Treatment Of Severe Infections Research Articles

Spectroscopic Determination and In vitro Bioequivalence Studies of Different Amoxicillin Capsule Brands

Amoxicillin is an aminopenicillin antibiotic, used in the treatment of several infections resulting from susceptible Gram-positive and Gram-negative, such as pneumonia, acute otitis media, acne vulgaris, bacterial endocarditis, streptococcal pharyngitis, urinary tract, Lyme borreliosis, Salmonella, Helicobacter pylori, chlamydia, and odontogenic infections. The study aimed to determine the in-vitro bioequivalence of amoxicillin capsules from various brands using physicochemical and spectroscopic parameters. Weight uniformity, friability, disintegration, dissolving tests, and UV spectroscopy were used to determine the in-vitro bioequivalence of different brands of amoxicillin capsules. The weight variation for all the capsules showed compliance with the USP specifications (≤10% weight deviation). All brands complied with the USP/BP specification for the disintegration test, as disintegration time ranged from 7 to 12 minutes. The dissolution profile of the innovator and the generic brands showed a percentage release from 80.81 – 89.11% within 30 minutes. The first-order kinetics, t1/2 and k of amoxicillin released ranged from 16.01 – 27.11 min and 2.56 – 4.33 x 10-2 min-1 respectively. A straight-line graph was obtained as a calibration curve of amoxicillin. UV absorption spectrum showed four distinctive peaks at 240, 275, 320, and 360 nm, with the maximum at 240 nm, while the percentage content of amoxicillin ranged from 90.58 ± 1.38 to 98.74 ± 0.97%. This result complied with the BP and USP specifications. Hence, there was a strong correlation between the release rate constant, k, and time since values were ≥ 0.8087 compared with the innovator and other brands.

Association of clinical factors with thrombocytopenia in patients receiving linezolid treatment: a retrospective study.

Linezolid (LZD) plays an important role in the treatment of severe infections caused by Gram-positive bacteria. Thrombocytopenia is regarded as one of the most common side effects of linezolid, which results from the destruction of platelets or myelosuppression. The study aimed to identify the risk factors associated with the development of thrombocytopenia in Vietnamese patients. This retrospective, descriptive cross-sectional study was performed on adult patients who received parenteral LZD therapy (1,200 mg/day) in at least 3 days between January 2020 and June 2021 at a tertiary referral hospital in Vietnam. Thrombocytopenia was defined as either a final platelet count of less than 100 G/L or a 25% decrease in platelet count from baseline. Multivariate logistic regression analysis was applied to predict risk factors associated with LZD-induced thrombocytopenia. In the 208 patients included in the study, the average age was 69 and males accounted for 73.1%. LZD-induced thrombocytopenia occurred in 37% of patients. LZD-induced thrombocytopenia was significantly associated with shock (HR = 8.26, 95% CI 3.82 - 17.84, p < 0.001), baseline creatinine clearance (HR = 1.02, 95% CI [1.01 - 1.03], p = 0.002), and duration of LZD treatment of at least 14 days (HR = 4.45, 95% CI [1.83 - 11.05], p = 0.001). The results showed that thrombocytopenia was fairly common in patients using linezolid. Shock, renal failure, and duration of linezolid therapy of at least 14 days were significant risk factors for the incidence of linezolid-induced thrombocytopenia.

Ceftaroline fosamil – fifth-generation cephalosporin with anti-MRSA activity in the treatment of severe infections in pediatric practice

Сeftaroline fosamil is a fifth-generation cephalosporin and a unique β-lactam and the only currently registered in the Russian Federation cephalosporin with activity against MRSA. Сeftaroline is approved for use in pediatric practice for the treatment of children with community-acquired pneumonia and complicated skin and soft tissue infections, including cases of patients with concomitant bacteremia. The place of ceftaroline in the treatment of severe and life-threatening infections in children is primarily due to its high activity against the key causative agents of community-acquired pneumonia and skin and soft tissue infections (first of all, S. pneumoniae and S. aureus, including MRSA), bactericidal mechanism of action, creation of effective concentrations and penetration into the infection’s site, low potential for resistance development, proven significant development of clinical effect, high clinical efficacy in these infections and favorable tolerability and safety profile. The review presents the results of the program of clinical evaluation of ceftaroline in children, analyzes current data on etiology and antimicrobial resistance of the key pathogens of community-acquired pneumonia and skin and soft tissue infections in the Russian Federation, defines the place of ceftaroline in clinical recommendations in children, and characterizes the patient’s profile to whom the prescription of ceftaroline in hospital is indicated.

Ceftaroline fosamil – fifth-generation cephalosporin with anti-MRSA activity in the treatment of severe infections in pediatric practice

Сeftaroline fosamil is a fifth-generation cephalosporin and a unique β-lactam and the only currently registered in the Russian Federation cephalosporin with activity against MRSA. Сeftaroline is approved for use in pediatric practice for the treatment of children with community-acquired pneumonia and complicated skin and soft tissue infections, including cases of patients with concomitant bacteremia. The place of ceftaroline in the treatment of severe and life-threatening infections in children is primarily due to its high activity against the key causative agents of community-acquired pneumonia and skin and soft tissue infections (first of all, S. pneumoniae and S. aureus, including MRSA), bactericidal mechanism of action, creation of effective concentrations and penetration into the infection’s site, low potential for resistance development, proven significant development of clinical effect, high clinical efficacy in these infections and favorable tolerability and safety profile. The review presents the results of the program of clinical evaluation of ceftaroline in children, analyzes current data on etiology and antimicrobial resistance of the key pathogens of community-acquired pneumonia and skin and soft tissue infections in the Russian Federation, defines the place of ceftaroline in clinical recommendations in children, and characterizes the patient’s profile to whom the prescription of ceftaroline in hospital is indicated.

Detection of Carbapenemase Producing Gram-negative Bacteria at a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Gram-negative bacteria have developed a broad spectrum of resistance due to antibiotic degradation enzymes, including Extended-spectrum Beta-lactamases (ESBL), AmpC β-lactamases, and carbapenemases. Carbapenemase- producing organisms, such as Escherichia coli, Klebsiella species, Acinetobacter species, and Pseudomonas species, have become one of the most important causes of nosocomial and community-acquired infections. Aim: To identify carbapenemase-producing organisms among Multidrug-resistant (MDR) clinical isolates and detect Metallo β-Lactam Carbapenemases (MBL). Materials and Methods: The present study is a cross-sectional study that included 1266 clinical samples from patients visiting the Department of Microbiology, Ranagaraya Medical College, Kakinada, Andhra Pradesh, India. from July 2022 to December 2022. The samples were processed using the standard culture and antimicrobial susceptibility test, employing the Kirby-Bauer Disk Diffusion method. The present study included organisms that were resistant to either imipenem or meropenem. Carbapenemases were detected using the Modified Hodge test (MHT), and MBL carbapenemases were detected using the Imipenem Ethylene Diamine Tetraacetic acid (EDTA) Double Disk Test (DDT) following the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Descriptive statistics were performed on the collected data. Results: The study samples comprised 842 (66.5%) Gram- negative isolates and 424 (33.5%) Gram-positive isolates. Among the Gram-negative isolates, 80 (9.5%) were carbapenem- resistant, of which MHT showed 56 (70%) positive isolates (carbapenemase-producing) and 24 (30%) negative isolates. Imipenem-EDTA DDT showed 50 (62.5%) positive isolates (MBL-producing) and 30 (37.5%) negative isolates. Conclusion: Carbapenemase production in Gram-negative organisms has reduced the clinical utility of the carbapenem group of drugs, posing a major challenge in the treatment of severe infections. In summary, the majority of carbapenem-resistant isolates in the present study were from the Enterobacteriaceae family. These isolates were subjected carbapenem-resistant isolates to MHT and DDT tests to identify carbapenemase and metallo-beta-lactamase-producing strains that were resistant to a wide spectrum of antibiotics. The present study enables the early detection of these MDR strains, ensuring appropriate management.

Phytochemical study and characterization of the fixed oil, extracted from the fruits of Gardenia ternifolia

This present study concerns the phytochemical study and the characterization of the fixed oil of the fruits of Gardenia ternifolia which is a plant recognized in several African pharmacopoeias for its therapeutic virtues. Its fruits, leaves and roots are used for the treatment of several infections. Thus, the overall objective of this study is to contribute to the valorization of Gardenia ternifolia fruits in phytomedicine and agri-food. Phytochemical screening is carried out using standard methods, based on coloring and precipitation reactions. The extraction of the fixed oil was done using a Soxhlet, providing an estimated yield of 3%. The evaluation of the chemical parameters of this oil according to the AFNOR standards (French Association for Standardization) made it possible to obtain the following results: iodine index (𝐼𝐼) = 5.6 ± 0.07 𝑔𝐼 /100 𝑔𝑐𝑔; acid value (𝐼𝐴) = 137.2 ± 0.001 𝑚𝑔𝐾𝑂𝐻/𝑔𝑐𝑔; saponification index (𝐼𝑆) = 201.6 ± 0.04 𝑚𝑔𝐾𝑂𝐻/𝑔𝑐𝑔; peroxide index (𝐼𝑃) = 8.4 ± 0.03 𝜇𝑔𝑂2/𝑔𝑐𝑔 and ester index (𝐼𝐸) = 64.4 ± 0.039 𝑚𝑔𝐾𝑂𝐻/𝑔𝑐𝑔. Ultimately, with much higher extraction quantities, the fruit oil of Gardenia ternifolia can present an interesting and valuable pharmaco-nutritional potential in the food industry and in pharmacology.

Piperacillin-tazobactam: prospects for use in real-world practice

A review of the literature concerning the efficacy and safety of combined anti-pseudomonas protected ureidopenicillin piperacillin/tazobactam usage. Randomized clinical trials and their meta-analysis have demonstrated that piperacillin/ tazobactam among non-carbapenem β-lactams is an equally effective alternative to carbapenems in the treatment of severe infections, including those caused by extended-spectrum β-lactamase producing strains, regardless of the infection locus. It can be used in cases of carbapenem de-escalation if it is necessary. The use of this antimicrobial therapy strategy is justified not only from a clinical, but also from an economic point of view.

Management of nonfermenting gram-negative infections: a critique of the guidelines.

In the present narrative review, we discuss the characteristics and differences between the Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines in terms on their recommendations/suggestions for the treatment of Pseudomonas aeruginosa and Acinetobacter baumannii infections. Treatment of severe infections caused by nonfermenting gram-negative bacteria (NF-GNB) is posing both novel hopes and novel challenges to physicians worldwide, and both the IDSA and the ESCMID have recently updated/released their guidelines or guidance documents, based on different philosophies and providing recommendations for the treatment of NF-GNB infections. In order to correctly exploit recent advances in the treatment of such infections, IDSA and ESCMID approaches should be viewed as complementary and evolving, and should not preclude further revision based on accumulating evidence on the use of novel β-lactams and β-lactam/β-lactamase inhibitor combinations. A joint consideration of both philosophies should leave the door opened for the wise use of novel agents, ultimately building precious experience on their use that could favorably influence future guidelines revisions.

Ceftazidime-Avibactam Treatment for Klebsiella pneumoniae Bacteremia in Preterm Infants in NICU: A Clinical Experience.

Ceftazidime/avibactam (CAZ/AVI) is an antibiotic combination approved for the treatment of several infections caused by multi-drug resistant (MDR) Gram-negative bacteria. Neonates admitted to the Neonatal Intensive Care Unit (NICU) are at high risk of developing bacterial infections, and the choice of appropriate antibiotics is crucial. However, the use of antibiotics in neonates carries risks such as antibiotic resistance and disruption of gut microbiota. This study aimed to assess the safety and efficacy of CAZ/AVI in preterm infants admitted to the NICU. Retrospective data from preterm infants with Klebsiella pneumoniae bacteremia who received CAZ/AVI were analyzed. Clinical and microbiological responses, adverse events, and outcomes were evaluated. Eight patients were included in the study, all of whom showed clinical improvement and achieved microbiological cure with CAZ/AVI treatment. No adverse drug reactions were reported. Previous antibiotic therapies failed to improve the neonates' condition, and CAZ/AVI was initiated based on clinical deterioration and epidemiological considerations. The median duration of CAZ/AVI treatment was 14 days, and combination therapy with fosfomycin or amikacin was administered. Previous case reports have also shown positive outcomes with CAZ/AVI in neonates. However, larger trials are needed to further investigate the safety and efficacy of CAZ/AVI in this population.

A Needs Assessment for Infectious Diseases Consultation in Community Hospitals.

Infectious diseases (ID) consultations have been demonstrated to improve patient outcomes in the treatment of severe infections. However, ID consultation is often unavailable to patients that live in rural communities. Little is known regarding the treatment of infections in rural hospitals with no coverage from an ID specialist. We characterized the outcomes of patients cared for in hospitals without coverage from an ID physician. Patients aged 18years or older admitted to eight community hospitals without access to ID consultation during a 6.5-month period were assessed. All patients had received at least three days of continuous antimicrobial therapy. The primary outcome was the need for transfer to a tertiary facility for ID services. The secondary outcome was the characterization of antimicrobials received. Antimicrobial courses were evaluated independently by two board-certified ID physicians. 3706 encounters were evaluated. Transfers for ID consultation occurred in 0.01% of patients. The ID physician would have made modifications in 68.5% of patients. Areas for improvement included treatment of chronic obstructive pulmonary disease exacerbations, broad-spectrum treatment of skin and soft tissue infection, long courses of azithromycin, and management of Staphylococcus aureus bacteremia, including choice and length of therapy, as well as obtaining echocardiography. Patients evaluated received 22,807days of antimicrobial therapy. Patients hospitalized in community hospitals are rarely transferred for ID consultation. Our work demonstrates a need for ID consultation in community hospitals, identifying opportunities to enhance patient care by modifying antimicrobial regimens to improve antimicrobial stewardship and avoid inappropriate antimicrobials. Efforts to expand the ID workforce to include coverage at rural hospitals will likely improve antibiotic utilization.

Fabrication of molecularly imprinted cotton fibers for quantification of streptomycin in honey samples

AbstractStreptomycin is a type of aminoglycoside used in treatment of several infections and with serious side effects in humans and animals, such as ototoxicity and nephrotoxicity. In the present study, we focused on the preparation of streptomycin‐imprinted cotton fiber for rapid, sensitive and selective quantification of streptomycin in honey samples. The imprinted cotton fibers were characterized by attenuated total reflectance‐Fourier transform spectroscopy, scanning electron microscopy, and x‐ray photoelectron spectroscopy. In addition, the imprinted cotton fibers showed high adsorption capacity (95.4 mg/g) with an imprinting factor of 3.69 and had satisfactory regeneration ability of up to 10 regenerations without significant change in adsorption capacity. The imprinted cotton fibers showed good linearity with a correlation coefficient of 0.9989 and limit of detection was determined to be 0.29 ng/mL for streptomycin in honey samples. The proposed method showed acceptable recovery ranges (98.0%–100.3%) with lower inter‐day and intra‐day precisions. Moreover, the performance of the proposed method was compared to the ELISA method. The results showed that the present method is as sensitive and selective as ELISA. It is concluded that the imprinted cotton fibers could be a potential alternative to antibiotic quantification based on traditional immunoassays or chromatographic techniques.

Pediatric Nephrotoxicity: How Aware Are We?

Vancomycin and aminoglycosides are potentially nephrotoxic broad-spectrum antibiotics, which can be used both in the treatment of severe infections and in surgical prophylaxis, in pediatric patients. Prolonged antibiotic therapy and high trough concentrations are associated with toxicity. Additionally, several individual factors contribute to nephrotoxicity increasing the risk of acute kidney injury (AKI) and consequent chronic kidney disease in the future. We developed a retrospective and observational study in the Pediatrics Department of a tertiary hospital in Portugal, to analyze clinical practice regarding monitoring and surveillance of vancomycin and aminoglycosides. The results showed low rates of monitoring, which reinforces the importance of raising awareness about this issue, recognizing its importance, and adopting preventive measures that may mitigate the risk of toxicity and improve children’s renal prognosis in adult life.

Chemical Characterization and Leishmanicidal Activity In Vitro and In Silico of Natural Products Obtained from Leaves of Vernonanthura brasiliana (L.) H. Rob (Asteraceae).

Vernonanthura brasiliana (L.) H. Rob is a medicinal plant used for the treatment of several infections. This study aimed to evaluate the antileishmanial activity of V. brasiliana leaves using in vitro and in silico approaches. The chemical composition of V. brasiliana leaf extract was determined through liquid chromatography-mass spectrometry (LC-MS). The inhibitory activity against Leishmania amazonensis promastigote was evaluated by the MTT method. In silico analysis was performed using Lanosterol 14alpha-demethylase (CYP51) as the target. The toxicity analysis was performed in RAW 264.7 cells and Tenebrio molitor larvae. LC-MS revealed the presence of 14 compounds in V. brasiliana crude extract, including flavonoids, flavones, sesquiterpene lactones, and quinic acids. Eriodictol (ΔGbind = -9.0), luteolin (ΔGbind = -8.7), and apigenin (ΔGbind = -8.6) obtained greater strength of molecular interaction with lanosterol demethylase in the molecular docking study. The hexane fraction of V. brasiliana showed the best leishmanicidal activity against L. amazonensis in vitro (IC50 12.44 ± 0.875 µg·mL-1) and low cytotoxicity in RAW 264.7 cells (CC50 314.89 µg·mL-1, SI = 25.30) and T. molitor larvae. However, the hexane fraction and Amphotericin-B had antagonistic interaction (FICI index ≥ 4.0). This study revealed that V. brasiliana and its metabolites are potential sources of lead compounds for drugs for leishmaniasis treatment.

Treatment of severe infections caused by ESBL or carbapenemases-producing Enterobacteriaceae

Treatment of severe infections caused by ESBL or carbapenemases-producing Enterobacteriaceae

The Effect of Corticosteroid Therapy on Choroidal Thickness in Patients With Covid-19 Infection: A Prospective, Comparative, and Observational Study.

Coronavirus disease 2019 (Covid-19) has many different ocular manifestations. This study evaluates the effects of the disease and the steroid used in this disease on ocular structures. To evaluate the effects ofCovid-19and the steroids used in the treatment of severe infection on ocular structures and choroidal thickness. This prospectivestudy included 76 eyes of 76 patients who were hospitalized due to Covid-19 and 30 eyes of 30 healthy volunteering controls. Group I included 35 eyes who were hospitalized due to moderate-to-severe involvement that received steroid treatment, group II included 41 eyes with moderate involvement that did not require steroid treatment, and group III included 30 eyes with age- and gender-matched control subjects. Ophthalmological examination and imaging results of the patients obtained in the third week and third month after the diagnosis were compared between the groups. Mean age of all participants was 40.2 ± 6.1 years. In the third week after the diagnosis of Covid-19, choroidal thickness in all regions (subfoveal, nasal, and temporal) was significantly greater in group I than in group II (for all,p<0.001). Moreover, choroidal thicknesses were significantly higher in group I and group II than in the control group (for all,p<0.001). In the third month, all the groups had similar choroidal thickness values (for subfoveal, nasal, and temporal; p=0.058,p=0.111,p=0.079, respectively). Our findings showed that Covid-19 infection causes choroidal thickening by affecting the choroidal layer and that steroid treatment further increases this thickness in the acute period. In addition, the reversal of this thickening to the normal level within a period of three months indicates that the effect of the disease on the choroid is reversible.

Essential Oils against Sarcoptes scabiei.

Herbal remedia are widely employed in folk medicine, and have been more and more often studied and considered in the treatment of several infections. Sarcoptic mange (scabies, when referring to human patients) is a highly contagious skin disease caused by Sarcoptes scabiei (sarcoptiformes, Sarcoptinae), an astigmatid mite which burrows into the epidermis, actively penetrating the stratum corneum. This parasitosis negatively affects livestock productions and represents a constraint on animal and human health. The treatment relies on permethrine and ivermectine but, since these molecules do not have ovicidal action, more than a single dose should be administered. Toxicity, the possible onset of parasite resistance, the presence of residues in meat and other animal products and environmental contamination are the major constraints. These shortcomings could be reduced by the use of plant extracts that have been in vitro or in vivo checked against these mites, sometimes with promising results. The aim of the present study was to review the literature dealing with the treatment of both scabies and sarcoptic mange by plant-derived agents, notably essential oils.

Anti-measles virus activity of 4-hydroxy-3-methoxy benzaldehyde (Vanillin) isolated from Xylopia aethiopica (Dunal) A. rich

Xylopia aethiopica is a plant used ethnomedicinally for the treatment of several infections in Nigeria. This study was carried out to isolate the active compound(s) in Xylopia aethiopica and evaluate their anti-measles virus activity. The Dichloromethane (DCM) fraction of Xylopia aethiopica was fractionated using chromatographic techniques, which led to the isolation of a compound characterized using spectroscopic techniques, FT-IR, 1D and 2D NMR in addition to in vitro anti-measles evaluation in adsorption and post-infection inhibition assays. The isolated compound characterized as 4-Hydroxy-3-methoxy benzaldehyde (Vanillin) was active on measles virus and has minimum nontoxic dose of 10 µg with cytotoxic and inhibitory activity of CC50 = 84.18 µg/mL, IC50 = 0.71 µg/mL and selectivity index (SI) = 118.56 (r2 = 0.979) and interfered with viral attachment and fusion. This is the first report of the isolation of Vanillin from Xylopia aethiopica leaf and its high antiviral activity shows it could be developed further into a promising antiviral lead compound.

Tigecycline treatment causes a decrease in peripheral blood platelet

Tigecycline with broad-spectrum activity against pathogens has advantages in the treatment of severe infections in clinical. Accompany with the huge increase of tigecycline usage, more side effects began to arouse people’s attention. The aim of this study was to assess the impact of tigecycline treatment on peripheral blood platelet in patients with severe infections. We retrospectively retrieved demographic and laboratory data in 24 cases of tigecycline-treated patients with severe infections. 18 patients (75%) who were administered tigecycline experienced a decrease in platelet count. The ages of platelet decrease group are significant older than normal group. In the platelet decreased group, the platelet count was significant decreased after 3 days tigecycline treatment. 9 patients’ platelet count recovered in 5 days after tigecycline treatment withdraw. Platelet decrease in patient after tigecycline treatment, which can be reversed after tigecycline discontinuation. Tigecycline-induced platelet decrease is associated with age.

Detection of a Novel G2603T Mutation in cfr Harboring Linezolid-Resistant Staphylococcus haemolyticus : First Report from India.

Background Staphylococcus haemolyticus has emerged as an important multidrug-resistant nosocomial pathogen. Linezolid is useful in the treatment of severe infections caused by methicillin-resistant Staphylococci . Resistance to linezolid in Staphylococci is due to one or more of the following mechanisms: acquisition of the cfr (chloramphenicol florfenicol resistance) gene, mutation in the central loop of domain V of the 23S rRNA, and mutation in the rplC and rplD genes. This study was carried out to detect and characterize resistance to linezolid among the clinical isolates of Staphylococcus haemolyticus . Materials and Methods The study included 84 clinical isolates of Staphylococcus haemolyticus . Susceptibility to various antibiotics was determined by disc diffusion method. Minimum inhibitory concentration (MIC) was determined by agar dilution method for linezolid. Methicillin resistance was screened using oxacillin and cefoxitin disc. Polymerase chain reaction was done to detect mecA, cfr and mutations in the V domain of the 23S rRNA gene. Results Resistance to linezolid was exhibited by 3 of the 84 study isolates with MIC more than 128 µg/mL. The cfr gene was detected in all the three isolates. The G2603T mutation was observed in the domain V of the 23S rRNA among two isolates, whereas one isolate lacked any mutation. Conclusion The emergence and spread of linezolid-resistant Staphylococcus haemolyticus isolates carrying G2603T mutation in the domain V of the 23S rRNA and harboring the cfr gene pose a threat in clinical practice.

Treatment of severe infections caused by ESBL or carbapenemases-producing Enterobacteriaceae

Enterobacteriaceae are the most frequent pathogens in the Intensive Care Unit. Due to their safety and activity, β-Lactams (BL) and carbapenems represented the most common strategy adopted against these germs. The increasing exposure to these molecules led to the development of several types of antimicrobial resistance as the expression of extended-spectrum β-lactamases (ESBLs) and carbapenemases. Great molecular variability exists among these enzymes, with significant clinical impact.To limit morbidity and mortality, old antibiotics were tested and represent viable alternatives for specific types of infections, or once the spectrum of susceptibility of each germ has been determined. Alongside, new molecules have been specifically designed but enzyme molecular variability prevents the existence of one single antibiotic which fits for all.Therefore, a quicker identification of the molecular identity of each germ, together with the knowledge of the activity spectrum of each antibiotic is crucial to tailor the therapy and make it effective.