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Siraj EA, Yayehrad AT, Belete A. How Combined Macrolide Nanomaterials are Effective Against Resistant Pathogens? A Comprehensive Review of the Literature. Int J Nanomedicine 2023; 18:5289-5307. [PMID: 37732155 PMCID: PMC10508284 DOI: 10.2147/ijn.s418588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
Macrolide drugs are among the broad-spectrum antibiotics that are considered as "miracle drugs" against infectious diseases that lead to higher morbidity and mortality rates. Nevertheless, their effectiveness is currently at risk owing to the presence of devastating, antimicrobial-resistant microbes. In view of this challenge, nanotechnology-driven innovations are currently being anticipated for promising approaches to overcome antimicrobial resistance. Nowadays, various nanostructures are being developed for the delivery of antimicrobials to counter drug-resistant microbial strains through different mechanisms. Metallic nanoparticle-based delivery of macrolides, particularly using silver and gold nanoparticles (AgNPs & AuNPs), demonstrated a promising outcome with worthy stability, oxidation resistance, and biocompatibility. Similarly, macrolide-conjugated magnetic NPs resulted in an augmented antimicrobial activity and reduced bacterial cell viability against resistant microbes. Liposomal delivery of macrolides also showed favorable synergistic antimicrobial activities in vitro against resistant strains. Loading macrolide drugs into various polymeric nanomaterials resulted in an enhanced zone of inhibition. Intercalated nanomaterials also conveyed an outstanding macrolide delivery characteristic with efficient targeting and controlled drug release against infectious microbes. This review abridges several nano-based delivery approaches for macrolide drugs along with their recent achievements, challenges, and future perspectives.
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Affiliation(s)
- Ebrahim Abdela Siraj
- Department of Pharmacy, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ashagrachew Tewabe Yayehrad
- Department of Pharmacy, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Anteneh Belete
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Moosazadeh Moghaddam M, Bolouri S, Golmohammadi R, Fasihi-Ramandi M, Heiat M, Mirnejad R. Targeted delivery of a short antimicrobial peptide (CM11) against Helicobacter pylori gastric infection using concanavalin A-coated chitosan nanoparticles. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:44. [PMID: 37650975 PMCID: PMC10471652 DOI: 10.1007/s10856-023-06748-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
Helicobacter pylori is the cause of most cases of stomach ulcers and also causes some digestive cancers. The emergence and spread of antibiotic-resistant strains of H. pylori is one of the most important challenges in the treatment of its infections. The present study aims to develop a concanavalin A (ConA) coated chitosan (CS) nanocarrier-based drug delivery for the targeted release of peptides to the site of H. pylori infection. Accordingly, chitosan was used as an encapsulating agent for CM11 peptide delivery by applying ionotropic gelation method. Con-A was used for coating CS nanoparticles to target H. pylori. The CS NPs and ConA-CS NPs were characterized by FTIR, dynamic light scattering (DLS), and scanning electron microscopy (SEM). The MIC of CM11-loaded ConA-CS NPs against H. pylori SS1 strain was analyzed in vitro. In order to evaluate the treatment efficiency in vivo, a gastric infection model of H. pylori SS1 strain was established in mice and histopathological studies and IL-1β cytokine assay were performed. Based on the results, the size frequency for CS NPs and ConA-CS NPs was about 200 and 350 nm, respectively. The prepared CM11-loaded ConA-CS NPs exhibited antibacterial activity against H. pylori SS1 strain with a concentration of 32 µg/ml. The highest healing process was observed in synthesized CM11-loaded ConA-CS NPs treatments and a significant decrease in IL-1β was observed. Our findings highlight the potential of chitosan nanoparticles as a drug delivery vehicle in the treatment of gastric infection model of H. pylori SS1 strain.
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Affiliation(s)
- Mehrdad Moosazadeh Moghaddam
- Tissue Engineering and Regenerative Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shahin Bolouri
- Research and Development Unit, Varia Hooman Kara Company, Tehran, Iran
| | - Reza Golmohammadi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahdi Fasihi-Ramandi
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Heiat
- Tissue Engineering and Regenerative Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Mirnejad
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Rational Use of Ceftriaxone in Necrotizing Fasciitis and Mortality Associated with Bloodstream Infection and Hemorrhagic Bullous Lesions. Antibiotics (Basel) 2022; 11:antibiotics11111454. [PMID: 36358109 PMCID: PMC9686534 DOI: 10.3390/antibiotics11111454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. The formation of hemorrhagic bullae is a special skin sign of NF. The purposes of this study were to investigate the incidence of hemorrhagic bullae formation and bacteremia associated with different organisms, to appraise the appropriate use of ceftriaxone, and to compare the clinical and laboratory risk indicators of NF patients with Gram-positive and Gram-negative infections on the initial examination. Methods: From March 2018 to December 2020, there were seventy-four NF patients with positive monomicrobial bacterial cultures enrolled based on surgical confirmation, and were categorized into two groups: the Gram-positive group and the Gram-negative group. Ceftriaxone susceptibility tests were carried out using the standard disk diffusion technique. Data, such as demographics, clinical outcomes, microbiological results, presentations of hemorrhagic bullae, and laboratory findings, were compared among these two groups. Results: The Gram-negative group included 52 patients, of whom 6 patients died, resulting in a mortality rate of 11.5%. The Gram-positive group included 22 patients and none died. Patients with bacteremia, hemorrhagic bullae, shock, fever, higher segmented forms and banded forms, and lower platelet counts constituted higher proportions in the Gram-negative group than in the Gram-positive group. The multivariate analysis identified six variables for the differentiation of Gram-negative and Gram-positive NF: the presentation of bacteremia, hemorrhagic bullae, shock at first consultation, fever with body temperature > 38.5 °C, band forms > 0%, and segmented forms ≦ 74%. A total of 66 isolates (89.2%) was susceptible to ceftriaxone. Conclusions: Gram-negative NF patients were significantly associated with hemorrhagic bullae presentation, blood stream infection, and mortality. Physicians should be alert to NF patients with the appearance of bacteremia, shock, fever, higher WBC banded and segmented forms, and lower platelet counts at the emergency department, with patients revealed to more likely have Gram-negative infections. Ceftriaxone with/without other appropriate antibiotics under the supervision of infectious doctors appeared to be clinically effective for the treatment of NF and blood stream infections.
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Bibi S, Mir S, Rehman W, Menaa F, Gul A, Alaryani FSS, Alqahtani AM, Haq S, Abdellatif MH. Synthesis and In Vitro/Ex Vivo Characterizations of Ceftriazone-Loaded Sodium Alginate/Poly(Vinyl Alcohol) Clay Reinforced Nanocomposites: Possible Applications in Wound Healing. MATERIALS 2022; 15:ma15113885. [PMID: 35683183 PMCID: PMC9182010 DOI: 10.3390/ma15113885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: Nanocomposite films are widely applied in the pharmaceutical industry (e.g., nanodrug delivery systems—NDDS). Indeed, these nanomaterials can be produced at a large industrial scale and display valuable properties (e.g., antibacterial, renewability, biodegradability, bioavailability, safety, tissue-specific targeting, and biocompatibility), which can enhance the activity of conventional marketed drugs. (2) Aim: To fabricate and investigate the in vitro properties of the antibiotic ceftriaxone sodium (CTX) once encapsulated into sodium alginate (SA)/poly(vinyl alcohol)PVA-clay reinforced nanocomposite films. (3) Methods: Different ratios of the polymers (i.e., SA, PVA) and CTX drug were used for the synthesis of nanocomposite films by solvent casting technique. Montmorillonite (MMT), modified organically, was added as a nanofiller to increase their thermal and mechanical strength. The prepared samples were physically characterized by thermogravimetric analysis (TGA), X-ray diffraction (XRD), scanning electronic microscopy (SEM), and energy-dispersive X-ray analysis (EDX). The physicochemical behavior (i.e., swelling, erosion, dissolution/drug release behavior and rat skin permeation) was also assessed. Comparisons were made with the currently marketed free CTX dosage form. (4) Results: TGA of the nanoformulation showed increased thermostability. XRD revealed its semi-crystalline nature. SEM depicted a homogeneous drug-loaded SA/PVA nanocomposite with an average size ranging between 300 and 500 nm. EDX confirmed the elemental composition and uniform distribution of mixing components. The water entrapment efficiency study showed that the highest swelling and erosion ratio is encountered with the nanoformulations S100(3) and S100D15(3). Ex vivo permeation revealed a bi-step discharge mode with an early burst liberation chased by continued drug discharge of devised nanoparticles (NPs). The dissolution studies of the drug-loaded polymer nanocomposites elicited sustained pH-dependent drug release. The cumulative drug release was the highest (90.93%) with S100D15(3). (5) Conclusion: S100D15(3) was the finest formulation. To the best of our knowledge, we also pioneered the use of solvent casting for the preparation of such nanoformulations. Polymers and reinforcing agent, concentrations and pH were rate-deterring features for the preparation of the optimized formulation. Thus, CTX-loaded SA/PVA-MMT reinforced nanocomposite appeared as a promising nanodrug delivery system (NDDS) based on its in vitro physicochemical properties.
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Affiliation(s)
- Shabana Bibi
- Department of Chemistry, Hazara University, Mansehra 21220, Pakistan;
| | - Sadullah Mir
- Department of Chemistry, COMSATS University Islamabad, Abbottabad Campus, Islamabad 22060, Pakistan;
| | - Wajid Rehman
- Department of Chemistry, Hazara University, Mansehra 21220, Pakistan;
- Correspondence: (W.R.); (F.M.)
| | - Farid Menaa
- Departments of Internal Medicine and Nanomedicine, California Innovations Corporation, San Diego, CA 92037, USA
- Correspondence: (W.R.); (F.M.)
| | - Alia Gul
- Department of Botany, Hazara University, Mansehra 21220, Pakistan;
| | | | - Ali M. Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia;
| | - Sirajul Haq
- Department of Chemistry, University of Azad Jammu & Kashmir, Muzaffarabad 13100, Pakistan;
| | - Magda H. Abdellatif
- Department of Chemistry, College of Sciences, Taif University, Taif 21944, Saudi Arabia;
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Al Hagbani T, Rizvi SMD, Hussain T, Mehmood K, Rafi Z, Moin A, Abu Lila AS, Alshammari F, Khafagy ES, Rahamathulla M, Abdallah MH. Cefotaxime Mediated Synthesis of Gold Nanoparticles: Characterization and Antibacterial Activity. Polymers (Basel) 2022; 14:polym14040771. [PMID: 35215685 PMCID: PMC8875691 DOI: 10.3390/polym14040771] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/11/2022] Open
Abstract
Cefotaxime (CTX) is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram negative and Gram positive bacteria. However, like other third-generation cephalosporin antibiotics, its efficacy is declining due to the increased prevalence of multidrug-resistant (MDR) pathogens. Recent advances in nanotechnology have been projected as a practical approach to combat MDR microorganisms. Therefore, in the current study, gold nanoparticles (AuNPs) were prepared using cefotaxime sodium, which acted as a reducing and capping agent, besides having well-established antibacterial activity. The synthesized cefotaxime-loaded gold nanoparticles (C-AuNPs) were characterized by UV-Visible spectroscopy, FTIR, TEM and DLS. In addition, the in vitro antibacterial activity of C-AuNPs was assessed against both Gram-positive and Gram-negative bacteria. UV-Visible spectroscopy verified the formation of C-AuNPs, while TEM and DLS verified their nano-size. In addition, CTX loading onto AuNPs was confirmed by FTIR. Furthermore, the colloidal stability of the synthesized C-AuNPs was ascribed to the higher net negative surface charge of C-AuNPs. Most importantly, the synthesized C-AuNPs showed superior antibacterial activity and lower minimum inhibitory concentration (MIC) values against Gram-negative (Escherichia coli, Klebsiella oxytoca, Pseudomonas aeruginosa) and gram-positive (Staphylococcus aureus) bacteria, compared with pure CTX. Collectively, CTX was successfully adopted, as reducing and capping agent, to synthesize stable, nano-sized spherical C-AuNPs. Furthermore, loading CTX onto AuNPs could efficiently restore and/or boost the antibacterial activity of CTX against resistant Gram-negative and Gram-positive bacteria.
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Affiliation(s)
- Turki Al Hagbani
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia; (T.A.H.); (S.M.D.R.); (A.S.A.L.); (F.A.); (M.H.A.)
| | - Syed Mohd Danish Rizvi
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia; (T.A.H.); (S.M.D.R.); (A.S.A.L.); (F.A.); (M.H.A.)
| | - Talib Hussain
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia;
| | - Khalid Mehmood
- Department of Pharmacy, Abbottabad University of Science and Technology, Havelian 22500, Pakistan;
| | - Zeeshan Rafi
- Nanomedicine and Nanotechnology Lab-6 (IIRC), Department of Biosciences, Integral University Lucknow, Lucknow 226026, India;
| | - Afrasim Moin
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia; (T.A.H.); (S.M.D.R.); (A.S.A.L.); (F.A.); (M.H.A.)
- Correspondence:
| | - Amr Selim Abu Lila
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia; (T.A.H.); (S.M.D.R.); (A.S.A.L.); (F.A.); (M.H.A.)
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia; (T.A.H.); (S.M.D.R.); (A.S.A.L.); (F.A.); (M.H.A.)
| | - El-Sayed Khafagy
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-kharj 11942, Saudi Arabia;
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Mohamed Rahamathulla
- Department of Pharmaceutics, College of Pharmacy, King Khalid University (KKU), Abha 61421, Saudi Arabia;
| | - Marwa H. Abdallah
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia; (T.A.H.); (S.M.D.R.); (A.S.A.L.); (F.A.); (M.H.A.)
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
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Nguyen PV, Aubry C, Boudaoud N, Gaubert A, Langlois MH, Marchivie M, Gaudin K, Arpin C, Barthélémy P, Kauss T. Oligonucleotide Solid Nucleolipid Nanoparticles against Antibiotic Resistance of ESBL-Producing Bacteria. Pharmaceutics 2022; 14:pharmaceutics14020299. [PMID: 35214036 PMCID: PMC8876242 DOI: 10.3390/pharmaceutics14020299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
Antibiotic resistance has become a major issue in the global healthcare system, notably in the case of Gram-negative bacteria. Recent advances in technology with oligonucleotides have an enormous potential for tackling this problem, providing their efficient intrabacterial delivery. The current work aimed to apply this strategy by using a novel nanoformulation consisting of DOTAU, a nucleolipid carrier, in an attempt to simultaneously deliver antibiotic and anti-resistance oligonucleotides. Ceftriaxone, a third-generation cephalosporin, was formulated with DOTAU to form an ion pair, and was then nanoprecipitated. The obtained solid nanocapsules were characterized using FT-IR, XRD, HPLC, TEM and DLS techniques and further functionalized by the anti-resistance ONα sequence. To obtain an optimal anti-resistance activity and encapsulation yield, both the formulation protocol and the concentration of ONα were optimized. As a result, monodispersed negatively charged nanoparticles of CFX–DOTAU-ONα with a molar ratio of 10:24:1 were obtained. The minimum inhibitory concentration of these nanoparticles on the resistant Escherichia coli strain was significantly reduced (by 75%) in comparison with that of non-vectorized ONα. All aforementioned results reveal that our nanoformulation can be considered as an efficient and relevant strategy for oligonucleotide intrabacterial delivery in the fight against antibiotic resistance.
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Affiliation(s)
- Phuoc Vinh Nguyen
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
| | - Clémentine Aubry
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
| | - Narimane Boudaoud
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
| | - Alexandra Gaubert
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
| | - Marie-Hélène Langlois
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
| | - Mathieu Marchivie
- UMR 5026, University of Bordeaux, CNRS, Bordeaux-INP, ICMCB, 87 Avenue du Dr Albert Schweitzer, CEDEX, 33608 Pessac, France;
| | - Karen Gaudin
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
| | - Corinne Arpin
- MFP, CNRS 5234, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France;
| | - Philippe Barthélémy
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
| | - Tina Kauss
- ARNA, Inserm U1212, CNRS 5320, University of Bordeaux, 146 rue Léo Saignat, CEDEX, 33076 Bordeaux, France; (P.V.N.); (C.A.); (N.B.); (A.G.); (M.-H.L.); (K.G.); (P.B.)
- Correspondence:
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Tewabe A, Marew T, Birhanu G. The contribution of nano-based strategies in overcoming ceftriaxone resistance: a literature review. Pharmacol Res Perspect 2021; 9:e00849. [PMID: 34331383 PMCID: PMC8324973 DOI: 10.1002/prp2.849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022] Open
Abstract
Antimicrobial drug resistance, including resistance to multiple antibiotics, is continuously increasing. According to research findings, many bacteria resistant to other antibiotics were susceptible to ceftriaxone. However, over the last few years, ceftriaxone resistance has become growing and extremely worrisome challenge to the global healthcare system and several strategies have been initiated to contain the spread of antimicrobial drug resistance. Its extended use for therapeutic or preventative measures in humans and farm animals resulted in the development and spread of resistance. Recent advances in nanotechnology also offer novel formulations based on distinct types of nanostructure particles with different sizes and shapes, and flexible antimicrobial properties. For ceftriaxone, several nanostructured formulations through conjugation, intercalation, encapsulation with lipid carrier, and polymeric films have been investigated by different groups with promising results in combating the development of resistance. This review addressed the existing knowledge and practice on the contribution of nano-based delivery approaches in overcoming ceftriaxone resistance. Evidences have been generated from published research articles using major search electronic databases such as PubMed, Medline, Google Scholar, and Science Direct.
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Affiliation(s)
- Ashagrachew Tewabe
- Department of Pharmaceutics and Social PharmacySchool of PharmacyCollege of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
- Department of PharmacyCollege of Medicine and Health SciencesBahir Dar UniversityBahir DarEthiopia
| | - Tesfa Marew
- Department of Pharmaceutics and Social PharmacySchool of PharmacyCollege of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Gebremariam Birhanu
- Department of Pharmaceutics and Social PharmacySchool of PharmacyCollege of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
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