Side Effects Of Antibiotics Research Articles

Prescription of antibiotics for urinary tract infections in outpatient care in Bavaria: An analysis of routine data.

Patients with urinary tract infection (UTI) in German outpatient care are usually treated by general practitioners (GPs), as well as by other specialties. To prevent antibiotic resistances and side effects, German guidelines recommend fosfomycin, nitrofurantoin, pivmecillinam and nitroxoline as first-line treatments, and advice against broad-spectrum antibiotics such as fluoroquinolones and cephalosporins. However, data from the European Centre for Disease Prevention and Control indicates a significant proportion of second-line antibiotics in German outpatient care. Our aim was to analyze whether antibiotic prescription has changed over time in accordance with guidelines. In addition, we aimed to investigate whether specialties prescribe different antibiotics for UTIs and whether prescription varies according to patient age and sex. For patients receiving more than one antibiotic, we wanted to determine whether subsequent prescriptions show a change in substances and specialties involved. This retrospective study involved routine data (2013 to 2019) provided by the Bavarian Association of Statutory Health Insurance Physicians. Data on diagnoses and prescriptions were transmitted from outpatient care physicians on a quarterly basis. UTI patients ≥12 years were included. We analyzed 1.7 million UTI prescription cases. In females, shares of fluoroquinolones decreased sharply over time, while shares of first-line substances fosfomycin and pivmecillinam increased. Gynecologists showed the highest shares of first-line substances compared to GPs and urologists. Fluoroquinolone shares decreased in all three specialty groups. In females, older patients showed lower shares of first-line substances than younger patients. If a second or third antibiotic was prescribed, fosfomycin shares decreased, while shares of nitrofurantoin, nitroxoline and cephalosporins increased. Our findings show a trend towards a more guideline-adherent prescribing in the treatment of UTI, with a significant increase of shares of fosfomycin and pivmecillinam, especially in women, and a sharp decrease of shares of fluoroquinolones.

Discovery of Cinnamic Acid Derivatives as Potent Anti-H. pylori Agents

Antibiotics are currently used for the treatment of Helicobacter pylori (H. pylori), which is confirmed to be the major cause of gastric disorders. However, the long-term consumption of antibiotics has already caused antibiotic resistance and side effects in vivo. Therefore, there is an emerging need for searching for safe and effective anti-H. pylori agents. Inspired by the excellent bioactivities of cinnamic acid, a series of cinnamic acid derivatives (compounds 1–30) were synthesized and determined for H. pylori inhibition. The initial screening revealed that compound 23, a 2,4-dinitro cinnamic acid derivative containing 4-methoxyphenol, showed excellent H. pylori inhibition with an MIC value of 4 μM. Further studies indicated that compound 23 showed anti-bacterial activity and had a bactericidal effect on H. pylori due to the destruction of the bacterial structure. Molecular docking analysis revealed that the 2,4-dinitro groups in cinnamic acid moiety formed hydrogen bonding with amino acid residues in an active pocket of H. pylori protein. Interestingly, the ester moiety fitted into the hydrophobic pocket, attaining additional stability to compound 23. Above all, the present study reveals that compound 23 could be considered a promising anti-H. pylori agent to treat H. pylori causing gastritis.

Stop antibiotics when you feel better? Opportunities, challenges and research directions.

Shortening standard antibiotic courses and stopping antibiotics when patients feel better are two ways to reduce exposure to antibiotics in the community, and decrease the risks of antimicrobial resistance and antibiotic side effects. While evidence shows that shorter antibiotic treatments are non-inferior to longer ones for infections that benefit from antibiotics, shorter courses still represent average treatment durations that might be suboptimal for some. In contrast, stopping antibiotics based on improvement or resolution of symptoms might help personalize antibiotic treatment to individual patients and help reduce unnecessary exposure. Yet, many challenges need addressing before we can consider this approach evidence-based and implement it in practice. In this viewpoint article, we set out the main evidence gaps and avenues for future research.

Probiotics as a Therapeutic Approach for Non-infectious Gastric Ulcer Management: a Comprehensive Review.

A gastric ulcer is a stomach lining or nearby intestine disruption caused by acid and pepsin. Helicobacter pylori (H. pylori) and NSAIDs are the primary culprits behind stomach infections that can lead to gastric ulcers and other digestive disorders. Additionally, lifestyle choices such as alcohol consumptionand cigarette smoking, stress, and exposure to cold environments can also contribute to non-infectious gastric ulcers. Various treatments are available for gastric ulcers, including antibiotics, anticholinergics, and antacids. However, potential concerns include antibiotic resistance, side effects, and treatment failure. Considering this, there is a need for an alternative approach to manage it. Fortunately, probiotics, typically Lactobacillus and Bifidobacterium, show potential for healing gastric ulcers, offering a non-invasive alternative to conventional treatments. A notable concern arises from applying probiotic bacteria stemming from the propensity of pathogenic bacteria to develop antimicrobial resistance in response to antibiotic therapies. Therefore, the use of yeast becomes more imperative due to its natural resistance to antibacterial antibiotics for antibacterial-treated patients. Probiotic bacteria and yeasts could heal gastric ulcers by regulating the immune response, reducing inflammation, and restoring the balance between defensive and aggressive factors of the gastric layer. This comprehensive review provides an in-depth analysis of the benefits of probiotics and their potential as a therapeutic treatment for non-infectious gastric ulcers, along with other probiotic options. In particular, this review provides a succinct summary of multiple literature studies on probiotics, emphasising the distinctive properties of yeast probiotics, as well as their (bacteria and yeasts) application in the management of non-infectious gastric ulcers.

Antimicrobial Potential of Polyphenols: An Update on Alternative for Combating Antimicrobial Resistance.

The last decade has encountered an increasing demand for plant-based natural antibiotics. This demand has led to more research-based investigations for natural sources of antimicrobial agents and published reports demonstrating that plant extracts are widely applied in modern medicine, reporting potential activity that may be due to polyphenol compounds. Interestingly, the effects of polyphenols on the sensitivity of bacteria to antibiotics have not been well-studied. Hence, the current review encompasses the prospective application of plant-based phenolic extracts from plants of Indian origin. The emergence of resistance to antimicrobial agents has increased the inefficacy of many antimicrobial drugs. Several strategies have been developed in recent times to overcome this issue. A combination of antimicrobial agents is employed for the failing antibiotics, which restores the desirable effect but may have toxicity-related issues. Phytochemicals such as some polyphenols have demonstrated their potent activity as antimicrobial agents of natural origin to work against resistance issues. These agents alone or in combination with certain antibiotics have been shown to enhance the antimicrobial activity against a spectrum of microbes. However, the information regarding the mechanisms and structure-activity relationships remains elusive. The present review also focuses on the possible mechanisms of natural compounds based on their structure- activity relationships for incorporating polyphenolic compounds in the drug-development processes. Besides this work, polyphenols could reduce drug dosage and may diminish the unhidden or hidden side effects of antibiotics. Pre-clinical findings have provided strong evidence that polyphenolic compounds, individually and in combination with already approved antibiotics, work well against the development of resistance. However, more studies must focus on in vivo results, and clinical research needs to specify the importance of polyphenol-based antibacterials in clinical trials.

Screening of phenolic components and antimicrobial properties of Iris persica L. subsp. persica extracts by in vitro and in silico methods

AbstractThe tendency toward natural herbal products has increased due to the antibiotic resistance developed by microorganisms and the severe side effects of antibiotics commonly used in infectious diseases worldwide. Although antimicrobial studies have been conducted with several species of the Iris genus, this study is the first in the literature to be performed with Iris persica L. subsp. persica aqueous and methanol extracts. In this study, the phenolic content of I. persica was determined by LC–MS/MS analysis, the in vitro antimicrobial activity of I. persica aqueous and methanol extracts was examined, and this study was supported by in silico analysis. Consequently, methanol and aqueous extracts were observed to have inhibitory effects against all tested microorganisms except Candida krusei. Although the MIC values of aqueous extract and methanol extract against Staphylococcus aureus and Klebsiella pneumoniae are the same (22.5 and 11.25 mg/mL, respectively), the inhibitory effect of aqueous extract is generally more potent (MIC value is 11.25 mg/mL for Candida parapsilosis and other bacterial species, and 90 mg/mL for Candida albicans and Candida tropicalis) than that of methanol extract. In silico results showed that hydroxybenzaldeyde, vanillin, resveratrol, isoquercitrin, kaempferol‐3‐glucoside, fisetin, and luteolin were more prone to antifungal activity. Hence, shikimic, gallic, protocatechuic, vanillic, caffeic, o‐coumaric, trans‐ferulic, sinapic acids, and hesperidin were more prone to antibacterial activity. In vitro and in silico results show that the antibacterial activity of our extracts may be higher than the antifungal activity. This preliminary study indicates the anti‐infective potential of I. persica extracts and their usability in medicine and pharmacology.

Understanding the bacteria in Mycobacterium avium complex (MAC) from a bioinformatic perspective – a review

Mycobacterium avium complex (MAC) houses a group of non-tuberculous mycobacteria causing pulmonary and disseminated infections. They are accountable for nodular bronchiectatic and fibrocavitary lung diseases in humans, Johne’s disease in ruminants, and respiratory diseases in birds. MAC infections pose challenges, owing to antibiotic resistance, prolonged therapy with antibiotic combinations, side effects, and risk of reinfections. Our objective was to summarize the outcome of computational research on the bacteria in MAC. This aimed to advance our understanding of characteristics, pathogenicity, and transmission dynamics to control infections. We incorporated information from the research on genomes, microbiomes, phylogeny, transcriptomes, proteomes, antibiotic resistance, and vaccine/drug target development to enhance our knowledge. It illuminated the significance of computational studies in distinguishing MAC species/subspecies and recognizing: virulence factors, lineage-specific markers, and transmission clusters. Moreover, it assisted in understanding: genomic diversity, resistance patterns, impact of polymorphisms in disease susceptibility, and taxa-induced dysbiosis in microbiomes. Additionally, this work highlighted the outcome of bioinformatic studies in predicting suitable vaccine epitopes, and novel drug targets to combat MAC infections. Bioinformatic research on bacteria within MAC has contributed to a deeper insight into the pathogens. These would facilitate better diagnosis, improved: therapeutic strategies, patient-specific surveillance, and community-level awareness.

PGC-1α-mediated imbalance of mitochondria-lipid droplet homeostasis in neomycin-induced ototoxicity and nephrotoxicity

Ototoxicity and nephrotoxicity are the most prevalent side effects of aminoglycoside antibiotics (gentamicin, amikacin, neomycin) and platinum anti-tumor drugs (cisplatin, carboplatin). The inner ear and kidney share similarities in drug deposition and toxicity, but the underlying pathophysiological mechanisms remain unclear. Investigating the shared mechanisms and metabolic alterations in these distinct organs will provide valuable insights for clinical therapy. A strong correlation has been identified between the spatiotemporal accumulation patterns of neomycin and the specific occurrence of lipid metabolism disorders in these two organs. The primary allocation of neomycin to mitochondria results in a notable escalation in the accumulation of lipid droplets (LDs) and more interactions between mitochondria and LDs, leading to a sequence of disturbances in lipid metabolism, such as increased lipid ROS and the blocked transfer of fatty acids from LDs to mitochondria. PGC-1α deficiency worsens the neomycin-induced disorders in lipid metabolism and intensifies the pathological interactions between mitochondria and LDs, as indicated by the exacerbated disturbance of dynamic LD turnover, increased level of oxidized lipids and decreased use of fatty acids. This investigation provides a fresh perspective on the lipid metabolic dysfunction related to mitochondria–LD interactions in drug-induced ototoxicity and nephrotoxicity, potentially providing novel avenues for intervention strategies.

Influence of antibiotics on the development of mitochondrial dysfunction.

Antibiotics are an indispensable component of therapeutic strategies in the treatment of severe bacterial infections. Unfortunately, in addition to the emerging resistance of bacteria to antibiotics, side effects are an important problem with their use. Knowledge of the mechanisms underlying the development of side effects can make it possible to understand how it is possible to reduce their negative impact on the health of patients. One of the negative effects of antibiotics on the human organism is interference with homeostasis and the functioning of mitochondria. Side effects of antibiotics based on this influence require further study. Here we consider the mitochondria as a side target of antibiotics and the main strategies of antibiotics that cause mitochondrial dysfunction. Options are also considered on how to deal with this problem and even use it for good.

Comparative evaluation of fermented ginseng on alleviating antibiotic-associated diarrhea in mice.

Antibiotic associated diarrhea (AAD) was a common side effect of antibiotics, and fermented ginseng exhibited potential in treating AAD. In this study, the effects of fermented red, white, and black ginseng on AAD were investigated, with a focus on intestinal flora and inflammation. Clindamycin was used to induce AAD in mice, which caused severe diarrhea and weight loss. However, treatment with fermented ginseng effectively alleviated diarrhea, and reduced inflammation in colonic serosal tissue, thereby mitigating antibiotic-induced intestinal tissue damage. 16S rRNA sequencing revealed that clindamycin disrupted the Bacteroides/Firmicutes ratio (P < 0.001), which was reversed by fermented ginseng treatment. Furthermore, inflammatory cytokines like IL-1β, IL-6, and TNF-α significantly decreased (P < 0.05) after clindamycin treatment but returned to normal levels following fermented ginseng treatment. In conclusion, fermented red, white, or black ginseng (at a dosage of 0.5g/kg) exhibited efficacy against AAD in mice, reinstating gut flora balance and easing inflammation.

Listeria brain abscess: a therapeutically challenging rare presentation of listeriosis

We report a very rare case of Listeria multiple brain abscesses manifested as delirium, which represented diagnostic and therapeutic challenges overcome only by the close cooperation between Infectious Diseases and Neuroradiology, without which a satisfactory outcome would not be achieved.An elderly man presented with confusion and drowsiness with a background of type-II diabetes mellitus. Although computed tomography of the brain only showed frontal lobe oedema, contrast magnetic resonance (MR) imaging showed numerous irregular rim-enhancing lesions containing central diffusion restriction, suggesting multiple pyogenic cerebral abscesses of unclear aetiology. Thereafter, Listeria monocytogenes was isolated from blood cultures, suggesting this as the causative organism. Deemed unsuitable for neurosurgical drainage, the patient received medical management with a protracted course of antibiotics. This case was extremely challenging, due to 1) the impossibility of source control, 2) the small number of effective antibiotics available to treat this condition, and 3) the inevitable antibiotic side-effects, derived from long-term exposure. A successful outcome was only possible thanks to strict close multidisciplinary follow up, requiring frequent MR imaging and a judicious antibiotic choice, including monitoring of their side-effects. Due to the rarity of this condition, there is lack of guidance on its management, hence the importance of multidisciplinary involvement with very close imaging and antibiotic monitoring.

Antibiotic-associated microbiotoxicity and possible ways of its prevention. Review

In recent years, there has been an exponential increase in interest to the human microbiome, a community of living microorganisms that colonize all external and internal surfaces of the body together with their microbial metabolites, organic compounds, and genetic material. Gut microbes are involved in a wide range of physiological functions, including the production of essential vitamins, bile salts, and short‑chain fatty acids such as butyrate; they inhibit tumor formation and inflammation, regulate glucose, lipid and energy exchanges; regulate adaptive immunity; play a central role in the development of immune tolerance to microbial and non‑microbial antigens and maintenance of the integrity of protective barriers. Resident microbes are important in the production of neurotransmitters including dopamine, serotonin and γ‑aminobutyric acid, as well as hormones such as glucagon‑like peptide 1 and a complex network of neurological, endocrine and microbial components involved in the homeostasis of the gut–microbiota–brain axis. Numerous studies have established the association between antimicrobial use, microbiome damage, and adverse health outcomes. Recently, by analogy with nephrotoxicity or hepatotoxicity, a new term «microbiotoxicity» has been proposed, which encompasses the unwanted side effects of antibiotics on the patient’s microbiome. It is emphasized that clinicians must carefully weigh the benefits of antibiotics in the treatment of infections against their microbiotoxic effects when making individual decisions about prescribing antibiotic therapy. An exception to this is rifaximin, with its atypical antimicrobial effects it is able to induce positive modulation of intestinal microflora, creating a favorable environment for the growth of bacteria useful for the host organism without changing their general composition. The review gives analysis of the role of the microbiome as a complex immunological, endocrine, and neurological ecosystem and the potentially harmful consequences of antibiotic exposure to it.

Blood cellular membrane-coated Au/polydopamine nanoparticle-targeted NIR-II antibacterial therapy

Bacterial infections are the primary causes of infectious diseases in humans. In recent years, the abuse of antibiotics has led to the widespread enhancement of bacterial resistance. Concerns have been raised about the identification of a common treatment platform for bacterial infections. In this study, a composite nanomaterial was used for near-infrared II (NIR-II) photothermal antibacterial treatment. Red blood cell membrane was peeled and coated onto the surface of the Au/polydopamine nanoparticle-containing aptamer. The composite nanomaterials based on Au/polydopamine exhibit highest photothermal conversion capability. Moreover, these assembled nanoparticles can quickly enter the body’s circular system with a specific capability to recognise bacteria. In vivo experiments demonstrated that the composites could kill bacteria from infected blood while significantly reducing the level of bacteria in various organs. Such assemblies offer a paradigm for the treatment of bacterial infections caused by the side effects of antibiotics.

Knowledge, perceptions, and beliefs about urinary tract infections in persons with neurogenic bladder and impacts on interventions to promote person-centered care.

Qualitative study. To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management. Three Veterans Affairs (VA) medical centers. Adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) with UTI diagnoses in the prior year participated in focus groups. Transcripts were coded using deductive codes linked to the Health Belief Model and inductive codes informed by grounded theory. Twenty-three Veterans (SCI/D, 78%; MS: 18.5%) participated in discussions. Three themes emerged: (1) UTI knowledge; (2) factors affecting the intervention environment; and (3) factors affecting modes of delivery. Knowledge gaps included UTI prevention, specific symptoms most indicative of UTI, and antibiotic side effects. Poor perceptions of providers lacking knowledge about NB and ineffective patient-provider communication were common in the Emergency Department and non-VA facilities, whereas participants had positive perceptions of home-based care. Participants perceived lower severity and frequency of antibiotic risks compared to UTI risks. Participant preferences for education included caregiver involvement, verbal and written materials, and diverse settings like peer groups. Identifying patient perspectives enhances person-centeredness and allows for novel interventions improving patient knowledge and behaviors about UTIs. Partnering with trusted providers and home-based caregivers and improving NB knowledge and communication in certain care settings were important. Patient education should address mental risk representations and incorporate preferences for content delivery to optimize self-efficacy and strengthen cues to action.

Ceftaroline for Central Nervous System Infections: Case Report of a Young Infant, and Scoping Review.

Managing health care acquired and device-associated intracranial infections in young children can be challenging given adverse antibiotic side effects and difficulties in achieving adequate central nervous system (CNS) antibiotic concentrations. Ceftaroline is a cephalosporin with a favorable safety profile and activity against methicillin-resistant Staphylococci and several Gram-negative organisms. Published data on the use of ceftaroline for CNS infections in children and adults are limited. We describe a 2-month-old infant with ventriculo-subgaleal shunt-associated methicillin-resistant Staphylococcus epidermidis ventriculitis, which was successfully treated with ceftaroline, in addition to vancomycin and rifampin. We conducted a scoping review of English-language literature retrieved from PubMed, EMBASE and Web of Science that assessed the use of ceftaroline for CNS infections. We identified 22 articles for inclusion in our review, which described 92 unique patients, of whom 2 were <21 years old. Ceftaroline was commonly used in conjunction with other antibiotics to treat infections caused by Staphylococcus aureus , coagulase-negative Staphylococci and Streptococcus pneumoniae . Most case reports described clinical success with ceftaroline, though small case series and cohort studies yielded mixed efficacy assessments. Adverse effects attributed to ceftaroline were rare and included reversible myelosuppression, eosinophilia, hepatotoxicity and nephrotoxicity. Pharmacokinetic/pharmacodynamic studies suggested similar CNS penetration through inflamed meninges as other beta lactam antibiotics. We identified a growing body of published evidence supporting the use of ceftaroline in combination with other agents for the treatment of CNS infections. In absence of clinical trials, additional real-world data are needed to define the efficacy and safety of ceftaroline for children and adults with CNS infections.

The effects and mechanisms of natural products on Helicobacter pylori eradication.

Helicobacter pylori (H. pylori) eradication is pivotal for alleviating gastric mucosal inflammation and preventing the progression of gastric diseases. While antibiotic-based therapies have achieved significant success in H. pylori eradication, challenges such as antibiotic resistance, drug toxicity, side effects, nonadherence, inapplicability, and disruption of gastrointestinal microflora have emerged. Updated therapies are urgently needed to suppress H. pylori. Nature has provided multitudinous therapeutic agents since ancient times. Natural products can be a potential therapy endowed with H. pylori eradication efficacy. We summarize the basic information, possible mechanisms, and the latest research progress of some representative natural products in H. pylori eradication, highlighting their safety, accessibility, efficiency, and ability to overcome limitations associated with antibiotic application. This review highlights the potential therapeutic advantages of incorporating ethnomedicine into anti-H. pylori regimens. The findings of this review may provide insights into the development of novel natural products and expand the therapeutic options available for H. pylori eradication.

Antimicrobial Activity of Garlic and Honey on Staphylococcus Aureus and Escherichia Coli

The numerous side effects of conventional antibiotics and increasing antibiotics resistance of some strains of bacteria such as Staphylococcus aureus and Escherichia coli which are commonly implicated in skin infection, surgical site infections, urinary tract infections (UTIs), neonatal meningitis, systemic infections and enteric infections in humans makes it is pertinent to source for alternative remedies. Aim: To assess the antimicrobial activity of honey and garlic on Staphylococcus aureus and Escherichia coli Methodology: Standard microbiological procedures were employed to isolate and identify the bacteria species. Antimicrobial activity was determined using the agar well diffusion method. Result: The S. aureus and E. coli were susceptible to the honey and garlic extracts. S. aureus was susceptible to garlic, honey and the mixture of both with zones of inhibition ranging from 6.9-17.2mm, 4.8- 12.9mm and 6.0-17.0mm respectively while those of E. coli ranged from 5.8-16.4mm, 5.0-11.8mm and 5.6-16.0 respectively. There was significant difference (p ≤ 0.05) in the antimicrobial activity of the garlic, honey and the mixture. Conclusion: This study therefore reveals that honey and garlic possess significant antimicrobial activity against the tested organisms with high antibacterial activity occurring at high concentrations. Honey and garlic can therefore, serve as substitute to antibiotics

Clinical and microbiological efficacy of intra-pocket application of diode laser in grade C periodontitis: a randomized controlled clinical trial

BackgroundPeriodontitis is a microbially induced disease destroying structures anchoring teeth to jaw bones. Although metronidazole in combination with spiramycin is the effective conventional treatment of stage III grade C periodontitis, it has several systemic side effects. Laser therapy is widely used nowadays as an adjunct to scaling and root planing (SRP) to modulate inflammatory host response and eradicate microbes, due to bactericidal and detoxifying effects. Since microbiological analysis is one of the diagnostic methods identifying periodontal risk; our research aimed to investigate the efficacy of intra-pocket application of diode laser (980 nm) versus antibiotic therapy in enhancing clinical and microbiological parameters in stage III grade C periodontitis.MethodsA randomized controlled clinical trial was conducted on fifty patients with stage III grade C periodontitis, divided equally into two groups. We managed test group by SRP with intra-pocket application of diode laser (980 nm) and the control group by SRP with systemic antibiotic administration (spiramycin and metronidazole). Then, we measured periodontal pocket depth (PPD) and clinical attachment loss (CAL) for both groups, before treatment (baseline), four and twelve weeks after. Moreover, we collected gingival crevicular fluid from both groups at baseline, four and twelve weeks after treatment and analyzed by real-time polymerase chain reaction to detect the relative count of Aggregatibacter actinomycetemcomitans and Porhyromonas gingivalis.ResultsCompared to baseline, all assessed clinical and microbiological parameters attested improvement at the end of the study period in each group individually with no significant difference between the two studied groups. Although, at twelve weeks, flare up of bacterial levels was detected with systemic antibiotic administration.ConclusionLaser therapy can be considered as an effective treatment modality in stage III grade C periodontitis, avoiding the systemic antibiotic side effects and solving the recurrence problems due to bacterial resistance by long term usage.Trial registrationNCT05222737 retrospectively on 03/02/2022, Clinicaltrial.gov.

Systematic Review and Meta-Analysis: Bismuth Enhances the Efficacy for Eradication of Helicobacter pylori.

In the eradication of Helicobacter pylori, the efficacy of bismuth remains inconclusive. We aimed to compare the efficacy of bismuth on various H. pylori eradication regimens. Randomized controlled trials were collected to compare the efficacy of bismuth to nonbismuth regimens in H. pylori eradication. We pooled information to study eradication, adverse events, and drug compliance. In addition, subgroup analyses for eradication efficacy were performed according to high or low clarithromycin-resistance area, bismuth drug form, and amount of bismuth element. Records for a total of 2506 patients in 15 trials from 13 randomized controlled studies were included. The eradication of H. pylori was superior when bismuth compared to nonbismuth regimen (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.33-2.00 in intention-to-treat [ITT]; OR = 2.05, 95% CI, 1.58-2.68 in per-protocol [PP] analyses), without significant difference in drug compliance or adverse events. Bismuth regimens in the high clarithromycin resistance area tend to enhance the eradication rate (OR = 1.66, 95% CI, 1.34-2.05 in ITT; OR = 2.22, 95% CI, 1.67-2.95 in PP analyses). Bismuth potassium citrate and bismuth subcitrate were more effective drug forms in regard to eradication rate. Bismuth at a dosage of < 500 mg/day was significantly higher for the eradication rate. Bismuth to the H. pylori eradication regimens achieve a higher eradication rate, especially in the high clarithromycin resistance area. It could be an eradication option achieving sufficient resistance rates without increasing antibiotic resistance, side effects, or poor compliance.

How Antibiotic Revolutionized Medicine: A Comprehensive Review of their Evolution, Application and Ongoing Challenges

This review paper delves into the rich history of antibiotics in subsequent years. Examining their multifaceted uses, we explore the pivotal role antibiotics play in modern medicine, encompassing the treatment of bacterial infections, prophylactic applications, and contributions to various fields, including agriculture. The paper provides an in-depth analysis of the advantages of antibiotics, underscoring their life-saving potential, support for medical procedures, and prevention of severe complications. However, we also address the associated disadvantages, including antibiotic resistance, side effects, and ecological concerns. Current issues, such as the emergence of antibiotic-resistant strains, are discussed alongside ongoing efforts in research and development. This comprehensive exploration aims to provide a nuanced understanding of antibiotics, paving the way for informed decisions in their use and development