESUMO

BACKGROUND: Vibrio cholerae non-O1 is a virulent pathogen that causes significant morbidity and mortality in humans. Herein, we report a case of corneal ulcer caused by this pathogen. CASE PRESENTATION: A 59-year-old fisherman with no systemic history was struck in the right eye by a marine shrimp and developed keratitis. Corneal scrapping culture revealed the presence of the V. cholerae non-O1, and its identification was confirmed by Analytical Profile Index 20E system and polymerase chain reaction. He was successfully treated with topical levofloxacin (0.3%) and fortified amikacin (12.5 mg/mL) for 2 weeks. The visual acuity recovered to 20/25 after treatment without complications. CONCLUSIONS: This is the first case report of keratitis caused by V. cholerae non-O1 strain. Ocular injury by marine creatures and contaminated seawater can contribute to severe corneal ulcer. Early diagnosis can be achieved by meticulous history taking and a comprehensive laboratory workup. Simultaneously, an effective antibiotic therapy can lead to a positive outcome.


Assuntos
Ceratite/microbiologia , Vibrioses/microbiologia , Vibrio cholerae não O1/isolamento & purificação , Administração Tópica , Amicacina/administração & dosagem , Amicacina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Organismos Aquáticos/microbiologia , Úlcera da Córnea/microbiologia , Olho/microbiologia , Olho/patologia , Humanos , Ceratite/tratamento farmacológico , Levofloxacino/administração & dosagem , Levofloxacino/uso terapêutico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Água do Mar/microbiologia , Resultado do Tratamento , Vibrioses/tratamento farmacológico , Vibrio cholerae não O1/genética
5.
BMC Infect Dis ; 19(1): 864, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638905

RESUMO

BACKGROUND: While Legionella is a common cause of pneumonia, extrapulmonary infections like arthritis are scarce. Here, we describe a case of monoarthritis due to Legionella bozemanii, with no history of pneumonia. We provide a literature review of the 9 previously published Legionella arthritis and highlight a dichotomous epidemiology suggesting different physiopathological pathways leading to joint infection. CASE PRESENTATION: A 56-year old woman under immunosuppressive treatment by oral and intra-articular corticosteroids, methotrexate, and tocilizumab for an anti-synthetase syndrome was hospitalized for worsening pain and swelling of the left wrist for 3 days. Clinical examination showed left wrist synovitis and no fever. The arthritis occurred a few days after an accidental fall on wet asphalt responsible for a cutaneous wound followed by a corticosteroid intra-articular injection. Due to both the negativity of conventional culture of articular fluid and suspicion of infection, 16S rRNA and specific PCRs were performed leading to the identification of L. bozemanii. Legionella-specific culture of the articular fluid was performed retrospectively and isolated L. bozemanii. The empiric antibiotic therapy was switched for oral levofloxacin and rifampin and the patient recovered after a 12-week treatment. CONCLUSION: We report a case of L. bozemanii monoarthritis in an immunosuppressed woman, following a fall on wet asphalt and intra-articular corticosteroid injection. The review of the literature found that the clinical presentation reveals the mode of infection and the bacterial species. Monoarthritis more likely occurred after inoculation in patients under immunosuppressive therapy and were associated with non-Legionella pneumophila serogroup 1 (Lp1) strains that predominate in the environment. Polyarthritis were more likely secondary legionellosis localizations after blood spread of Lp1, the most frequently found in pneumonia. In both settings, 16S rRNA and Legionella-specific PCR were key factors for the diagnosis.


Assuntos
Artrite Infecciosa/imunologia , Artrite Infecciosa/microbiologia , Legionellaceae/isolamento & purificação , Legionelose/microbiologia , Acidentes por Quedas , Administração Oral , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Feminino , Humanos , Hidrocarbonetos , Hospedeiro Imunocomprometido , Injeções Intra-Articulares , Legionellaceae/genética , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Rifampina/uso terapêutico , Resultado do Tratamento
7.
Gastroenterol. hepatol. (Ed. impr.) ; 42(8): 476-485, oct. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183883

RESUMO

Objective: Helicobacter pylori resistance to antimicrobial agents is on the rise and it is thus imperative to be aware of local resistance rates. The main objective of the present study was to describe the evolution of primary antimicrobial resistance in H. pylori, analysing its antibiotic susceptibility over a 13-year period in a region of northern Spain, as well as host-related factors. Patients and methods: Between 2004 and 2016 a total of 3426 patients who met the H. pylori eradication criteria underwent gastroscopy. The gastric biopsies were processed and those testing positive for H. pylori were identified and tested for clarithromycin, metronidazole and levofloxacin susceptibility using E-test. Results: H. pylori was isolated in 1604 (47%) patients, ranging from 63% (133/212) in 2004 to 39% (137/347) in 2016. Primary resistances to clarithromycin, metronidazole and levofloxacin were on average 19% (278/1116), 40% (572/865) and 17% (137/669), respectively. Clarithromycin resistance was 24% (167/686) in females and 15% (11/753) in males (p=0.0002); metronidazole resistance was 29% (72/246) in patients over 70 years compared to 42% (499/1190) in younger patients (p=0.0396); levofloxacin resistance increased with age, being 13% (57/439) in patients ≤55 years, 19% (46/236) for those between 56 and 70, and 26% (34/130) in patients >70 years (p=0.0087). Discussion: A decline in the prevalence of H. pylori infection was observed over the years, along with relatively high rates of primary resistance to clarithromycin, metronidazole and levofloxacin. Variations in resistance rates were found with sex and age


Objetivo: El aumento de la resistencia de Helicobacter pylori a los antibióticos hace indispensable conocer las tasas de resistencia locales. El principal objetivo de este estudio fue describir la evolución de la resistencia primaria de H. pylori a los antibióticos, analizando su sensibilidad durante un período de tiempo de 13 años en una región del norte de España, así como los factores asociados del huésped. Pacientes y métodos: Entre 2004 y 2016 se realizaron gastroscopias a 3.426 pacientes que cumplían criterios de erradicación de la infección por H. pylori. En las biopsias gástricas en las que se detectó crecimiento compatible con H. pylori se identificó este microorganismo y se testó la sensibilidad a claritromicina, metronidazol y levofloxacino mediante Etest(R). Resultados: Se aisló H. pylori en 1.604 (47%) pacientes, desde el 63% (133/212) en 2004 hasta el 39% (137/347) en 2016. Las resistencias primarias a claritromicina, metronidazol y levofloxacino fueron del 19% (278/1.116), 40% (572/865) y 17% (137/669), respectivamente. La resistencia a claritromicina fue mayor en mujeres: 24% (167/686) vs. 15% (11/753) (p=0,0002); la resistencia a metronidazol fue mayor en jóvenes: 29% (72/246) en >70 años vs. 42% (499/1.190) en ≤70 años (p=0,0396); la resistencia a levofloxacino aumentó con la edad de los pacientes: 13% (57/439) en <55 años, 19% (46/236) entre 56 y 70 años y 26% (34/130) en >70 años (p=0,0087). Discusión: Se observa una disminución en la prevalencia de la infección por H. pylori a lo largo de los años, con tasas relativamente altas de resistencia primaria a claritromicina, metronidazol y levofloxacino. Se encuentran variaciones en estas tasas de resistencia en función del sexo y de la edad de los pacientes


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Resistência Microbiana a Medicamentos , Helicobacter pylori/efeitos dos fármacos , Infecções por Helicobacter/epidemiologia , Espanha/epidemiologia , Antibacterianos , Estudos Retrospectivos , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Sensibilidade e Especificidade , Claritromicina , Metronidazol , Levofloxacino
8.
Am J Vet Res ; 80(10): 957-962, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556716

RESUMO

OBJECTIVE: To determine the pharmacokinetics of levofloxacin following oral administration of a generic levofloxacin tablet and IV administration to dogs and whether the achieved plasma levofloxacin concentration would be sufficient to treat susceptible bacterial infections. ANIMALS: 6 healthy adult Beagles. PROCEDURES: Levofloxacin was administered orally as a generic 250-mg tablet (mean dose, 23.7 mg/kg) or IV as a solution (15 mg/kg) to each dog in a crossover study design, with treatments separated by a minimum 2-day washout period. Blood samples were collected at various points for measurement of plasma levofloxacin concentration via high-pressure liquid chromatography. Pharmacokinetic analysis was performed with compartmental modeling. RESULTS: After oral administration of the levofloxacin tablet, mean (coefficient of variation) peak plasma concentration was 15.5 µg/mL (23.8%), mean elimination half-life was 5.84 hours (20.0%), and mean bioavailability was 104% (29.0%). After IV administration, mean elimination half-life (coefficient of variation) was 6.23 hours (14.7%), systemic clearance was 145.0 mL/kg/h (22.2%), and volume of distribution was 1.19 L/kg (17.1%). CONCLUSIONS AND CLINICAL RELEVANCE: In these dogs, levofloxacin was well absorbed when administered orally, and a dose of approximately 25 mg/kg was sufficient to reach pharmacokinetic-pharmacodynamic targets for treating infections with susceptible Enterobacteriaceae (ie, ≤ 0.5 µg/mL) or Pseudomonas aeruginosa (ie, ≤ 1 µg/mL) according to clinical breakpoints established by the Clinical and Laboratory Standards Institute.


Assuntos
Antibacterianos/farmacocinética , Cães/metabolismo , Levofloxacino/farmacocinética , Administração Intravenosa , Administração Oral , Animais , Área Sob a Curva , Disponibilidade Biológica , Cromatografia Líquida de Alta Pressão/veterinária , Estudos Cross-Over , Feminino , Meia-Vida , Levofloxacino/administração & dosagem , Masculino , Comprimidos
9.
Environ Pollut ; 255(Pt 1): 113180, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31525559

RESUMO

Despite the strong association of azithromycin (AZM), a macrolide antibiotic, and levofloxacin (LVF), a quinolone antibiotic, to sediment, sorption data are scarce. We conducted sorption experiments with eight river sediments, their major clay minerals (illite and chlorite), a highly negatively charged clay mineral (montmorillonite), and an organic-matter-rich soil (Andosol). The sorption of AZM and LVF to the sediments was influenced by the concentration and type of coexisting inorganic cations as much as by reported organic cations. In addition, their linear sorption coefficients (Kd) to sediments were correlated with cation exchange capacity (CEC) but not organic carbon content, so cation exchange is the dominant sorption mechanism. Multiple linear regression analysis showed improved prediction of sediment Kd from CEC contributed by minerals and organic matter for AZM, but not for LVF. Kcec (= Kd/CEC) values of AZM were 2-3 orders of magnitude higher on minerals than on Andosol, but those of LVF ranged within a factor of 4. Therefore, mineral and organic components need to be separated in estimating AZM sorption to sediments. Sediment Kd values of AZM and LVF were satisfactorily predicted by a cation-exchange-based model using individual Kcec values on illite, chlorite, and Andosol (mean absolute error of 0.57 and 0.22 log units, respectively). Kcec values on montmorillonite and chlorite ranged within a factor of about 3 from those of illite for both antibiotics, and Kcec differences by mineral type would generally be negligible in model estimation. Because AZM was sorbed mostly to minerals in sediments, the model and sorption data can be applicable to various soils or sediments. Overall, the trend of LVF sorption corresponds to reported sorption of other organic cations, whereas remarkably higher AZM Kcec to minerals than to Andosol is attributable to its large lactone ring, higher molecular weight, or two charged amines.


Assuntos
Antibacterianos/química , Azitromicina/química , Levofloxacino/química , Poluentes do Solo/química , Solo/química , Adsorção , Bentonita/química , Cátions , Argila/química , Sedimentos Geológicos/química , Minerais/química , Rios/química , Poluentes da Água/química
10.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31488697

RESUMO

Mycoplasma pneumoniae pneumonia is prevalent in children and can be followed by upper airway carriage for months. Treatment of M pneumoniae pneumonia with macrolides is widespread and can lead to the development of macrolide resistance. The clinical consequences of chronic M pneumoniae carriage are unknown. In this article, we describe a child with acute lymphoblastic leukemia who developed macrolide-susceptible M pneumoniae pneumonia confirmed by nasopharyngeal secretions polymerase chain reaction and culture with good response to azithromycin. Five months later, the patient developed another M pneumoniae pneumonia that was diagnosed with positive macrolide-resistant M pneumoniae polymerase chain reaction and culture from the bronchoalveolar lavage. The child responded well to fluoroquinolones and eventually was discharged from the hospital. The M pneumoniae recovered from the second pneumonia is a novel strain and is genetically identical to the M pneumoniae that caused the first pneumonia, apart from the macrolide-resistance 23S ribosomal RNA gene. Both isolates are identical in both P1 (subtype 2 with a novel variant, 2bv) and multiple-locus variable number tandem repeat analysis type (53662). This is indicative of chronic M pneumoniae carriage with de novo macrolide-resistance mutation and subsequent breakthrough pneumonia that is reported for the first time here. Children with immunosuppression may be at increased risk of life-threatening macrolide-resistant pneumonia after M pneumoniae carriage. Further studies are required to evaluate the impact of this phenomenon. This will then guide strategies to limit the associated morbidity, such as testing for macrolide resistance, treatment of M pneumoniae pneumonia in high-risk children with bactericidal antibiotics (such as fluoroquinolones), and possibly eradication protocols of M pneumoniae carriage to prevent subsequent life-threatening infections.


Assuntos
Portador Sadio/microbiologia , Farmacorresistência Bacteriana/genética , Mycoplasma pneumoniae/genética , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , Pré-Escolar , Feminino , Humanos , Levofloxacino/uso terapêutico , Reação em Cadeia da Polimerase , Leucemia-Linfoma Linfoblástico de Células Precursoras , RNA Ribossômico 23S/genética
11.
Expert Opin Drug Saf ; 18(11): 1055-1063, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31500468

RESUMO

Introduction: Ciprofloxacin, levofloxacin, and moxifloxacin belong to the fluoroquinolone class of antibiotics and are amongst the most commonly prescribed antibiotics. In 2018 and 2019, Food and Drug Administration (FDA) and the European Medicine Agency (EMA) requested that manufacturers harmonize FQ safety information related to neuropsychiatric, aortic dissection, and long-term disability. The authors hypothesize that FDA and EMA epidemiologists support a strong association between these drugs and the three toxicities. Areas covered: Studies of FQ-associated neuropsychiatric toxicity, long-term disability, and aortic ruptures/dissections. Clinical sources include FDA Advisory Committee documents, a 2014 Citizen Petition filed with the FDA requesting safety information additions to FQ labels for neuropsychiatric toxicities (partially granted in 2018), an under-review Citizen Petition under review by the FDA requesting a FQ Risk Evaluation and Mitigation Strategy, and safety notifications from the EMA. Expert opinion: FDA and the EMA report state that neuropsychiatric toxicity, long-term disability, and aortic dissections//aneurysms occur with all FQs. Disability and neuropsychiatric toxicity can occur after one dose or several months after FQs. United States' and European' regulators warn physicians not to prescribe FQs for uncomplicated acute urinary tract infection, sinusitis, or bronchitis, unless other possible choices are tried first, as risks outweigh benefits in these settings.


Assuntos
Ciprofloxacino/efeitos adversos , Levofloxacino/efeitos adversos , Moxifloxacina/efeitos adversos , Aneurisma Dissecante/induzido quimicamente , Animais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Aneurisma Aórtico/induzido quimicamente , Ruptura Aórtica/induzido quimicamente , Ciprofloxacino/administração & dosagem , Avaliação da Deficiência , União Europeia , Humanos , Levofloxacino/administração & dosagem , Moxifloxacina/administração & dosagem , Síndromes Neurotóxicas/etiologia , Estados Unidos , United States Food and Drug Administration
13.
Chemosphere ; 237: 124464, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394454

RESUMO

This present study reported the synthesis and characterization of a low-cost, environment friendly and high efficient biochar, ferromanganese modified biochar (Fe/Mn-BC) for the removal of levofloxacin (LEV) from aqueous medium. Fe/Mn-BC was synthesized through the facile co-precipitation of Fe, Mn with vinasse wastes and then pyrolysis under controlled conditions. The characterization of Fe/MnBC was analyzed by scanning electron microscope (SEM), transmission electron microscope (TEM), X-ray diffraction patterns (XPS), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and Raman. Some influencing factors (e.g., pH, Fe/Mn-BC dosage, initial LEV concentration, ionic strength, contact time and temperature) were comprehensively investigated. The results manifested that the adsorption process of LEV onto Fe/Mn-BC was high pH dependence and the maximum adsorption capacity was achieved at pH 5. Moreover, the adsorption capacity of LEV was increased with increasing ionic strength. To gain a clearer perspective on the adsorption behavior of LEV onto Fe/Mn-BC, the adsorption kinetics and isotherms were also performed, revealing pseudo-second-order and Freundlich model had a better fitting effect. Reusability experiments indicated that Fe/Mn-BC could maintain a certain adsorption capacity for LEV after 5 recycles. Overall, this work showed that Fe/Mn-BC was an effective and promising adsorbent for eliminating LEV from aqueous medium.


Assuntos
Carvão Vegetal/química , Ferro/química , Levofloxacino/isolamento & purificação , Manganês/química , Poluentes Químicos da Água/isolamento & purificação , Adsorção , Concentração de Íons de Hidrogênio , Cinética , Levofloxacino/química , Microscopia Eletrônica de Varredura , Microscopia Eletrônica de Transmissão , Concentração Osmolar , Espectroscopia de Infravermelho com Transformada de Fourier , Temperatura Ambiente , Poluentes Químicos da Água/química , Purificação da Água/métodos , Difração de Raios X
14.
Molecules ; 24(16)2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395831

RESUMO

Despite the numerous studies on dendrimers for biomedical applications, the antibacterial activity of anionic phosphorus dendrimers has not been explored. In our research, we evaluated the antibacterial activity of modified polycationic and polyanionic dendrimers in combination with levofloxacin (LVFX) against Gram-negative (Escherichia coli ATCC 25922, Proteus hauseri ATCC 15442) and Gram-positive (Staphylococcus aureus ATCC 6538) bacteria. In the case of Gram-negative bacteria, we concluded that a combination of dendrimers and antibiotic gave satisfactory results due to a synergistic effect. The use of fluoroquinolone antibiotics, such as LVFX, not only caused resistance in disease-causing microorganisms but also increased environmental pollution. Therefore, reduction of drug dosage is of general interest.


Assuntos
Antibacterianos , Bactérias/crescimento & desenvolvimento , Dendrímeros , Levofloxacino , Antibacterianos/química , Antibacterianos/farmacologia , Dendrímeros/química , Dendrímeros/farmacologia , Sinergismo Farmacológico , Levofloxacino/agonistas , Levofloxacino/química , Levofloxacino/farmacologia
15.
Am J Health Syst Pharm ; 76(2): 108-113, 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31408091

RESUMO

PURPOSE: The stages of development of a health system-wide antimicrobial stewardship program (ASP) using existing personnel and technology are described. SUMMARY: Small hospitals with limited resources may struggle to meet ASP requirements, particularly facilities without onsite infectious disease physicians and/or experienced infectious disease pharmacists. Strategies for ASP development employed by Avera Health, a 33-hospital health system in the Midwest, included identifying relevant drug utilization and resistance patterns, education and pathway development, and implementation of Web-based conferencing to provide pharmacists throughout the system with access to infectious disease expertise on a daily basis. These efforts resulted in an evolving single-system ASP that has leveraged existing resources to overcome some system barriers. Program outcomes to date include a reduction in the use of a targeted agent, improved pathogen susceptibility trends, and rates of hospital-associated Clostridium difficile infection below national benchmarks. CONCLUSION: The Avera Health ASP grew from a collaborative project targeting levofloxacin overuse and resistance among key bacteria to a formal, health system-wide ASP in a rural setting. This program used existing personnel to provide standardized processes, educational campaigns, and antimicrobial expertise through the use of technology. This ASP program may provide helpful examples of ASP strategies for other rural health systems with similar resources.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Infecções por Clostridium/tratamento farmacológico , Hospitais Rurais/organização & administração , Desenvolvimento de Programas , Antibacterianos/farmacologia , Gestão de Antimicrobianos/economia , Infecções por Clostridium/microbiologia , Clostridium difficile/efeitos dos fármacos , Clostridium difficile/isolamento & purificação , Clostridium difficile/fisiologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Uso de Medicamentos , Hospitais Rurais/economia , Humanos , Levofloxacino/farmacologia , Levofloxacino/uso terapêutico , Testes de Sensibilidade Microbiana , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/organização & administração
16.
AAPS PharmSciTech ; 20(7): 272, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31372767

RESUMO

Bacterial conjunctivitis is a leading cause of ocular infections requiring short-term therapeutic treatment with frequent administration of drugs on daily basis. Topical dosage forms available in the market for the treatment of bacterial conjunctivitis such as simple drug solutions and suspensions are rapidly eliminated from the precorneal space upon instillation due to tear turn over and nasolacrimal drainage, limiting intraocular bioavailability of drug to less than 10% of the administered dose. To overcome issues related to conventional drop, an effort was made to design and evaluate prolong release ophthalmic solution of levofloxacin hemihydrate (LFH) using ion-sensitive in situ gelling polymer. Gellan gum was used as the in situ gelling agent. Formulations were screened based on in vitro gelation time, in vitro drug release, and stability towards sol to gel conversion upon storage. The prototype formulations exhibiting quick in vitro gelling time (< 15 s), prolonged in vitro drug release (18-24 h), and stability for at least 6 months at 25°C/40% relative humidity (RH) and 40°C/25% RH were evaluated for pharmacokinetic studies using healthy New Zealand white rabbits. Tested formulations were found to be well-tolerated and showed significant increase in AUC0-24 (22,660.39 h ng/mL) and mean residence time (MRT 12 h) as compared with commercially available solution Levotop PF® (Ajanta Pharma Ltd., India)(AUC0-24 6414.63 h ng/mL and MRT 4 h). Thus, solution formulations containing in situ gelling polymer may serve as improved drug delivery system providing superior therapeutic efficacy and better patient compliance for the treatment of bacterial conjunctivitis.


Assuntos
Antibacterianos/síntese química , Sistemas de Liberação de Medicamentos/métodos , Levofloxacino/síntese química , Soluções Oftálmicas/síntese química , Polissacarídeos Bacterianos/síntese química , Animais , Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Disponibilidade Biológica , Conjuntivite Bacteriana/tratamento farmacológico , Conjuntivite Bacteriana/metabolismo , Composição de Medicamentos , Avaliação Pré-Clínica de Medicamentos/métodos , Liberação Controlada de Fármacos/fisiologia , Levofloxacino/administração & dosagem , Levofloxacino/farmacocinética , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/farmacocinética , Polissacarídeos Bacterianos/administração & dosagem , Polissacarídeos Bacterianos/farmacocinética , Coelhos
17.
BMC Infect Dis ; 19(1): 720, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416441

RESUMO

BACKGROUND: Non-tuberculous mycobacteria cause chronic pulmonary infection, but pleuritis and pleural effusion are rarely associated with infection with non-tuberculous mycobacteria, especially rapid-growing mycobacteria. CASE PRESENTATION: A 68-year-old woman with rheumatoid arthritis who was using prednisone, azathioprine, and certolizumab pegol presented complaining of fever, dry cough, and night sweats for the past 2 weeks. Chest examination revealed bilateral opacity that was more pronounced on her right side. Bronchoalveolar lavage fluid and pleural effusion fluid were obtained, and revealed coinfection with Mycobacterium fortuitum and Mycobacterium mageritense. Imipenem/cilastatin, levofloxacin, and minocycline were prescribed for 6 months, and the patient was well and asymptomatic for the subsequent 6 months. CONCLUSIONS: This is the first case report describing pleural effusion associated with coinfection with two different mycobacterial species. If the species cannot be identified, the possibility of mycobacterial coinfection should be considered.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/patogenicidade , Derrame Pleural/microbiologia , Idoso , Líquido da Lavagem Broncoalveolar/microbiologia , Combinação Imipenem e Cilastatina/uso terapêutico , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Feminino , Humanos , Levofloxacino/uso terapêutico , Minociclina/uso terapêutico , Infecções por Micobactéria não Tuberculosa/etiologia , Mycobacterium fortuitum/patogenicidade , Derrame Pleural/tratamento farmacológico
18.
Indian J Med Microbiol ; 37(1): 127-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424025

RESUMO

We report here the first case of pulmonary infection due to Mycobacterium kyorinense in a 55-year-old hypertensive woman treated for pulmonary tuberculosis earlier on two occasions. She presented with productive cough, intermittent episode of left-sided chest pain, loss of appetite, low-grade fever, and breathlessness. Sputum cultures revealed non-tuberculous mycobacteria (NTM). She remained persistently symptomatic with sputum cultures positive for acid-fast bacilli even after 6 months of treatment. Hence, a 16SrRNA gene amplification and sequencing were done that revealed M. kyorinense. Based on the guidelines of the American Thoracic Society, she was started on weight-based dosing of clarithromycin, levofloxacin, ethambutol, isoniazid and injection amikacin daily. The patient improved symptomatically and became culture-negative after 3 months of therapy with the above regimen and continued to be culture negative for 12 months of treatment. She continues to remain symptom-free without evidence of any clinical or bacteriological relapse.


Assuntos
Antituberculosos/uso terapêutico , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Mycobacterium/genética , Infecções Respiratórias/diagnóstico , Amicacina/uso terapêutico , Claritromicina/uso terapêutico , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Mycobacterium/isolamento & purificação , Infecções por Micobactéria não Tuberculosa/microbiologia , RNA Ribossômico 16S/genética , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia
19.
Sci Total Environ ; 696: 133962, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31442719

RESUMO

In this work, a series of Ag/AgCl@ZIF-8 modified g-C3N4 composites were synthesized and used to degrade levofloxacin (LVFX) in water under visible light irradiation with the assistant of peroxymonosulfate (PMS). The morphologies and physicochemical properties of the materials were characterized by SEM, TEM, XRD, XPS, FTIR, and DRS technologies. The results of photocatalytic experiments showed that in the presence of PMS, the degradation rate of LVFX reached 87.3% in 60min. Furthermore, factors affecting photocatalytic efficiency such as the concentration of PMS, photocatalyst dosage and different pH values were investigated. The degradation products of LVFX were analyzed by LC-MS and the degradation pathway was inferred. Active species trapping experiments indicated that O2-, h+ and SO4- played important roles in the degradation process in the presence of PMS and the possible degradation mechanism was put forward. This work provides a photocatalyst system that is beneficial to the separation of photogenerated carriers and demonstrates the great potential of PMS-assisted photocatalysis in the purification of organic pollutants.


Assuntos
Levofloxacino/química , Modelos Químicos , Peróxidos/química , Luz , Processos Fotoquímicos , Prata/química
20.
Zhonghua Nei Ke Za Zhi ; 58(8): 596-598, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365982

RESUMO

To explore how to diagnose and treat brucellosis accurately and timely in patients with fever of unkown origin in non-pastoral areas. The epidemiological history, clinical symptoms, complete blood counts, procalcitonin and treatment efficacy of 7 patients with brucellosis were analyzed retrospectively. Some characteristic manifestations should be differentiated from tuberculosis. The clinical symptoms were relieved after combination of doxycycline, rifampicin, levofloxacin and amikacin for 6 weeks, only one patient with bone destruction needed orthopedic surgery. The overall response rate was 6/7. No relapse occurred during half year follow-up.


Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Levofloxacino/uso terapêutico , Rifampina/uso terapêutico , Doença Aguda , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Humanos , Levofloxacino/administração & dosagem , Pró-Calcitonina , Estudos Retrospectivos , Rifampina/administração & dosagem , Resultado do Tratamento
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