Dose Of Amoxicillin Research Articles

Antibiotic resistance, heteroresistance, and eradication success of Helicobacter pylori infection in children.

Antibiotic resistance is a well-known factor of Helicobacter pylori eradication failure. Heteroresistance indicates the coexistence of resistant and susceptible strains and might lead to underestimating antimicrobial resistance. This study aims to evaluate the susceptibility profile, the frequency of heteroresistance of H. pylori strains, and their effect on eradication success in a pediatric population. Children aged 2-17 years who underwent an upper gastrointestinal endoscopy from 2011 to 2019 with positive H. pylori status were included. Susceptibility was measured by disk diffusion and E-test. The difference in susceptibility profiles between isolates from the antrum and the corpus was used to detect heteroresistance. For those who received eradication treatment, we evaluated eradication rate and factors affecting treatment success. Inclusion criteria were met by 565 children. Strains susceptible to all antibiotics were detected in 64.2%. Primary resistance rates for clarithromycin (CLA), metronidazole (MET), levofloxacin (LEV), tetracyclin (TET), and amoxicillin (AMO) were 11%, 22.9%, 6.9%, 0.4%, and 0% and secondary resistance rates were 20.4%, 29.4%, 9.3%, 0%, and 0%. Heteroresistance was present in untreated children in 2%, 7.1%, 0.7%, 0.7%, and 0% for CLA, MET, LEV, TET, and AMO. First-line eradication rates were 78.5% in intention-to-treat (ITT), 88.3% in full-analysis-set (FAS), and 94.1% in per-protocol (PP). Factors affecting eradication success were the duration of treatment when the triple-tailored treatment was used, the number of daily doses of amoxicillin administered, and the patient's adherence to treatment. This study shows the presence of relatively low primary resistance rates for H. pylori isolates but demonstrates the presence of heteroresistance in our population. Routine biopsies from the antrum and corpus must be considered for susceptibility testing to allow tailored treatments and increase eradication rates. Treatment success is affected by treatment choice, correct dosing of medications, and adherence. All these factors should be considered when evaluating the efficacy of an eradication regimen.

Antibiotic prescribing for children referred to an emergency dental clinic during the COVID-19 lockdown

Introduction During the COVID-19 pandemic, antibiotics for dental infections have been prescribed more frequently owing to reduced access to face-to-face appointments. Updated guidance emphasised antimicrobial prescribing for children. This study assessed whether the correct dose of antibiotics had been prescribed for children who were triaged by telephone at a dental emergency clinic in a London teaching hospital during the COVID-19 lockdown. Methods Data were collected for a retrospective service evaluation from the case notes of children whose parents had contacted the triage telephone line between May and September 2020. A proforma was used to extract information including the type of antibiotics that had been prescribed, the prescriber and the dose. Results Of the 815 children who were triaged via the telephone emergency clinic, 229 (28%) had received antibiotics. Three-quarters (n = 175, 76%) had been prescribed amoxicillin. Half of these (n = 88, 50%) had been prescribed a lower than recommended dose of amoxicillin; all incorrect dosages were prescribed by dentists in primary care. Patients aged 5–11 years were most affected by this (65%). Conclusions Incorrect antibiotic dose prescribing is a likely contributor to antimicrobial resistance as these patients often required further antimicrobial treatment. Our service evaluation highlights the importance of prescribing in line with the latest guidelines and literature.

Harmonization of Amoxicillin Dose, Duration, and Formulation for Acute Childhood Respiratory Infections.

Pediatric guidelines vary in their recommended amoxicillin dosing for common respiratory infections. It would help program delivery if there was harmonization of dosing and formulation of amoxicillin across multiple clinical respiratory infections, considering the pharmacokinetics, common targets, drug resistance, availability, cost effectiveness, and ease of administration. The World Health Organization EML AWaRe Book recommends higher dose amoxicillin given twice daily for five days for all uncomplicated respiratory infections where an antibiotic is indicated. The WHO AWaRe Book amoxicillin dosing guidance can be achieved for infants and older children using only scored 250 mg and 500 mg dispersible tablets (DTs), the WHO recommended child formulation. There is a clear need for wider availability of 250 mg/500 mg dispersible tablets of amoxicillin in both public and private health care sectors, to improve access to essential antibiotics.

Amoxicillin therapeutic drug monitoring for endocarditis: A comparative study (EI-STAB)

IntroductionInternational guidelines recommend high doses of β-lactams for most cases of infective endocarditis (IE). Therapeutic drug monitoring (TDM) is increasingly used to adjust β-lactam dose based on plasma concentrations, although there are no comparative studies to support this practice. The benefit of amoxicillin TDM during IE was evaluated. MethodsAn observational, retrospective, cohort study of adults treated with high-dose amoxicillin for enterococcal or streptococcal IE was conducted in two referral centers. Patients with, or without TDM were compared. The primary outcome was mean daily amoxicillin dose. ResultsA total of 206 cases of streptococcal (n=140, 68%) or enterococcal (n=66, 32%) IE were included. IE occurred on prosthetic valves in 77 (37%) cases, and on intracardiac devices in 28 (14%) cases. Aortic valve was involved in 136 (66%) cases. There were 154 men (75%), mean age was 70 ± 14 years, valve surgery was performed in 81/206 (39%) patients, and in-hospital mortality was 8% (17/206). All patients in the TDM group and most patients in the group without TDM received amoxicillin as continuous infusion. Amoxicillin TDM was performed for 114 patients (55.3%), with a mean of 4.7 ± 2.3 measures per patient, a mean plasma steady-state concentration of 41.2 ± 19 mg/L, most (82/114, 72%) being within the therapeutic target (20–80 mg/L). Mean amoxicillin dose was lower in patients with TDM (10.0 ± 3.3 g/day) than those without TDM (11.3 ± 2.0 g/day) (P=0.003). ConclusionAmoxicillin TDM was associated with a reduction in daily doses, with no impact on adverse events and prognosis. Individualized treatment of IE through TDM may contribute to decreased use of antibiotics.

Amoxicillin-Induced Neurotoxicity: Contribution of a Healthcare Data Warehouse to the Determination of a Toxic Concentration Threshold.

Amoxicillin (AMX)-induced neurotoxicity is well described and may be associated with AMX overexposure. No neurotoxic concentration threshold has been determined thus far. A better knowledge of maximum tolerable AMX concentrations is of importance to improve the safety of high doses of AMX. We conducted a retrospective study using the local hospital data warehouse EhOP® to generate a specific query related to AMX neurotoxicity symptomatology. All patient medical reports containing a mention of neurotoxicity clinical symptoms coupled with AMX plasma concentration measurements were explored. Patients were classified into two groups according to the imputability of AMX in the onset of their neurotoxicity, on the basis of chronological and semiological criteria. A receiver-operating characteristic curve was performed to identify an AMX neurotoxic steady-state concentration (Css) threshold. The query identified 101 patients among 2054 patients benefiting from AMX TDM. Patients received a median daily dose of 9 g AMX, with a median creatinine clearance of 51 mL/min. A total of 17 of the 101 patients exhibited neurotoxicity attributed to AMX. The mean Css was higher for patients with neurotoxicity attributed to AMX (118 ± 62 mg/L) than those without 74 ± 48 mg/L (p = 0.002). A threshold AMX concentration of 109.7 mg/L predicted the occurrence of neurotoxicity. This study identified, for the first time, an AMX Css threshold of 109.7 mg/L associated with an excess risk of neurotoxicity. This approach needs to be confirmed by a prospective study with systematic neurological evaluation and TDM.

Comparative Efficacy of Different Amoxicillin Dosing Regimens in Preventing Early Implant Failure—A Systematic Review with Network Meta-Analysis

The review was registered in PROSPERO [CRD42022319385]. A search was conducted for trials published in Medline, Cochrane, PubMed, and Scopus. A network meta-analysis was performed on the data from randomized controlled trials. Agents were ranked according to their effectiveness based on outcomes (implant failure, prosthetic failure, postsurgical complications, and adverse effects) using the surface under the cumulative ranking [SUCRA]. A total of 15 articles were included in the quantitative analysis. When compared to the placebo, 2 g of amoxicillin given 1 h preoperatively (RR = 0.42 (95%CI: 0.27, 0.67)), 2 g of amoxicillin given 1 h preoperatively with postoperative 500 mg thrice for 5 days (RR = 0.36 (95%CI: 0.15, 0.87)), and post-operative amoxicillin with clavulanic acid 625 mg 3 times daily for 5 days (RR = 0.38 (95%CI: 0.16, 0.90)) were effective in reducing early implant failures. In addition, 2 g of amoxicillin given 1 h preoperatively (RR = 0.42 (95%CI: 0.25, 0.73)) was the only protocol that was significant in the pairwise meta-analysis results. However, sensitivity analysis, which excluded trials with a high risk of bias, showed that none of the protocols were statistically significant in reducing early implant failure. A single 2 g dose of preoperative amoxicillin significantly reduces early implant failure in healthy individuals. More high-quality trials are required to establish this recommendation, as the quality of this evidence is weak.

Stage-, dose-, and course-dependent inhibition of prenatal amoxicillin exposure on fetal articular cartilage development in fetal mice

Amoxicillin is widely used in the treatment of infectious diseases during pregnancy; however, the effects of prenatal amoxicillin exposure (PAE) on fetal development remain largely unknown. Therefore, this study aimed to investigate the toxic effects of PAE on fetal cartilage at different stage-, dose-, and course. Pregnant Kunming mice were orally administered 300 mg/kg·d (converted from clinical dose) amoxicillin on gestational days (GD) 10–12 or 16–18 (mid or late pregnancy stage), 150 or 300 mg/kg.d amoxicillin on GD16–18 (different doses), 300 mg/kg·d amoxicillin on GD16 (single course) or 16–18 (multiple courses), respectively. The fetal articular cartilage of the knee was collected on GD18. The number of chondrocytes and the expression of matrix synthesis/degradation, proliferation/apoptosis-related markers, and the TGF-β signaling pathway were detected. The results showed that the number of chondrocytes and the expression of matrix synthesis markers were reduced in male fetal mice treated with PAE (GD16–18, 300 mg/kg.d, single course and multiple courses), whereas the above indices in female mice showed no changes. The inhibited expression of PCNA, increased expression of Caspase-3, and down-regulated expression of the TGF-β signaling pathway were found in male PAE fetal mice. Accordingly, PAE exerted its “toxic effect window” on the knee cartilage development in male fetal mice, which manifested as reduced chondrocyte number and inhibited expression of matrix synthesis at a clinical dose of multiple courses in the late pregnancy stage. This study provides a theoretical and experimental basis for elucidating the risk of chondrodevelopmental toxicity associated with amoxicillin during pregnancy.

Amoxicillin-docosahexaenoic acid encapsulated chitosan-alginate nanoparticles as a delivery system with enhanced biocidal activities against Helicobacter pylori and improved ulcer healing.

Encapsulation of amoxicillin (AMX) for drug delivery against Helicobacter pylori infection and aspirin-induced ulcers in rat's stomachs was performed using docosahexaenoic acid (DHA)-loaded chitosan/alginate (CA) nanoparticles (NPs) developed by ionotropic gelation method. The physicochemical analyses of the composite NPs were performed by scanning electron microscopy, Fourier transform infrared spectroscopy, zeta potential, X-ray diffraction, and atomic force microscopy. The encapsulation efficiency of AMX was increased to 76% by incorporating DHA, which resulted in a reduction in the particle size. The formed CA-DHA-AMX NPs effectively adhered to the bacteria and rat gastric mucosa. Their antibacterial properties were more potent than those of the single AMX and CA-DHA NPs as demonstrated by the in vivo assay. The composite NPs attained higher mucoadhesive potential during food intake than during fasting (p = 0.029). At 10 and 20 mg/kg AMX, the CA-AMX-DHA showed more potent activities against H. pylori than the CA-AMX, CA-DHA, and single AMX. The in vivo study showed that the effective dose of AMX was lower when DHA was included, indicating better drug delivery and stability of the encapsulated AMX. Both mucosal thickening and ulcer index were significantly higher in the groups receiving CA-DHA-AMX than in the groups receiving CA-AMX and single AMX. The presence of DHA declines the pro-inflammatory cytokines including IL-1β, IL-6, and IL-17A. The synergistic effects of AMX and the CA-DHA formulation increased the biocidal activities against H. pylori infection and improved ulcer healing properties.

The Main Statements of the Consensus “Maastricht-VI” (2022) on the Diagnostics and Treatment of <i>Helicobacter pylori</i> Infection

Aim: to present an analysis of the published materials of the consensus “Maastricht-VI” on the management of patients with Helicobacter pylori (H. рylori) infection.Key points. The content of the new consensus “Maastricht-VI” largely corresponds to that of the previous “Maastricht-V” consensus. This refers to the methods of diagnostics of this infection, indications for eradication. The introduction of eradication schemes of the 3rd and 4th lines, as well as a double scheme with increased doses of proton pump inhibitors (PPI) and amoxicillin can be considered new. The important role of measures that increase the effectiveness of eradication (14-day duration of the course, increasing the dose of PPI, the use of probiotics) is emphasized.Conclusion. The publication of materials of the new consensus “Maastricht-VI” will contribute to improving the results of H. рylori eradication therapy.

Direct toxicity of six antibiotics on soil bacterial communities affected by the addition of bio-adsorbents

Reducing the toxicity caused by antibiotics on bacterial communities in the soil is one of the great challenges of this century. For this, the effectiveness of amending the soil with different bioadsorbents such as crushed mussel shell (CMS), pine bark (PB) and biomass ash (BA), as well as combinations of them (CMS + PB and PB + BA) was studied at different doses (0 g kg−1 to 48 g kg−1). Soil samples were spiked, separately, with increasing doses (0–2000 mg kg−1) of cefuroxime (CMX), amoxicillin (AMX), clarithromycin (CLA), azithromycin (AZI), ciprofloxacin (CIP) and trimethoprim (TMP). Their toxicity on bacterial growth was estimated using the tritium-labeled leucine (3H) incorporation method. Toxicity was observed to behave differently depending on the antibiotic family and bioadsorbent, although in different magnitude and at different doses. The toxicity of β-lactams (AMX and CXM) was reduced by up to 54% when the highest doses of bio-adsorbents were added due to the increase in pH (CMS and BA) and carbon (PB) contribution. Macrolides (CLA and AZI) showed slight toxicity in un-amended soil samples, which increased by up to 65% with the addition of the bio-adsorbents. The toxicity of CIP (a fluoroquinolone) increased with the dose of the bio-adsorbents, reaching up to 20% compared with the control. Finally, the toxicity of TMP (a diaminopyrimidine) slightly increased with the dose of bio-adsorbents. The by-products that increase soil pH are those that showed the highest increases of CLA, AZI, CIP and TMP toxicities. These results could help to prevent/reduce environmental pollution caused by different kinds of antibiotics, selecting the most appropriated bio-adsorbents and doses.

Therapeutic eradication choices in Helicobacter pylori infection in children.

Current recommendations on Helicobacter pylori (H. pylori) eradication in children differ from adults. In H. pylori-infected adults, the eradication is always recommended because of the risk to develop gastrointestinal and non-gastrointestinal associated diseases. Instead, before treating infected children, we should consider all the possible causes and not merely focus on H. pylori infection. Indeed, pediatric international guidelines do not recommend the test and treat strategy in children. Therefore, gastroscopy with antimicrobial susceptibility testing by culture on gastric biopsies should be performed before starting the eradication therapy in children to better evaluate all the possible causes of the symptomatology and to increase the eradication rate. Whether antibiotic susceptibility testing is not available, gastroscopy is anyway recommended to better set any possible cause of symptoms and not simply focus on the presence of H. pylori. In children the lower antibiotics availability compared to adults forces to treat based on antimicrobial susceptibility testing to minimize the unsuccessful rates. The main antibiotics used in children are amoxicillin, clarithromycin, and metronidazole in various combinations. In empirical treatment, triple therapy for 14 days based either on local antimicrobial susceptibility or on personal antibiotic history is generally recommended. Triple therapy with high dose of amoxicillin is a valid alternative choice, either in double resistance or in second-line treatment. Moving from therapeutic regimens used in adults, we could also select quadruple therapy with or without bismuth salts. However, all the treatment regimens often entail unpleasant side effects and lower compliance in children. In this review, the alternative and not yet commonly used therapeutic choices in children were also analyzed.

About the use of antibiotics as a prevention of inflammatory complications in patients during dental implantation

Dentists often resort to systemic antibiotics to minimize the risk of inflammatory complications when performing dental implant surgery Literature data are ambiguous: a number of studies prove the need for systemic prescription of antibiotics for dental implantation, others say that antibiotic prophylaxis is an excessive measure that does not affect the outcome of treatment when other aseptic and antiseptic rules are followed.
 Materials and methods. The search was carried out on the online platforms Scopus, Web of Science, PubMed, Cochrane, ResearchGate, Online library, Elibrary. For the review, a search was performed on articles, mainly from the last 10 years, using randomization of patients, with a minimum follow-up period of 1 year. We compared 3 strategies for patient management: without antibiotic prophylaxis, using a prophylactic dose of the antibiotic amoxicillin, using a prolonged dose of amoxicillin. Clinical signs of wound healing, general well-being of the patient were assessed.
 Results. It has been shown in clinical practice that prescribing antibiotics at the time of dental implant placement is recommended, as this approach increases the likelihood of success and makes treatment more effective, but attention should be paid to rational antibiotic prescribing, with an adequate number of days of drug administration, to reduce the likelihood of the formation of antibiotic-resistant strains of microorganisms and minimize side effects. Most scientific studies indicate that the appointment of an antibiotic in the postoperative period does not increase the effectiveness of treatment in a contingent of patients without a burdened anamnesis.
 Conclusion. The results of the research allow to substantiate the advantages of perioperative antibiotic prophylaxis carried out before the dental implantation. A prophylactic dose of the antibiotic amoxicillin is the dominant approach for the prevention of early inflammatory complications of dental implantation. The wider use of microbiological diagnostic methods (including PCR diagnostics) to identify the carriage of representatives of periodontopathogenic bacteria in preparing a patient for dental implant surgery allows optimizing the indications. In this case, perioperative prophylaxis should be recognized as necessary.

Single-step Direct Drug Provocation Testing is Safe for Delabelling Selected Non−low-risk Penicillin Allergy Labels

To describe the outcome of an oral amoxicillin challenge in patients labeled allergic to penicillin.One hundred forty nine patients from 1 to 98 years of age labeled allergic to penicillin were included in the study.Patients were categorized as low risk (side effects, family history of penicillin allergy, remote [>5 years] history of penicillin allergy without IgE-mediated features, or unknown reaction not requiring hospitalization, n = 64) or nonlow risk (anaphylaxis, urticaria within 2 hours of penicillin administration, or angioedema with or without urticaria, n = 85). The low risk patients underwent challenge with a single dose of oral amoxicillin (125 mg for patients 1 to 11 months of age, 250 mg for 1 to 11 years, and 500 mg for all patients more than 12 years) followed by 2 hours of observation to evaluate for Gell and Coombs type 1/IgE-mediated/immediate-type hypersensitivity reactions. The nonlow risk patients underwent penicillin skin testing and if negative, oral amoxicillin challenge. Excluded patients were those with history of: (1) Gell and Coombs type 2 reactions, for example, hemolytic anemia or thrombocytopenia; (2) type 3 reactions, for example, serum sickness or vasculitis; or (3) severe type 4 or severe cutaneous adverse reactions, for example, Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis or drug reaction with eosinophilia and systemic symptoms.All (64 of 64, 100%) of the low risk patients tolerated the amoxicillin challenge without reaction during the observation period, although 3 developed a maculopapular rash subsequently. All (85 of 85, 100%) of the nonlow risk patients had negative penicillin skin testing, and 84 of 85 (99%) tolerated the amoxicillin challenge without reaction during the observation period, whereas 1 patient developed pruritus and rash that resolved with antihistamine treatment, and 2 subsequently developed a maculopapular rash.The authors conclude that a single step oral amoxicillin challenge is safe.Six percent of children are reported to be allergic to penicillin, although only about 5% of that 6% (0.3%) have positive penicillin skin tests. The remainder either never had IgE-mediated allergy or the allergy was lost over time. Being mislabeled as allergic to penicillin is not benign, but rather leads to suboptimal treatment, more side effects (eg, Clostridium difficile), higher costs, and more antibiotic resistance. Thus, there is currently a strong push to “delabel” the vast majority of children who are labeled as allergic to penicillin but are not. Children are typically referred to allergists to undergo oral amoxicillin challenges under observation with or without prior penicillin skin testing, depending on the history. However, this paper suggests that, given the safety of these challenges, consideration can be given to performing them in pediatricians’ offices. If a careful history excludes patients with histories of “nonlow risk” immediate allergic reactions and those with serious nonimmediate reactions, the remainder with low risk histories can undergo a single dose oral amoxicillin challenge, which the vast majority will tolerate and can be successfully “delabeled.”URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1016/j.anai. 2021.04.008

Development of Thermoresponsive-Gel-Matrix-Embedded Amoxicillin Trihydrate-Loaded Bovine Serum Albumin Nanoparticles for Local Intranasal Therapy.

A high dose of amoxicillin is recommended as the first-line therapy for acute bacterial rhinosinusitis (ABR). However, oral administration of amoxicillin is connected to many adverse reactions coupled with moderate bioavailability (~60%). Therefore, this study aimed to develop a topical nasal preparation of amoxicillin, employing a thermoresponsive nanogel system to increase nasal residence time and prolong drug release. Rheological investigations revealed that formulations containing 21-23% w/w Poloxamer 407 (P407) were in accordance with the requirement of nasal administration (gelling temperature ~35 °C). The average hydrodynamic diameter (<200 nm), pH (6.7-6.9), and hypertonic osmolality (611-663 mOsmol/L) of the in situ gelling nasal nanogel appeared as suitable characteristics for local rhinosinusitis treatment. Moreover, taking into account the mucoadhesive strength and drug release studies, the 21% w/w P407 could be considered as an optimized concentration for effective nasal delivery. Antibacterial activity studies showed that the ability of amoxicillin-loaded in situ gelling nasal nanogel to inhibit bacterial growth (five common ABR pathogens) preserved its effectiveness in comparison to 1 mg/mL amoxicillin aqueous solution as a positive control. Altogether, the developed amoxicillin-loaded in situ gelling thermoresponsive nasal nanogel can be a potential candidate for local antibiotic therapy in the nasal cavity.

Amoxicillin dosing and pharmacokinetics in obesity for the treatment of bacterial respiratory infection secondary to COVID-19: a systematic review

Objective: To conduct a systematic review of Amoxicillin (AMX) dosing and pharmacokinetics (PK) in obese subjects for the treatment of the outpatient respiratory tract infection which may be a secondary co-infection with COVID-19. Methodology: A systematic review was performed up to January 2022 on MEDLINE, EMBASE, and Web of Science. Full-text manuscripts describing AMX dosing for respiratory infection or PK in obese children, adults, and RYGB bariatric patients treated with AMX were included. Results: A total of 179 records were screened, of which 8 met the inclusion criteria. Four studies described AMX dosing in obese children and adults, while 4 described PK in obese adults and RYGB bariatric subjects. Overall, in the dosing studies, 54% of children >20 kg and 10% <40 kg with respiratory infection were considered underdosed, according to guidelines or recommendations. Underdosing of 10% occurred in both overweight and non-obese children’s groups. For morbidly obese adults, 70% were considered underdosed. In the PK studies, obese and bariatric adult subjects showed reduced exposure compared to normal weight patients for all AMX formulations. Conclusion: More PK studies are needed to confirm the optimal dose of AMX for obese patients, particularly in children. However, considering that all obese and bariatric adults had reduced exposure compared to subjects of normal weight, 1 g 8/8h should be recommended and liquid formulations are preferable for bariatric patients. To minimize the risks of therapeutic failure and avoid toxicity, a higher threshold of doses should be prescribed for obese children.

S3684 Treating Helicobacter pylori via IV Route in a Patient With Malabsorption Due to Gastric Bypass Surgery

Introduction: Helicobacter pylori (H. pylori) is checked in all patients off of proton pump inhibitor (PPI) therapy prior to Roux-en-Y surgery because of the risk for ulcers and their complications. Ulcers carry a potential for bleeding; and if located in the excluded stomach, it would not be possible to reach by scope. Over time, H. pylori has become more difficult to treat. Failed attempts at treatment are usually attributed to poor medication adherence or antibiotic resistance.1 This case highlights a patient with treatment resistant H. pylori infection after Roux-en-Y gastric bypass. Case Description/Methods: A 48-year-old female with a history of Roux-en-Y performed in 2012 due to obesity presented to clinic with ongoing abdominal pain, nausea, 18 kg weight loss, and poor oral intake. She was initially diagnosed with H. pylori in 2014, with EGD and gastric biopsies revealing chronic active gastritis with H. pylori. She reported being treated twice without eradication. Repeat EGD took place in 2020 with persistent H. pylori on biopsy. She was prescribed quadruple therapy: bismuth subcitrate potassium, metronidazole, tetracycline, and PPI. Despite this, she did not clear the infection. She was re-biopsied and tissue specimen was sent for susceptibility. Results only showed resistance to metronidazole. Based on susceptibilities, she was prescribed high dose amoxicillin three times daily and rabeprazole. Despite appropriate therapy, she tested positive once again. It became clear that the etiology of treatment resistance was secondary to malabsorption. She was ultimately treated with IV ampicillin, IV levofloxacin, and omeprazole for 10 days. Finally, her stool antigen studies returned negative. Discussion: This case describes a patient with history of gastric bypass surgery who had persistent infection with H. pylori despite completing appropriate therapies. She was treated with an oral regimen in accordance to susceptibilities without clearance, suggesting malabsorption secondary to her gastric anatomy was rendering treatment ineffective. This predicament was overcome by administering antibiotics intravenously. This case brings to light the need for further research regarding treatment of H. pylori in the setting of malabsorption, as this not clearly outlined in current guidelines or literature.

Current Epidemiologic Status and Public Health Importance of Listeriosis: A Review

Listeriosis is a bacterial disease caused by different listeria species, among which Listeria monocytogenes are the most pathogenic species of ruminant animals and humans. This paper aimed to review current updates on the epidemiology and public health significance of listeriosis. The disease is an acute central nervous system infection, with associated abortions occurring in pregnant cattle. Reservoirs of infection are the soil and the intestinal tracts of asymptomatic animals, including wild and feral mammals, birds, and fish. Listeria, like other infections, occurs through ingestion as well as inhalation or direct contact and venereal transmission. In animals, listeriosis typically occurs after the consumption of contaminated silage or other feed sources. Consequently, contaminated food sources, such as raw meat and fish, unpasteurized dairy products, and uncooked vegetables, are good sources of infection in humans. The major clinical forms of listeriosis in cattle are encephalitis, abortion, Mastitis, iritis, The major clinical forms of listeriosis in cattle are encephalitis, abortion, mastitis, ophthalmitis, and keratoconjunctivitis ophthalmitis, iritis and keratoconjunctivitis. The disease can be tentatively diagnosed based on clinical symptoms, and its confirmation is achieved through serological tests and blood culture. Listeriosis shares similar clinical signs with other diseases, such as rabies, Coenurosis, and Scrapie. Response to antibiotic therapy may be poor in neural listeriosis. Prolonged high doses of ampicillin or amoxicillin combined with aminoglycosides may effectively prevent listeriosis in animals. Generally, disease prevention heavily depends on the protection of animal feed and vaccination. Moreover, humans are recommended to avoid eating and drinking uncooked meat and unpasteurized milk products.

Clinical utility of a model-based amoxicillin dosage regimen in neonates with early-onset sepsis.

Early-onset sepsis (EOS) is one of the most significant causes of morbidity and mortality in neonates. Currently, amoxicillin is empirically used to treat neonates with EOS. However, data on its effectiveness in neonates with EOS are still limited. Therefore, we aimed to evaluate the pharmacodynamics (PD) target attainment and effectiveness of a model-based amoxicillin dosage regimen in these neonates. We used a previously developed model and collected additional clinical data from the EOS neonates who used the model-based dosage regimen (25 mg/kg every 12 h). The primary outcomes were PD target attainment (free drug concentration above minimum inhibitory concentration during 70% of the dosing interval) and treatment failure rate. The secondary endpoints were length of amoxicillin treatment, duration of hospitalization etc. Seventy-five neonates (postmenstrual age 28.4-41.6wk) were enrolled. A total of 70 (93.3%) neonates reached their PD target using 1mg/L as the minimum inhibitory concentration breakpoint. The treatment failure rate was 10.7%.

Steering Away from Current Amoxicillin Dose Reductions in Hospitalized Patients with Impaired Kidney Function to Avoid Subtherapeutic Drug Exposure.

Current dose reductions recommended for amoxicillin in patients with impaired kidney function could lead to suboptimal treatments. In a prospective, observational study in hospitalized adults with varying kidney function treated with an IV or oral dose of amoxicillin, amoxicillin concentrations were measured in 1–2 samples on the second day of treatment. Pharmacometric modelling and simulations were performed to evaluate the probability of target attainment (PTA) for 40% of the time above MIC following standard (1000 mg q6h), reduced or increased IV dosing strategies. A total of 210 amoxicillin samples was collected from 155 patients with kidney function based on a CKD-EPI of between 12 and 165 mL/min/1.73 m2. Amoxicillin clearance could be well predicted with body weight and CKD-EPI. Recommended dose adjustments resulted in a clinically relevant reduction in the PTA for the nonspecies-related PK/PD breakpoint MIC of 8 mg/L (92%, 62% and 38% with a CKD-EPI of 10, 20 and 30 mL/min/1.73 m2, respectively, versus 100% for the standard dose). For MICs ≤ 2 mg/L, PTA > 90% was reached in these patients following both reduced and standard dose regimens. Our study showed that for amoxicillin, recommended dose reductions with impaired kidney function could lead to subtherapeutic amoxicillin concentrations in hospitalized patients, especially when targeting less susceptible pathogens.

The efficacy of vonoprazan combined with different dose amoxicillin on eradication of Helicobacter pylori: an open, multicenter, randomized clinical study.

BackgroundThe use of vonoprazan (VPZ) has improved the Helicobacter pylori (H. pylori) eradication therapy in Japan. There is no agreement on the dosage and frequency of amoxicillin administration in the VPZ dual treatment in China. We aimed to investigate the clinical effectiveness and safety of 3 treatment regimens using VPZ as an acid-suppressing medication to eradicate H. pylori.MethodsThis experiment involved an open, multicenter, randomized, and parallel controlled clinical investigation. A total of 230 newly diagnosed H. pylori-infected patients were then randomly assigned to 1 of 3 groups: (I) H-VA (high-dose amoxicillin combined with VPZ): VPZ 20 mg b.i.d with amoxicillin 750 mg q.i.d for 7 days; (II) L-VA (low-dose amoxicillin combined with VPZ): VPZ 20 mg b.i.d plus amoxicillin 500 mg q.i.d for 7 days; (III) VAC (amoxicillin combined with VPZ and clarithromycin): VPZ 20 mg b.i.d plus amoxicillin 750 mg plus clarithromycin 500 mg for 7 days. At least 4 weeks after treatment, the urea breath test (UBT) was reexamined. The effectiveness of various regimens was assessed based on compliance, safety, and eradication rate.ResultsThe regimen effectiveness was 63.5% (54/85) in the H-VA group, 58.3% (49/84) in the L-VA group, and 60.7% (37/61) in the VAC group, according to intention to treat (ITT) analysis. According to per protocol (PP) analysis, the eradication rate of the H-VA group was 65.1% (54/83), that of the L-VA group was 66.2% (49/74), and that of the VAC group was 64.9% (37/57). There was no discernible difference in the eradication rate across the 3 regimens, as shown by the results of ITT analysis (χ2=0.032, P=0.984) and PP analysis (χ2=0.480, P=0.786). The rate of adverse effect was 16.90% in the H-VA group, 13.20% in the L-VA group, and 24.10% in the VAC group. There was no discernible difference in the incidence of adverse effect between the three groups (χ2=2.784, P=0.266).ConclusionsNone of the 7-day elimination regimens investigated in this study, which included the acid-suppressing medicine VPZ and either a dual treatment paired with amoxicillin, or a triple treatment combined with amoxicillin and clarithromycin, achieved an acceptable eradication rate of H. pylori. Further research is required to identify an effective and safe treatment regimen.Trial RegistrationChinese Clinical Trial Registry identifier: ChiCTR2000040955.