Dose Of Amoxicillin Research Articles

Comparison of Amoxicillin Administered Twice versus Four Times a Day in First-Line Helicobacter pylori Eradication Using Tegoprazan, Clarithromycin, and Bismuth: A Propensity Score Matching Analysis.

This study aimed to investigate the effects of different amoxicillin (AMX) dosing schedules on bismuth quadruple therapy in Helicobacter pylori treatment-naïve patients. A total of 139 H. pylori-infected patients received a 2-week eradication regimen consisting of 50 mg tegoprazan, 500 mg clarithromycin, and 300 mg bismuth tripotassium dicitrate twice daily, 1000 mg AMX twice daily (BID group), or 500 mg AMX four times daily (QID group). We performed a urea breath test to evaluate H. pylori eradication eight weeks after treatment and compared the H. pylori eradication rate, patient compliance, and adverse drug events between the BID and QID groups. Based on propensity score matching, 114 and 100 patients were included in intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. The H. pylori eradication rate did not differ significantly according to the ITT (82.5% vs. 87.7%, p = 0.429) and PP (95.9% vs. 98.0%, p = 0.536) analyses between the BID and QID groups. No significant differences were found in treatment compliance or adverse drug event rates between the two groups. In conclusion, the eradication rate of first-line H. pylori therapy containing tegoprazan, clarithromycin, and bismuth was not affected by AMX dosing schedules administered twice and four times daily.

Single dose amoxicillin challenges are safe for the evaluation of pediatric penicillin allergy

Single dose amoxicillin challenges are safe for the evaluation of pediatric penicillin allergy

Helicobacter pylori: High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort

BACKGROUND Helicobacter pylori (H. pylori ) eradication rates have fallen globally, likely in large part due to increasing antibiotic resistance to traditional therapy. In areas of high clarithromycin and metronidazole resistance such as ours, Maastricht VI guidelines suggest high dose amoxicillin dual therapy (HDADT) can be considered, subject to evidence for local efficacy. In this study we assess efficacy of HDADT therapy for H. pylori eradication in an Irish cohort. AIM To assess the efficacy of HDADT therapy for H. pylori eradication in an Irish cohort as both first line, and subsequent therapy for patients diagnosed with H. pylori . METHODS All patients testing positive for H. pylori in a tertiary centre were treated prospectively with HDADT (amoxicillin 1 g tid and esomeprazole 40 mg bid × 14 d) over a period of 8 months. Eradication was confirmed with Urea Breath Test at least 4 wk after cessation of therapy. A delta-over-baseline > 4% was considered positive. Patient demographics and treatment outcomes were recorded, analysed and controlled for basic demographics and prior H. pylori treatment. RESULTS One hundred and ninety-eight patients were identified with H. pylori infection, 10 patients were excluded due to penicillin allergy and 38 patients refused follow up testing. In all 139 were included in the analysis, 55% (n = 76) were female, mean age was 46.6 years. Overall, 93 (67%) of patients were treatment-naïve and 46 (33%) had received at least one previous course of treatment. The groups were statistically similar. Self-reported compliance with HDADT was 97%, mild side-effects occurred in 7%. There were no serious adverse drug reactions. Overall the eradication rate for our cohort was 56% (78/139). Eradication rates were worse for those with previous treatment [43% (20/46) vs 62% (58/93), P = 0.0458, odds ratio = 2.15]. Age and Gender had no effect on eradication status. CONCLUSION Overall eradication rates with HDADT were disappointing. Despite being a simple and possibly better tolerated regime, these results do not support its routine use in a high dual resistance country. Further investigation of other regimens to achieve the > 90% eradication target is needed.

Impact of medication dosage on Helicobacter pylori eradication rates among pediatric patients.

Helicobacter pylori rates of eradication to common first-line regimens continue to decline globally. Prescription of the appropriate medication dosage is an important consideration, particularly in the pediatric population due to medication weight-based dosing. Limited data is available on the impact of guideline-recommended weight-based dosing on the successful eradication of H. pylori in children. Retrospective study of patients with histologic evidence of H. pylori from two pediatric tertiary care centers in New England. We excluded patients who were not treated or those missing eradication data. We compared the eradication rates of patients prescribed recommended weight-based dosages, duration, and frequency of treatment with those who were not. One hundred forty-four patients were included. The overall eradication rate was 73.6% (106/144). All treatment regimens were properly prescribed for 14 days. There was a high rate of improper weight-based dosing: proton pump inhibitor (PPI) 31.2% (45/144), amoxicillin 31.7% (39/123), metronidazole (MET) 19.4% (12/62), clarithromycin (CLA) 23.9% (22/70), tetracycline 50% (6/12), bismuth 26.1% (6/23). When PPIs were properly weight-dosed, there was a 78.8% eradication rate that dropped to 62.2% with suboptimal dosing (p = 0.036, OR: 2.26, CI: 1.04-4.87). When amoxicillin was properly weight-dosed, successful eradication was achieved in 81% versus only 53.8% when improperly dosed (p = 0.002; OR: 3.64, CI: 1.58-8.37). There was no statistically significant impact on eradication rates with improper weight-based dosing of MET, CLA, tetracycline, or bismuth. Proper weight-based dosing of amoxicillin and PPI is important for the successful eradication of H. pylori among children in the New England area.

Rational Use of Antibiotics in Childhood Pneumonia: A review

Inappropriate antibiotic treatment in childhood pneumonia may lead to greater expense, antibiotic resistance, toxic side effects, or even death. Important risk factors are infant and young children, low birth weight, nonexclusive breastfeeding, malnutrition, vitamin A deficiency, incomplete immunization and exposure to polluted air. Common organisms involved in pneumonia in neonatal periods are gram negative rods, group B streptococcus and staphylococcus. Beyond the neonatal period S. pneumoniae, H. influenzae, staphylococcus and mycoplasma are common. MRSA, gram negative rods and Legionella spp are commonly involved in nosocomial pneumonia. Rational use of antibiotic for bacterial pneumonia is based on probable organism, age, vaccination and clinical status of the child. Children who do not require hospitalization should have high doses of amoxicillin 90 mg/kg/day orally divided twice daily, alternatives include cefuroxime and amoxicillin/clavulanate. For schoolaged children when mycoplasma is suspected, azithromycin is generally preferred, alternatives clarithromycin can be given. Fully immunized against H. influenzae type b and S. pneumoniae children who are not severely ill should give ampicillin or penicillin G. For children who do not meet these criteria: ceftriaxone or cefotaxime should be given. If clinical features suggest staphylococcal pneumonia (pneumatocele or empyema), then include oxacillin or vancomycin. Vancomycin and meropenem are the initial treatment of choice for nosocomial pneumonia. Pneumonia in neonatal period should have ampicillin plus gentamicin or ceftazidime plus amikacin. Antibiotics should be continued until the patient has been afebrile for 72 hours, and the total duration should be 10 days. Selection of appropriate antibiotic in childhood pneumonia considering age of the child, risk factor, probable organism, immunization status and clinical severity are paramount important. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 102-109

Vonoprazan-based therapies versus PPI-based therapies in patients with H. pylori infection: Systematic review and meta-analyses of randomized controlled trials.

This study aims to evaluate the efficacy and safety of vonoprazan-amoxicillin (VA), vonoprazan-amoxicillin-clarithromycin (VAC), vonoprazan-based bismuth-containing quadruple therapy (VBQT), and PPI-based triple (PAC) or quadruple therapy (PBQT) for H. pylori infection with the consideration of duration of therapy and amoxicillin dose (H: high; L: low). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for eligible randomized controlled trials (RCTs) up to December 15, 2023. The efficacy outcome was eradication rate, and safety outcomes included the rates of adverse events and treatment discontinuation. Twenty-seven RCTs were included. The pooled eradication rates were 82.8% for VA, 89.1% for VAC, and 91.8% for VBQT, which increased with the higher amoxicillin frequency of administration and extended duration of therapy within each regimen. There were no significant differences in eradication rate when comparing 7-VA versus 7-VAC and 14-VA versus 14-VAC. VA was at least comparable to PAC. The eradication rate did not differ significantly between 10-H-VA or 14-H-VA versus 14-PBQT. 7-L-VAC demonstrated higher eradication rate versus 7-PAC and comparable rate to 14-PAC. 14-VBQT showed higher eradication rates versus 14-PBQT. The adverse events rate was 19.3% for VA, 30.6% for VAC, and 38.4% for VBQT. VA had similar risk of adverse events versus VAC and significantly fewer adverse events compared to PBQT. The treatment discontinuation rate did not differ significantly between treatments. The eradication rate of VBQT was the highest at above 90% followed by VAC and VA. VA was as effective as VAC and superior to PPI-based therapies with favorable safety, highlighting the potential of VA therapy as a promising alternative to traditional PPI-based therapies. VPZ-based triple or quadruple therapies was more effective than PPI-based therapies. Further studies are needed to establish the optimal treatment regimen especially in the western countries.

Knowledge, Attitudes, and Practices (KAP) of community pharmacists regarding antibiotic use and resistance: a cross-sectional study from the United Arab Emirates

ABSTRACT One of the main contributing factors of antibiotic resistance is the dispensing of antibiotics without prescription. This study investigated community pharmacists’ knowledge, attitudes, and practices in relation to antibiotic dispensing and resistance in United Arab Emirates (UAE). A cross-sectional survey was conducted using validated questionnaire. (40.1%) had an overall positive KAP score. A total of (88%) respondents were aware of the illegality of dispensing antibiotics without a prescription. Only (31%) had good knowledge regarding amoxicillin dosage for upper respiratory tract infection. The primary misconduct found numerous pharmacists prescribing antibiotics without a prescription, even though they were aware that this should never be done. Pharmacists who attended events focused on antibiotic use and resistance were more likely to have good knowledge about antibiotics (Adjusted Odd Ratio (AOR): 1.673; 95%CI: 1.029–2.719; p = 0.038), more likely to have positive attitude (AOR: 1.889; 95%CI: 1.133–3.149; p = 0.015), and more likely to have good practice (AOR: 3.182; 95%CI: 1.541–6.572; p = 0.002).

A Pharmacy-Based Cross-Sectional Study to Assess the Antibiotic Prescription Pattern by Medical and Dental Practitioners in Saudi Arabia

ABSTRACT Introduction: The misuse and overuse of antibiotics in dental practice are well known and have become widespread worldwide. Its potential effect and high risk of serious reaction have emphasized the need to reduce and limit the precipitation. In this study we aimed to identify the prevalence, type, dose, and duration of antibiotics prescribed by general medical and dental practitioners in Saudi Arabia. Materials and Methods: This cross-sectional study was performed from April 2020 to December 2020. A total of 45,100 antibiotic prescriptions were collected from different governmental and private pharmacies and screened to be included in this study. Data extraction from all prescriptions followed a standardized form that included the following information: Doctor specialty, type of antibiotic, duration, and dose of antibiotic. Results: A total of 38,175 antibiotic prescriptions prescribed by licensed doctors practicing in governmental or private hospitals were included in this study. Thirty-five thousand one hundred and seventy-eight (92%) outpatient antibiotics were prescribed by medical practitioners, and 2997 (8%) antibiotics were prescribed by dentists. The most commonly prescribed antibiotic was Augmentin (60%), followed by metronidazole and amoxicillin (35%). The most common dose and duration prescribed by dentists for Augmentin was 625 mg, 3 times per day for 5 days, whereas that of metronidazole was 500 mg, 3 times per day for 7 days. Prescribed dose and duration of amoxicillin was 500 mg, 3 times per day for 7 days. Conclusions: This study helps in understanding healthcare practitioners’ patterns and adds to the knowledge on how to deal with odontogenic infections. Further national studies are recommended to include more regions in Saudi Arabia and to illustrate the misuse of outpatient antibiotics.

Vonoprazan-amoxicillin dual therapy with different amoxicillin dosages for treatment-naive patients of Helicobacter pylori infection in China: a prospective, randomized controlled study.

The vonoprazan (VPZ)-amoxicillin (AMO) dual therapy (VA) demonstrates a satisfactory eradication rate for Helicobacter pylori (H. pylori ). However, the optimal dosage of AMO in this regimen remains uncertain. The objective of this study is to investigate the efficacy of different doses of AMO in the VA regimen for first-line treatment of H. pylori infection. A total of 192 treatment-naive H. pylori -infected patients were randomly assigned to one of three groups: low-dose VA (LD-VA: VPZ 20 mg b.i.d + AMO 750 mg t.i.d), moderate-dose VA (MD-VA:VPZ 20 mg b.i.d + AMO 1000 mg t.i.d), and high-dose VA (HD-VA: VPZ 20 mg b.i.d + AMO 1250 mg t.i.d). All groups received 14 days of treatment. The study evaluated and compared the eradication rates, adverse events (AEs), and patient compliance among the three groups. Eradication rates for LD-VA, MD-VA, and HD-VA were 76.6% (49/64), 79.7% (51/64), and 84.4% (54/64), respectively, as determined by intention-to-treat analysis; 90.6% (48/53), 94.3% (50/53), and 98.1% (53/54) according to per-protocol analysis; 89.1% (49/55), 94.4% (51/54), and 96.4% (54/56) with modified intention-to-treat analysis (all P > 0.05). Although not statistically significant, numerically higher eradication rates were observed with the higher dose AMO VA regimen. There were no statistically significant differences in the incidence of AEs and compliance among the three VA regimens. Fourteen-day VA regimens with AMO doses exceeding 2 g/day demonstrated satisfactory eradication rates. HD-VA therapy is potentially the most effective regimen. Large-sample clinical trials are required to further validate these findings.

Lateral ovariohysterectomy in female cats: an alternative for birth control programmes

Ovariohysterectomy through the linea alba is one of the most applied surgical techniques in companion animals; however, this technique presents frequent postoperative complications. The present study aims to demonstrate the feasibility and advantages of ovariohysterectomy in cats through the lateral approach. In total, 30 clinically healthy cats weighing 2.9 ± 0.9 kg body weight, 1.5- 4 years old and of various breeds, were operated on. In the preanesthetic medication, xylazine hydrochloride (0.1 mg/kg) and ketamine hydrochloride (0.5 mg/kg) were applied IM, anesthesia was done with diazepam (0.5 mg/kg) and ketamine hydrochloride (10 mg/kg). IV route, and maintenance with boluses of ketamine hydrochloride (0.5 mg/kg) based on dose-response. A single dose of amoxicillin (10 mg/kg) was applied IM at the end of surgery. The time of the surgical intervention was 19.8 ± 2.5 minutes and for wound healing it was 6.9 ± 1.2 days. Two patients 6.7% (2/30) presented inflammation and local infection. It is concluded that ovariohysterectomy through a lateral approach in cats is a viable alternative due to its ease of execution, reduced healing time and minimal presentation of postoperative complications.

Vonoprazan-Amoxicillin Dual Therapy With Different Amoxicillin Administration Regimens for Helicobacter pylori Treatment: A Randomized Controlled Trial.

The effect of preprandial or postprandial administration of amoxicillin on the efficacy of vonoprazan-amoxicillin dual therapy (VA-dual therapy) for Helicobacter pylori treatment has not been studied. It is also unclear whether amoxicillin dosing four times daily is more effective than three times daily. We aimed to investigate the effect of different amoxicillin administration regimens on the efficacy of VA-dual therapy. H. pylori-infected subjects were randomly assigned to three groups in a 1:1:1 ratio to receive a 14-day dual therapy consisting of vonoprazan 20 mg twice daily + amoxicillin 1000 mg three times daily before meals (BM-TID) or 1000 mg three times daily after meals (AM-TID) or 750 mg four times daily after meals (AM-QID). H. pylori eradication rates, adverse events rates, compliance, and antibiotic resistance were compared. Between May 2021 to April 2023, 327 subjects were enrolled. The eradication rates of BM-TID, AM-TID, and AM-QID dual therapy were 88.1%, 89.9%, and 93.6% in intention-to-treat (ITT) analysis, 90.6%, 94.2%, and 99.0% in modified ITT (MITT) analysis, and 90.4%, 94.1%, and 99.0% in per-protocol (PP) analysis. Although there was non-inferiority between BM-TID and AM-TID, as well as between AM-TID and AM-QID, AM-QID was significantly more effective than BM-TID. There were no significant differences in adverse event rates, compliance, and antibiotic resistance among the three groups. Postprandial administration and the increased frequency of administration of amoxicillin may contribute to a better efficacy of VA-dual therapy, especially for rescue therapy. All VA-dual therapy in our study could achieve good efficacy for first-line treatment. clinicaltrials.gov: NCT05901051.

Efficacy and Safety of Vonoprazan-Amoxicillin Dual Regimen With Varying Dose and Duration for Helicobacter pylori Eradication: A Multicenter, Prospective, Randomized Study

Background & AimsPrevious studies confirm vonoprazan-amoxicillin effectiveness for Helicobacter pylori. This study aims to investigate vonoprazan with varying amoxicillin dose and duration. MethodsThis multicenter, prospective, randomized,controlled, noninferiority trial enrolled patients with treatment naive Helicobacter pylori infection from five clinical centers. Eligible participants were randomly assigned to H-VA-10 (vonoprazan 20mg b.i.d + amoxicillin 750mg q.i.d, 10 days), L-VA-10 (vonoprazan 20mg b.i.d + amoxicillin 1000mg b.i.d, 10 days) and H-VA-14 (vonoprazan 20mg b.i.d + amoxicillin 750mg q.i.d, 14 days) in a 1:1:1 ratio. The eradication rate was assessed using the 13C-urea breath test at least 28 days after treatment. ResultsOf the 623 eligible patients,516 patients were randomized. In both the intention-to-treat and pre-protocol analyses, eradication rates were comparable between H-VA-10 and H-VA-14 groups (86.6% vs 89.5%and 90.9% vs 94.5%, P=.021 and .013 for noninferiority, respectively). However, eradication rates were significantly lower in the L-VA-10 group than the H-VA-14 group (79.7% vs 89.5% and 82.0% vs 94.5%, P=.488 and .759, respectively). Rates of study withdrawal, loss to follow up and adverse events were similar across study groups. ConclusionsH-VA-10 and H-VA-14 regimens provide satisfactory efficacy for Helicobacter pylori infection, while the L-VA-10 regimen was inferior..

P24 Penicillin allergy de labelling: a whole system approach

Abstract Background Approximately 10% of patients have a documented allergy to penicillin on their health records.1 However, when checked up to 95% are thought to be incorrect2 with side effects such as nausea, vomiting and gastrointestinal upset often being documented as allergy. Inappropriate and over labelling of penicillin allergy is detrimental to individuals and healthcare systems as alternatives to penicillins are associated with more complications, adverse events, financial costs and extended length of stay. Unnecessary use of penicillin alternatives also increases the risk of antimicrobial resistance development. Penicillin allergy de-labelling is a viable option for patients within primary care and acute settings where they meet specific criteria, leading to financial benefits for the health board and optimal treatment outcomes for the patient. NHS Tayside is the first and only Board in Scotland to adopt a whole system approach to de-labelling patients in both acute and community settings. Through the implementation of evidence-based, collaborative and systematic risk assessment processes, clinical teams are able to identify patients who may be eligible for the penicillin allergy de-labelling programme. Methods Within the acute sector, two pilot wards were identified. A Short Life Working Group (SLWG) was developed to oversee the de-labelling process and governance. Patients were identified by clinical teams and consent gained prior to carrying out the process. A single dose of oral flucloxacillin or amoxicillin was administered to the patient. The patient was monitored for any reaction as per Scottish Antimicrobial Prescribing Group (SAPG) algorithm.3 If the patient experienced no reaction, they were de-labelled, a request was sent to GP to remove the label and their details were added to a database held by the SLWG. A similar project was piloted in primary care across three Angus GP practices. The aim of the project is to identify a patient population that are labelled penicillin allergic but have received a subsequent prescription for a penicillin allowing a primary care SLWG to carry out a patient consultation with the aim of retrospectively de-labelling and updating the record. This will allow patients to receive optimal treatment options in the future. Results Within the acute setting, the pilot was initiated in May 2022. Since then, 44 patients have been recruited to the penicillin allergy de-labelling process with 98% having no immediate reaction and 67% of labels removed from patient care records at the 3 month follow-up stage. Within primary care across three GP practices, 163 patients were eligible for the pilot. A total of 85 patients (52%) were contacted via telephone and a consultation on allergy status carried out. Overall, 42 patients (50%) were successfully de-labelled and patient records were updated. Conclusions Following similar processes, there is potential for practitioners within the acute and community sectors to adopt this pilot as part of an integrated work plan across all wards and GP practices. By de-labelling patients within the community or acute sector, the patients’ records will be accurate and future treatment options can be optimized to ensure positive outcomes and minimize harm.

Determination of the presence of an antibiotic in implant-bone biopsy specimens by Raman spectroscopy in experiment

Was to determine the presence of an amoxicillin-based antibiotic in bone implant biopsies by Raman spectroscopy in an experiment. Experimental animals (n=10, a miniature pig of the Svetlogorsk breed) were divided into 2 groups of 5 animals. Groups 1 and 2 were injected with amoxicillin 2 ml per 20 kg of body weight 30 minutes before dental implantation surgery, then group 2 was additionally injected with 1 ml per 20 kg of body weight for 5 days. Each animal has 6 implants installed. On the 1st, 3rd, 7th, 14th day, an implant-bone biopsy was removed from each animal, micro-preparations were made and Raman spectroscopy was performed to assess the peak matching of the Raman spectrum. In animals of the 1st and 2nd groups, the main peak of the Raman spectrum, which is closest to the values of the antibiotic spectrum of interest to us, is located closer to 1448 cm-1 and 1446 cm-1, respectively. At the same time, in both observations, the peaks relate to the spectrum of bone tissue, which cannot indicate the content of an antibiotic in the drug. No scattering spectra corresponding to the antibiotic molecule were found in any animal from both groups, regardless of the mode of administration and dosage of amoxicillin. The detected peaks corresponded to bone tissue without an antibiotic.

A pilot study evaluating high dose esomeprazole, bismuth subcitrate and amoxicillin for eradicating Helicobacter pylori infection in Iran.

Helicobacter pylori (H. pylori) is strongly associated with peptic ulcer disease and gastric cancer. We evaluated two triple therapy regimens comprising esomeprazole, high dose bismuth, and different doses of amoxicillin for first-line H. pylori eradication. Two hundred patients with dyspepsia and naive H. pylori infection were randomly assigned into two groups (n = 100). Both groups were treated for 14 days similarly with esomeprazole (40 mg, twice daily) and bismuth subcitrate (240 mg, three times daily), but the dose of amoxicillin was varied between Groups A (750 mg) and B (1000 mg) three times daily. Treatment compliance and side effect were evaluated following the therapies and after 8 weeks, a negative test of stool H. pylori antigen confirmed eradication. The two groups were comparable with respect to sex and age. According to intention to treat analysis, eradication rates were 80% (95% CI: 77.2%-82.8%) and 90% (95% CI: 84.1%-95.9%) in A and B groups, respectively (p = 0.22). Per-protocol eradication rates were 87% (95% CI: 80.4%-93.6%) and 92.8% (95% CI: 87.7%-97.9%), respectively (p = 0.23). Severe adverse effects were 3% and 2%, respectively (p = 0.34). High dose esomeprazole, amoxicillin and bismuth achieved 92.8% cure rates per protocol in a country with a high background rate of resistance. Additional studies are needed to ascertain whether this therapy can be further improved. Until then, it can be recommended as a first-line H. pylori eradication in north of Iran.

THE DEVELOPMENTAL WINDOWS WHEN EXPOSURE TO ANTIBIOTICS INCREASES THE RISK OF EARLY ONSET COLORECTAL CANCER

Abstract Colorectal cancer is the third most diagnosed cancer and the second leading cause of cancer deaths in the US. About 50,000 people die from colorectal cancer each year. Early onset Colorectal cancer (EOCRC) is a colon and rectum cancer occurring in people under 50. There has been a decline in cases in people over 50 due to healthier lifestyle choices. However, in the last few decades there has been a steady increase in EOCRC cases, and we do not know why. The increase in EOCRC has paralleled the increased use of antibiotics. Antibiotics are especially important for fighting infections, but overuse has become an epidemic. Our study tested the hypothesis that exposure to antibiotics in early life causes dysbiosis and inflammation in the colon that can lead to an increased risk for EOCRC. To test the hypothesis a mice model was used. Female mice who have given birth are giving antibiotic treatment for 7 days, so the children are exposed to the antibiotics through their mother’s milk at an early age. The children are weaned from their mothers and at 5 weeks old they are given Azoyxmethane (AOM) treatment once a week for 6 weeks. Fecal pellets were collected before and after the AOM treatment of the kids and antibiotic treatment of the mother. The results show if given multiple dosages of amoxicillin there will be tumor burden in the proximal colon which can increase the risk for EOCRC.

Amoxicillin treatment of pneumococcal pneumonia impacts bone marrow neutrophil maturation and function.

Pneumonia caused by Streptococcus pneumoniae is a leading cause of death worldwide. A growing body of evidence indicates that the successful treatment of bacterial infections results from synergy between antibiotic-mediated direct antibacterial activity and the host's immune defenses. However, the mechanisms underlying the protective immune responses induced by amoxicillin, a β-lactam antibiotic used as the first-line treatment of S. pneumoniae infections, have not been characterized. A better understanding of amoxicillin's effects on host-pathogen interactions might facilitate the development of other treatment options. Given the crucial role of neutrophils in the control of S. pneumoniae infections, we decided to investigate amoxicillin's impact on neutrophil development in a mouse model of pneumococcal superinfection. A single therapeutic dose of amoxicillin almost completely eradicated the bacteria and prevented local and systemic inflammatory responses. Interestingly, in this context, amoxicillin treatment did not impair the emergency granulopoiesis triggered in the bone marrow by S. pneumoniae. Importantly, treatment of pneumonia with amoxicillin was associated with a greater mature neutrophil count in the bone marrow; these neutrophils had specific transcriptomic and proteomic profiles. Furthermore, amoxicillin-conditioned, mature neutrophils in the bone marrow had a less activated phenotype and might be rapidly mobilized in peripheral tissues in response to systemic inflammation. Thus, by revealing a novel effect of amoxicillin on the development and functions of bone marrow neutrophils during S. pneumoniae pneumonia, our findings provide new insights into the impact of amoxicillin treatment on host immune responses.

An in vitro dynamic bioreactor model for evaluating antimicrobial effectiveness on periodontal polymicrobial biofilms: a proof-of-concept study.

The aim of this study was to investigate an in vitro dynamic bioreactor model by evaluating the antimicrobial effect of clinically relevant amoxicillin doses on polymicrobial microcosm biofilms derived from subgingival plaque. Biofilms from pooled subgingival plaque were grown for 108 hours in control and experimental dynamic biofilm reactors. Amoxicillin was subsequently infused into the experimental reactor to simulate the pharmacokinetic profile of a standard 500mg thrice-daily dosing regimen over 5 days and biofilms were assessed by live/dead staining, scanning electron microscopy, and quantitative polymerase chain reaction. Following establishment of the oral microcosm biofilms, confocal imaging analysis showed a significant increase in dead bacteria at 8hours (p = 0.0095), 48hours (p = 0.0070), 96hours (p = 0.0140), and 120hours (p<0.0001) in the amoxicillin-treated biofilms compared to the control biofilms. Nevertheless, viable bacteria remained in the center of the biofilm at all timepoints. Significant reductions/elimination in Campylobacter rectus, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and Peptostreptococcus anaerobius was observed among the amoxicillin-treated biofilms at the 96 and 120hour timepoints. A novel in vitro dynamic model of oral microcosm biofilms was effective in modeling the antimicrobial effect of a pharmacokinetically simulated clinically relevant dose of amoxicillin.

Inhibition of Acinetobacter baumannii Biofilm Formation Using Different Treatments of Silica Nanoparticles.

There exists a multitude of pathogens that pose a threat to human and public healthcare, collectively referred to as ESKAPE pathogens. These pathogens are capable of producing biofilm, which proves to be quite resistant to elimination. Strains of A. baumannii, identified by the "A" in the acronym ESKAPE, exhibit significant resistance to amoxicillin in vivo due to their ability to form biofilm. This study aims to inhibit bacterial biofilm formation, evaluate novel silica nanoparticles' effectiveness in inhibiting biofilm, and compare their effectiveness. Amoxicillin was utilized as a positive control, with a concentration exceeding twice that when combined with silica NPs. Treatments included pure silica NPs, silica NPs modified with copper oxide (CuO.SiO2), sodium hydroxide (NaOH.SiO2), and phosphoric acid (H3PO4.SiO2). The characterization of NPs was conducted using scanning electron microscopy (SEM), while safety testing against normal fibroblast cells was employed by MTT assay. The microtiter plate biofilm formation assay was utilized to construct biofilm, with evaluations conducted using three broth media types: brain heart infusion (BHI) with 2% glucose and 2% sucrose, Loria broth (LB) with and without glucose and sucrose, and Dulbecco's modified eagle medium/nutrient (DMEN/M). Concentrations ranging from 1.0 mg/mL to 0.06 µg/mL were tested using a microdilution assay. Results from SEM showed that pure silica NPs were mesoporous, but in the amorphous shape of the CuO and NaOH treatments, these pores were disrupted, while H3PO4 was composed of sheets. Silica NPs were able to target Acinetobacter biofilms without harming normal cells, with viability rates ranging from 61-73%. The best biofilm formation was achieved using a BHI medium with sugar supplementation, with an absorbance value of 0.35. Biofilms treated with 5.0 mg/mL of amoxicillin as a positive control alongside 1.0 mg/mL of each of the four silica treatments in isolation, resulting in the inhibition of absorbance values of 0.04, 0.13, 0.07, 0.09, and 0.08, for SiO2, CuO.SiO2, NaOH.SiO2 and H3PO4.SiO2, respectively. When amoxicillin was combined, inhibition increased from 0.3 to 0.04; NaOH with amoxicillin resulted in the lowest minimum biofilm inhibitory concentration (MBIC), 0.25 µg/mL, compared to all treatments and amoxicillin, whereas pure silica and composite had the highest MBIC, even when combined with amoxicillin, compared to all treatments, but performed better than that of the amoxicillin alone which gave the MBIC at 625 µg/mL. The absorbance values of MBIC of each treatment showed no significant differences in relation to amoxicillin absorbance value and relation to each other. Our study showed that smaller amoxicillin doses combined with the novel silica nanoparticles may reduce toxic side effects and inhibit biofilm formation, making them viable alternatives to high-concentration dosages. Further investigation is needed to evaluate in vivo activity.

Amoxicillin overdose in the pediatric emergency department: A descriptive study

ObjectiveTo describe the characteristics of pediatric patients treated in the emergency department due to amoxicillin overdosing. MethodA retrospective single-center observational study was conducted on patients aged 0 to 16 years treated in a pediatric emergency department due to amoxicillin overdosing between 2011 and 2021. Epidemiological and anthropometric data was collected as well as information on the circumstances of overdosing, clinical manifestations, emergency department management, and discharge destination. ResultsThe study comprised 15 patients, 66.6% of them male, with a median age of 3.8 years (interquartile range: 1.9). The most frequent cause of overdosing was accidental ingestion (8/15; 53.3%). Amoxicillin was mainly ingested in liquid form, except for one case with autolytic attempt, where it was ingested in the form of tablets. Eighty percent of subjects (12/15) received a single dose of the drug. The median time to presentation to emergency department was 2.1 hours from ingestion (interquartile range: 2.7) and the median dose of amoxicillin was 219 mg/kg/dose (interquartile range: 148). All patients were asymptomatic, with a normal physical examination. Blood tests were performed in 7 patients (46.6%) and urinary sediment analysis in 2 (13.3%), all of them without alterations. Activated charcoal was administered to 5 (33.3%), patients with a median time to administration of one hour (interquartile range: 1.2). All patients were discharged to their homes. Eleven cases (73.3%) required withdrawal of amoxicillin. ConclusionsAmoxicillin overdosing in this study did not appear to result in adverse effects, despite the fact that the recommended doses were significantly exceeded.