Antibiotic use in the emergency department. II The aminoglycosides, macrolides, tetracyclines, sulfa drugs, and urinary antiseptics

Combination of sulfonamides, silver antimicrobial agents and quorum sensing inhibitors as a preferred approach for improving antimicrobial efficacy against Bacillus subtilis

More and more antibacterial agents are used together to treat bacterial infections in diverse fields, but the overuse of antibacterial agents may cause the environmental pollution of antibiotic resistance genes (ARGs). In order to reduce the use of antimicrobial agents, the potential joint effects of quorum-sensing inhibitors (QSIs) and traditional antimicrobial agents have been proposed to be effective. In this study, the joint effects of traditional antimicrobial agents, represented by sulfonamides (SAs) and silver antibacterial agents (silver nitrate (AgNO₃) and nanosilver (AgNP, 5 nm)), and five potential QSIs, were investigated using B. subtilis. It was found that AgNP showed higher toxicity than AgNO₃, whereas the joint effects on B. subtilis showed no difference between AgNO₃ and AgNP when they combined with SAs or QSIs, respectively. In general, AgNO₃ and AgNP presented synergetic and additive effects with QSIs, but additive and antagonistic effects with SAs; SAs exhibited synergetic, additive and antagonistic effects with different QSIs whether in binary or ternary mixed system. Moreover, it was found that the use of antimicrobials was reduced and the synergistic combined toxicity of antimicrobial agents on B. subtilis was increased through the addition of the QSIs. This study can offer a valuable reference for the combined medication of the different antimicrobial agents, which will benefit the environmental and human health.

Elderly and drugs: risks and necessity of rational use

In recent decades, the world has undergone a demographic transformation with a rapid growth of the elderly population, resulting in an increased demand for funds to maintain their health and drug consumption. Pharmacokinetic and pharmacodynamic changes occurring in the elderly can interfere directly in the adverse effects of drugs and increase the risk of intoxication. In addition, there are external factors interfering with the pharmacotherapy of the elderly, such as inappropriate use and the lack of access to information. Many therapeutic classes of drugs should be used with caution or avoided in the elderly population, such as anti-inflammatory and some anti-hypertensive drugs, diuretics and digitalis. If not managed carefully, these medicines can affect the safety and quality of life in the elderly. Thus, the aim of this review was to identify drugs that should be used with caution in elderly patients in order to avoid intoxication and/or adverse drug events.

Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance

Tetracyclines were discovered in the 1940s and exhibited activity against a wide range of microorganisms including gram-positive and gram-negative bacteria, chlamydiae, mycoplasmas, rickettsiae, and protozoan parasites. They are inexpensive antibiotics, which have been used extensively in the prophlylaxis and therapy of human and animal infections and also at subtherapeutic levels in animal feed as growth promoters. The first tetracycline-resistant bacterium, Shigella dysenteriae, was isolated in 1953. Tetracycline resistance now occurs in an increasing number of pathogenic, opportunistic, and commensal bacteria. The presence of tetracycline-resistant pathogens limits the use of these agents in treatment of disease. Tetracycline resistance is often due to the acquisition of new genes, which code for energy-dependent efflux of tetracyclines or for a protein that protects bacterial ribosomes from the action of tetracyclines. Many of these genes are associated with mobile plasmids or transposons and can be distinguished from each other using molecular methods including DNA-DNA hybridization with oligonucleotide probes and DNA sequencing. A limited number of bacteria acquire resistance by mutations, which alter the permeability of the outer membrane porins and/or lipopolysaccharides in the outer membrane, change the regulation of innate efflux systems, or alter the 16S rRNA. New tetracycline derivatives are being examined, although their role in treatment is not clear. Changing the use of tetracyclines in human and animal health as well as in food production is needed if we are to continue to use this class of broad-spectrum antimicrobials through the present century.