Combined Administration Of Antibiotics Research Articles

Designed De Novo α-Sheet Peptides Destabilize Bacterial Biofilms and Increase the Susceptibility of E. coli and S. aureus to Antibiotics.

Biofilm-associated microbes are 10-1000 times less susceptible to antibiotics. An emerging treatment strategy is to target the structural components of biofilm to weaken the extracellular matrix without introducing selective pressure. Biofilm-associated bacteria, including Escherichia coli and Staphylococcus aureus, generate amyloid fibrils to reinforce their extracellular matrix. Previously, de novo synthetic α-sheet peptides designed in silico were shown to inhibit amyloid formation in multiple bacterial species, leading to the destabilization of their biofilms. Here, we investigated the impact of inhibiting amyloid formation on antibiotic susceptibility. We hypothesized that combined administration of antibiotics and α-sheet peptides would destabilize biofilm formation and increase antibiotic susceptibility. Two α-sheet peptides, AP90 and AP401, with the same sequence but inverse chirality at every amino acid were tested: AP90 is L-amino acid dominant while AP401 is D-amino acid dominant. For E. coli, both peptides increased antibiotic susceptibility and decreased the biofilm colony forming units when administered with five different antibiotics, and AP401 caused a greater increase in all cases. For S. aureus, increased biofilm antibiotic susceptibility was also observed for both peptides, but AP90 outperformed AP401. A comparison of the peptide effects demonstrates how chirality influences biofilm targeting of gram-negative E. coli and gram-positive S. aureus. The observed increase in antibiotic susceptibility highlights the role amyloid fibrils play in the reduced susceptibility of bacterial biofilms to specific antibiotics. Thus, the co-administration of α-sheet peptides and existing antibiotics represents a promising strategy for the treatment of biofilm infections.

Перкутанная нефролитотрипсия на фоне первичного иммунодефицита (клиническое наблюдение)

This article presents a case study of a female patient with primary immunodeficiency, who underwent percutaneous nephrolithotripsy. The presence of a serious concomitant disease affects different aspects of preoperative and postoperative management of the patient. The choice of percutaneous nephrolithotripsy is necessitated by the need to render the patient stone free using a one-stage and the most effective surgical modality. The article describes the choice of antibacterial therapy to treat inflammatory complications in this category of patients. Broad-spectrum antibiotics should be used to prevent the onset of pyelonephritis, while pyelonephritis exacerbation requires administration of reserve antibiotics in combination with human immunoglobulin.

Clinical Efficacy of Azithromycin as an Adjunctive Therapy to Non-Surgical Periodontal Treatment of Periodontitis: A Systematic Review and Meta-Analysis.

Over the years, numerous trials have sufficiently documented benefits of adjuvant administration of antibiotics in combination to Scaling and Root Planing (SRP) in treatment of periodontitis. Nevertheless there are justified doubts in respect to antibiotics administration with regard to increasing development of resistances. The aim of this review study and meta-analysis was to verify a possible benefit of Azithromycin (AZM) as an alternative adjuvant antibiotic in combination with SRP. Electronic databases (Pubmed) were searched from the earliest point of record until May 2015. A hand search was also conducted. The variables considered in this respect were Probing Depth (PD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and SRP. A meta-analysis containing trials comparing SRP as a sole therapy with SRP and administration of AZM was produced once all of the data obtained had been reviewed. Six randomised clinical trials were accepted into the review and the meta-analysis following the process of trial selection. Meta-analysis revealed larger overall effects by the systemic administration of AZM compared with SRP on their own in terms of PD, CAL, BOP, Plaque-Index and total bacterial load reduction after three and six months. The data used in this study revealed that the systemic administration of AZM is beneficial compared with SRP on its own for the treatment of chronic periodontitis.

Severe pneumonia requiring ICU admission: Revisited

Abstract Objectives To describe the aetiology, outcome and management approach for patients with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) who required ICU admission and to determine the predictors of mortality. Methods A prospective observational study of 119 consecutive patients who were admitted to the ICU with diagnoses of CAP (n = 89) or HAP (n = 30) from May 2011 until December 2012. Results The overall ICU and hospital mortality rates for CAP and HAP were 24.4% and 30.3%, respectively. There were no significant differences between the patients with CAP and HAP in terms of ICU mortality or the average length of hospital stay. The most commonly isolated pathogens were H1N1 (23%) and Streptococcus pneumonia (17%) in the patients with CAP and Acinetobacter baumannii (37%) in the patients with HAP. Multidrug resistant (MDR) organisms were detected in 32 (38.6%) isolates. The median time for receiving antibiotics was 2 h. Most of the patients (82%) received double antibiotic coverage. Multiple regression analysis identified septic shock (beta = 0.43, p Conclusion The outcomes of patients with severe pneumonia who were admitted to the ICU were better than those of previous reports. Early administration of combination antibiotics was practiced with vigilance. MDR organisms and respiratory viruses were the commonly isolated pathogens. The presence of septic shock, ARDS and high PSI were independent predictors of mortality.

T細胞型悪性リンパ腫を併発した神経ボレリア症の1例

An 80-year-old Japanese man developed sensory disturbance of his extremities. One week after the onset of sensory disturbance, he also developed bilateral facial nerve palsy, weakness of the extremities, vesicorectal disturbance, general fatigue, and syndrome of inappropriate antidiuretic hormone secretion (SIADH). His symptoms worsened gradually. Despite the absence of apparent tick bite and characteristic skin lesions, we suspected Lyme neuroborreliosis (LNB) because of pleocytosis and elevated protein levels in the cerebrospinal fluid (CSF), in addition to the aforementioned symptoms. After combined administration of antibiotics and steroids, his symptoms improved rapidly. CSF showed highly elevated levels of the chemokine CXCL-13 and his serum was positive for IgM against Borrelia afzelii. Therefore, we diagnosed him as having LNB. He developed an exacerbation of SIADH and generalized fatigue during the course of LNB. His condition deteriorated despite further administration of antibiotics and steroids. Bone marrow aspiration revealed the presence of medium- to large-sized atypical lymphoma cells and lymphoma cells positive for CD8 but negative for CD45. Therefore, we diagnosed T-cell lymphoma. In recent years, an association between Borrelial infection and lymphoma development has been suspected. Borrelia afzelii infection may have been involved in the development of T-cell lymphoma in this case.

Pyogenic splenic abscess in an infant with serological evidence of cat scratch disease

Pyogenic splenic abscess is a rare intraperitoneal infection caused by a variety of bacteria, with S. aureus and streptococci most commonly isolated. Splenectomy is indicated when it is resistant to antimicrobial therapy. We report on a pyogenic splenic abscess requiring repeated aspiration in an infant who was serologically diagnosed as having cat scratch disease (CSD). A 7-month-old boy was admitted to a general hospital due to intermittent low-grade fever of 2 weeks’ duration, splenomegaly and multiple cystic lesions in the spleen detected by ultrasonography. Despite intravenous administration of cefotaxime on suspicion of splenic abscess, high fever persisted and the intrasplenic lesions expanded. Five days after admission, he was referred to our hospital. There was no history of the presence of a pet. On physical examination, anemia and splenomegaly were noted. There was a strong acute phase response indicated by white blood cell (WBC) count (24,350/μl), C-reactive protein level (117 mg/l) and erythrocyte sedimentation rate (83 mm/h). Microcytic hypochromic anemia [red blood cells (RBCs) 3.88×10/μl, hemoglobin (Hb) 8.2 mg/dl, hematocrit (Ht) 27.9%] was also noted. Chest X-ray showed a small infiltration in the left lower lung field, adjacent to the diaphragm. Abdominal computed tomography revealed an enlarged spleen with multiple cystic lesions, indicating intrasplenic abscesses (Fig. 1a). The patient’s immunological parameters, including immunoglobulin levels, IgG subclass levels, lymphocyte subsets, proliferation to phytohemagglutinin, NK activity, and phagocytic and bactericidal activities of neutrophils, were normal. As the cystic lesions continued to enlarge, despite the intravenous administration of panipenem/betamipron and ampicillin, ultrasonography-guided puncture and aspiration were performed on the 10th hospital day. Three abscess lesions yielded a total of 20 ml of odorless yellowish-white pus (Fig. 1b). Cytological and histological examination of the aspirated material showed abscess and necrotic tissue without atypical cells. Neither bacteria nor fungus was identified by microbiological examination [smear, histology including Gram, periodic acid-Schiff (PAS), acid-fast and Warthin-Starry staining, and culture]. After the first aspiration, despite sequential and combined administration of antibiotics including meropenem, clindamycin, doxycycline, tobramycin, rifanpin, azithromycin and clarithromycin, small, low-density areas suppurated to form new abscesses one after another, necessitating a total of six sets (three–to-eight punctures per set) of aspiration (Fig. 1c). Eur J Pediatr (2007) 166:1289–1291 DOI 10.1007/s00431-006-0386-7

A questionnaire survey of patient preparation and techniques for prostate biopsy among urologists in the Kyushu and Okinawa regions of Japan

We surveyed urologists in the Kyushu and Okinawa regions of Japan regarding their standard approach to patient preparation and their prostate biopsy technique. A total of 155 survey questionnaires were prepared and mailed to community and academic urologists in the Kyushu and Okinawa regions. Incidences were derived from the total numbers of responses, by item, divided by the total number of responses per practice type. There were 27 responses from clinics (17.4%), 115 from general hospitals (74.2%), and 13 from university hospitals or cancer centers (8.4%). Most urologists performed biopsy in patients with prostate-specific antigen (PSA) levels greater than 4 ng/ml when digital rectal examination (DRE) and/or transrectal ultrasound (TRUS) results were normal. Of the urologists, 83% reported performing the procedure with hospitalization; 51% of urologists do not advocate enema use, 69% performed the procedure under spinal anesthesia or a sacral block, 53% reported the combined administration of antibiotics orally and intramuscularly or intravenously, 70% used only the transrectal route for prostate biopsy, and 86.5% performed six or more biopsy cores at the initial prostate biopsy session. This survey shows substantial variation in the prostate biopsy protocols among urologists in the Kyushu and Okinawa regions in Japan, and suggests that national, evidence-based, guidelines are required, particularly as to antibiotic prophylaxis and the number of biopsy cores.

The Suppressive Effect of Bovine Colostrum Combined with Antibiotics on Renal Inflammation

Purpose: Bovine colostrum contains three times more immunoglobulin than human colostrums does. We investigated the effectiveness of administering Bovine colostrum combined with antibiotics in an animal model of ascending pyelonephritis. Materials and Methods: Thirty female Sprague-Dawley rats were divided into 5 groups: the normal group, the non-treated control group, the Bovine colostrum administered group, the antibiotic treatment group and the combined administration of antibiotics and Bovine colostrums group. After anesthetizing, an inoculum of 1x10 colony forming units per ml of Escherichia coli (E. coli, ATCC 25922 strain) was instilled into the bladder through the urethra and the urethra was occluded for 4 hours. We began treatment with ciprofloxacin (15mg/kg, for 5 days, intramuscularly) alone or Bovine colostrum (6ml/kg, for 5 days, orally) alone or with combination treatment 72 hours after inoculation. The rats were sacrificed 4 weeks after infection. Both kidneys were examined pathologically. We carried bacterial culture examinations of the urine and the kidney tissue. Results: As the results of examining the cultures of the urine and kidney tissues, no bacteria were cultivated in the antibiotics treatment group and the combined treatment group. 66.7% of the control group and 33.3% of the bovine colostrum treatment group had positive urine cultures and 66.7% of the control group and 41.7% of the bovine colostrum treatment group showed a positive reaction on the kidney tissue culture. The severity of pyelonephritis, as noted on the pathological examination, was highest in the control group. The combined treatment group had the lowest degree of infection among all the groups. Conclusions: The administration of bovine colostrum in combination with antibiotics can significantly reduce the inflammation associated with ascending pyelonephritis. (Korean J Urol 2006;47:1111-1116) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Antibiotic Prophylaxis in Clean-Contaminated Head and Neck Oncologic Surgery

The use of antibiotic prophylaxis in head and neck oncologic surgery has greatly reduced the risk of postoperative wound infection and the corresponding increase in morbidity and health care costs. Conversely, inappropriate perioperative use of antibiotics increases costs and risk to patients. Antibiotic prophylaxis is beneficial only in clean-contaminated head and neck surgery; targets are the bacterial flora that commonly inhabit the skin and upper aerodigestive tract, with antibiotics effective against gram-positive aerobic organisms and anaerobic organisms providing the best coverage. Maximum efficacy is achieved with immediate preoperative and short-term (less than 48 hours) postoperative antimicrobial administration in adequate doses. Optimum benefit from prophylaxis in head and neck oncologic surgery depends on appropriate selection and administration of antibiotics in combination with sound, established surgical principles.

Hypocholesterolemic Effect of Polysaccharides and Polysaccharide-rich Foodstuffs in Cholesterol-fed Rats

The hypocholesterolemic effect of cellulose, sodium carboxymethyl-cellulose (CMC), pectin, alginic acid (free), agar-agar, gum arabic, konnyaku powder (prepared from the tubers of Amorphophalus konjac), konbu (Laminaria japonica), hijiki (Hijikia fusiformis) and aonori (Enteromorpha prolifera) was examined in rats fed hypercholesterolemic diets. The hypocholesterolemic effect was reconfirmed for pectin and a new demonstration of the plasma- and liver cholesterol-depressing activity was achieved for CMC and konnyaku powder. Absorption of cholesterol was significantly depressed in rats fed pectin and konnyaku powder, but rats fed CMC showed no alteration in cholesterol absorption as compared with the control group. The activity of konnyaku powder which is known to be hydrolyzed by intestinal microorganisms did not increase by the combined administration of antibiotics. From these facts, it appears that the mechanisms depressing plasma cholesterol differ appreciably in these three substances.

TREATMENT OF CHRONIC SINUSITIS MAXILLARIS WITH PRONASE-P Part 3

Biochemical studies were made in Pronase-Porally administered cases of chronic sinusitis maxillaris to clarify the drug's healing mechanism which has been only partially reported. Of the various kinds of proteolytic enzymes those with powerful hydrolysis seem favorable for a pus-dissolving action in clinical use. In this report, Pronase-P is found to be most satisfactory, followed by a-chymotripsin and Varidase in descending order.In cases where responses to a single oral administration of Pronase-P were not seen, favorabe results were obtained with a combined administration of antibiotics.

赤痢菌の実験的感染に関する研究

In a previous study the authors reported that Shigilla infection was experimentally induced in miceby oral inoculation of resistant strains of Shigella. This was accomplished by continuous administration ofantibiotics in combination with pre- and post-inoculation of resistance-lowering agents, such as carbon tetrachloride, which were very useful in the establishment of infection. In this connection the authors showedthat in such an infection, the presence of an increase number of antibiotic-resistant organisms, mainly Escherichia coli, due to the effect of chloramphenicol, disrupts the Shigella population.