Side Effects Of Antibiotics Research Articles

1978. Statements about Antibiotic Side-Effects and Patient Desire for Unnecessary Antibiotics

BackgroundAntibiotic resistance is a global health emergency fueled in part by non-indicated use of antibiotics. Current public education campaigns primarily focus on the risks of global antibiotic resistance or society-wide adverse impacts of antibiotic misuse. There has been little research into what messages have the greatest impact on patient requests for non-indicated antibiotics.MethodsWe administered a survey at a primary care clinic in August 2018. Participants rated 18 statements about potential harm from antibiotics on how that statement changed their likelihood to request antibiotics for an upper respiratory tract infection (URI) on an 11-point Likert scale. These included 8 statements about potential harm to the individual, 4 statements about potential harm to contacts of the individual, and 6 statements about resistance or the societal impact of antibiotic misuse. Before and after the survey, participants rated how likely they were to request antibiotics for a URI.ResultsOf 1150 adult patients in clinic over the 6 days of the survey, 250 completed the survey. Statements about potential harm to the individual decreased patient likelihood to request antibiotics more than statements about societal impacts of antibiotic misuse. (P < 0.001). Statements about potential harm to contacts of the patient also decreased patient likelihood to request antibiotics more than statements about resistance or societal impacts of antibiotic misuse (P < 0.001). Statements discussing antibiotic resistance were less likely to impact patient likelihood to request antibiotics than statements not mentioning antibiotic resistance (P < 0.001). All statements decreased patient likelihood to request antibiotics. Overall likelihood to request antibiotics decreased after the survey (from 5.3 pre- to 3.1 post-survey, P < 0.001).ConclusionStatements about how potential harm of antibiotics to the individual had a greater impact than statements about resistance or societal impact of antibiotics. Our results suggest that when dissuading patients from requesting non-indicated antibiotics, providers and public health campaigns focus on the potential harm of antibiotics to the individual patient rather than on antibiotic resistance or societal impacts.Disclosures All authors: No reported disclosures.

2065. Reducing Inappropriate Antibiotic Prescriptions in the Primary Care Setting

BackgroundIn 2015, the CDC established the National Action Plan for Combating Antibiotic-Resistant Bacteria, with the goal of reducing inappropriate outpatient antibiotic use by 50% by 2020. Upper respiratory infections, (URIs) account for one of the top three diagnoses prompting outpatient visits, and despite viral pathogens being the etiology of most URIs, many patients are treated with antibiotics. This study aimed to reduce inappropriate antibiotics prescribing for URIs at Cooper Primary Care offices.MethodsUsing the electronic medical record, we analyzed office visits (OVs) of 63 primary care providers during the influenza season (November 1, 2017–February 28, 2018) that were associated with a URI diagnosis code and resulted in an antibiotic prescription. The intervention was a personalized digital URI score card (Figure 1) emailed to each primary care physician. It included (1) Cooper Hospitals’ Primary Care Department Average Rate of Antibiotic Prescribing for URI OVs and (2) each physician’s average rate of antibiotic prescribing for URI office visits. Data were collected post-intervention (November 1, 2018–February 28, 2019) to evaluate for changes in antibiotic prescribing patterns.ResultsUsing Fischer’s Exact test we analyzed the pre vs. post-intervention rate of antibiotic prescribing for URI OVs. There were 7,295 total pre-intervention office visits. Of these, 41.03% resulted in an antibiotic prescription. There were 6,642 total post-intervention office visits. Of these, 35.85% resulted in an antibiotic prescription. There was a 5.18% overall decrease in antibiotics prescribed for all URI office visits (P < 0.001) (see Figure 2).ConclusionIncreasing providers’ awareness of their own prescribing patterns compared with their department’s prescribing patterns utilizing a single report card decreased the rate of antibiotics prescribed for URIs by 5.18% for all URI-related office visits. Specifically, there was 10.19% decrease in antibiotics prescribed for bronchitis, which is by definition, of viral etiology. This is significant given the potential side-effects of unnecessary antibiotics, and the emergence of antibiotic resistance. Limitations include a lack of certainty in “true” inappropriate prescriptions and diagnosis coding. Disclosures All authors: No reported disclosures.

Patterns of self-medication with antibiotics in Maputo City: a qualitative study

BackgroundMozambique classifies but does not yet enforce antibiotics as prescription-only-medicine (POM) allowing the public access to a variety of antibiotics that otherwise are provided on prescription. This contributes to the growing practice of self-medication with antibiotics (SMA) which systematically exposes individuals to the risk of developing antibiotic resistance, antibiotic side effects and increases the health service costs and morbidity. This study aimed at describing the patterns of SMA among Maputo city pharmacy customers.MethodsA qualitative study conducted between October 2018 and March 2019 was developed with thirty-two pharmacy customers and seventeen pharmacists. Using convenience sampling, customers were recruited after buying antibiotics without prescription from nine private pharmacies. Of the thirty-two participants, twenty participated in in-depth interviews and twelve in two focus groups discussions (FGD) with six participants each. Purposive sampling and a snowball technique were used to recruit pharmacists. The transcripts were coded and analyzed using latent content analysis. Nvivo 11 was used to store and retrieve the data. The COREQ (Tong, 2007) checklist for interviews and FGD was performed.ResultsCustomers admitted practices of SMA, pharmacists admitted dispensing a variety of antibiotics without prescription. Non-prescribed antibiotics (NPA) were obtained through five different patterns including; using the generic name, describing the physical appearance and using empty package, describing symptoms or health problem to pharmacists, using old prescriptions and sharing antibiotics with family, friends, and neighbors.ConclusionDifferent patterns of SMA are contributing to the indiscriminate use of antibiotics among customers. The NPA utilization is perceived as an expression of self-care where participants experience self-perceived symptoms and indulge in self-treatment as a method of caring for themselves. Moreover, antibiotics are mostly used to treat diseases that do not necessarily need antibiotics. Strong and effective public health education and promotion initiatives should be implemented to discourage inappropriate utilization of antibiotics and SMA practices.

Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study.

Inappropriate antibiotic use for upper respiratory tract infections (URTIs) is an ongoing problem in primary care. There is extreme variation in the prescribing practices of individual physicians, which cannot be explained by clinical factors. To identify factors associated with high and low prescriber status for management of URTIs in primary care practice. Exploratory sequential mixed-methods design including interviews with primary care physicians in a large health system followed by a survey. Twenty-nine physicians participated in the qualitative interviews. Interviews were followed by a survey in which 109 physicians participated. Qualitative interviews were used to obtain perspectives of high and low prescribers on factors that influenced their decision making in the management of URTIs. A quantitative survey was created based on qualitative interviews and responses compared to actual prescribing rates. An assessment of self-prescribing pattern relative to their peers was also conducted. Qualitative interviews identified themes such as clinical factors (patient characteristics, symptom duration, and severity), nonclinical factors (physician-patient relationship, concern for patient satisfaction, preference and expectation, time pressure), desire to follow evidence-based medicine, and concern for adverse effects to influence prescribing. In the survey, reported concern regarding antibiotic side effects and the desire to practice evidence-based medicine were associated with lower prescribing rates whereas reported concern for patient satisfaction and patient demand were associated with high prescribing rates. High prescribers were generally unaware of their high prescribing status. Physicians report that nonclinical factors frequently influence their decision to prescribe antibiotics for URTI. Physician concerns regarding antibiotic side effects and patient satisfaction are important factors in the decision-making process. Changes in the health system addressing both physicians and patients may be necessary to attain desired prescribing levels.

Assessment of Antibiotic Knowledge Among Final Year Pharmacy Students at Baghdad University

Background:Antibiotics are life-saving drugs that if misused lead to antibiotic resistance and consequently to a substantial public health issue. Pharmacists have a major role in ensuring the rational use of antibiotics to prevent antibiotic resistance. This study aimed to assess antibiotic knowledge among final year pharmacy students at Baghdad University.Methods:A cross sectional study using a newly developed and validated questionnaire was given for 148 final year (5thstage) students at Baghdad University – College of Pharmacy during November 2016. Only 140 students (response rate 93%) completed the questionnaire. The 10 items-questionnaire consisted of 5 major domains: Antibiotic effectiveness, side effects, resistance, use in specific cases (e.g., during pregnancy and septicemia), and the legal issues of antibiotic dispensing.Results:Only 20% of students have good overall antibiotic knowledge. The least knowledge for pharmacy student was in regard to antibiotic side effects and antibiotic resistance at which only 22% and 19% of pharmacists possessed good antibiotic knowledge respectively. Knowledge of student was the best in legal issues of antibiotic dispensing. There was a non-significant difference in antibiotic knowledge between male and female pharmacy students.Conclusion:Antibiotic knowledge among pharmacy students at Baghdad University was very poor and less than expected.

Chemical Composition, Nutritional Values and Antibacterial Activities of Watermelon Seed (Citrullus lanatus)

The World Health Organization (WHO) defines traditional medicine as the sum total of the knowledge, skills, and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Plants are traditionally used for treatment of bacterial infections. The aim of this study was to investigate chemical composition, nutritional evaluation and antibacterial activities of watermelon seeds. The qualitative phytochemical analysis of watermelon indicated that alkaloids were moderately present, tannins, saponins, flavonoids, and phenols were all present. The quantitative analysis of watermelon indicated 3.080 mg/g for alkaloids, 0.304mg/g for phenols, 0.117 mg/g for tannins, 0.200mg/g for saponins and 2.675 mg/g for flavonoids. The vitamin composition of watermelon seeds indicated 0.03 mg/100 g for vitaminB1, 0.01 vitaminB2, 0.64 mg/100g for vitaminB3, 0.24 mg /100 g vitaminB6 and 0.01 for vitaminB12.The bioactivities of extract were tested, against Proteus mirabilis, Bacillus cereus, Staphylococcus aureus, Escherichia coli, Necropsobacter rosorum, Tsukamurella hongkongensis, Lactobacillus sp, Staphylococcus petrasii, Neisseria sicca, Dietzi amaris, Pseudomonas oryzyhabitans, Klebsiella pneumoniae, Advenella incenata, Neiserria subflava and Serriatia marcescens. Researchers are advised to turn their attention towards plants products, which is most promising area in search of new biologically activity compounds with better activity against multi drug resistant strains and reduced antibiotic related side effects.

Inhibitory effects of selected antibiotics on the activities of α-amylase and α-glucosidase: In-vitro, in-vivo and theoretical studies

Antibiotics are effective drugs that are used to treat infectious diseases either by killing bacteria or slowing down their growth. The well-adapted structural features of antibiotics for the inhibition/activation of enzymes include several available hydrogen bond (H-bond) acceptors and donors, flexible backbone and hydrophobic nature. The substrates of α-amylase and α-glucosidase, known as key absorbing enzymes, have functional groups (OH groups) rembling antibiotics. Given the possibility of developing in diabetics and the significant association between diabetes and infection, the present study was conducted to investigate the influences of tetracycline (TET), kanamycin (KANA), lincomycin (LIN), erythromycin (ERM) and azithromycin (AZM) on α-glucosidase and α-amylase activities with calculating IC50 and Ki values. Also, the efficacy of antibiotics after oral administration was evaluated by analysis of blood glucose concentrations in rats, as well as a molecular docking analysis was explored. α-glucosidase and α-amylase activities were inhibited in a dose dependent fashion by TET with an IC50 of 38.7 ± 1.4 and 47.8 ± 3.2 μM respectively, by KANA with an IC50 of 46.2 ± 1.6 and 65.1 ± 1.6, by LIN with an IC50 of 59.1 ± 2.1 and 51.3 ± 4.1, by ERM with an IC50 of 94.9 ± 4.7 and 65.7 ± 3.8 and by AZM with an IC50 of 69.4 ± 4.4 and 103.6 ± 6.2. Moreover, the Ki values of TET were calculated as 4.4 ± 0.6 and 8.4 ± 0.8 μM for α-glucosidase and α-amylase in a competitive-mode and mixed-mode inhibition. In addition, to communicate with the active site of α-glucosidase and α-amylase respectively, TET presented a binding energy of −9.8 and −8.8 kcal/mol, KANA −7.9 and −7.1, LIN -7.8 and −6.7, ERM −6.8 and −6.4, and AZM −6.4 and −7.5 kcal/mol. In-vivo studies also suggested a decrease in the blood glucose concentration after administering TET compared to the positive controls (P < 0.01). The results obtained from the present research can therefore help the scientific community explore the possible interconnection between the clinical side-effects of antibiotics and their α-glucosidase and α-amylase inhibitory properties, as the target enzymes in hypoglycemia conditions.

Comparative Study on the Efficacy of Postsurgical Oral Prophylactic Antibiotic Versus Antimicrobial Suture Placement Alone in Preventing Surgical Site Infection After Removal of Impacted Mandibular Third Molar.

To evaluate the efficacy of postsurgical oral prophylactic antibiotic versus antimicrobial suture placement in preventing infection after removal of an impacted mandibular third molar. This was a prospective, single-blind study including 150 individuals of 18-40years divided into two groups with 75 patients each. The patients in Group 1 were administered oral amoxicillin tablets 500mg for 5days postsurgery with 3-0 polyglactin sutures for closure and in group 2 with (3-0) antimicrobial chlorhexidine diacetate-impregnated polyglactin sutures only. Evaluation was done on 3rd, 7th, 15thdays and 1month. There was no significant difference in rates of infection between the groups. Abnormal erythema, pain and trismus showed statistically better results in group 2 on 3rd and 7th days. An antibiotic side effect assessment showed 17.65% patients with minor side effects. Chlorhexidine diacetate-impregnated polyglactin sutures showed reduced erythema, pain and trismus in healthy patients undergoing surgical removal of third molar.

Biocatalytic degradation/redefining "removal" fate of pharmaceutically active compounds and antibiotics in the aquatic environment.

Recently, the increasing concentration and persistent appearance of antibiotics traces in the water streams are considered an issue of high concern. In this context, an array of antibiotics has been categorized as pollutants of emerging concern due to their complex and highly stable bioactivity, indiscriminate usage with ultimate release into water bodies, and notable persistence in environmental matrices. Moreover, antibiotics traces containing household sewage/drain waste and pharmaceutical wastewater effluents contain a range of bioactive/toxic organic compounds, inorganic salts, pharmaceutically-active ingredients, or a mixture of all, which possesses negative influences ranging from ecological pollution to damage biodiversity. Moreover, their uncontrolled and undesirable bioaccumulation also poses a potential threat to target and non-target organisms in the environment. Aiming to tackle this issue effectively, various detection, quantification, degradation, and redefining "removal" processes have been proposed and investigated based on physical, chemical, and biological strategies. Though both useful and side effects of antibiotics on humans and animals are usually investigated thoroughly following safety and toxicity measures, however, their direct or indirect environmental impacts are not well reviewed yet. Owing to the considerable research gap, the environmental perfectives of antibiotics traces and their effects on target and non-target populations have now become the topic of research interest. Based on literature evidence, over the past several years, numerous individual studies have been performed and published covering various aspects of antibiotics. However, a comprehensive compilation on enzyme-based degradation of antibiotics is still lacking and requires careful consideration. Hence, this review summarizes up-to-date literature on enzymes as biocatalytic systems, explicitly, free as well as immobilized forms and their effective exploitation for the degradation of various antibiotics traces and other pharmaceutically-active compounds present in the water bodies. It is further envisioned that the enzyme-based strategies, for antibiotics degradation or removal, discussed herein, will help readers for a better understanding of antibiotics persistence in the environment along with the associated risks and removal measures. In summary, the current research thrust presented in this review will additionally evoke researcher to engineer robust and sustainable processes to effectively remediate antibiotics-contaminated environmental matrices.

Toward Early Diagnosis of Late-Onset Sepsis in Preterm Neonates: Dual Magnetoimmunosensor for Simultaneous Procalcitonin and C-Reactive Protein Determination in Diagnosed Clinical Samples.

Early diagnosis of sepsis, combining blood cultures and inflammation biomarkers, continues to be a challenge, especially in very low birth weight (VLBW) infants because of limited availability of blood samples. Traditional diagnostic procedures are cumbersome, not fast enough, and require relatively large volumes of sample. Empiric use of antibiotics, before diagnostic confirmation, is required to decrease mortality, leading to potential antibiotic resistance and side effects in VLBW infants. To solve such a serious problem, a dual magnetoimmunosensor is proposed for simultaneous assessment of two of the most important sepsis biomarkers: procalcitonin (PCT for early phase) and C-reactive protein (CRP for late phase). This "sample-to-result" approach exhibited excellent sensitivity, selectivity, precision, and stability using low sample volumes (<30 μL) and under 20 min of total assay. The analytical usefulness of the approach was demonstrated by analyzing clinically relevant samples of preterm neonates with suspicion of sepsis.

Das Kreuz mit der Kreuzallergie: Betalaktamantibiotika-Allergie

Hypersensitivity reactions to betalactam antibiotics are the most commonly mentioned drug allergies. Up to 10 percent of patients report to suffer from a penicillin allergy. However, classical side effects of antibiotics are often misdiagnosed as an allergy. Many of these patients with suspected betalactam allergy tolerate betalactam antibiotics well. Therefore, a thorough allergy workup is essential to confirm a suspected allergy or to enable again a treatment with betalactam antibiotics. Most important is a good documentation as skin- and in-vitro tests have a reduced sensitivity. Gold standard is the provocation test to help exclude a supposed allergy or to test alternative, potential cross reactive betalactam antibiotics. Cross-reactions between penicillins and cephalosporins, especially cephalosporins of the third and fourth generation are unusual. Cross reactions to carbapenem antibiotics are rare.

Role of Nickel (II) Salicylhydroxamic Acid and its Aniline Adduct as an Antimicrobial Substitute

The development of drug resistance as well as the appearance of undesirable side effects of certain antibiotics has led to the search of new antimicrobial agents with the goal to discover new chemical structures which overcome the above disadvantages. As a ligand with potential oxygen and nitrogen donors, hydroxamic acids are interesting and have gained special attention not only because of the structural chemistry of their coordination modes, but also because of their importance in medical chemistry. This study was undertaken to synthesis salicylhydroxamic acid, complex it with nickel (II) and its aniline adduct and evaluate the antimicrobial potential of the ligand and its complex in order to orient future investigations towards the finding of new potent and safe antimicrobial drugs. Solubility, conductivity, UV spectroscopy and antimicrobial studies of the compounds was carried out Salicylic hydroxamic acid (SHA) and Nickel (II) complex showed significant in vitro antibacterial and antifungal activities against all tested organisms. The mode of action by which SHA exhibited antifungal and antibacterial activities may involve the formation of a hydrogen bond through the nitrogen and oxygen atoms in Salicylic hydroxamic acid (SHA) with the active centers of the cell constituents, resulting in interference with the normal cell process. There is great potential for the development of Ni (SHA)2 C6 H5 NH2 into a potent drug with better efficacy than the current antimicrobial therapies available which are easily prone to resistance.

Efficacy of Short Course Antibiotic Prophylaxis in Surgical Treatment of Closed Fracture

Introduction: Unnecessary and rampant use of antibiotic for perioperative prophylaxis are not only increasing cost of treatment but also are hazardous in terms of increasing antibiotic resistance, super infection with resistant pathogens and antibiotic toxicity.&#x0D; Objective: Our primary objective is to assess the efficacy of short course antibiotic prophylaxis in preventing surgical site infection (SSI) in surgery of closed orthopedic fracture.&#x0D; Methodology: Patients fulfilling all the inclusion criteria and willing and able to give informed consent were included in the study. All participants were treated by standard surgical technique following standard surgical protocol. Short course antibiotic prophylaxis was administered in peri-operative period to all patients in given format: Three divided dose of intravenous 1.5 gram cefuroxime during peri-operative period followed by no intravenous or oral antibiotics; 1st dose half an hour before incision; 2nd and 3rd dose repeated at 12 hours interval.&#x0D; Results: Of total 100 patient included, three developed surgical site infection till one year follow-up. All three patients with surgical site infection were treated successfully with intravenous antibiotic based on the culture sensitivity report. The average cost of antibiotic for short course antibiotic prophylaxis was 1500 NPR for each patient.&#x0D; Conclusions: There was no significant increase in rate of surgical site infection with short course antibiotic prophylaxis, rather it was less expensive and may have less adverse effect, in terms of antibiotic resistance and antibiotic side effects on long run.

Clarithromycin and endoscopic sinus surgery for adults with chronic rhinosinusitis with and without nasal polyps: study protocol for the MACRO randomised controlled trial

BackgroundChronic rhinosinusitis (CRS) is a common source of ill health; 11% of UK adults reported CRS symptoms in a worldwide population study. Guidelines are conflicting regarding whether antibiotics should be included in primary medical management, reflecting the lack of evidence in systematic reviews. Insufficient evidence to inform the role of surgery contributes to a fivefold variation in UK intervention rates. The objective of this trial is to establish the comparative effectiveness of endoscopic sinus surgery (ESS) or a prolonged course of antibiotics (clarithromycin) in adult patients with CRS in terms of symptomatic improvement and costs to the National Health Service compared with standard medical care (intranasal medication) at 6 months.Methods/designA three-arm parallel-group trial will be conducted with patients who remain symptomatic after receiving appropriate medical therapy (either in primary or secondary care). They will be randomised to receive: (1) intranasal medication plus ESS, (2) intranasal medication plus clarithromycin (250 mg) or (3) intranasal medication plus a placebo. Intranasal medication (current standard medical care) is defined as a spray or drops of intranasal corticosteroids and saline irrigations. The primary outcome measure is the SNOT-22 questionnaire, which assesses disease-specific health-related quality of life. The study sample size is 600. Principal analyses will be according to the randomised groups irrespective of compliance. The trial will be conducted in at least 16 secondary or tertiary care centres with an internal pilot at six sites for 6 months.DiscussionThe potential cardiovascular side effects of macrolide antibiotics have been recently highlighted. The effectiveness of antibiotics will be established through this trial, which may help to reduce unnecessary usage and potential morbidity. If ESS is shown to be clinically effective and cost-effective, the trial may encourage earlier intervention. In contrast, if it is shown to be ineffective, then there should be a significant reduction in surgery rates. The trial results will feed into the other components of the MACRO research programme to establish best practice for the management of adults with CRS and design the ideal patient pathway across primary and secondary care.Trial registrationISRCTN36962030. Registered on 17 October 2018.

Procalcitonin to guide antibiotic decision making.

There is convincing evidence linking antibiotic-stewardship efforts which include the infection marker procalcitonin (PCT) to more rational use of antibiotics with improvements in side-effects and clinical outcomes. This is particularly true in the setting of respiratory infection and sepsis. Yet, some recent trials have shown no benefit of PCT-guided care. Our aim was to discuss the benefits and limitations of using PCT for early infection recognition, severity assessment and therapeutic decisions in individual patients based on most the recent study data. Current evidence from randomized trials, and meta-analyses of these trials, indicates that PCT-guided antibiotic stewardship results in a reduction in antibiotic use and antibiotic side-effects, which translates into improved survival of patients with respiratory infections and sepsis. Notably, initial PCT levels have been found to be helpful in defining the risk for bacterial infection in the context of a low pretest probability for bacterial infections (i.e., patients with bronchitis or chronic bastructive pulmonary disease exacerbation). Monitoring of repeated PCT measurements over time has also been found helpful for estimating recovery from bacterial infection and prognosis in higher risk situations (i.e., pneumonia or sepsis) and results in early and safe discontinuation of antibiotic therapy. Some trials, however, did not find a strong effect of PCT guidance which may be explained by low protocol adherence, assessment using only a single rather than repeat PCT levels and lower antibiotic exposure in control group patients. Using PCT in the right patient population, with high-sensitivity assays and with adequate training of physicians is important to increase protocol adherence and reduce antibiotic exposure. Inclusion of PCT into antibiotic stewardship algorithms has the potential to improve the diagnostic and therapeutic management of patients presenting with respiratory illnesses and sepsis, and holds great promise to mitigate the global bacterial resistance crisis and move from a default position of standardized care to more personalized treatment decisions.

Immunization with a Synthetic Helicobacter pylori Peptide Induces Secretory IgA Antibodies and Protects Mice against Infection.

Helicobacter pylori is a spiral Gram-negative bacterium associated with inflammation of the gastric mucosa, peptic ulcer, and gastric adenocarcinoma, whose treatment has failed due to antibiotic resistance and side effects. Furthermore, because there are no vaccines effective against H. pylori, an appropriate vaccine design targeting conserved/essential genes must be identified. In the present study, a H. pylori 50–52 kDa immunogen-derived peptide antigen with the sequence Met-Val-Thr-Leu-Ile-Asn-Asn-Glu (MVTLINNE) was used to immunize against H. pylori infection. For this, mice received an intraperitoneal injection of 100 μg of H. pylori peptide on the first week, followed by two weekly subcutaneous reinforcements and further 109 bacteria administration in the drinking water for 3 weeks. Thymic cells proliferative responses to concanavalin A, serum levels of IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, and TNF-α cytokines, and IgG1, IgG2a, IgG2b, IgG3 IgM, and IgA immunoglobulins were evaluated. Significant (p < 0.05) increases on lymphoproliferation and spleen weights after immunization were observed. In contrast, infection significantly (p < 0.05) decreased lymphoproliferation, which was recovered in immunized mice. In addition, levels of serum TH1 and TH2 cytokines were not altered after immunization, except for the significant increase in IL-6 production in immunized and/or infected animals. Moreover, immunization correlated with plasma secretory IgA and IgG, whereas infection alone only elicited IgM antibodies. Peptide immunization protected 100% of mice against virulent H. pylori. MVTLINNE peptide deserves further research as an approach to the prophylaxis of H. pylori infection.

Macrolide prescription in Dutch children: compliance with guidelines.

For reasons of antibiotic resistance and side effects, macrolides should be prescribed with care in the pediatric population. We evaluated the adherence to Dutch guidelines of macrolide prescription in children and estimated the risk of Mycoplasma pneumoniae-associated pneumonia based on Fischer's decision tree. In this retrospective study, we included children aged 0-18years who were treated with azithromycin or clarithromycin for pulmonary disease in four settings from general practice to hospital ward for (1) the prescriptions not in accordance with the guideline of the Dutch Association of Pediatrics and (2) the risk of M. pneumoniae in patients with community-acquired pneumonia (CAP) according to Fischer's decision tree. The latter suggests that children older than three years with a fever lasting more than two days are at high risk for M. pneumoniae and that it is therefore justified to treat them with macrolides. In total, 189 macrolide prescriptions from 2015 until 2017 were analyzed: 139 children used macrolides for a pulmonary indication (75%); 18% (n = 25) of the prescriptions were not in accordance with Dutch guidelines. Only 9.1% of patients with CAP were classified as having a high risk of M. pneumoniae according to Fischer's decision tree. A significant proportion of macrolide prescriptions for Dutch children with a pulmonary disease appears not to be in accordance with the guidelines. Most patients with CAP treated with a macrolide actually had a low risk of having M. pneumoniae according to Fischer's decision tree. Both observations suggest overuse of macrolides in children.

A study on side effects of antibiotics used in the treatment of patients with head trauma and legal responsibility of clinicians in terms of the right to health

Aim: Patients with head trauma are routinely, and commonly treated with prophylactic antibiotics, which may also be used for the treatment of infection that may be developed during hospital stay. The relevant antibiotic may, however, some side effects and adverse event. The present study aimed to investigate whether the side effects and adverse events of the prophylactic antibiotics were considered as a complication or medical negligence.Material and Methods: Descriptive statistics were used for the evaluation of the data.Results: No studies were found in the literature. Ceftriaxone, ampicillin-sulbactam, and cefazolin sodium were preferred for antibiotherapy. Meropenem or vancomycin was solely administered to patients when observed active pathogens in culture-antibiogram. Clinicians should be cautioned the potential side effects and adverse events of some drugs frequently used in clinics. Conclusion: Otherwise, they may legally be held liable for medical negligence.Keywords: Adverse effect; head trauma; human rights; malpractice; negligence; rational antibiotic use; right to health; side effect; professional liability.

In vitro Antibacterial Effect of Hydroalcoholic Extract of Lawsonia inermis, Malva sylvestris, and Boswellia serrata on Aggregatibacter actinomycetemcomitans.

Background:Considering the increased rate of microbial resistance to antibiotics and chemical side effects of antibiotics and antiseptics used for the treatment of periodontal disease, there is a need for an alternative antimicrobial agent with fewer complications. Medicinal herbs have recently become popular as novel antimicrobial agents. This study aimed to assess the antibacterial effects of hydroalcoholic extracts of Lawsonia inermis, Malva sylvestris, and Boswellia serrata on Aggregatibacter actinomycetemcomitans.Materials and Methods:Hydroalcoholic extracts of the three medicinal plants were obtained by the maceration technique and A. actinomycetemcomitans was cultured. Antimicrobial efficacy of the three medicinal plants was compared with that of 0.2% chlorhexidine (CHX) according to the Clinical and Laboratory Standards Institute protocol using agar disc diffusion and broth microdilution techniques. All tests were repeated three times.Results:Hydroalcoholic extracts of all three plants had antimicrobial activity against A. actinomycetemcomitans. The minimum inhibitory concentration (MIC) of L. inermis, M. sylvestris, and B. serrata was 78.1, 156.2, and 1666 μg/mL with no significant difference between them. The MIC of CHX was 3.33 μg/mL, which was significantly higher than that of B. serrata extract.Conclusion:Given that further in vivo studies confirm other properties of these extracts and their safety in terms of cytotoxicity and mutagenicity, hydroalcoholic extracts of L. inermis and M. sylvestris may be used in mouthwashes or local delivery systems to affect periodontal biofilm.

Bio-Orthogonal Chemistry and Reloadable Biomaterial Enable Local Activation of Antibiotic Prodrugs and Enhance Treatments against Staphylococcus aureus Infections.

Systemic administration of antibiotics can cause severe side-effects such as liver and kidney toxicity, destruction of healthy gut bacteria, as well as multidrug resistance. Here, we present a bio-orthogonal chemistry-based strategy toward local prodrug concentration and activation. The strategy is based on the inverse electron-demand Diels–Alder chemistry between trans-cyclooctene and tetrazine and involves a biomaterial that can concentrate and activate multiple doses of systemic antibiotic therapy prodrugs at a local site. We demonstrate that a biomaterial, consisting of alginate hydrogel modified with tetrazine, is efficient at activating multiple doses of prodrugs of vancomycin and daptomycin in vitro as well as in vivo. These results support a drug delivery process that is independent of endogenous environmental markers. This approach is expected to improve therapeutic efficacy with decreased side-effects of antibiotics against bacterial infections. The platform has a wide scope of possible applications such as wound healing, and cancer and immunotherapy.