Antibiotic resistance in dermatology: The scope of the problem and strategies to address it

Rapid determination of 111 anti-infective drugs possibly added in cosmetics using high-performance liquid chromatography-tandem mass spectrometry with scheduled multiple reaction monitoring

RATIONALE

Illegal addition of anti-infective drugs to cosmetics at low concentrations has been found. The illicit addition of anti-infective drugs encompasses a wide variety of medications. The current sample purification methods are inadequate to detect all these compounds. A sensitive, wide-coverage, and weak-matrix-effect measurement method needs to be established to address this issue.

METHODS

Samples were extracted using acetonitrile, diluted 25 times, and then analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) to detect 111 anti-infective drugs. The method was validated and assessed for matrix effect before being applied to cosmetic products.

RESULTS

The calibration curves for the analytes exhibited a strong correlation coefficient (r > 0.995). The limit of detection ranged from 0.006 to 0.6 mg/kg. Matrix effects were significantly improved after a 25-fold dilution. The method was successfully applied to various cosmetics. Two of 82 samples tested contained lincomycin and miconazole, respectively.

CONCLUSIONS

The developed method is quick and reliable to analyze anti-infective drugs in cosmetics, with potential for both qualitative and quantitative analyses. It is a valuable tool for cosmetic research and development, contributing to safer and more effective cosmetic products.

Are antibiotics still relevant in acne? A review of the therapeutic conundrum

Antibiotics have constituted the mainstay of acne therapy despite acne being classified as an inflammatory disorder. The indiscriminate usage of antibiotics over the years has thus fueled the issue of antimicrobial resistance. Cutibacterium acnes (C. acnes) can acquire resistance due to chromosomal mutation or genetic acquisition. C. acnes can transfer resistance to other resident flora, complicating the management of skin and soft tissue infections. It can also transfer resistant strains to other body sites and to immunocompromised and elderly patients thus putting them at risk of serious infections. Recent studies have highlighted the physiologic role of C. acnes in maintaining the normal homeostasis of the skin microbiome. The role of Malassezia in causation of acne has piqued interest in recent times. The efficacy of antibiotics in acne is attributed to their para-antibiotic, anti-inflammatory action rather than antimicrobial action. Thus, usage of low-dose antibiotics and alternatives to antibiotics has been advocated. Some alternative therapies showing efficacy in acne are probiotics, oral zinc, precision therapy using succinic acid, bacteriophages, and anti-biofilm therapy like myrtacin, topical azelaic acid, and salicylic acid. Using isotretinoin in early stages of acne can reduce the incidence of scarring and alleviate the need for antibiotics. Thus, a gradual shift from antibiotics to alternative therapies in acne is the need of the hour.

Acne accounts for an almost 2.5-fold higher proportion of dermatology visits among adult females compared to adult males in the United States: A study of the national ambulatory medical care survey from 2002-2016

BACKGROUND

Acne vulgaris affects a significant number of females into adulthood. Juvenile acne and adult acne have different presentations and potentially distinctive pathogeneses. However, patterns in treatments specifically related to the adult female population have previously not been studied.

METHODS

Retrospective database analysis of healthcare utilization and medications prescribed for acne using the National Ambulatory Medical Care Survey (NAMCS) data from 2002-2016 was performed.

RESULTS

After age 20, acne accounted for an almost 2.5-fold higher proportion of dermatology visits among females compared to males (10.1% vs. 4.1%, P < 0.001). Tetracycline-class antibiotics were the most prescribed therapy within all age groups of females between 2002-2016. However, there was also a substantial rise in prescriptions of spironolactone beginning in 2012.

CONCLUSION

A significantly greater proportion of dermatology visits by adult females are for acne in comparison to adult males. Tetracycline-class antibiotics remain the most prescribed therapy in adult age groups despite a potentially different pathogenesis of adult acne. Therefore, there is a need for further studies comparing the effectiveness of therapies specifically for adult female acne.

Natural Compounds of Fungal Origin with Antimicrobial Activity-Potential Cosmetics Applications

The phenomenon of drug resistance in micro-organisms necessitates the search for new compounds capable of combating them. Fungi emerge as a promising source of such compounds as they produce a wide range of secondary metabolites with bacteriostatic or fungistatic activity. These compounds can serve as alternatives for commonly used antibiotics. Furthermore, fungi also accumulate compounds with antiviral activity. This review focuses on filamentous fungi and macrofungi as sources of antimicrobial compounds. The article describes both individual isolated compounds and extracts that exhibit antibacterial, antifungal, and antiviral activity. These compounds are produced by the fruiting bodies and mycelium, as well as the biomass of mycelial cultures. Additionally, this review characterizes the chemical compounds extracted from mushrooms used in the realm of cosmetology; specifically, their antimicrobial activity.

Oxazolidinone: A promising scaffold for the development of antibacterial drugs

Due to the long-term and widespread use of antibiotics in clinic, the problem of bacterial resistance is increasingly serious, and the development of new drugs to treat drug-resistant bacteria has gradually become the mainstream direction of antibiotic research. The oxazolidinone-containing drugs linezolid, tedizolid phosphate and contezolid have been approved to the market, which are effective against a variety of Gram-positive bacterium infections. Moreover, there are also many antibiotics containing oxazolidinone fragment under clinical investigation that show good pharmacokinetic and pharmacodynamic properties with unique mechanism of action against resistant bacteria. In this review, we summarized the oxazolidinone-based antibiotics already on the market or in clinical trials and the representative bioactive molecules, and mainly focused on their structural optimizations, development strategies and structure-activity relationships in hope of insight into the reasonable design for medical chemists to develop new oxazolidinone antibiotics with highly potency and fewer side effects.

Prevalence of antibiotic misuse in cases of pneumonia and diarrhea in Saudi Arabia

Background

Antibiotic misuse is a major public health issue with long-term repercussions.

Objective

The purpose of this investigation was to evaluate the effects of pneumonia and diarrhea, with an emphasis on antibiotic misuse.

Methodology

This study included 410 participants (217 fathers and 193 mothers), of whom 239 purchased antibiotics for their children without a prescription, whereas 171 had a prescription or were unsure if one was required.

Results

Antibiotics were used incorrectly by 58.1% of respondents. About 51.2% of participants said they were taking two antibiotics at the same time. Around 30% of people admitted to using antibiotics inefficiently. The most prevalent reason for use was "viral and bacterial," followed by "viral," and then "bacterial," with 35%, 21%, and 20%, respectively. In addition, 22.4% of patients have used antibiotics for an unknown reason.

Conclusion

Saudi parents of children with pneumonia and diarrhea abuse antibiotics. Saudi legislation banning medications without a prescription has helped reduce antibiotic abuse, but more community-based education and awareness are needed.

Maintenance of Remission after Oral Metronidazole Add-on Therapy in Rosacea Treatment: A Retrospective, Comparative Study

BACKGROUND

Rosacea is a chronic inflammatory disease which requires treatment to maintain remission.

OBJECTIVE

Recently, the effect of Demodex mites in recurrence of rosacea has been described. Although there is limited data, previous reports have suggested that oral metronidazole demonstrated efficacy in treatment of rosacea.

METHODS

Fifty-eight Korean patients with rosacea who received treatment with oral minocycline (50 mg twice daily) only or with two-week of oral metronidazole (250 mg thrice daily) were evaluated retrospectively. Their responses were evaluated by Investigator's Global Assessment (IGA), Clinician's Erythema Assessment (CEA), and patient's Global Assessment. The recurrence rate and odds ratio of risk factors for recurrence were also estimated.

RESULTS

The combination treatment group reported earlier clinical improvement and lower mean IGA and CEA than the monotherapy group. Approximately 48% of patients with combination treatment did not show relapse within 24 weeks, which is significantly higher than that in the monotherapy group (p=0.042).

CONCLUSION

Add-on therapy of oral metronidazole appeared to be a significant protective factor for recurrence of rosacea (p<0.05). This study suggests that oral metronidazole can be added to oral minocycline to reduce relapses in rosacea patients with tolerable safety.

A Study of the Degradation of LEV by Transparent PVA/NCD-TiO2 Nanocomposite Films with Enhanced Visible-Light Photocatalytic Activity

In recent years, antibiotics (such as levofloxacin (LEV)) have been detected widely in the environment. Semiconductor photocatalysis has been recognized as a promising technology for removing pollutants in the environment. In this work, nitrogen and carbon codoped titanium dioxide nano-catalyst (NCD-TiO2) was immobilized in polyvinyl alcohol (PVA) matrix to form PVA/NCD-TiO2 films through solution casting and thermal treatment, which exhibited good photocatalytic efficiency for LEV degradation. The results showed that about 42% LEV can be degraded after 2 h in the presence of PVA/NCD-TiO2 nanocomposite film (the weight ratio of NCD-TiO2 to PVA is 8% and thermal treatment is 120 °C) under visible light. Moreover, possible pathways of photocatalytic degradation of LEV according to the detected intermediates are proposed, which provide insight into the degradation mechanism of LEV by using PVA/NCD-TiO2 photocatalytic films. Finally, the synthesized PVA/NCD-TiO2 films exhibited excellent reusability and stability in photocatalysis. This work provides fundamental support for the design of a high-stability, excellent photocatalyst for practical application.

Exploration of Trends in Antimicrobial Use and Their Determinants Based on Dispensing Information Collected from Pharmacies throughout Japan: A First Report

The purpose of this study was to evaluate the defined daily doses (DDD)/1000 prescriptions/month (DPM) as a new indicator that can be used in pharmacies, and to describe antimicrobial use patterns in pharmacies nationwide in Japan. Dispensing volumes, number of prescriptions received, and facility information were obtained from 2638 pharmacies that participated in a survey. DPM was calculated based on the dispensing volume and number of prescriptions, which are routinely collected data that are simple to use. Use of third-generation cephalosporins, quinolones, and macrolides in pharmacies that received prescriptions primarily from hospitals or clinics decreased from January 2019 to January 2021. In particular, the antimicrobial use was higher in otorhinolaryngology departments than in other departments, despite a decrease in the antimicrobial use. In the linear multiple regression analysis, otorhinolaryngology department was independently associated with the third-generation cephalosporin, quinolone, and macrolide prescription in all periods. This study reveals for the first-time trends in antimicrobial use through a new indicator using the volume of drugs dispensed in pharmacies throughout Japan. Antimicrobial use differed by the medical department, suggesting the need to target interventions according to the department type.

Microbial Landscape and Antibiotic Susceptibility Dynamics of Skin and Soft Tissue Infections in Kazakhstan 2018–2020

Skin and soft tissue inflammatory diseases of bacterial origin occupy a significant part of hospitalizations to emergency departments. One of the most common causes of sepsis is soft tissue infection, which accounts for about a quarter of all nosocomial infections. The aim of this study was to determine the differences in microbial landscape and antibiotic susceptibility of soft tissue infection pathogens among adults and children during the period 2018–2020. We studied 110 samples of pus admitted to the Scientific Research laboratory of the Karaganda Medical University from 2018 to 2020. Each sample was studied using the standard and express methods. The antibiotic susceptibility was determined by using the diffuse disk method in accordance with the CLSI 2018 recommendations. As such, 50% of S. epidermidis strains in children and 30% in adults were methicillin resistant. Differences in the resistance of S. aureus strains in children and adults were insignificant. Thus, methicillin-resistant S. aureus (MRSA) was not detected in children, but in adults, on the other hand, their percentage was 12.5%. The third cause of infection in adults was E. coli (13.72%), among which 75% were multidrug resistant. A. baumanii was found in 4.9% of adult patients’ samples, of which 60% were multidrug resistant. The effectiveness of the most prescribed antibiotics decreased due to the isolated strain resistance.