Efficacy Of Antimicrobial Drugs Research Articles

Improving the detection of integrative conjugative elements in bovine nasopharyngeal swabs using multiplex recombinase polymerase amplification

Bovine respiratory disease (BRD) is an important health and economic burden to the cattle industry worldwide. Three bacterial pathogens frequently associated with BRD (Mannheimia haemolytica, Pasteurella multocida, and Histophilus somni) can possess integrative and conjugative elements (ICEs), a diverse group of mobile genetic elements that acquire antimicrobial resistance (AMR) genes (ARGs) and decrease the therapeutic efficacy of antimicrobial drugs. We developed a duplex recombinase polymerase amplification (RPA) assay to detect up to two variants of ICEs in these Pasteurellaceae. Whole genome sequence analysis of M. haemolytica, P. multocida, and H. somni isolates harbouring ICEs revealed the presence of tnpA or ebrB next to tet(H), a conserved ARG that is frequently detected in ICEs within BRD-associated bacteria. This real-time multiplex RPA assay targeted both ICE variants simultaneously, denoted as tetH_tnpA and tetH_ebrB, with a limit of detection (LOD) of 29 (95% CI [23, 46]) and 38 genome copies (95% CI [30, 59]), respectively.DNA was extracted from 100 deep nasopharyngeal swabs collected from feedlot cattle on arrival. Samples were tested for ICEs using a real-time multiplex RPA assay, and for M. haemolytica, P. multocida, H. somni, and Mycoplasma bovis using both culture methods and RPA. The assay provided sensitive and accurate identification of ICEs in extracted DNA, providing a useful molecular tool for timely detection of potential risk factors associated with the development of antimicrobial-resistant BRD in feedlot cattle.

Bacteriological profile, antimicrobial susceptibility, and factors associated with urinary tract infection in pregnant women.

Urinary tract infection (UTI) is a common bacterial complication in pregnancy. The study aimed to estimate the prevalence, risk factors, and bacterial etiology of UTI during pregnancy and determine the efficacy of antimicrobial drugs in treating UTIs. Urine specimens and clinical data were collected from pregnant women who attended primary health centers in Erbil, Iraq. All specimens were cultured on appropriate media and identified by standard microbiological methods. The pregnant women were grouped into symptomatic UTI group, asymptomatic bacteriuria group, and the control group. The agar dilution method was used to determine antimicrobial susceptibility. Among the 5,042 pregnant women included in this study, significant bacteriuria was found in 625 (12.40%) of the cases, and 198 (31.68%) had symptomatic UTI, of which 43.59% were diagnosed during the third trimester. Out of the 643 bacteria isolated, 33.28% were symptomatic UTI, of which 43.59% developed during the third trimester. There was a significant difference in the bacterial etiology between symptomatic UTI and asymptomatic bacteriuria (p = 0.002), as well as between cystitis and pyelonephritis (p = 0.017). The most common bacterial species isolated was Escherichia coli, which was susceptible to fosfomycin (100%), meropenem (99.45%), and nitrofurantoin (97.8%). Pregnant women are more likely to develop UTI in the third trimester. Escherichia coli is the predominant pathogen. The study suggests the use of fosfomycin, meropenem, and nitrofurantoin for the treatment of UTI. No Gram-positive isolates were resistant to daptomycin.

Embelia ribes Burm.f. fruit extract inhibit quorum sensing-dependent production of virulence factors and biofilm formation: An integrated in vitro and in silico approach

Quorum sensing (QS) is a cell-to-cell signaling method that allows bacteria to control gene expression and regulate a variety of physiological processes, particularly the synthesis of virulence factors and biofilm formation. Inhibition of QS has been proposed as a promising strategy in attenuating the pathogenicity and enhancing the efficacy of antimicrobial drugs targeting bacterial infections. This study investigated the potential utilization of Embelia ribes fruit extract (ERFE) as an inhibitor of QS-dependent virulence factors and biofilm development in Gram negative pathogens. Further, the results were correlated with the inhibition of biofilms. High performance thin-layer chromatography (HPTLC), followed by analysis of phytochemicals using gas chromatography-mass spectrometry (GC–MS) was conducted. Analyzing ADMET (absorption, distribution, metabolism, excretion and toxicity) profiles, PAINS (Pan-assay interference compounds), and molecular docking analyses of selected potential phytochemicals were performed against proteins participating in QS and formation of biofilm. In-vitro analysis of anti-QS activity of ERFE against Chromobacterium violaceum (violacein production), Pseudomonas aeruginosa (pyocyanin production) and Serratia marcescens (prodigiosin production) demonstrated significant dose-dependent interference in pigment formation at sub-MIC concentrations. The development of biofilm was significantly reduced by 84.10, 85.52 and 70.64% over control at the highest sub-MIC levels for C. violaceum, P. aeruginosa and S. marcescens, respectively. Furthermore, in the presence of ERFE, swarming motility and exopolysaccharide production (EPS) were also reduced. As a result, further insights have been gained into the mechanism underlying the anti-QS activity. Further investigations with in-vivo studies are warranted to fully explore the therapeutic applications of this natural compound in managing the bacterial pathogenicity and biofilm-related infections.

CDC Guidelines for the Prevention and Treatment of Anthrax, 2023.

Bacillus anthracis spores if resources become limited or a multidrug-resistant B. anthracis strain is used (Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885-900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36). Specifically, this report updates antimicrobial drug and antitoxin use for both postexposure prophylaxis (PEP) and treatment from these previous guidelines best practices and is based on systematic reviews of the literature regarding 1) in vitro antimicrobial drug activity against B. anthracis; 2) in vivo antimicrobial drug efficacy for PEP and treatment; 3) in vivo and human antitoxin efficacy for PEP, treatment, or both; and 4) human survival after antimicrobial drug PEP and treatment of localized anthrax, systemic anthrax, and anthrax meningitis. B. anthracis strain. In addition, these updated guidelines include new recommendations regarding special considerations for the diagnosis and treatment of anthrax meningitis, including comorbid, social, and clinical predictors of anthrax meningitis. The previously published CDC guidelines and recommendations described potentially beneficial critical care measures and clinical assessment tools and procedures for persons with anthrax, which have not changed and are not addressed in this update. In addition, no changes were made to the Advisory Committee on Immunization Practices recommendations for use of anthrax vaccine (Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1-14). The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis.

Rapid In Vitro Assessment of Antimicrobial Drug Effect Bridging Clinically Relevant Pharmacokinetics: A Comprehensive Methodology.

Rapid in vitro assessment of antimicrobial drug efficacy under clinically relevant pharmacokinetic conditions is an essential element of both drug development and clinical use. Here, we present a comprehensive overview of a recently developed novel integrated methodology for rapid assessment of such efficacy, particularly against the emergence of resistant bacterial strains, as jointly researched by the authors in recent years. This methodology enables rapid in vitro assessment of the antimicrobial efficacy of single or multiple drugs in combination, following clinically relevant pharmacokinetics. The proposed methodology entails (a) the automated collection of longitudinal time-kill data in an optical-density instrument; (b) the processing of collected time-kill data with the aid of a mathematical model to determine optimal dosing regimens under clinically relevant pharmacokinetics for single or multiple drugs; and (c) in vitro validation of promising dosing regimens in a hollow fiber system. Proof-of-concept of this methodology through a number of in vitro studies is discussed. Future directions for the refinement of optimal data collection and processing are discussed.

Management of virulence in Pseudomonas aeruginosa and Serratia marcescens using environmentally-friendly titanium dioxide nanoparticles

Antimicrobial resistance (AMR), a condition in which the efficacy of antimicrobial drugs in fighting microorganisms is reduced, has become a global challenge.

A UPLC-MS/MS method for simultaneous determination of eight special-grade antimicrobials in human plasma and application in TDM

Linezolid, vancomycin, teicoplanin, tigecycline, imipenem, meropenem, voriconazole, and micafungin are eight special-grade antimicrobials commonly used for patients with severe infections. Changes in the pharmacodynamics and pharmacokinetics of critically ill patients severely affect the efficacy of antimicrobial drugs. Therefore, conventional or standard dosing regimens do not achieve satisfactory anti-infective effects. In the current study a simple and specific ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) method was developed and validated for simultaneously determining the concentrations of the above-mentioned eight antimicrobials in human plasma only 3 min after one-step magnetic solid phase extraction pre-treatment. Multiple-reaction monitoring and positive ion modes were used for detection. The calibration curves were established over a concentration range of 0.1–25.0 μg/mL for teicoplanin, linezolid, micafungin, voriconazole, imipenem, igecyclin, and meropenem, and 0.2–50.0 μg/mL for vancomycin; the coefficient of correlation was > 0.9971 for all the compounds. The inter- and intra-day coefficients of variation were < 6.88% at the lower limit of quantification and quality control (QC) levels (low concentration-QC, medium concentration-QC, and high-concentration QC). The UPLC-MS/MS method was successfully used for clinical therapeutic drug monitoring of linezolid, vancomycin, teicoplanin, tigecycline, imipenem, meropenem, voriconazole, and micafungin for critically ill patients.

Visualizing and quantifying antimicrobial drug distribution in tissue.

The biodistribution and pharmacokinetics of drugs are vital to the mechanistic understanding of their efficacy. Measuring antimicrobial drug efficacy has been challenging as plasma drug concentration is used as a surrogate for tissue drug concentration, yet typically does not reflect that at the intended site(s) of action. Utilizing an image-guided approach, it is feasible to accurately quantify the biodistribution and pharmacokinetics within the desired site(s) of action. We outline imaging modalities used in visualizing drug distribution with examples ranging from in vitro cellular drug uptake to clinical treatment of microbial infections. The imaging modalities of interest are: radio-labeling, magnetic resonance, mass spectrometry imaging, computed tomography, fluorescence, and Raman spectroscopy. We outline the progress, limitations, and future outlook for each methodology. Further advances in these optical approaches would benefit patients and researchers alike, as non-invasive imaging could yield more profound insights with a lower clinical burden than invasive measurement approaches used today.

Evaluation of Antibacterial Drugs Using Silkworms Infected by Cutibacterium acnes.

Simple SummaryCutibacterium acnes, a common bacterium on human skin, is a causative agent of inflammatory skin diseases and systemic infections. Systemic infections caused by C. acnes are difficult to treat because of the drug resistance to typical macrolides. The development of a systemic infection model for C. acnes contributes to searching candidates for drug discovery. Silkworm is a useful model animal for evaluating the efficacy of compounds. Several silkworm infection models have been established for the identification of virulence-related genes and novel antibacterial drugs. However, the systemic infection model of C. acnes using silkworms was not yet established. We established a new silkworm infection model with C. acnes and evaluated the efficacy of antibacterial drugs using the silkworm infection model. The silkworm infection model might be used to identify drug candidates for the treatment against C. acnes infection.Cutibacterium acnes is a causative agent of inflammatory skin diseases and systemic infections. Systemic infections caused by C. acnes are difficult to treat, and the development of a systemic infection model for C. acnes would be useful for elucidating the mechanisms of infection and searching for therapeutic agents. In this study, we established a silkworm infection model as a new experimental system to evaluate the interaction between C. acnes and the host, and the efficacy of antibacterial drugs. Silkworms infected with C. acnes died when reared at 37 °C. The dose of injected bacterial cells required to kill half of the silkworms (LD50) was determined under rearing conditions at 37 °C. The viable cell number of C. acnes was increased in the hemolymph and fat body of the infected silkworms. Silkworms injected with autoclaved C. acnes cells did not die during the study period. The survival time of silkworms injected with C. acnes was prolonged by the injection of antibacterial drugs such as tetracycline and clindamycin. These findings suggest that the silkworm C. acnes infection model can be used to evaluate host toxicity caused by C. acnes and the in vivo efficacy of antimicrobial drugs.

Microsampling Assays for Pharmacokinetic Analysis and Therapeutic Drug Monitoring of Antimicrobial Drugs in Children: A Critical Review.

With the increasing prevalence of multidrug resistant organisms, therapeutic drug monitoring (TDM) has become a common tool for assuring the safety and efficacy of antimicrobial drugs at higher doses. Microsampling techniques, including dried blood spotting (DBS) and volumetric absorptive microsampling (VAMS), are attractive tools for TDM and pediatric clinical research. For microsampling techniques to be a useful tool for TDM, it is necessary to establish the blood-plasma correlation and the therapeutic window of antimicrobial drugs in the blood. DBS involves the collection of small volumes of blood (30-50 µL per spot) on a filter paper, whereas VAMS allows the accurate and precise collection of a fixed volume of blood (10-30 µL) with microsampling devices. One of the major advantages of VAMS is that it reduces or eliminates the volumetric blood hematocrit (HCT) bias associated with DBS. Liquid chromatography with tandem mass spectrometry is a powerful tool for the accurate quantification of antimicrobial drugs from small volumes of blood specimens. This review summarizes the recent liquid chromatography with tandem mass spectrometry assays that have used DBS and VAMS approaches for quantifying antimicrobial drugs. Sample collection, extraction, validation outcomes, including the interassay and intra-assay accuracy and precision, recovery, stability, and matrix effect, as well as the clinical application of these assays and their potential as tools of TDM are discussed herein. Microsampling techniques, such as VAMS, provide an alternative approach to traditional plasma sample collection for TDM.

Outpacing the resistance tsunami: Antimicrobial stewardship in equine medicine, an overview

SummaryAntimicrobial stewardship (AMS) is the term increasingly used to describe the multiple approaches needed to sustain the efficacy of antimicrobial drugs in the face of the increasing development and spread of antimicrobial resistance in bacterial pathogens, and the global crisis in medicine that it is engendering. The concept and the practices associated with AMS continue to evolve but the general approach is a dynamic and multifaceted one of continuous improvement based on reducing, improving, monitoring and evaluating the use of antimicrobials so as to preserve their future efficacy and to protect human and animal health. Using many equine examples, this basic overview discusses the multiple and interacting elements of AMS: Practice guidelines, infection control and prevention, clinical microbiology, resistance and use surveillance, dosage, pharmacokinetics and pharmacodynamics, regulation, education and owner compliance, leadership, coordination and measurement. There have been impressive advances in recent years in reporting and analysis of AMR in horses, in the scrutiny and assessment of how antimicrobial drugs are used in horses and in identification of areas for improvement including dosing, surgical prophylaxis, infection control, development of practice standards and the use of clinical microbiology. Antimicrobial stewardship is taking shape as we start to see the emergence of evidence‐based recommendations but far more is required. Containing and even rolling back AMR will need the continued engagement of practitioners, equine national and international practitioner organisations, researchers and educators in the academic community, horse owners, regulators and others.

A computational subtractive genome analysis for the characterization of novel drug targets in Klebsiella pneumonia strain PittNDM01

The emergence of carbapenem-resistant Klebsiella Pneumoniae had been reported previously, which needs rapid attention. Currently, Pittsburgh University Hospital reported a new strain of carbapenem-resistant Klebsiella pneumoniae that was co-producing OXA-232 and NDM-1 named as PittNDM01. This strain is resistant to almost all beta-lactam antibiotics such as Carbapenem as well as to fluoroquinolones and aminoglycosides. Globally, failure to the wide-spread pathogenic strains had been observed due to the increased and antibiotic resistance, which leads to less antimicrobial drug efficacy. Since last decades, computational genomic approaches have been introduced to fight against resistant pathogens, which is an advanced approach for novel drug targets investigation. The current study emphasizes the utilization of the available genomic and proteomic data of Klebsiella pneumoniae PittNDM01 for the identification of novel drug targets for future drug developments. Comparative genomic analysis and molecular biological tools were applied, results in observing 582 non-human homologous-essential proteins of Klebsiella pneumoniae. Among the total 582 proteins, 66 were closely related to the pathogen-specific pathway. Out of all 66-targeted proteins, ten non-homologous essential proteins were found to have druggability potential. The subcellular localization of these proteins revealed; 6 proteins in the cytoplasm, 2 in the inner membrane, and one each in periplasmic space and outer membrane. All the above 10 proteins were compared to the proteins sequences of gut flora to eliminate the homologous proteins. In total, 6-novel non-human and non-gut flora essential drug targets of Klebsiella pneumoniae PittNDM01 strain were identified. Further, the 3D structures of the identified drug target proteins were developed, and protein-protein interaction network analysis was performed to know the functional annotation of the desire proteins. Therefore, these non-homologous essential targets ensure the survival of the pathogen and hence can be targeted for drug discovery.

The effect of enrofloxacin on enteric Escherichia coli: Fitting a mathematical model to in vivo data.

Antimicrobial drugs administered systemically may cause the emergence and dissemination of antimicrobial resistance among enteric bacteria. To develop logical, research-based recommendations for food animal veterinarians, we must understand how to maximize antimicrobial drug efficacy while minimizing risk of antimicrobial resistance. Our objective is to evaluate the effect of two approved dosing regimens of enrofloxacin (a single high dose or three low doses) on Escherichia coli in cattle. We look specifically at bacteria above and below the epidemiological cutoff (ECOFF), above which the bacteria are likely to have an acquired or mutational resistance to enrofloxacin. We developed a differential equation model for the antimicrobial drug concentrations in plasma and colon, and bacteria populations in the feces. The model was fit to animal data of drug concentrations in the plasma and colon obtained using ultrafiltration probes. Fecal E. coli counts and minimum inhibitory concentrations were measured for the week after receiving the antimicrobial drug. We predict that the antimicrobial susceptibility of the bacteria above the ECOFF pre-treatment strongly affects the composition of the bacteria following treatment. Faster removal of the antimicrobial drugs from the colon throughout the study leads to improved clearance of bacteria above the ECOFF in the low dose regimen. If we assume a fitness cost is associated with bacteria above the ECOFF, the increased fitness costs leads to reduction of bacteria above the ECOFF in the low dose study. These results suggest the initial E. coli susceptibility is a strong indicator of how steers respond to antimicrobial drug treatment.

The Risk of Development of Antimicrobial Resistance with the Use of Coccidiostats in Poultry Diets

The Risk of Development of Antimicrobial Resistance with the Use of Coccidiostats in Poultry Diets

Auditing and Improving Surgical Antibiotic Prophylaxis

There is extensive evidence of the efficacy of anti-microbial drugs in preventing infections from surgical efforts. Our objective was to describe the results obtained in our annual surgical antibiotic prophylaxis (SAP) audit in the years 2013-2017. This was a retrospective observational study of SAP in surgical procedures carried out between 2013 and 2017 in a tertiary-level hospital. We examined the results from the services of general surgery, vascular surgery, neurosurgery, the breast unit, otolaryngology, maxillofacial surgery, traumatology, urology, pediatric surgery, gynecology, and plastic surgery. Establishment of six process quality indicators and their evaluation in the annual audit were carried out by the pharmacy service for approximately 500 operations. The indicators that had a high percentage of compliance were indication for SAP, choice of anti-microbial agent, dose and route of administration, and administration of an intra-operative dose when this was appropriate. In contrast, time of administration of the first dose and duration of prophylaxis had a worse percentage of compliance. Compliance with the SAP protocols in our hospital is high. We consider that these better results are attributable to the establishment of quality indicators of SAP and to the annual audit that evaluates said indicators. Communication of the results obtained in the audit to the surgical services, which have as part of their objectives included in their management contracts compliance with said SAP protocols, encourages improvement. The use of prophylaxis kits is an improvement strategy that facilitates the correct choice of anti-microbial agent and prevents SAP from being prolonged inappropriately.

Knowledge, attitudes and practices toward antimicrobial usage: a cross-sectional study of layer and pig farm owners/managers in Chiang Mai, Lamphun, and Chonburi provinces, Thailand, May 2014 to February 2016

This study aimed at determining the current knowledge, attitude, and practices (KAP) of layer and pig farmers to antimicrobial usage and its consequences. Description of such KAP could provide insights useful for promoting the rational use of antimicrobials in livestock. From May 2014 to February 2016, a survey involving 251 respondents in Chiang Mai, Lamphun, and Chonburi provinces, Thailand, was conducted by using a validated questionnaire. More than half (51.0%) of the respondents incorrectly believed that antimicrobial drug efficacy could not be reduced by using sub-recommended dosages, 61.2% had misconceptions about non-therapeutic antimicrobial use, and 66.9% inaccurately felt that antimicrobials were also effective for virus and fungi. Over half (50.6-55.2%) did not see the need to follow instructions or advice of veterinarians. Moreover, only 10.4% regularly relied on responses to drugs sensitivity tests when evaluating the effectiveness of antimicrobials. Overall, assessment of KAP regarding antimicrobial usage indicated that the majority of respondents had low levels of knowledge of antimicrobials, neutral rather than positive attitudes, and employed poor practices in the use of antimicrobials. The results indicate improvements in KAP could be helpful in developing more effective interventions by farmers, reduce antibiotic usage, and slow the growth of antimicrobial resistance.

Comparison between effects of antibiotics, NSAIDs and their mixture on the growth of microorganisms

Aim: To compare the effects of antibiotics, NSAIDs and their mixture on the growth of microorganisms. Introduction: Commonly, when a patient has an infection, doctors prescribe NSAIDs for pain and inflammation that may be caused by infection as a part of symptomatic treatment. And antibiotics are also prescribed as an etiological treatment. Our experiment that was performed last year came to a conclusion that NSAIDs, notably: Aspirin, Ibuprofen and Diclofenac could inhibit the growth of some microorganisms including Staphylococcus aureus, Escherichia coli and Candida albicans. These results, although performed in vitro were promising especially with the growing rate of bacterial resistance towards antimicrobial agents. Methods: We used antibiotics: Penicillin, Gentamicin and Ceftriaxone; NSAIDs-non-selective: Aspirin, Diclofenac and Ibuprofen and COX-2 selective: Celecoxib. Samples were taken from the oral cavity of patients with liver diseases. Cultures were made of the samples taken and they were inoculated onto an agar plate. Then three well were made in the agar plate: in the first well we put an NSAIDs, second well with an antibiotic and in the third we put the mixture of both NSAID and antibiotic. The agar plates were placed into an incubator for 24h at a temperature of 37°C. The experiment was done twice to get accurate results. Results: The analysis of the obtained results shows that in group 1 (antibiotics) was the highest inhibition 39.3±3.6mm, in the group 2 in which there were NSAIDs gave the results as shown 31.7±4.1mm, and last investigative group 3 with mixture was 27.3±1.8. Conclusion: From the obtained results we can conclude that a mixture of NSAIDs and antibiotics does not improve antibacterial effect of antibiotics. In fact, NSAIDs seem to even lower the efficacy of antimicrobial drugs. Special attention should be paid while administering NSAIDs to patients who are on antibiotic therapy since the combination of these two groups of drugs lower the antimicrobial effect. Acknowledgements: Assistant professor Marta Panas (our scientific advisor).

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: Second edition.

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: Second edition.

Annacardium occidentale Stem Bark Extract can Decrease the Efficacy of Antimicrobial Drugs

&lt;p class="MsoNormal" style="text-align: justify;"&gt;Background: Due to the growing use of phytotherapy clinical strategies for infectious diseases, healthcare providers and patients must know the risks of interactions between such preparations and synthetic drugs. Cashew extracts are widely used in Brazil for complementary treatments of infectious diseases, and often are combined to antimicrobial drugs. However, the possible consequences of such combinations are unknown. Objective: To assess the interference of the Cashew stem bark hydroethanolic extract (CSBE) on certain antimicrobials against clinical isolates of staphylococcal species. Methodology: Antimicrobial susceptibility test and interference assays were performed using gentamycin, ampicilin, ciprofloxacin, G penicillin, neomycin, rifampicin and vancomycin disks. Results: Here we show that the CSBE might reduce the therapeutic activity of some antimicrobial drugs in Staphylococcal species. We found in controlled in vitro assays that the antagonistic effect was seen in all antimicrobial drugs tested for most of the strains and statistically significant differences were found when compared to the control antimicrobials. Our results also indicate the presence of tannins, flavonoids and saponins in the CSBE. Conclusion: Such combinations are suggested to be not adequate for clinical treatments. Further researches are needed for a better understating of such interactions at the molecular level.&lt;/p&gt;

Mycobacterium kyorinenseInfection

<i>Mycobacterium kyorinense</i>Infection