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1.
J Environ Manage ; 302(Pt A): 114045, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34749086

RESUMO

The sea contains elements that can play a useful role in catalyzing reactions. Therefore, this research was done to focus on eliminating amoxicillin (AMX) from wastewater utilizing zeolite Y- sea salt catalyst in the presence of H2O2. The influences of furnace temperature (200-500 °C) and time duration in the furnace (1-4 h) were optimized during catalyst generation. Also, the effects of different parameters on AMX removal, such as pH (5.0-9.0), catalyst dose (0-10 g.L-1), AMX concentration (50-300 mg.L-1), contact time (10-130 min), and H2O2 concentration (0-6 mL/100 mL distilled water) were investigated. Different analyses like Brunauer-Emmett-Teller (BET), Fourier transform infrared (FTIR), X-ray diffraction (XRD), and thermogravimetric analysis (TGA) were conducted to reveal catalyst properties. The BET-specific surface area of the catalyst (12.69 m2g-1) insignificantly (p-value > 0.05) changed after AMX removal (13.04 m2g-1), indicating the strength of the prepared catalyst. The active groups of N-H, O-H-O, O-Si-O, C-H, Si-O-Si, and Si-O-Al were determined in the catalyst structure. The highest removal of AMX (93%) was achieved in the zeolite-sea salt/H2O2 system at a pH level of 6.0 and an H2O2 concentration of 0.1 mL/100 mL. Elimination of the AMX followed pseudo-first-order kinetics. The catalyst was reclaimed up to 7 times and the removal efficiency was suitable up to the fifth stage. The by-products and reaction pathways were investigated by gas chromatography-mass spectrometry (GC-MS). The results showed that zeolite-sea salt can be utilized as an H2O2 activator for the effective degradation of AMX from wastewater.


Assuntos
Poluentes Químicos da Água , Zeolitas , Amoxicilina , Catálise , Peróxido de Hidrogênio , Águas Residuárias , Poluentes Químicos da Água/análise
2.
J Environ Manage ; 303: 114216, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34896858

RESUMO

The presence of antibiotics in waste and drinking water is causing increasing concern around the world, thereby an advanced sustainable technology needs to be developed to eliminate the antibiotics from water resources. Hence, an efficient spinning disc photoreactor (SDPR) equipped with visible light-activated Ag/Ag2O/TiO2 heterostructure thin film photocatalyst was assessed for the degradation of amoxicillin (AMX) as a typical antibiotic. The surface morphology, optoelectronic and structural features of Ag/Ag2O/TiO2 heterojunction were characterized by TEM, BET, mott Schottky, FESEM, EDS, AFM, XRD, UV-Vis-DRS, and contact angle measurements. Results confirm that Ag and Ag2O have a significant effect on the photocharge carrier separation and transfer of the as-developed photocatalyst system. The operative variables including illumination time, rotational speed, solution flow rate, aeration rate, pH, and initial AMX concentration were optimized by CCD. The results displayed the maximum AMX photodegradation (97.91%) could be achieved at optimal conditions involving illumination time of 80 min, a rotational speed of 225 rpm, the solution flow rate of 0.6 L/min, aeration rate of 20 L/min, pH = 6, and initial AMX concentration of 20 mg/L. Interestingly, more than 79% COD and 64% TOC were removed under optimum conditions during 80 min illumination time, respectively. Active species tests confirmed the dominant role of ·OH and ·O2- in AMX degradation. finally, the XRD pattern confirmed that the reusability assessments of the heterojunction film could successfully retain its stability for six consecutive photocatalytic degradation runs. This work demonstrates the feasibility of utilizing visible-light-driven thin-film photocatalysts in spinning disc photoreactors in treating the tenacious antibiotic pollutants.


Assuntos
Amoxicilina , Titânio , Catálise , Luz
3.
J Hazard Mater ; 421: 126634, 2022 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-34330077

RESUMO

Developing sheet-on-sheet (2D/2D) heterostructure with built-in electric field (BIEF) is effective in boosting the performance of photocatalysts for emerging contaminants degradation. Herein, the 2D/2D microtopography and (-)TiO2/(+)Bi2MoO6 BIEF were precisely integrated into hierarchical nanosheets, which can provide the basis and driving force for charge transfer both in in-plane and interface of heterojunction. The prepared photocatalyst (TiO2/Bi2MoO6) showed high-efficiency and stable performance for photocatalytic amoxicillin (AMX) degradation, which was 18.2 and 5.7 times higher than TiO2 and Bi2MoO6, respectively. More importantly, TiO2/Bi2MoO6 showed more efficient photocatalytic activity and photogenerated charge separation than TiO2@Bi2MoO6 (different morphology). Besides, four possible pathways of AMX degradation were proposed depending on Gaussian calculations and intermediates analysis by GC-MS and HPLC-TOFMS. This work sheds light on the design and construction of unique 2D/2D heterostructure photocatalysts for AMX degradation.


Assuntos
Amoxicilina , Bismuto , Catálise , Molibdênio , Titânio
4.
World J Gastroenterol ; 27(44): 7661-7668, 2021 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-34908805

RESUMO

Therapy of Helicobacter pylori (H.pylori) requires a combination of antibiotics together with an acid suppressing agent; most treatment regimens include Amoxicillin as one of the antibiotics, which is an important constituent as resistance to it is low. However, allergies to the penicillin group of antibiotics are not uncommon, and treating H.pylori infection in such individuals can be challenging due to the restricted choice of regimens. The aim of this review is to summarise the evidence for therapeutic options in patients with H.pylori infection and penicillin allergy. A literature search was conducted in PubMed for English language publications using the key words 'Helicobacter' and 'treatment' or 'therapy' and 'penicillin' or 'beta-lactam' and 'allergy' or 'anaphylaxis'. Eighteen studies were identified that specifically evaluated H.pylori treatment success in penicillin allergic patients. The number of subjects in most of them was low and many were retrospective, uncontrolled, single cohort studies. The most effective option for first-line treatment appears to be Bismuth-based quadruple therapy for 10-14 d. The evidence supports second-line treatment with Levoflaxacin-based triple therapy for 10 d. Patients with persistent H.pylori infection after 2 treatment courses should be considered for testing to confirm penicillin allergy. Further treatment should be guided by the results of H.pylori culture and sensitivity testing.


Assuntos
Hipersensibilidade a Drogas , Infecções por Helicobacter , Helicobacter pylori , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Bismuto/uso terapêutico , Quimioterapia Combinada , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Metronidazol/uso terapêutico , Penicilinas/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
5.
Water Sci Technol ; 84(12): 3616-3628, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34928830

RESUMO

Advanced oxidation process (AOP) has attracted widespread attention because it can effectively remove antibiotics in water, but its practical engineering application is limited by the problems of the low efficiency and difficult recovery of the catalyst. In the study, nano-spinel CoFe2O4 was prepared by hydrothermal method and served as the peroxymonosulfate (PMS) catalyst to degrade antibiotic amoxicillin (AMX). The reaction parameters such as CoFe2O4 dosage, AMX concentration, and initial pH value were also optimized. The reaction mechanism was proposed through free radical capture experiment and possible degradation pathway analysis. In addition, the magnetic recovery performance and stability of the catalyst were evaluated. Results showed that 85.5% of AMX could be removed within 90 min at optimal conditions. Sulfate radicals and hydroxyl radicals were the active species for AMX degradation. Moreover, the catalyst showed excellent magnetism and stability in the cycle experiment, which has great potential in the AOP treatment of antibiotic polluted wastewater.


Assuntos
Amoxicilina , Águas Residuárias , Antibacterianos , Catálise , Fenômenos Magnéticos
6.
BMC Gastroenterol ; 21(1): 424, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758726

RESUMO

BACKGROUND: Helicobacter pylori (H. pylori) prevalence is lower in patients with inflammatory bowel disease (IBD) than in those without IBD, suggesting that H. pylori plays a protective role in IBD. It has been reported that IBD may occur due to H. pylori eradication; however, it is unclear whether H. pylori eradication increases the incidence of IBD. Moreover, the effect of H. pylori eradication on IBD activity is unclear. CASE PRESENTATION: An 11-year-old boy diagnosed with ulcerative colitis (UC) was in clinical remission, with treatment involving 5-aminosalicylic acid. Fecal calprotectin (FC) level had decreased to 33.2 mg/kg, indicating mucosal healing. At age 12, he experienced epigastric pain on an empty stomach, which was relieved with dietary intake. His FC level was elevated without UC symptoms, such as diarrhea and bloody stools. He was diagnosed with H. pylori duodenal ulcer. H. pylori eradication (clarithromycin and amoxicillin for 7 days and a proton-pump inhibitor) led to symptom improvement the day after treatment initiation. However, he developed diarrhea and his FC level remained high despite improvement in duodenal ulcer symptoms and endoscopic findings of H. pylori eradication. Colonoscopy results indicated UC relapse. CONCLUSIONS: H. pylori eradication may worsen UC activity. However, further studies are required as this case report involved only one pediatric patient with increased UC activity after H. pylori eradication.


Assuntos
Colite Ulcerativa , Úlcera Duodenal , Infecções por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Criança , Claritromicina/uso terapêutico , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Humanos , Masculino , Recidiva
7.
JAMA ; 326(17): 1713-1724, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34726708

RESUMO

Importance: The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear. Objective: To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days. Design, Setting, and Participants: Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019. Interventions: Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401). Main Outcomes and Measures: The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates. Results: Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI -∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI -∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, -∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, -∞ to 7.4%]; P value for interaction = .73). Conclusions and Relevance: Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings. Trial Registration: ISRCTN Identifier: ISRCTN76888927.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Administração Oral , Pré-Escolar , Esquema de Medicação , Duração da Terapia , Feminino , Humanos , Lactente , Masculino , Alta do Paciente , Retratamento/estatística & dados numéricos , Índice de Gravidade de Doença
8.
BMC Infect Dis ; 21(1): 1141, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749665

RESUMO

BACKGROUND: In areas where Lyme disease is endemic, bites from ticks are common, but no vaccine is currently available against Lyme disease for humans. Therefore, the feasibility of using antibiotic prophylaxis to prevent Lyme disease after a tick bite is worth further exploration. Previous meta-analyses lack sufficient power to demonstrate the efficacy of about antibiotic prophylaxis for the prevention of Lyme disease following a tick bite. In this study, we explored more precise evidence and attempted to identify and update optimum treatment strategies. METHODS: We searched PubMed, Embase, and the Cochrane Library for studies until March 23, 2021. We included studies if the enrolled patients were randomly allocated to a treatment or control group within 72 h following a tick bite and had no clinical evidence of Lyme disease at enrolment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for data abstraction. Two authors (GZZ and XX) independently reviewed the abstracts and identified articles for detailed assessment. We used a random-effects model to calculate the pooled results and reported the 95% confidence interval (CI). Study quality was assessed using a modified Jadad scale, and publication bias was assessed using Egger's test. We calculated the risk ratio (RR) for the rates of unfavorable events in patients who received intervention versus the control group. This study is registered with PROSPERO, number CRD42021245002. RESULTS: Six studies (3,766 individuals) were included. The pooled rate of unfavorable events in persons receiving treatment and the control group were 0.4% (95%CI: 0.1-1.1%) and 2.2% (95%CI: 1.6-3.0%), respectively. The pooled RR was 0.38 (95%CI: 0.22-0.66). Subgroup analysis revealed that the pooled RR was 0.29 (95%CI: 0.14-0.60) in the single-use 200-mg doxycycline group; 0.28 (95%CI: 0.05-1.67) in a 10-day course group (Amoxicillin, Penicillin or tetracycline); and 0.73 (95%CI: 0.25-2.08) in a topical antibiotic treatment group (Azithromycin). CONCLUSIONS: The available evidence supports the use of antibiotics for the prevention of Lyme disease, and reveals advantages of using single-dose; however, further confirmation is needed.


Assuntos
Doença de Lyme , Picadas de Carrapatos , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Doxiciclina/uso terapêutico , Humanos , Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Doença de Lyme/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Picadas de Carrapatos/tratamento farmacológico
9.
Health Technol Assess ; 25(60): 1-72, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34738518

RESUMO

BACKGROUND: Data are limited regarding the optimal dose and duration of amoxicillin treatment for community-acquired pneumonia in children. OBJECTIVES: To determine the efficacy, safety and impact on antimicrobial resistance of shorter (3-day) and longer (7-day) treatment with amoxicillin at both a lower and a higher dose at hospital discharge in children with uncomplicated community-acquired pneumonia. DESIGN: A multicentre randomised double-blind 2 × 2 factorial non-inferiority trial in secondary care in the UK and Ireland. SETTING: Paediatric emergency departments, paediatric assessment/observation units and inpatient wards. PARTICIPANTS: Children aged > 6 months, weighing 6-24 kg, with a clinical diagnosis of community-acquired pneumonia, in whom treatment with amoxicillin as the sole antibiotic was planned on discharge. INTERVENTIONS: Oral amoxicillin syrup at a dose of 35-50 mg/kg/day compared with a dose of 70-90 mg/kg/day, and 3 compared with 7 days' duration. Children were randomised simultaneously to each of the two factorial arms in a 1 : 1 ratio. MAIN OUTCOME MEASURES: The primary outcome was clinically indicated systemic antibacterial treatment prescribed for respiratory tract infection (including community-acquired pneumonia), other than trial medication, up to 28 days after randomisation. Secondary outcomes included severity and duration of parent/guardian-reported community-acquired pneumonia symptoms, drug-related adverse events (including thrush, skin rashes and diarrhoea), antimicrobial resistance and adherence to trial medication. RESULTS: A total of 824 children were recruited from 29 hospitals. Ten participants received no trial medication and were excluded. Participants [median age 2.5 (interquartile range 1.6-2.7) years; 52% male] were randomised to either 3 (n = 413) or 7 days (n = 401) of trial medication at either lower (n = 410) or higher (n = 404) doses. There were 51 (12.5%) and 49 (12.5%) primary end points in the 3- and 7-day arms, respectively (difference 0.1%, 90% confidence interval -3.8% to 3.9%) and 51 (12.6%) and 49 (12.4%) primary end points in the low- and high-dose arms, respectively (difference 0.2%, 90% confidence interval -3.7% to 4.0%), both demonstrating non-inferiority. Resolution of cough was faster in the 7-day arm than in the 3-day arm for cough (10 days vs. 12 days) (p = 0.040), with no difference in time to resolution of other symptoms. The type and frequency of adverse events and rate of colonisation by penicillin-non-susceptible pneumococci were comparable between arms. LIMITATIONS: End-of-treatment swabs were not taken, and 28-day swabs were collected in only 53% of children. We focused on phenotypic penicillin resistance testing in pneumococci in the nasopharynx, which does not describe the global impact on the microflora. Although 21% of children did not attend the final 28-day visit, we obtained data from general practitioners for the primary end point on all but 3% of children. CONCLUSIONS: Antibiotic retreatment, adverse events and nasopharyngeal colonisation by penicillin-non-susceptible pneumococci were similar with the higher and lower amoxicillin doses and the 3- and 7-day treatments. Time to resolution of cough and sleep disturbance was slightly longer in children taking 3 days' amoxicillin, but time to resolution of all other symptoms was similar in both arms. FUTURE WORK: Antimicrobial resistance genotypic studies are ongoing, including whole-genome sequencing and shotgun metagenomics, to fully characterise the effect of amoxicillin dose and duration on antimicrobial resistance. The analysis of a randomised substudy comparing parental electronic and paper diary entry is also ongoing. TRIAL REGISTRATION: Current Controlled Trials ISRCTN76888927, EudraCT 2016-000809-36 and CTA 00316/0246/001-0006. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 60. See the NIHR Journals Library website for further project information.


Assuntos
Amoxicilina , Pneumonia , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Pneumonia/tratamento farmacológico , Avaliação da Tecnologia Biomédica
10.
Rev Esp Enferm Dig ; 113(10)2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34607441

RESUMO

Helicobacter pylori infection is very common in the Spanish population and represents the main cause of chronic gastritis, peptic ulcer, and gastric cancer. The last iteration of Spanish consensus guidelines on H. pylori infection was conducted in 2016. Recent changes in therapeutic schemes along with increasing supporting evidence were key for developing the V Spanish Consensus Conference (May 2021). Fourteen experts performed a systematic review of the scientific evidence and developed a series of recommendations that were subjected to an anonymous Delphi process of iterative voting. Scientific evidence and the strength of the recommendation were classified using GRADE guidelines. An eradication therapy, when prescribed empirically, is considered acceptable when it reliably achieves, or preferably surpass, 90% cure rates. Currently, only quadruple therapies (with or without bismuth) and generally lasting 14 days, accomplish this goal in first- and second-line therapies. A non-bismuth quadruple concomitant regimen (proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole) or a quadruple bismuth-based combination (proton pump inhibitor, bismuth, tetracycline, and metronidazole), are recommended as first-line regimens. Rescue therapies after eradication failure and management of H. pylori infection in peptic ulcer disease were also reviewed.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Humanos , Metronidazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico
11.
J Chromatogr A ; 1658: 462605, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34662823

RESUMO

The presence of antibiotics in the aquatic environment is becoming one of the main research focus of scientists and policy makers. Proof of that is the inclusion of four antibiotics, amongst which is amoxicillin, in the EU Watch List (WL) (Decision 2020/1161/EU)) of substances for water monitoring. The accurate quantification of amoxicillin in water at the sub-ppb levels required by the WL is troublesome due to its physicochemical properties. In this work, the analytical challenges related to the determination of amoxicillin, and six related penicillins (ampicillin, cloxacillin, dicloxacillin, penicillin G, penicillin V and oxacillin), have been carefully addressed, including sample treatment, sample stability, chromatographic analysis and mass spectrometric detection by triple quadrupole. Given the low recoveries obtained using different solid-phase extraction cartridges, we applied the direct injection of water samples using a reversed-phase chromatographic column that allowed working with 100% aqueous mobile phase. Matrix effects were evaluated and corrected using the isotopically labelled internal standard or correction factors based on signal suppression observed in the analysis of spiked samples. The methodology developed was satisfactorily validated at 50 and 500 ng L - 1 for the seven penicillins studied, and it was applied to different types of water matrices, revealing the presence of ampicillin in one surface water sample and cloxacillin in three effluent wastewater samples.


Assuntos
Amoxicilina , Água , Ampicilina/análise , Cromatografia Líquida de Alta Pressão , União Europeia , Penicilinas/análise , Extração em Fase Sólida
12.
BMC Infect Dis ; 21(1): 1083, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670500

RESUMO

BACKGROUND: Penicillin allergy prevalence is internationally reported to be around 10%. However, the majority of patients who report a penicillin allergy do not have a clinically significant hypersensitivity. Few patients undergo evaluation, which leads to overuse of broad-spectrum antibiotics. The objective of this study was to monitor prevalence and implement screening and testing of hospitalized patients. METHODS: All patients admitted to the medical department in a local hospital in Oslo, Norway, with a self-reported penicillin allergy were screened using an interview algorithm to categorize the reported allergy as high-risk or low-risk. Patients with a history of low-risk allergy underwent a direct graded oral amoxicillin challenge to verify absence of a true IgE-type allergy. RESULTS: 257 of 5529 inpatients (4.6%) reported a penicillin allergy. 191 (74%) of these patients underwent screening, of which 86 (45%) had an allergy categorized as low-risk. 54 (63%) of the low-risk patients consented to an oral test. 98% of these did not have an immediate reaction to the amoxicillin challenge, and their penicillin allergy label could thus be removed. 42% of the patients under treatment with antibiotics during inclusion could switch to treatment with penicillins immediately after testing, in line with the national recommendations for antibiotic use. CONCLUSIONS: The prevalence of self-reported penicillin allergy was lower in this Norwegian population, than reported in other studies. Screening and testing of hospitalized patients with self-reported penicillin allergy is a feasible and easy measure to de-label a large proportion of patients, resulting in immediate clinical and environmental benefit. Our findings suggest that non-allergist physicians can safely undertake clinically impactful allergy evaluations.


Assuntos
Hipersensibilidade a Drogas , Penicilinas , Amoxicilina/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Humanos , Penicilinas/efeitos adversos , Projetos Piloto , Testes Cutâneos
13.
Zhonghua Nei Ke Za Zhi ; 60(11): 977-981, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34689518

RESUMO

Objective: To analyze the impact of previous exposure to macrolide, quinolones and nitroimidazole antibiotics on eradication rate of bismuth quadruple therapy (BQT) in newly diagnosed patients with Helicobacter pylori(H. pylori). Methods: A total of 469 patients with H. pylori initially treated at the Third Hospital of Peking University from September 2017 to August 2020 were retrospectively recruited. The therapeutic regimens were BQT containing clarithromycin/levofloxacin/metronidazole recommended by Chinese guidelines. Clinical data were collected, including general demographic data, exposure history of antibiotics, CYP2C16 metabolic pattern, endoscopic diagnosis, bacterial density, H.pylori resistance, eradication results, etc. Univariate analysis, Chi-square test, Fisher exact probability test, Kruskal-Wallis H test and Logistic regression model were used as statistical methods. Results: Among different eradication therapies, univariate and multivariate analyses suggested that previous exposure to macrolides (OR=3.37,95%CI 1.04-10.98, P<0.05) was relevant to the decreased eradication rate of BQT containing clarithromycin. This may be due to increased resistance to clarithromycin (OR=6.12,95%CI 3.99-9.40, P<0.01).The previous exposure to quinolones (OR=3.65, 95%CI 1.27-10.49, P<0.05) was relevant to the decreased eradication rate of BQT containing levofloxacin, which was probably explained by the increased resistance to levofloxacin (OR=2.50, 95%CI 1.69-3.71, P<0.01). But the previous history of nitroimidazole did not impact the efficacy of BQT containing metronidazole. Conclusions: In patients newly diagnosed with H.pylori infection, the previous exposure to macrolide or quinolones antibiotics is related to lower eradiation rates of H. pylori. Although the exposure to nitroimidazole also indicates drug resistance to metronidazole, the clinical efficacy of BQT with metronidazole 400 mg four times a day is not affected.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Claritromicina/uso terapêutico , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos
14.
World J Gastroenterol ; 27(31): 5247-5258, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34497448

RESUMO

BACKGROUND: Antibiotic resistance to Helicobacter pylori (H. pylori) infection, which ultimately results in eradication failure, has been an emerging issue in the clinical field. Recently, to overcome this problem, an antibiotic sensitivity-based tailored therapy (TT) for H. pylori infection has received attention. AIM: To investigate the efficacy and safety profiles of TT for H. pylori infection treatment compared to a non-bismuth quadruple therapy, concomitant therapy (CT) regimen. METHODS: We included patients (> 18 years) with an H. pylori infection and without a history of Helicobacter eradication who visited the Gil Medical Center between March 2016 and October 2020. After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner, patient compliance, eradication success rate (ESR), and patient-reported side effects profiles were assessed and compared between the two groups. H. pylori infection was diagnosed using a rapid urease test, Giemsa stain, or dual priming oligonucleotide polymerase chain reaction (DPO-PCR). Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation. For the TT group, a DPO-PCR test, which detected A2142G and/or A2143G point mutations, and a clarithromycin resistance test were performed. Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy, while those with sensitive results were treated with the standard triple regimen. RESULTS: Of the 217 patients with a treatment naive H. pylori infection, 110 patients [mean age: 58.66 ± 13.03, men, n = 55 (50%)] were treated with TT, and 107 patients [mean age: 56.67 ± 10.88, men, n = 52 (48.60%)] were treated with CT. The compliance (TT vs CT, 100% vs 98.13%, P = 0.30), and follow-up loss rates (8.18% vs 9.35%, P = 0.95) were not significantly different between the groups. The ESR after treatment was also not statistically different between the groups (TT vs CT, 82.73% vs 82.24%, P = 0.95). However, the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group (22.77% vs 50.52%, P < 0.001). CONCLUSION: The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea, especially when physicians are confronted with increased antibiotic resistance rates.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Idoso , Amoxicilina/uso terapêutico , Antibacterianos/efeitos adversos , Claritromicina/efeitos adversos , Quimioterapia Combinada , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/efeitos adversos , República da Coreia
16.
Tohoku J Exp Med ; 255(1): 41-48, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34526429

RESUMO

Effective Helicobacter pylori (H. pylori) eradication is a major public health concern; however, eradication failure rates with the standard triple therapy remain high. We aimed to investigate the effectiveness and tolerability of ranitidine bismuth citrate (RBC) pretreatment before standard triple therapy for H. pylori eradication. A prospective, randomized, controlled, and open-label clinical trial was conducted from June to December 2019. H. pylori eradication rate, safety, and tolerability were compared between the standard treatment group (esomeprazole, amoxicillin, and clarithromycin for 7 days) and RBC pretreatment group (RBC for 2 weeks before standard triple therapy). This trial ended earlier than estimated owing to the N-nitrosodimethylamine concerns with ranitidine. Success rates of H. pylori eradication were 80.9% and 67.3% in the RBC pretreatment (n = 47) and standard treatment (n = 52) (p = 0.126) groups, respectively. Our trial was discontinued earlier than planned; however, a statistical significance would be achieved by expansion of our data (p = 0.031) if patient enrollment numbers reached those initially planned. Adverse event rates were comparable between groups (25.5% in the pretreatment group vs. 28.8% in the standard treatment group), without serious event. Tolerability was excellent in both groups, recorded as 97.9% and 100% in the pretreatment and standard treatment groups, respectively. Compared with the standard triple regimen, RBC pretreatment for 2 weeks may achieve higher H. pylori eradication rates, with excellent safety and tolerability. However, this study necessitates further validation as it was discontinued early owing to the N-nitrosodimethylamine issues of ranitidine.


Assuntos
Bismuto/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Ranitidina/análogos & derivados , Adulto , Idoso , Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Carga Bacteriana/efeitos dos fármacos , Claritromicina/administração & dosagem , Esquema de Medicação , Quimioterapia Combinada , Esomeprazol/administração & dosagem , Feminino , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Antagonistas dos Receptores H2 da Histamina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ranitidina/administração & dosagem , Falha de Tratamento , Resultado do Tratamento
17.
J Control Release ; 338: 858-869, 2021 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-34534590

RESUMO

In this paper, rectal absorption and tissue tolerance of amoxicillin sodium (AS) suppositories prepared in a hydrophilic base, polyethylene glycol (PEG) or lipophilic base, Suppocire® NA 15 (SNA 15), were investigated. Following in vitro characterization, including drug distribution in the suppository bases, drug-base interactions and drug release, pharmacokinetics were investigated in rabbits to determine absolute bioavailability (F) at two dose levels (100 mg and 200 mg). Both types of suppositories were found uniform in weight and content. Powder X-ray diffraction (XRD) and differential scanning calorimetry indicated that AS existed as solid dispersion or anhydrous crystalline dispersion in both suppositories at different ratios without changing melting points of the bases. This was supported by Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy conjugated with energy dispersive X-ray (SEM/EDX). In dissolution medium, melting and spreading of SNA 15 and dissolution of PEG suppositories accounted for their different drug release kinetics and mean dissolution time (MDT). A rapid and complete amoxicillin absorption (F close to 100%) with a double peak pharmacokinetic profile was observed alongside minimal signs of tissue irritation in rabbits treated with SNA 15 suppositories at both dose levels. In contrast, the F of amoxicillin from PEG suppositories was 59%, increasing to 77.3% as AS dose doubled from 100 mg to 200 mg, reflected in the slower release predominately controlled by erosion of the base. An in vitro - in vivo correlation was observed (MDT vs F; p < 0.01). AS was stable in SNA 15 suppositories at least for three months at 20 ± 0.2 °C. This research highlighted the advantages of SNA 15 suppositories over the PEG suppositories in providing rapid and complete rectal absorption of AS and tissue compatibility.


Assuntos
Amoxicilina , Reto , Amoxicilina/metabolismo , Animais , Disponibilidade Biológica , Liberação Controlada de Fármacos , Coelhos , Reto/metabolismo , Supositórios
18.
BMJ Open ; 11(9): e046158, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535473

RESUMO

BACKGROUND: Pneumonia is a leading cause of death among children under 5 specifically in South Asia and sub-Saharan Africa. Hypoxaemia is a life-threatening complication among children under 5 with pneumonia. Hypoxaemia increases risk of mortality by 4.3 times in children with pneumonia than those without hypoxaemia. Prevalence of hypoxaemia varies with geography, altitude and severity (9%-39% Asia, 3%-10% African countries). In this protocol paper, we describe research methods for assessing impact of Lady Health Workers (LHWs) identifying hypoxaemia in children with signs of pneumonia during household visits on acceptance of hospital referral in district Jamshoro, Sindh. METHODS AND ANALYSIS: A cluster randomised controlled trial using pulse oximetry as intervention for children with severe pneumonia will be conducted in community settings. Children aged 0-59 months with signs of severe pneumonia will be recruited by LHWs during routine visits in both intervention and control arms after consent. Severe pneumonia will be defined as fast breathing and/or chest in-drawing, and, one or more danger sign and/or hypoxaemia (Sa02 <92%) in PO (intervention) group and fast breathing and/or chest in-drawing and one or more danger sign in clinical signs (control) group. Recruits in both groups will receive a stat dose of oral amoxicillin and referral to designated tertiary health facility. Analysis of variance will be used to compare baseline referral acceptance in both groups with that at end of study. ETHICS AND DISSEMINATION: Ethical approval was granted by the Ethics Review Committee of the Aga Khan University (4722-Ped-ERC-17), Karachi. Study results will be shared with relevant government and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT03588377.


Assuntos
Pneumonia , Amoxicilina , Criança , Humanos , Oximetria , Paquistão , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta
19.
Molecules ; 26(17)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34500607

RESUMO

Based on the adsorption performance of a porous nanocomposite with limestone (LS), activated carbon (AC) and sodium alginate (SG), a unique, multifunctional LS-AC-SG nanocomposite absorbent was designed and prepared for extracting antibiotics and drugs from aqueous solutions. The composite exhibited the following advantages: quick and simple to prepare, multifunctionality and high efficiency. Amoxicillin (AMX) and diclofenac (DCF) were chosen as the conventional antibiotic and the drug, respectively. The prepared nanocomposite's physicochemical characteristics were calculated through numerous characterization methods. The structure of the surface was made up of interconnected pores that can easily confine pollutants. The surface area was measured to be 27.85 m2/g through BET analysis. The results show that the maximum absorption capacity of amoxicillin and diclofenac was 99.6% and 98.4%, respectively, at a contact time of 40 min. The maximum removal of amoxicillin and diclofenac was reached at pH = 2. Adsorption analysis revealed that adsorption isotherm and kinetic data matched the pseudo-first-order kinetic and the Langmuir isotherm models. The results imply that the synthesized nanocomposites have the capacity to remove amoxicillin (AMX) and diclofenac (DCF) from aqueous solutions.


Assuntos
Alginatos/química , Antibacterianos/química , Carbonato de Cálcio/química , Carvão Vegetal/química , Nanocompostos/química , Preparações Farmacêuticas/química , Soluções/química , Água/química , Adsorção , Amoxicilina/química , Diclofenaco/química , Concentração de Íons de Hidrogênio , Cinética , Porosidade , Poluentes Químicos da Água/química , Purificação da Água/métodos
20.
Int J Mol Sci ; 22(17)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34502136

RESUMO

Plasmids play a crucial role in spreading antimicrobial resistance genes. Plasmids have many ways to incorporate various genes. By inducing amoxicillin resistance in Escherichia coli, followed by horizontal gene transfer experiments and sequencing, we show that the chromosomal beta-lactamase gene ampC is multiplied and results in an 8-13 kb contig. This contig is comparable to a transposon, showing similarities to variable regions found in environmental plasmids, and can be transferred between E. coli cells. As in eight out of nine replicate strains an almost completely identical transposon was isolated, we conclude that this process is under strict control by the cell. The single transposon that differed was shortened at both ends, but otherwise identical. The outcome of this study indicates that as a result of exposure to beta-lactam antibiotics, E. coli can form a transposon containing ampC that can subsequently be integrated into plasmids or genomes. This observation offers an explanation for the large diversity of genes in plasmids found in nature and proposes mechanisms by which the dynamics of plasmids are maintained.


Assuntos
Elementos de DNA Transponíveis , Proteínas de Escherichia coli/genética , Resistência beta-Lactâmica , beta-Lactamases/genética , Amoxicilina/toxicidade , Antibacterianos/toxicidade , Escherichia coli , Transferência Genética Horizontal
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