Combination Of Clavulanic Acid Research Articles

Assessment of Cefuroxime and Cefuroxime Clavulanic Acid Prescription Practices for Infection Management in Routine Indian Healthcare Settings: Expert Insights

Background: Cefuroxime axetil has shown effectiveness as part of intravenous/oral sequential therapy for community-acquired pneumonia (CAP) treatment, although some countries currently lack dosage recommendations for this regimen. In addition, the perspectives of clinicians were not studied. So, this study evaluated the prescription practice of cefuroxime, and cefuroxime+ clavulanic acid in the management of infections in routine Indian settings. Methods: The cross-sectional survey, titled ‘Cefuroxime & Cefuroxime+Clavulanic acid in Management of Infections: Expert Perspective (CARE) Study’, utilized a 20-item, multiple-response questionnaire to gather expert opinion from specialists regarding the clinical use of cefuroxime and cefuroxime + clavulanic acid in managing infections. The survey encompassed questions about current prescription practices, clinical observations, preferences, and experiences related to the use of these antibiotics in routine settings. Results: Among the 164 clinicians surveyed, 78% of the respondents indicated that cefuroxime was highly effective in managing lower respiratory tract infections. Additionally, 91% of the experts stated that the combination of cefuroxime and clavulanic acid was very effective in managing infections. The majority of clinicians recommended cefuroxime + clavulanic acid as the initial therapy for complicated urinary tract infections (88%), as well as first-line therapy for uncomplicated skin and soft tissue infections (45%) and community-acquired pneumonia (58%). According to 40% of the clinicians, cefuroxime + clavulanic acid was recommended as the initial therapy for 21-30% of patients suspected of methicillin-resistant Staphylococcus aureus infection. Most respondents (88%) preferred cefuroxime + clavulanic acid as the antibiotic for managing Pseudomonas aeruginosa infection. Conclusion: The survey has emphasized the critical role of cefuroxime and cefuroxime + clavulanic acid as antibiotics in managing diverse infections. Clinicians' recognition of their efficacy and preference for combination therapy has underscored the importance of antibiotic stewardship in optimizing patient care.

Efficacy of amoxicillin/clavulanic acid after surgical drainage of perianal abscess in the prevention of the development of anal fistula (PERIQxA study): study protocol for a multicenter randomized, double-blind clinical trial

BackgroundAnorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26–37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula.MethodThe aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months).DiscussionThis clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess.Trial registrationEudraCT Number: 2021–003376-14. Registered on November 26, 2021.

Surgical Site Infection in the General Surgery Department of the Commune I Reference Health Center of Bamako

Objective: To study surgical site infections in the general surgery department of the CSRéf in Commune I of the Bamako district. Method: This was a 12-month prospective descriptive and analytical study from 1er June 2021 to 1er May 2022, including all patients operated on and hospitalised in the department. Results: During the study period, we recorded 80 cases of surgical site infection out of 442 patients included in the study, i.e. an overall total of 18.1%. The mean age of the patients was 32.24 years, with extremes ranging from 1 to 82 years. The rate of SSI was influenced by the surgical indication, the type of anaesthesia, the type of surgery according to the Altemeier classification, whether or not antibiotic prophylaxis and drainage were practised, and the length of postoperative hospitalisation. The majority of surgical site infections were diagnosed within the first 5-10 days postoperatively. Superficial infection was the most common (81%). E coli was the most common germ isolated from the site of infection at 49.15%. Most germs were sensitive to the combination of amoxicillin and clavulanic acid, imipenem and gentamicin.

Fast sequential determination of amoxicillin and clavulanate in pharmaceutical samples using batch injection analysis with amperometric detection

AbstractThe combination of amoxicillin (AMX) and clavulanic acid (CLA) is one of the most widely used antibiotic medicines in the world. This paper describes a novel electrochemical method for the fast sequential determination of AMX and CLA using batch injection analysis with amperometric detection (BIA‐AD) and boron‐doped diamond (BDD) as the working electrode. In the proposed strategy, AMX was selectively detected at +1.3 V and both compounds (AMX+CLA) at +1.8 V. The oxidation current from CLA was accessed by subtracting the currents detected at both potential pulses (i+1.8 V–i+1.3V) and using a simple correction factor. The developed method proved to be simple, cost‐effective, precise (RSD<1.3 %, n=10), rapid (>200 injection h−1), required simple sample preparation steps (dissolution and dilution only) and can be used in laboratories with minimal infrastructure (portable characteristics). The limits of detection were 0.31 (0.13) and 1.99 (0.47) μmol L−1 (mg L−1) for AMX and CLA, respectively. The results obtained by the proposed BIA‐AD method were comparable to those obtained by capillary electrophorese (95 % confidence level).

Development and validation of a high-performance thin layer chromatography method for the simultaneous determination of amoxicillin and clavulanic acid combinations in tablet dosage forms

A simple and sensitive high-performance thin layer chromatography (HPTLC) method was developed and validated as per the International Council for Harmonization (ICH) guidelines for the simultaneous determination of amoxicillin (AMX) and clavulanic acid (CLA) combinations in tablet formulations. Chromatography was performed on precoated glass plates with normal phase silica gel 60 F254. The mobile phase was acetone:ethyl acetate:glacial acetic acid:water (11:9:4:2 (v/v)). The plate was scanned at a wavelength of 428 nm after derivatization with ninhydrin. The validation of the method revealed that the linearity range lies between 400 and 1200 ng/band for AMX and 100–300 ng/band for CLA, with coefficients of determination of 0.9997 and 0.9966, respectively. Recoveries in standard addition accuracy studies were 100.3 % for AMX and 96.75 % for CLA. The limit of detection (LOD) and limit of quantitation (LOQ) of the developed method are 20.3 ng/band and 61.6 ng/band for AMX and 18.5 ng/band and 56.2 ng/band for CLA, respectively. The new, novel high-performance thin layer chromatography (HPTLC) method that was successfully developed in this study was applied for the simultaneous determination of AMX and CLA in their fixed-dose tablet dosage forms obtained from retail pharmacies and offered comparable results with the official British Pharmacopoeial high-performance liquid chromatography (HPLC) method.

Pharmacological activity of calcium lactate on a model of dysbiosis in rats

Relevance. Under the influence of endogenous and /or exogenous factors, the intestinal microflora inhabiting all parts of the gastrointestinal tract may change, which disrupts the normal course of physiological processes, and in some cases leads to severe pathological conditions. One of the reasons for the development of intestinal dysbiosis is the use of antibacterial drugs. Thus, the search and development of means for the prevention and treatment of dysbiosis is an urgent task.Goal. The aim of the study was to evaluate the effectiveness of a candidate for a calcium lactate-based drug with repeated intragastric administration on a model of antibiotic-induced dysbiosis in rats.Methods. The study used 40 male Wistar rats (four groups of 10 animals each). A model of antibiotic-induced intestinal dysbiosis was tested in rats by a course of intragastric administration of a combination of amoxicillin and clavulanic acid for 7 days at a dose of 75 mg/kg. The development of dysbiosis was confirmed by a change in the quantitative composition of representatives of the intestinal microbiota. Similarly, for 7 days, the test drug was administered in doses of 5 mg/kg, 25 mg/kg, 125 mg /kg daily 2 hours after the introduction of the pathology inducer. The control group received a 1 % starch solution.Results. The peak of dysbiosis development was recorded on the 4th day of pathology induction. The use of calcium lactate at a dose of 5 mg/kg did not have a significant effect, while in the groups receiving calcium lactate at doses of 25 mg/kg and 125 mg/kg, there was a statistically significant (Mann-Whitney criterion, p < 0.05) decrease in the severity of the pathological process compared with the negative control group.Conclusion. According to the results of this study, it was found that the use of calcium lactate in doses of 25 mg/kg and 125 mg/kg contributed to a faster disappearance of symptoms of dysbiosis and normalization of the intestinal microbiota in comparison with animals that did not receive treatment.

Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study

BackgroundThe success rate of non-operative treatment (NOT) of acute uncomplicated appendicitis (AUA) in children varies from 65% to 95%. There are no recommendations on the appropriate antibiotic therapy.ObjectiveTo determine the...

Drug utilization pattern in patients of upper respiratory tract infections in pediatrics outpatient department at a tertiary care hospital

Background: Upper respiratory tract infections are the most common and frequently occurring infections in the pediatric population. These infections include conditions like common cold, laryngitis, pharyngitis, tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. Young children have an average of 6-8 colds per year, however 10 -15% of children have at least 12 infections per year. This study concentrates on prescription pattern of Upper Respiratory Tract Infections in children. primary objective was to study the prescription pattern of drugs used in URTI in pediatric outpatient department and the secondary objective was to determine whether the drugs being prescribed comply with those listed in the National list of essential medicines. Methods: This study was a Cross-sectional, observational study conducted at the Pediatric Outpatient Department in a tertiary care hospital, India. The data was collected from patients visiting Pediatrics OPD from June 2021 to December 2021 after taking written informed consent. Sample size was calculated to be 303. Results: Total 943 drugs were prescribed for 303 patients with an average of 3.11±1.15 drugs per prescription. Most common class of drugs prescribed was Antipyretics of which Paracetamol was the most common drug. Antibiotics were prescribed for 19.80% patients & combination of Amoxicillin and Clavulanic acid was the most common antibiotic prescribed. 68.29% drugs were prescribed by generic name. 43.16% drugs were prescribed from National List of Essential Medicines 2015. Conclusions: The study revealed that the majority of children suffering from URTI were below 5 years of age. Our study highlighted the prescribing.

Antimicrobial Prescription Pattern in ENT Outpatient Department in a Tertiary Care Teaching Hospital, Telangana, India

Introduction Otorhinolaryngological infections are very common in adults and in children also. These infections are caused by various microorganisms and to treat these infections, antimicrobial agents are used frequently. As irrational use of antimicrobials leads to the development of antibiotic resistance and it is a big threat to the society, the present study was planned to get awareness among the practitioners regarding the antimicrobial prescription pattern. Aim To study the prescription pattern of antimicrobial agents in outpatient department of otorhinolaryngology in a tertiary care teaching hospital. Materials and Methods An observational study was planned over a period of 8 months from July 2019 to February 2020 in ENT outpatient department (OPD) at Mamata General Hospital, Khammam in Telangana. In total, 562 prescriptions were collected. Patient's details, probable diagnosis, prescribed medication details such as generic name, dose, and dosage forms were taken. The collected data was analyzed and the conclusions were drawn using descriptive analysis. Results Total number of prescriptions were 562. The majority of the prescriptions belonged to the 21 to 40 years of age group. Males were included more than females (males 320 and females 242). Chronic suppurative otitis media (CSOM) (16.2%) was the commonest infection. Most commonly prescribed antimicrobial was amoxicillin and clavulanic acid combination (26.17%), followed by cefpodoxime with clavulanic acid (21.9%) and ciprofloxacin (19.06%). In 371 (66.01%) prescriptions, only one antimicrobial was prescribed, whereas in 36 (6.40%) prescriptions no antibiotic was given. The average number of drugs per prescription was 3.18 and the average number of antimicrobials per prescription was 1.25. Tablet form (52.9%) was the commonest dosage form and most of the drugs were prescribed by generic name (74.06%). Conclusion The present study though prescription pattern of antibiotics and adherence to the hospital formulary by the physicians in the hospital is encouraging, still there is a chance in reducing the number of drugs prescribed per patient. The findings of this study will be useful to prescribe antimicrobials rationally so that the patient and health care system on the whole will be benefited.

EFFICACY OF COMBINATION OF AMOXICILLIN AND CLAVULANIC ACID IN THE TREATMENT OF PYODERMA IN BEETAL GOATS


 
 
 The present study was conducted in forty Beetal goats presented with severe-graded pyoderma on clinical grounds. These goats were treated with amoxicillin and clavulanic acid combination and compared with the treatment regimen already practiced in field i.e. co-trimazine. For this purpose, goats were randomly divided into two groups; A (control) and B (experimental), with 20 animals in each group. Group A was treated with co-trimazine, while group B was administered intramuscularly with amoxicillin and clavulanic acid combination at the rate of 15 mg/kg body weight (BW). At seventh day of treatment, goats of both groups were evaluated for comparative efficacy of two treatment protocols through observing the clinical manifestations of disease. Complete clinical cure of the lesions or a marked improvement was set as the main criterion for evaluation of efficacy of drugs. In group B, 18 (90%) goats showed clinical cure of therapy, while cure rate in group A was 11 (55%) which showed a significant difference (P < 0.05) in success rate of treatment protocol in group B over its counterpart (group A). The results of the study have shown that that severe cases of pyoderma in goats could be effectively treated with the combination of amoxicillin and clavulanic acid.
 
 

Study of Drug Utilization Pattern during Second Wave of Covid-19 in a Tertiary Care Centre: A Retrospective Cross Sectional Study

Background: To study the drug utilization trends among patients with COVID-19 disease during the second wave in a tertiary care hospital.
 Methods: A retrospective cross-sectional study was conducted in patients admitted in COVID-19 wards during second wave of SARS – COVID-19 pandemic from 1st March 2021 to 30th June 2021. A total of 300 prescriptions were analysed. Assessment of prescription patterns were done as per the WHO-The International Network for Rational Use of Drugs (INRUD)drug use indicators. 
 Results: A total of 3106 drugs were analysed.The average number of drugs prescribed was 11±5.1. The most frequent prescription was that of analgesic and antipyretic drug Paracetamol (95.26%) followed by vitamin C (94.74%) and multivitamins(87.89%) . Nearly all patients in this study received antibacterials, 68% received antivirals. Antibacterials commonly used were cephalosporins, amoxicillin- clavulanic acid combination and pipercillin –tazobactam combination. Antiviral drug Remdesivir was also used extensively in our study (54.21%). Other class of drugs which were commonly prescribed to more patients were Dalteparin (73.16%) and corticosteroids like methyl prednisolone (52.63%) and dexamethasone (51.05%). 35.68% of the drugs were prescribed with generic name .45.43% of the drugs were injectables . 2.96% of the drugs were prescribed as fixed dose combinations.
 Conclusion: In summary, the drug utilization for hospitalized patients with COVID-19 was diverse but generally complied with the ongoing guidelines. The drug were mostly prescribed from WHO essential drug list and percentage of fixed dose combination prescription was low. However not prescribing the drugs by generic name and large encounters of injectable was matter of concern. To get a better glimpse of drug utilization a more extensive study needs to be undertaken.

Epidemiological, Clinical, Bacteriological Profile of Urinary Tract Infection in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract infection in the internal medicine unit of the Fousseyni Daou hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all outpatients and hospitalized patients presenting with a urinary tract infection during the study period. Results: We identified 79 cases of urinary tract infection out of 145 requests for ECBU, that is a positivity rate of 53.10% and out of a total of 1883 admissions that is a hospital prevalence of 4.19%. The age groups of 36 to 45 years and 46 to 55 years were more represented in 28 cases (35.44%) and 25 cases (31.64%) with an average age of 45 years ± 10. The female sex was predominant, 42 cases (53.16%) with a sex ratio of 0.88. Housewives were more represented 28 cases (34.44%). The majority of patients resided in rural areas 49 cases (62.03%). The history was dominated by the following pathologies: hypertension 48.10%, diabetes 36.70% and gastropathy 30.37%. The main clinical manifestations were: Urinary burning 67 cases (84.81%), Dysuria 65 cases (82.27%), Pelvic pain 59 cases (74.68%), Fever 57 cases (72.15%). The epidemiological profile of the isolated strains was dominated by enterobacteriaceae, followed by gram-positive cocci and gram-negative bacilli. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli (45.56%), Klebsiella pneumoniae (11.39%), Pseudomonas aeruginosa (8.86%), Staphylococcus aureus (7.59%), Streptococcus sp (6.33%), Enterobacter cloacae (3.79%), Acinetobacter sp (3.79%). The study of the susceptibility and resistance profiles of the isolated strains showed significant sensitivity of enterobacteriaceae to colistin and resistance to amoxicillin and to the amoxicillin + clavulanic acid combination. Conclusion: Urinary tract infections are a major public health problem since they are responsible for significant morbidity and mortality and a high cost of care. Knowledge of the epidemiological-clinical and bacteriological profile of these infections is essential for efficient management.

Prevalence and Resistance Profile of Muenchen Cefotaximase (CTX-M) Group 1 Extended Spectrum Beta-Lactamase (ESBL)-Producing Uropathogenic <i>Escherichia coli</i> Strains in Dakar, Senegal

Background: Extended-spectrum beta-lactamase (ESBL) producing bacteria are a real public health problem, particularly in Africa. Among these ESBLs, there are the Muenchen Cefotaximase (CTX-M) described all over the world of which the most frequent is the CTX-M of group 1 particularly the CTX-M-15 variant. The objective of this study was to determine the prevalence of CTX-M group 1 ESBL-producing Escherichia coli strains and to test their antibiotics susceptibility profile. Methodology: A retrospective cross-sectional descriptive study was conducted to detect ESBL-secreting Escherichia coli strains by the synergy test. Identification of CTX-M type ESBL from group 1 was performed using the NG-Test CTX-M rapid diagnostic test (NG-Biotech®). Antibiotic susceptibility profile was determined using CA-SFM/EUCAST guidelines 2019. Data entry and statistical analysis were performed with Excel version 2010 and SPSS 20.0 respectively. Results: Eighty-two ESBL-producing Escherichia coli strains were tested. A group 1 CTX-M ESBL was detected in 75.6% of the strains (n = 62). These strains were highly resistant to cefotaxim (100%), aztreonam (100%), ceftazidim (85.4%) and cefepim (66.1%). They were also resistant to quinolones, gentamycin and sulfadoxine-trimethoprim combination. However, these strains showed sensitivity to ertapenem (100%), cefoxitin (69.3%), tigecyclin (66%), and amikacin (66.1%). The combination of piperacillin and tazobactam was active on 30.6% of the strains against 6.4% for the combination of amoxicillin and clavulanic acid. Conclusion: The CTX-M type ESBL of group 1 was present in the majority of ESBL-producing Escherichia colis trains. Despite the production of this enzyme conferring resistance to most beta-lactam antibiotics, some antibiotics remain active to treat infections caused by these germs.

Prescribing Pattern of Antibiotics in ENT Outpatients of Tertiary Care Hospital in Bharatpur, Nepal

Introduction: Upper respiratory tract infection (URTI) like pharyngitis, tonsillitis, sinusitis, laryngitis and otitis media are the most common infections encountered in ENT outpatients. As these infections are caused by the microorganism they should be treated with the antimicrobial agents. The aim of this study was to determine the prescribing pattern of antibiotics in ENT outpatients of tertiary Care Hospital in Bharatpur, Nepal. Methods: It was prospective observational study which was carried out in the ENT Department of College of Medical Science, Bharatpur, Chitwan, Nepal. Total 267 prescriptions were studied. Patient of all age groups and sex were included in the study. Prescriptions were evaluated based on the World Health Organization (WHO) core drug prescribing indicators. Results on categorical measurements are presented in numbers and percentage which was used to generate tables and graphs. Data analysis was done by SPSS software version 20.0. Results: A total of 267 prescriptions were collected and analyzed during the study. Average number of drugs per prescription was 3.12 in which average number of antibiotic per prescription was 1.041. Commonly prescribed antibiotics belongs to the penicillin group (52%) followed by macrolide (27%). Most of the drugs were prescribed by their brand names (92%). Besides antibiotics the common adjuvant drugs that are being prescribed were nasal decongestant (44%) followed by anti-histaminics (27.7%). Conclusions: The present study highlights the wide use of Amoxicillin and clavulanic acid combination for ENT infections. Measures to emphasize the use of generic names are necessary to promote rational drug use.

Molecular Characterization of Extended-Spectrum Beta-Lactamase-Producing Extra-Intestinal Pathogenic Escherichia coli Isolated in a University Teaching Hospital Dakar-Senegal

Extra-Intestinal Pathogenic Escherichia coli (ExPEC) is a predominant Gram-negative bacterial pathogen and is responsible of several diseases including Urinary Tract Infections (UTI), nosocomial pneumonia, and neonatal meningitis. ExPEC isolates are often multidrug resistant and clones producing Extended-Spectrum Beta-Lactamases (ESBL) are increasingly reported all over the world. Seventy-eight clinical ExPEC strains (49 Community-Acquired (CA) and 29 Hospital-Acquired (HA)) were selected for this study. The majority was from UTIs (n=51), while the rest (n=27) was from pus, sputum, bronchial fluid and vaginal samples (non-uropathogenic ExPEC). Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method. Standard polymerase chain reaction was used to screen major ESBL genes (blaCTX-M, blaOXA-1, blaTEM, blaSHV) and blaCTX-M variants (blaCTX-M-1, blaCTX-M-9, blaCTX-M-15, blaCTX-M-25). All the tested isolates were resistant to ampicillin, ticarcillin, amoxicillin/ clavulanic acid combination, cefalotin, cefotaxime, ceftazidime, cefepime and aztreonam, but showed a high susceptibityto fosfomycin (98.7%, n = 77), ertapenem (96.2%, n = 75), and imipenem (100%). Moreover, isolates harbored at least one ESBL gene, including blaCTX-M (98.7%), blaOXA-1 (78.2%), blaTEM (44.9%) and blaSHV (3.8%). The CTX-M variants were also found with the predominance of blaCTX-M-1 (89.7%) and blaCTX-M-15 (89.7%) followed by blaCTX-M-9 (11.5%). Despite the resistance to most of the tested antibiotics, ExPEC isolates showed fortunately good susceptibility to fosfomycin and carbapenems. blaCTX-M1, blaCTX-M15 and blaOXA-1 seem to be E.coli major ESBL genes circulating in Senegal. The high level of resistance to antimicrobials observed stresses the need of establishing an epidemiological surveillance of antimicrobial resistance in both community and hospital settings.

Prevalence of Extended-Spectrum Beta-Lactamases Enzymes in Enterobacter Aerogenes Isolated from Urinary Tract Infections in Shahrekord City

Introduction: Enterobacteriaceae produce the Extended-Spectrum Beta-Lactamases which is considered as an important resistant mechanism of beta-lactam antibiotics. The resistance to beta-lactam antibiotics is the main problem in the bacterial infections therapy. The prevalence of these enzymes changes in different geographical areas and with time. The present study aims to explore the frequency of the extended-spectrum blaSHV, blaCTX-M, blaTEM, in Enterobacter aerogenes isolated from urinary tract infections in Shahrekord City; the mentioned genes were investigated from the phenotypic and genotypic point of view.
 Methods: In this cross-sectional descriptive study, antibacterial susceptibility patterns of 50 isolates of Enterobacter aerogenes to Cefotaxim, Ceftazidim, Cefterixon and cephalotin were tested using disk diffusion (Kirby-Buer) method. In addition, confirmatory tests for detecting ESBLs phenotypes were performed using Ceftazidim-clavulanic acid and Cefotaxim- clavulanic acid combination disks. Then, the presence of blaSHV, blaCTX-M, blaTEM, genes in the broad-spectrum beta-lactamase producing strains was assessed in the presence of specific primers.
 Results: Out of 50 isolates of Enterobacter aerogenesis investigated in this study, 32 isolates (64%) were identified to produce broad-spectrum β-lactamases in the phenotypic study of ESBLS, and the prevalence of blaCTX-M, blaTEM and blaSHV was reported as 30%, 20% and 14%, respectively. In the statistical analysis, a statistically significant correlation was observed between resistance to the antibiotic ceftriaxone and the blaCTX-M, gene (p<0.05).
 Conclusion: The present study suggests that ESBL producing Enterobacter aerogenes isolates have a high prevalence. The increase in the number of these species is often caused due to the irrational prescription of antibiotics, which requires the use of new antimicrobial agents and limiting the unnecessary use of antimicrobial agents and increasing the use of infection control tools.

Amoxicillin hypersensitivity: Patient outcomes in a seven-year retrospective study

BackgroundThe beta-lactam antibiotic amoxicillin and the beta-lactamase inhibitor clavulanic acid in combination with amoxicillin are known to cause both immediate- and nonimmediate-type hypersensitivity. ObjectiveTo characterize a large cohort of patients with a history of amoxicillin or amoxicillin-clavulanic acid hypersensitivity. MethodsA retrospective analysis was conducted of the demographics, presentation, investigation, and management of 331 patients presenting to 1 allergy center with a history of hypersensitivity to amoxicillin or amoxicillin-clavulanic acid. ResultsHypersensitivity was confirmed in 37 of 221 patients (17%) who took amoxicillin and 47 of 110 patients (43%) who took amoxicillin-clavulanic acid as the index drug.In immediate hypersensitivity, skin test results confirmed the diagnosis in 66 of 139 patients (47%). Penicillin cross-reactivity was observed in 16 of 36 patients (44%). Of the 16 patients who were cross-reactive, 13 (81%) reacted to amoxicillin-clavulanic acid as the index drug. All patients who had negative skin test results (73/139) underwent drug provocation. The negative predictive value of skin tests was 89%.In nonimmediate hypersensitivity, delayed intradermal tests confirmed diagnosis in 12 of 170 patients (7%). Of the 12 patients whose skin test results were positive, 8 (67%) presented with drug reaction with eosinophilia and systemic symptoms. All patients with a negative skin test result (158/170) underwent drug provocation. The negative predictive value of skin tests was 95%. Penicillin cross-reactivity was observed in 3 of 12 patients (25%).Ten patients were diagnosed with hypersensitivity to clavulanic acid. ConclusionThe negative predictive value of skin tests in both immediate and nonimmediate hypersensitivity reactions is excellent and excludes severe allergy. Nonimmediate hypersensitivity is rare. Confirmed hypersensitivity is more likely if amoxicillin-clavulanic acid is the index drug. Cross-reactivity was more common in patients presenting with immediate hypersensitivity, typically involving benzylpenicillin. A minority of patients were allergic to clavulanic acid.

SELF-MEDICATION PATTERN OF ANTIBIOTICS AMONG THE PEOPLE OF IMPHAL WEST DISTRICT OF MANIPUR, INDIA

Background and aim: Self-medication with antibiotics is one of the growing issues in developing countries. Irrational use of antibiotics leads to development of resistance. Antibiotic resistance is a growing threat in management of infectious disease which leads to morbidity and mortality. Our study is to assess the self-medication pattern of antibiotic among the people of Imphal West district of Manipur. Materials and methods: A cross-sectional study was conducted on 1980 randomly selected people from populations of Manipur during September 2020. Data was collected using modified pre-structured questionnaire. Using SPSS software version 21, descriptive data analysis was done and expressed in frequencies and percentages. Result: In the study, female participants were more than male participants and majority were from the age group 18-30 years, educated and low-income group. Azithromycin was the most commonly used antibiotics followed by amoxicillin and clavulanic acid combination. Majority of them obtained the antibiotics from local pharmacies and was mainly recommended by the pharmacists. Only 16.92% of them faced mild adverse reaction. Around 65.04% of the participant considered that self-medication with antibiotics is not a safe practice. Conclusion: This study showed that antibiotics were easily accessible and many people were not aware about the antibiotic usage and risk of developing its resistance in Imphal West. Higher authorities need to enlighten the public about the rational use of antibiotics and the dangerous effects of self-medication to overcome the antibiotic resistance.

CD203c showed greater diagnostic value than CD63 for evaluating immediate reactions to amoxicillin-clavulanic by basophil activation test

Basophil activation test (BAT) is widely used in the evaluation of immediate allergic reactions to the combination of amoxicillin (AX) and clavulanic acid (CLV). Although the CD63 activation marker is usually employed, some authors claim that CD203c is better for these reactions. The aim of this study was to evaluate the real value of CD63 and CD203c as activation markers in BAT for diagnosing AX-CLV reactions.

Ventilator-Associated Lung Disease in an Emergency Intensive Care Unit: Epidemiological, Clinical and Bacteriological Characteristics and Antibiotic Resistance Status: Study of 202 Cases

Nosocomial pneumonia is the second most common cause of nosocomial infection in the intensive care unit. They pose serious diagnostic, therapeutic and economic problems and increase the risk of death by increasing the length of stay in the ICU. Our work is a retrospective descriptive study of all patients hospitalized in the ICU who presented with ventilator-associated pneumonia (VAP) over a period of one year in the intensive care unit of Ibn Tofail Hospital in Marrakech. In our study, gram-negative bacilli were the most frequently isolated germs, with Acinetobacter baumannii predominating. Gram-positive cocci came in second place, represented by Staphylococcus aureus. In 69% of cases, the infection was polymicrobial. The resistance rate of the isolated strains was high; 95.7% of Acinetobacter baumannii were resistant to imipenem. Isolated strains of Enterobacteriaceae were resistant to the combination of amoxicillin and clavulanic acid in 53.3% of cases, to C3G in 30.7% of cases, to imipenem in 2.7% of cases, to amikacin in 1.4% of cases and to cotrimoxazole in 41.7% of cases. Staphylococcus aureus resistance was 4% to penicillin M and decreased compared to other antibiotics. The emergence of resistance to antibiotics of last resort in therapy defines multi-resistant bacteria. These were isolated in 38% of cases. Acinetobacter baumannii was the most isolated multidrug-resistant pathogen. In the light of this study, it appears that good management of antibiotic prescriptions, strict application of hygiene and asepsis measures as well as resistance monitoring within each ICU are necessary for the reduction of nosocomial pneumopathies with multi-resistant germs.