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Taha AM, Elmasry MS, Hassan WS, Sayed RA. Spider chart, greenness and whiteness assessment of experimentally designed multivariate models for simultaneous determination of three drugs used as a combinatory antibiotic regimen in critical care units: Comparative study. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 313:124115. [PMID: 38484641 DOI: 10.1016/j.saa.2024.124115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/24/2024] [Accepted: 03/02/2024] [Indexed: 04/02/2024]
Abstract
In this study, five earth-friendly spectrophotometric methods using multivariate techniques were developed to analyze levofloxacin, linezolid, and meropenem, which are utilized in critical care units as combination therapies. These techniques were used to determine the mentioned medications in laboratory-prepared mixtures, pharmaceutical products and spiked human plasma that had not been separated before handling. These methods were named classical least squares (CLS), principal component regression (PCR), partial least squares (PLS), genetic algorithm partial least squares (GA-PLS), and artificial neural network (ANN). The methods used a five-level, three-factor experimental design to make different concentrations of the antibiotics mentioned (based on how much of them are found in the plasma of critical care patients and their linearity ranges). The approaches used for levofloxacin, linezolid, and meropenem were in the ranges of 3-15, 8-20, and 5-25 µg/mL, respectively. Several analytical tools were used to test the proposed methods' performance. These included the root mean square error of prediction, the root mean square error of cross-validation, percentage recoveries, standard deviations, and correlation coefficients. The outcome was highly satisfactory. The study found that the root mean square errors of prediction for levofloxacin were 0.090, 0.079, 0.065, 0.027, and 0.001 for the CLS, PCR, PLS, GA-PLS, and ANN models, respectively. The corresponding values for linezolid were 0.127, 0.122, 0.108, 0.05, and 0.114, respectively. For meropenem, the values were 0.230, 0.222, 0.179, 0.097, and 0.099 for the same models, respectively. These results indicate that the developed models were highly accurate and precise. This study compared the efficiency of artificial neural networks and classical chemometric models in enhancing spectral data selectivity for quickly identifying three antimicrobials. The results from these five models were subjected to statistical analysis and compared with each other and with the previously published ones. Finally, the whiteness of the methods was assessed by the recently published white analytical chemistry (WAC) RGB 12, and the greenness of the proposed methods was assessed using AGREE, GAPI, NEMI, Raynie and Driver, and eco-scale, which showed that the suggested approaches had the least negative environmental impact. Furthermore, to demonstrate solvent sustainability, a greenness index using a spider chart methodology was employed.
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Affiliation(s)
- Asmaa M Taha
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt.
| | - Manal S Elmasry
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Wafaa S Hassan
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Rania A Sayed
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
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Muhammad A, Zhang Y, Huang L, Yuan Q, Wang W, Pu J, Lin W, Tang R, Xiao X. The diagnosis of acute interstitial nephritis caused by infection versus antibiotic-induced interstitial nephritis: a narrative review. Clin Kidney J 2024; 17:sfae054. [PMID: 38572500 PMCID: PMC10986214 DOI: 10.1093/ckj/sfae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Indexed: 04/05/2024] Open
Abstract
Acute interstitial nephritis (AIN) is a significant contributor to acute kidney injury and can be attributed to a variety of factors, including but not limited to allergens or drugs, infections, autoimmune or systemic diseases, and idiopathic forms of the disease. In some cases, AIN requires a therapeutic action according to a single specific etiology by handling the offending agent and applying an immunosuppressant. Although AIN can be diagnosed through renal biopsy, it is not able to pinpoint the precise cause when multiple causes are suspected to be present simultaneously. Such situations arise when a patient suffering from infection develops AIN during antibiotic therapy, the exact causative factor of which becomes a challenge for the clinicians to determine. This is attributed to the different approaches employed in different etiologies, wherein clinicians are required to maintain the current antibiotic therapy or augment the dose in cases of infection as AIN etiology, without resorting to immunosuppressant therapy as the primary objective is infection killing. In contrast, antibiotics as an etiology for AIN require an alternative drug from the antibiotics group, along with an immunosuppressant. In the interim, delaying the identification of the precise cause may result in interstitial fibrosis and chronic kidney disease. This narrative review highlights certain findings that can be typical of infection-associated ATIN compared with antibiotic-associated ATIN based on clinical history and physical examination, clinical presentation of different antibiotic drug classes, histopathological features, classical and novel biomarkers, serum and urine cytokines and chemokines, cellular biomarkers, and genetic biomarkers. Although these findings cannot provide conclusive and clear recommendations that can be useful in the clinical practice, they can entice researchers to conduct original research on these features to discover clear recommendations.
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Affiliation(s)
- Amir Muhammad
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Yingli Zhang
- Department of Nephrology, Third Hospital of Changsha, Changsha, China
| | - Ling Huang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiongjing Yuan
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Wang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaxi Pu
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Rong Tang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
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A retrospective review of antibiotic use for acute respiratory infections in urgent-care patients. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e189. [PMID: 36505944 PMCID: PMC9727505 DOI: 10.1017/ash.2022.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 12/09/2022]
Abstract
Objective We examined the use of antibiotics for acute respiratory infections in an urgent-care setting. Design Retrospective database review. Setting The study was conducted in 2 urgent-care clinics staffed by academic emergency physicians in San Diego, California. Patients Visits for acute respiratory infections were identified based on presenting complaints. Methods The primary outcome was a discharge prescription for an antibiotic. The patient and provider characteristics that predicted this outcome were analyzed using logistic regression. The variation in antibiotic prescriptions between providers was also analyzed. Results In total, 15,160 visits were analyzed. The patient characteristics were not predictive of antibiotic treatment. Physicians were more likely than advanced practice practitioners to prescribe antibiotics (1.31; 95% confidence interval [CI], 1.21-1.42). For every year of seniority, a provider was 1.03 (95% CI, 1.02-1.03) more likely to prescribe an antibiotic. Although the providers saw similar patients, we detected significant variation in the antibiotic prescription rate between providers: the mean antibiotic prescription rate within the top quartile was 54.3% and the mean rate in the bottom quartile was 21.7%. Conclusions The patient and provider characteristics we examined were either not predictive or were only weakly predictive of receiving an antibiotic prescription for acute respiratory infection. However, we detected a marked variation between providers in the rate of antibiotic prescription. Provider differences, not patient differences, drive variations in antibiotic prescriptions. Stewardship efforts may be more effective if directed at providers rather than patients.
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Chittireddy HNPR, Kumar JVS, Bhimireddy A, Shaik MR, Shaik AH, Alwarthan A, Shaik B. Development and Validation for Quantification of Cephapirin and Ceftiofur by Ultraperformance Liquid Chromatography with Triple Quadrupole Mass Spectrometry. Molecules 2022; 27:molecules27227920. [PMID: 36432023 PMCID: PMC9696115 DOI: 10.3390/molecules27227920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Cross contamination of β-lactams is one of the highest risks for patients using pharmaceutical products. Penicillin and some non-penicillin β-lactams may cause potentially life-threatening allergic reactions. The trace detection of β-lactam antibiotics in cleaning rinse solutions of common reactors and manufacturing aids in pharmaceutical facilities is very crucial. Therefore, the common facilities adopt sophisticated cleaning procedures and develop analytical methods to assess traces of these compounds in rinsed solutions. For this, a highly sensitive and reproducible ultra-performance liquid chromatography with triple quadrupole mass spectrometry (UHPLC-MS/MS) method was developed for the analysis of Cephapirin and Ceftiofur. As per the FDA guidelines described in FDA-2011-D-0104, the contamination of these β-lactam antibiotics must be regulated. The analysis was performed on an XBridge C18 column with 100 mm length, 4.6 mm diameter, and 3.5 µm particle size at an oven temperature of about 40 °C. The mobile phase was composed of 0.15% formic acid in water and acetonitrile as mobile phases A and B, and a flow rate was set to 0.6 mL/min. The method was validated for Cephapirin and Ceftiofur. The quantification precision and accuracy were determined to be the lowest limit of detection 0.15 parts per billion (ppb) and the lowest limit of quantification 0.4 ppb. This method was linear in the range of 0.4 to 1.5 ppb with the determination of coefficient (R2 > 0.99). This sensitive and fast method was fit-for-purpose for detecting and quantifying trace amounts of β-lactam contamination, monitoring cross contamination in facility surface cleaning, and determining the acceptable level of limits for regulatory purposes.
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Affiliation(s)
- Hari Naga Prasada Reddy Chittireddy
- Department of Engineering Chemistry, College of Engineering, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Guntur 522 502, Andhra Pradesh, India
| | - J. V. Shanmukha Kumar
- Department of Engineering Chemistry, College of Engineering, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Guntur 522 502, Andhra Pradesh, India
- Correspondence: (J.V.S.K.); (M.R.S.); Tel.: +91-9000586007 (J.V.S.K.); +966-11-4670439 (M.R.S.)
| | | | - Mohammed Rafi Shaik
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
- Correspondence: (J.V.S.K.); (M.R.S.); Tel.: +91-9000586007 (J.V.S.K.); +966-11-4670439 (M.R.S.)
| | - Althaf Hussain Shaik
- Department of Zoology, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Abdulrahman Alwarthan
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Baji Shaik
- School of Chemical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
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Leporini C, De Sarro C, Palleria C, Caccavo I, Piro B, Citraro R, De Sarro G. Pediatric Drug Safety Surveillance: A 10-Year Analysis of Adverse Drug Reaction Reporting Data in Calabria, Southern Italy. Drug Saf 2022; 45:1381-1402. [PMID: 36112324 PMCID: PMC9483327 DOI: 10.1007/s40264-022-01232-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 01/09/2023]
Abstract
Introduction The paucity of pediatric clinical trials has led to many medicines frequently prescribed to children without a license for use in pediatrics, resulting in an increased risk of adverse drug reactions. Pharmacovigilance databases remain, among others, a valuable tool for evaluating pediatric drug safety in the real-life setting. Objective We aimed to characterize pediatric adverse drug reactions reported in the Italian Pharmacovigilance database coming from the Calabria region (Southern Italy) over 10 years. Methods All Individual Case Safety Reports (ICSRs) concerning individuals aged under 18 years were extracted from 2010 to 2019. Duplicate and vaccine ICSRs were excluded. The remaining ICSRs were analyzed with respect to patients’ demographic data, suspected drugs, and category of adverse drug reactions across different age groups. Results Among 6529 selected ICSRs, 395 pediatric ICSRs corresponding to 556 adverse drug reactions were analyzed. From 2010 to 2015, an increasing number of ICSRs were observed, but the reporting rate decreased after 2015. The highest proportion of ICSRs concerned children and adolescents. Around 52% of ICSRs involved boys: a trend observed in all age groups excluding newborns. Sixty ICSRs were serious and among them, 75% required hospitalization mainly in children and adolescents. Most of the ICSRs were issued by physicians (64.1%), followed by other healthcare professionals (22.5%) and pharmacists (9.9%). Anti-infective agents for systemic use and skin disorders were, respectively, the most frequently reported drug group and adverse drug reaction category. Conclusions This study provides an overview of adverse drug reactions reported in the pediatric population of the Calabria region and emphasizes the need for strengthening the surveillance in specific age subgroups and on given drugs in relation to their pattern of use. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01232-w.
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Tang W, Tan J. Cephalexin-Induced Leukocytoclastic Vasculitis. Cureus 2022; 14:e26545. [PMID: 35936130 PMCID: PMC9347303 DOI: 10.7759/cureus.26545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
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Rosman Y, Elmalak M, Meir-Shafrir K, Lachover-Roth I, Cohen-Engler A, Confino-Cohen R. Clinical history in suspected cases of immediate allergy to beta-lactam. World Allergy Organ J 2021; 14:100506. [PMID: 33537115 PMCID: PMC7829261 DOI: 10.1016/j.waojou.2020.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/04/2020] [Accepted: 12/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background Mislabeling patients as allergic to beta lactams poses an increased risk of morbidity, healthcare costs, and even mortality. This study aimed to define the accuracy of medical history, taken by a specialist, in diagnosing immediate reaction to beta lactams. Methods All patients labeled as allergic to beta lactam were interviewed by a specialist in allergy and clinical immunology and defined as suspected of having a history of immediate or non-immediate reaction. When indicated, skin tests to major and minor determinants and oral graded challenge to the culprit drug were performed. Results A total of 909 patients were evaluated. A total of 798 (87.7%) were labeled as allergic to penicillin. In 108 (11.9%) cases, the allergist suspected an immediate reaction based on clinical history. Skin test or challenge proven diagnosis of IgE-mediated allergy to beta lactam were significantly more prevalent in the group with an allergist's suspicion of an immediate allergy (23.1% vs. 5%, p < 0.01). The sensitivity and negative predictive values of an anamnesis of immediate reaction were high (0.9 and 0.95, respectively), but the specificity and positive predictive value were low (0.37 and 0.23, respectively). Conclusion Medical history taken by an allergist can exclude immediate hypersensitivity reaction, but it is not specific enough to confirm the diagnosis. Skin testing and graded challenge in suspected cases of immediate hypersensitivity reaction are indicated.
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Affiliation(s)
- Yossi Rosman
- Allergy and Clinical Immunology Unit, Meir Medical Center, Israel
- Sackler School of Medicine, Tel-Aviv University, Israel
- Corresponding author. Allergy and Clincial Immunology Unit, Meir Medical Center, Tsharnichovsky 57, Cfar Saba, Israel
| | | | | | - Idit Lachover-Roth
- Allergy and Clinical Immunology Unit, Meir Medical Center, Israel
- Sackler School of Medicine, Tel-Aviv University, Israel
| | - Anat Cohen-Engler
- Allergy and Clinical Immunology Unit, Meir Medical Center, Israel
- Sackler School of Medicine, Tel-Aviv University, Israel
| | - Ronit Confino-Cohen
- Allergy and Clinical Immunology Unit, Meir Medical Center, Israel
- Sackler School of Medicine, Tel-Aviv University, Israel
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Mascitti H, Bonsang B, Dinh A, Assan F, Perronne V, Leblanc T, Duran C, Bouchand F, Matt M, Le Gal A, N'guyen Van Thanh J, Lanore A, Jacob L, Kiavue N, Siméon S, Bessis S, de Truchis P, Landowski S, Davido B, Moreau F, Rameix-Welti MA, Gault E, Gaillard JL, Roux AL, Sivadon-Tardy V, Salomon E, El Sayed F, Carlier R, Emile JF, Perronne C, Bourgault-Villada I. Clinical Cutaneous Features of Patients Infected With SARS-CoV-2 Hospitalized for Pneumonia: A Cross-sectional Study. Open Forum Infect Dis 2020; 7:ofaa394. [PMID: 33204745 PMCID: PMC7650967 DOI: 10.1093/ofid/ofaa394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/25/2020] [Indexed: 12/29/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a current pandemic worldwide. This virus can reach all organs and disturbs the immune system, leading to a cytokine storm in severe forms. We aimed to report cutaneous features among coronavirus disease 2019 (COVID-19) hospitalized patients. Methods We performed a cross-sectional study on 1 given day among all patients hospitalized in acute care for COVID-19 and included all patients with cutaneous features. Follow-up 48 hours later was obtained. Results Among 59 adult patients hospitalized on the day of the study in an infectious diseases ward for SARS-CoV-2 infection who were confirmed by molecular assay and/or radiological findings (computed tomography scan), 40 were included. Several cutaneous manifestations were found: macular exanthema (80%), face edema (32%), livedo (13%), urticarial rash (8%), purpura (5%), oral lichenoid lesions (33%), and conjunctivitis (18%). Cutaneous biopsy was performed in 17 patients. Histological findings showed mast cell hyperplasia (100%), superficial perivascular infiltrate of lymphocytes (94%), and superficial edema (47%) consistent with capillary leak. Conclusions Various dermatological signs can be encountered during COVID-19. A macular rash was the most frequent. All cutaneous features could be related to a vascular leak process.
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Affiliation(s)
- Hélène Mascitti
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Benjamin Bonsang
- Department of Pathological Anatomy and Cytology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Aurélien Dinh
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Florence Assan
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Véronique Perronne
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Thibault Leblanc
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Clara Duran
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Frédérique Bouchand
- Department of Pharmacy, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Morgan Matt
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aurélie Le Gal
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Julia N'guyen Van Thanh
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aymeric Lanore
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Louis Jacob
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Nicolas Kiavue
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Soline Siméon
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Simon Bessis
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Pierre de Truchis
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Stéphanie Landowski
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Benjamin Davido
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Frédérique Moreau
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Marie-Anne Rameix-Welti
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Elyanne Gault
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Anne-Laure Roux
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Valérie Sivadon-Tardy
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Elsa Salomon
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Faten El Sayed
- Department of Microbiology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Robert Carlier
- Department of Radiology, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Jean-François Emile
- Department of Pathological Anatomy and Cytology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Christian Perronne
- Infectious and Tropical Diseases Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Isabelle Bourgault-Villada
- Department of Dermatology and Immunology, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
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Kim BK, Kim JH, Sohn KH, Kim JY, Chang YS, Kim SH. Incidence of teicoplanin adverse drug reactions among patients with vancomycin-associated adverse drug reactions and its risk factors. Korean J Intern Med 2020; 35:714-722. [PMID: 31722513 PMCID: PMC7214367 DOI: 10.3904/kjim.2018.404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/15/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIMS Teicoplanin can be used as an alternative to vancomycin when treating beta-lactam-resistant gram-positive bacterial infections. Both vancomycin and teicoplanin are associated with relatively high rates of adverse drug reactions (ADRs), including hypersensitivity reactions. There is limited data on teicoplanin-vancomycin cross-reactivity. This study examined the incidence of teicoplanin ADRs and risk factors for cross-reactivity between vancomycin and teicoplanin. METHODS We analyzed the incidence of teicoplanin ADRs in a retrospective study of 304 newly teicoplanin-exposed, immunocompetent, hospitalized patients at a single Korean Medical Center between January 1, 2006 and December 31, 2015. RESULTS Among 304 patients, 238 (78.3%) experienced vancomycin-associated ADRs prior to their teicoplanin exposure and 58 (19.1%) experienced teicoplanin- associated ADRs, which were mostly hypersensitivity reactions without acute kidney injury. The incidence of teicoplanin ADRs was higher in patients who previously experienced vancomycin-related ADRs (23.1% vs. 5.3%, p < 0.001). History of drug allergy was a statistically significant risk factor of teicoplanin ADRs. The incidence of teicoplanin ADRs significantly increased in patients with multiple organ involvement in vancomycin hypersensitivity reactions. CONCLUSION Teicoplanin should be administered with caution and clinicians must consider the risk factors of cross-reaction when prescribing teicoplanin to individuals with a history of vancomycin hypersensitivity.
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Affiliation(s)
- Byung-Keun Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jung-Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Kyoung-Hee Sohn
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Ju-Young Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
- Correspondence to Sae-Hoon Kim, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7046 Fax: +82-31-787-4052 E-mail:
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10
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A Practical Guide for Managing Antibiotic Allergies in the Emergency Department. Adv Emerg Nurs J 2020; 41:306-315. [PMID: 31687994 DOI: 10.1097/tme.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Up to 30% of patients report at least one antibiotic allergy, but oftentimes these antibiotic allergies are misdiagnosed. In fact, of the 10% of patients reporting penicillin allergies, 90%-98% are not truly allergic. In an era of increasing antibiotic resistance coupled with a limited number of new antibiotics, evaluating antibiotic allergies is critical in providing optimal patient care. Differentiating adverse drug reactions from antibiotic allergies may seem like a daunting task for clinicians and providers, especially in the emergency department, where decisions are made quickly. However, a systemic approach, including medical record review coupled with patient and/or family interview, is vital in managing patients with antibiotic allergies. Inappropriate, alternative antibiotics are frequently chosen due to patient allergies, and data suggest higher rates of broad-spectrum antibiotic use, antibiotic resistance, and poor outcomes as a result. Herein, we review antibiotic selection in patients reporting antibiotic allergies in the emergency department.
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11
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Affiliation(s)
- Robin Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
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12
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Zafar F, Iqbal AM, Mubarik A, Rojas M, Muddassir S. Rivaroxaban-Induced Acute Interstitial Nephritis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1719-1722. [PMID: 31748498 PMCID: PMC6883982 DOI: 10.12659/ajcr.917492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/20/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Direct oral anticoagulant agents (DOACs) have become increasingly more popular in recent years and have largely replaced warfarin in the treatment of certain conditions, such as atrial fibrillation, and in the prevention of thromboembolic events. Rivaroxaban is one of the most commonly used direct anticoagulant drugs for conditions such as atrial fibrillation and thromboprophylaxis. CASE REPORT We present a case of a 70-year-old male who developed acute interstitial nephritis after starting rivaroxaban, and who responded to medical treatment, which included corticosteroid therapy. A renal biopsy was not performed because the patient was on essential anticoagulation therapy secondary to a high CHADS2VASc score. CONCLUSIONS Dose adjustments when using rivaroxaban are necessary in patients with underlying renal failure. Acute interstitial nephritis is a rare condition associated with direct anticoagulant drugs. The treatment of acute interstitial nephritis is usually to remove the offending agent and treat the underlying cause.
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Chastain DB, Hutzley VJ, Parekh J, Alegro JVG. Antimicrobial Desensitization: A Review of Published Protocols. PHARMACY 2019; 7:E112. [PMID: 31405062 PMCID: PMC6789802 DOI: 10.3390/pharmacy7030112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022] Open
Abstract
Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs that may otherwise cause hypersensitivity reactions. While no universal antimicrobial desensitization protocols exist, this review critically analyzes previously published desensitization protocols. The purpose of this review is to provide a greater insight for clinicians and institutions to ensure desensitization procedures are efficacious while minimizing potential for patient harm. With an increasing rate of antimicrobial resistance and the critical need to preserve antimicrobial agents, desensitization may represent another option in our antimicrobial stewardship toolkit.
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Affiliation(s)
| | | | - Jay Parekh
- Roosevelt University College of Pharmacy, Schaumburg, IL 60173, USA
| | - Jason Val G Alegro
- Mount Sinai Hospital, Chicago, IL 60608, USA.
- Roosevelt University College of Pharmacy, Schaumburg, IL 60173, USA.
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Bondarenko S, Chang CB, Cordero-Ampuero J, Kates S, Kheir M, Klement MR, McPherson E, Morata L, Silibovsky R, Skaliczki G, Soriano A, Suárez R, Szatmári A, Webb J, Young S, Zimmerli W. General Assembly, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S61-S73. [PMID: 30348584 DOI: 10.1016/j.arth.2018.09.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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15
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Sacco KA, Cochran BP, Epps K, Parkulo M, Gonzalez-Estrada A. Inpatient β-lactam test-dose protocol and antimicrobial stewardship in patients with a history of penicillin allergy. Ann Allergy Asthma Immunol 2018; 122:184-188. [PMID: 30465860 DOI: 10.1016/j.anai.2018.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/17/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Penicillin allergy is the most commonly reported drug allergy in hospitalized patients, resulting in increased second-line antibiotic use, nosocomial infections, and health care use. Given that most patients are not truly allergic, a safe strategy that empowers the admitting physician is needed. OBJECTIVE To assess the effect on antibiotic prescribing practices for hospitalized patients with penicillin allergy using a validated intervention. METHODS An intervention was implemented to educate health care professionals on management of patients with penicillin allergy using a validated risk stratification algorithm to guide testing and antibiotic use. Thirty days of control data using current standard of care was compared with 60 days of postintervention data measuring documentation of penicillin allergy history and antibiotic selection. RESULTS The relative use of cephalosporin and penicillin antibiotics increased by 121.2% (P = .03) and 256% (P = .04), respectively, without an increase in adverse drug reactions. There was a decrease in the use of broad-spectrum antibiotics: vancomycin, 67.2% (P = .04); quinolones, 33.3% (P = .31); carbapenems, 81.9% (P = .08); and aztreonam, 73.8% (P = .18). CONCLUSION The antibiotic choice in patients admitted to the hospital with a reported penicillin allergy can be improved by better evaluation of the allergy history and the use of a risk stratification guideline.
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Affiliation(s)
- Keith A Sacco
- Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Kevin Epps
- Department of Pharmacy, Mayo Clinic, Jacksonville, Florida
| | - Mark Parkulo
- Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Alexei Gonzalez-Estrada
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
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Allergie aux antibiotiques dans la mucoviscidose : cohorte rétrospective des patients adultes suivis au centre de ressources et de compétences pour la mucoviscidose d’Angers et revue de la littérature. REVUE FRANCAISE D ALLERGOLOGIE 2018. [DOI: 10.1016/j.reval.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ito T. Diffuse maculopapular exanthema and a positive lymphocyte transformation test reaction in response to clarithromycin. Oxf Med Case Reports 2018; 2018:omy061. [PMID: 30159155 PMCID: PMC6109200 DOI: 10.1093/omcr/omy061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/15/2018] [Accepted: 06/26/2018] [Indexed: 11/29/2022] Open
Abstract
Macrolides are one of the most widely used antibiotics, but the mechanisms underlying macrolide allergy have not been clearly elucidated. Diffuse maculopapular exanthema caused by clarithromycin is extremely rare, of which clinical images have not been reported. Here, we report a case of a 55-year-old Japanese female who was treated with oral clarithromycin and lysozyme hydrochloride due to odontogenic maxillary sinusitis. On the 15th day after starting both drugs, she suffered from diffuse maculopapular exanthema, which worsened despite the discontinuation of lysozyme hydrochloride and the introduction of treatment with oral and topical corticosteroids and oral levocetirizine. Clarithromycin was discontinued and an intravenous corticosteroid introduced on the 19th day. A lymphocyte transformation test was positive for clarithromycin but negative for lysozyme hydrochloride. Although adverse effects of clarithromycin are extremely rare, physicians should be aware of clarithromycin as a potential cause of a type IV allergic reaction.
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Affiliation(s)
- Toshiki Ito
- Division of Internal Medicine, Department of Internal Medicine, Chitose City Hospital, Hokkaido, Japan
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18
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Qiu C, Zhu H, Ruzicka C, Keire D, Ye H. A General LC-MS/MS Method for Monitoring Potential β-Lactam Contamination in Drugs and Drug-Manufacturing Surfaces. AAPS JOURNAL 2018; 20:70. [PMID: 29766324 DOI: 10.1208/s12248-018-0224-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
Penicillins and some non-penicillin β-lactams may cause potentially life-threatening allergic reactions. Thus, possible cross contamination of β-lactams in food or drugs can put people at risk. Therefore, when there is a reasonable possibility that a non-penicillin product could be contaminated by penicillin, the drug products are tested for penicillin contamination. Here, a sensitive and rapid method for simultaneous determination of multiple β-lactam antibiotics using high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed and validated. Mass spectral acquisition was performed on a Q-Exactive HF mass spectrometer in positive ion mode with parallel reaction monitoring (PRM). The method was validated for seven β-lactam antibiotics including one or two from each class and a synthetic intermediate. The quantification precision and accuracy at 200 ppb were in the range of ± 1.84 to ± 4.56 and - 5.20 to 3.44%, respectively. The limit of detection (LOD) was 0.2 ppb, and the limit of quantitation (LOQ) was 2 ppb with a linear dynamic range (LDR) of 2-2000 ppb for all eight β-lactams. From various drug products, the recoveries of eight β-lactams at 200 and 2 ppb ranged from 93.8 ± 3.2 to 112.1 ± 4.2% and 89.7 ± 4.6 to 110.6 ± 1.9%, respectively. The application of the method for detecting cross contamination of trace β-lactams (0.2 ppb) and for monitoring facility surface cleaning was also investigated. This sensitive and fast method was fit-for-purpose for detecting and quantifying trace amount of β-lactam contamination, monitoring cross contamination in manufacturing processes, and determining potency for regulatory purposes and for quality control.
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Affiliation(s)
- Chen Qiu
- Division of Pharmaceutical Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 645 S. Newstead Ave, St. Louis, Missouri, 63110, USA
| | - Hongbin Zhu
- Division of Pharmaceutical Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 645 S. Newstead Ave, St. Louis, Missouri, 63110, USA.,ThermoFisher Scientific Inc., 3747 N Meridian Rd, Rockford, Illinois, 61101, USA
| | - Connie Ruzicka
- Division of Pharmaceutical Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 645 S. Newstead Ave, St. Louis, Missouri, 63110, USA
| | - David Keire
- Division of Pharmaceutical Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 645 S. Newstead Ave, St. Louis, Missouri, 63110, USA
| | - Hongping Ye
- Division of Pharmaceutical Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 645 S. Newstead Ave, St. Louis, Missouri, 63110, USA.
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Bouquet É, Star K, Jonville-Béra AP, Durrieu G. Pharmacovigilance in pediatrics. Therapie 2018; 73:171-180. [DOI: 10.1016/j.therap.2017.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022]
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20
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Identification of Possibility of Glycyrrhiza uralensis as an Allergen by Protein Analysis. BIOCHIP JOURNAL 2018. [DOI: 10.1007/s13206-017-2110-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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How to Manage Antibiotic Allergy in Cystic Fibrosis? Epidemiologic, Diagnostic, and Therapeutic Aspects. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Sacco KA, Bates A, Brigham TJ, Imam JS, Burton MC. Clinical outcomes following inpatient penicillin allergy testing: A systematic review and meta-analysis. Allergy 2017; 72:1288-1296. [PMID: 28370003 DOI: 10.1111/all.13168] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of broader-spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization. METHODS We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library over the past 20 years. Inpatients having a documented penicillin allergy that underwent penicillin allergy testing were included. RESULTS Twenty-four studies met eligibility criteria. Study sample size was between 24 and 252 patients in exclusively inpatient cohorts. Penicillin skin testing (PST) with or without oral amoxicillin challenge was the main intervention described (18 studies). The population-weighted mean for a negative PST was 95.1% [CI 93.8-96.1]. Inpatient penicillin allergy testing led to a change in antibiotic selection that was greater in the intensive care unit (77.97% [CI 72.0-83.1] vs 54.73% [CI 51.2-58.2], P<.01). An increased prescription of penicillin (range 9.9%-49%) and cephalosporin (range 10.7%-48%) antibiotics was reported. Vancomycin and fluoroquinolone use was decreased. Inpatient penicillin allergy testing was associated with decreased healthcare cost in four studies. CONCLUSIONS Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy. The rate of negative tests is comparable to outpatient and perioperative data. Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship.
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Affiliation(s)
- K. A. Sacco
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
| | - A. Bates
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
| | - T. J. Brigham
- Winn-Dixie Foundation Medical Library; Mayo Clinic; Jacksonville FL USA
| | - J. S. Imam
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
| | - M. C. Burton
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
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Li M, Zhang T, Zhu L, Wang R, Jin Y. Liposomal andrographolide dry powder inhalers for treatment of bacterial pneumonia via anti-inflammatory pathway. Int J Pharm 2017; 528:163-171. [DOI: 10.1016/j.ijpharm.2017.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 12/14/2022]
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Confino-Cohen R, Rosman Y, Meir-Shafrir K, Stauber T, Lachover-Roth I, Hershko A, Goldberg A. Oral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:669-675. [DOI: 10.1016/j.jaip.2017.02.023] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/15/2017] [Accepted: 02/28/2017] [Indexed: 11/28/2022]
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26
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Raghavan R, Shawar S. Mechanisms of Drug-Induced Interstitial Nephritis. Adv Chronic Kidney Dis 2017; 24:64-71. [PMID: 28284381 DOI: 10.1053/j.ackd.2016.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/11/2022]
Abstract
Drug-induced acute interstitial nephritis (DI-AIN) is a drug hypersensitivity reaction (DHR) that manifests 7 to 10 days after exposure to the culprit drug. DHRs account for fewer than 15% of reported adverse drug reactions. The kidneys are susceptible to DHR because: (1) the high renal blood flow whereby antigens are filtered, secreted, or concentrated, and (2) it is a major site of excretion for drugs and drug metabolites. More than 250 different drugs from various classes have been incriminated as causative agents of DI-AIN, the third most common cause of acute kidney injury in the hospital. DI-AIN must be differentiated from drug-induced nephrotoxic acute tubular necrosis because of their differing pathophysiology and treatment. DI-AIN begins with antigen processing and presentation to local dendritic cells. The dendritic cells activate T cells, and the subsequent effector phase of the immune response is mediated by various cytokines. Incriminated antigenic mechanisms include response to a conjugation product of the drug or its metabolite with a host protein (eg, beta-lactam or sulfonamide antibiotic) or the direct binding of the drug to a particular host allele to elicit a hypersensitivity response (eg, certain anti-epileptic drugs). If the offending drug is not identified and discontinued in a timely manner, irreversible fibrosis and chronic kidney disease will occur. The core structure of each drug or its metabolite is an antigenic determinant, and the host interaction is termed the structure-activity relationship. Differing structure-activity relationships accounts for effect, hypersensitivity, and cross-reactivity among and between classes. The essence of management of DI-AIN lies with the four sequential steps: anticipation, diagnosis, treatment, and prevention. Corticosteroids are used in the treatment of DI-AIN because of their potent anti-inflammatory effects on T cells and eosinophils. Anticipation and prevention require notifying the patient that DI-AIN is an idiosyncratic, hypersensitivity reaction that recurs on re-exposure, and the drug should be avoided.
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Wyatt RWB, Maletis GB, Lyon LL, Schwalbe J, Avins AL. Efficacy of Prophylactic Antibiotics in Simple Knee Arthroscopy. Arthroscopy 2017; 33:157-162. [PMID: 27372184 DOI: 10.1016/j.arthro.2016.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the association between the use of preoperative antibiotics and the risk of postoperative infection after simple knee arthroscopy. METHODS The electronic medical records of a large integrated health care organization were used to identify patients who underwent simple knee arthroscopy between 2007 and 2012. Patient demographics, potential infection risk factors, and antibiotic administration data were extracted. Simple knee arthroscopy included debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release. Complex knee arthroscopy, septic knees, and cases involving fractures were excluded. Deep infection was defined as a positive synovial fluid culture or signs and symptoms of infection and gross pus in the knee. Superficial infection was defined as clinical signs of infection localized to a portal site and treatment with an antibiotic. RESULTS Of 40,810 simple knee arthroscopies, 32,836 (80.5%) received preoperative antibiotics and 7,974 (19.5%) did not. There were 25 deep infections in the antibiotic group (0.08%) and 11 in the no-antibiotics group (0.14%) (risk ratio = 0.55, 95% confidence interval: 0.27 to 1.12, P = .10). There were 134 superficial infections in the antibiotic group (0.41%) and 32 in the no-antibiotics group (0.40%) (risk ratio = 1.01, 95% confidence interval: 0.29 to 1.49, P = .93). CONCLUSIONS In our large sample of patients who underwent simple knee arthroscopy, there was no association between preoperative antibiotic use and postoperative deep or superficial infection rates at the 95% confidence level (P = .05). There was an association between preoperative antibiotic use and a decreased deep infection rate at the P = .10 level. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Ronald W B Wyatt
- Department of Orthopedic Surgery, Kaiser-Permanente Walnut Creek, Walnut Creek, California, U.S.A..
| | - Gregory B Maletis
- Department of Orthopedic Surgery, Kaiser-Permanente Baldwin Park, Baldwin Park, California, U.S.A
| | - Liisa L Lyon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, U.S.A
| | - Joan Schwalbe
- Division of Research, Kaiser Permanente Northern California, Oakland, California, U.S.A
| | - Andrew L Avins
- Division of Research, Kaiser Permanente Northern California, Oakland, California, U.S.A
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Les bronchospasmes iatrogènes. ACTUALITES PHARMACEUTIQUES 2016. [DOI: 10.1016/j.actpha.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Moreno E, Laffond E, Muñoz-Bellido F, Gracia MT, Macías E, Moreno A, Dávila I. Performance in real life of the European Network on Drug Allergy algorithm in immediate reactions to beta-lactam antibiotics. Allergy 2016; 71:1787-1790. [PMID: 27543745 DOI: 10.1111/all.13032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 12/27/2022]
Abstract
European Network on Drug Allergy (ENDA) has proposed an algorithm for diagnosing immediate beta-lactam (BL) allergy. We evaluated its performance in real life. During 1994-2014, 1779 patients with suspected immediate reactions to BL were evaluated following ENDA's short diagnostic algorithm. Five hundred and nine patients (28.6%) were diagnosed of BL hypersensitivity. Of them, 457 (25.7%) were at first evaluation [403 by skin tests (ST), 12 by positive IgE and 42 by controlled provocation tests (CPT)]. At second evaluation (SE), 52 additional patients (10.2% of allergic patients) were diagnosed, [50 (2.8%) by ST and 2 (0.1%) by CPT]. Time between reaction and study was significantly longer in patients diagnosed at SE (median 5 vs 42 months; IQR 34 vs 170; P < 0.0001). Anaphylaxis was significantly associated with a diagnosis at SE. European Network on Drug Allergy/EAACI protocol was appropriate and safe when evaluating BL immediate reactions. Re-evaluation should be performed, particularly when anaphylaxis and long interval to diagnosis are present.
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Affiliation(s)
- E. Moreno
- Allergy Service; University Hospital of Salamanca; Spain
- IBSAL (Instituto Biosanitario de Salamanca); Salamanca Spain
- Department of Biomedical and Diagnostic Sciences; Salamanca Medical School; University of Salamanca; Spain
| | - E. Laffond
- Allergy Service; University Hospital of Salamanca; Spain
- IBSAL (Instituto Biosanitario de Salamanca); Salamanca Spain
- Department of Biomedical and Diagnostic Sciences; Salamanca Medical School; University of Salamanca; Spain
| | - F. Muñoz-Bellido
- Allergy Service; University Hospital of Salamanca; Spain
- IBSAL (Instituto Biosanitario de Salamanca); Salamanca Spain
| | - M. T. Gracia
- Allergy Service; University Hospital of Salamanca; Spain
- IBSAL (Instituto Biosanitario de Salamanca); Salamanca Spain
| | - E. Macías
- Allergy Service; University Hospital of Salamanca; Spain
- IBSAL (Instituto Biosanitario de Salamanca); Salamanca Spain
| | - A. Moreno
- Allergy Service; University Hospital of Salamanca; Spain
| | - I. Dávila
- Allergy Service; University Hospital of Salamanca; Spain
- IBSAL (Instituto Biosanitario de Salamanca); Salamanca Spain
- Department of Biomedical and Diagnostic Sciences; Salamanca Medical School; University of Salamanca; Spain
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Abstract
Assessment, prevention, and treatment of bacterial infection in donors are critically important to the welfare of grafts and recipients after transplantation. Transmission of bacterial, viral, fungal, and protozoan infections from a donor to recipient(s) has been documented to have serious or fatal consequences. This article reviews issues of bacterial infection only. The organ procurement coordinator, supported by guidelines developed and prospectively modified by the organ procurement organization, must assess the donor for the presence and severity of bacterial tissue invasion and administer appropriate antimicrobial agents during donor care. Continuation of infection control measures, obtaining serial or surveillance samples for culture, review of antibiotic sensitivity data, initiation of empiric treatment, and modification of medications or their dosing are components of this important responsibility during donor care.
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Affiliation(s)
- David J. Powner
- University of Texas Health Science Center at Houston (DJP), Memorial Hermann Texas Medical Center Hospital (TAA), Houston, Texas
| | - Teresa A. Allison
- University of Texas Health Science Center at Houston (DJP), Memorial Hermann Texas Medical Center Hospital (TAA), Houston, Texas
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Nazir S, Azim M. Assessment of antibiotic self-medication practice among public in the northwestern region of Pakistan. Eur J Hosp Pharm 2016; 24:200-203. [PMID: 31156941 DOI: 10.1136/ejhpharm-2015-000733] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 04/20/2016] [Accepted: 04/28/2016] [Indexed: 11/03/2022] Open
Abstract
Background Self-medication with antibiotics is a common practice, which may lead to the development of antimicrobial resistance (AMR)-a major health concern worldwide. The most common reason for the development of AMR is a lack of education and regulatory policies and the lack of community pharmacists. Objective To assess various factors that lead to self-medication with antibiotics, which might cause AMR and hinder effective healthcare. Methods A cross-sectional study was carried out using a predesigned questionnaire to collect data from 800 respondents. The respondents were selected by simple random sampling during November 2014 to January 2015 from different regions of Khyber Pakhtunkhwa (KPK), Pakistan. Only properly completed questionnaires were assessed for different variables. The collected data were analysed using SPSS V.16. Results 527 people completed and returned the questionnaire-a response rate of 66%. Self-medication with antibiotics was reported by 135 participants (26%), with a higher prevalence of men than women (48% vs 38%, respectively). The main reason for self-medication was previous experience with the same antibiotic (68%). The most commonly used antibiotics were amoxicillin-clavulanate (40%) and major indications for self-medication were sore throat (29%) and flu (24%). Of the 527 respondents, only 104 (20%) were aware of AMR. Conclusions This study is the first to evaluate self-medication with antibiotics in KPK, Pakistan. In view of the high prevalence of self-medication, introduction of a public health policy through drug regulatory authorities, public awareness programmes/campaigns, patient education about AMR and appropriate use of antibiotics are critically required. The role of community pharmacists needs to be strengthened.
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Affiliation(s)
- Shabnam Nazir
- Kohat University of Science and Technology, Kohat, KPK, Pakistan
| | - Marium Azim
- Department of Pharmaceutical Sciences, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa (KPK), Pakistan
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Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai X, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis--A Comprehensive Review and Guide to Therapy. I. Systemic Disease. Ocul Surf 2015; 14:2-19. [PMID: 26549248 DOI: 10.1016/j.jtos.2015.10.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/01/2015] [Accepted: 10/15/2015] [Indexed: 01/06/2023]
Abstract
The intent of this review is to comprehensively appraise the state of the art with regard to Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to the ocular surface complications and their management. SJS and TEN represent two ends of a spectrum of immune-mediated, dermatobullous disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. The widespread keratinocyte death seen in SJS/TEN is rapid and irreversible, and even with early and aggressive intervention, morbidity is severe and mortality not uncommon. We have divided this review into two parts. Part I summarizes the epidemiology and immunopathogenesis of SJS/TEN and discusses systemic therapy and its possible benefits. We hope this review will help the ophthalmologist better understand the mechanisms of disease in SJS/TEN and enhance their care of patients with this complex and often debilitating disease. Part II (April 2016 issue) will focus on ophthalmic manifestations.
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Affiliation(s)
- Sahar Kohanim
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, TN
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Hajirah N Saeed
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Sayan Basu
- LV Prasad Eye Institute, Hyderabad, India
| | | | | | - John K Dart
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Xiaowu Gai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | | | - Darren G Gregory
- Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, Aurora, CO
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Deborah S Jacobs
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA; Boston Foundation for Sight, Boston, MA
| | | | | | | | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | | | | | | | - Chie Sotozono
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Scheffer C G Tseng
- Ocular Surface Center, Ocular Surface Research & Education Foundation, Miami, FL
| | - Mayumi Ueta
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
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Żukiewicz-Sobczak WA, Wróblewska P, Adamczuk P, Zwoliński J, Oniszczuk A, Wojtyła-Buciora P, Silny W. Drugs as important factors causing allergies. Postepy Dermatol Alergol 2015; 32:388-92. [PMID: 26759548 PMCID: PMC4692812 DOI: 10.5114/pdia.2014.44021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/29/2014] [Indexed: 01/15/2023] Open
Abstract
Medications can cause many adverse reactions, both non-immunologic and immunologic ones. Allergies can take many forms, allergic reactions include all types of reactions according to Gell and Coombs. Typically, allergic reactions to drugs are manifested by skin lesions such as maculopapular rash or urticaria and life-threatening systemic reactions such as anaphylaxis. Allergy to drugs is diagnosed based on medical history and a number of specific tests: skin tests, blood tests. In diagnosing the causes of anaphylaxis, the basophil activation test is used to exclude false negative and false positive results of skin tests and specific IgE levels. Allergic reactions to medications usually resolve themselves after discontinuation of the drug. Sometimes in the treatment anti-allergic drugs are used to inhibit the development of skin lesions. After observing any signs of drug allergy it is important to accurately diagnose the cause, since the subsequent exposure to the drug may lead to a strong anaphylactic reaction and consequently death.
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Affiliation(s)
- Wioletta A. Żukiewicz-Sobczak
- Pope John Paul II State School of Higher Education, Biala Podlaska, Poland. Rector of the School: Prof. Józef Bergier
| | - Paula Wróblewska
- Department of Allergology and Environmental Hazards, Institute of Rural Health, Lublin, Poland. Head of the Department: Wioletta A. Żukiewicz-Sobczak PhD
| | - Piotr Adamczuk
- Department of Allergology and Environmental Hazards, Institute of Rural Health, Lublin, Poland. Head of the Department: Wioletta A. Żukiewicz-Sobczak PhD
| | - Jacek Zwoliński
- Department of Allergology and Environmental Hazards, Institute of Rural Health, Lublin, Poland. Head of the Department: Wioletta A. Żukiewicz-Sobczak PhD
| | - Anna Oniszczuk
- Department of Inorganic Chemistry, Medical University of Lublin, Lublin, Poland. Head of the Department: Prof. Monika Waksmundzka-Hajnos
| | - Paulina Wojtyła-Buciora
- Department of Hygiene, Poznan University of Medical Sciences, Poznan, Poland. Head of the Department: Prof. Jerzy Marcinkowski MD, PhD
| | - Wojciech Silny
- Greater Allergy and Dermatology Center “Art Clinic”, Poznan, Poland. Head of the Department: Paweł Silny MD, PhD
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Ferner RE. Adverse drug reactions in dermatology. Clin Exp Dermatol 2015; 40:105-9; quiz 109-10. [PMID: 25622648 DOI: 10.1111/ced.12572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/21/2022]
Abstract
Adverse drug reactions (ADRs) - that is, unintended and harmful responses to medicines - are important to dermatologists because many present with cutaneous signs and because dermatological treatments can cause serious ADRs. The detection of ADRs to new drugs is often delayed because they have a long latency or are rare or unexpected. This means that ADRs to newer agents emerge only slowly after marketing. ADRs are part of the differential diagnosis of unusual rashes. A good drug history that includes details of drug dose, time-course of the reaction and factors that may make the patient more susceptible, will help. For example, Stevens-Johnson syndrome with abacavir is much commoner in patients with HLA-B*5701, and has a characteristic time course. Newer agents have brought newer reactions; for example, acneiform rashes associated with epidermal growth factor receptor inhibitors such as erlotinib. Older systemic agents used to treat skin disease, including corticosteroids and methotrexate, cause important ADRs. The adverse effects of newer biological agents used in dermatology are becoming clearer; for example, hypersensitivity reactions or loss of efficacy from antibody formation and progressive multifocal leucoencephalopathy due to reactivation of latent JC (John Cunningham) virus infections during efalizumab treatment. Unusual or serious harm from medicines, including ADRs, medication errors and overdose, should be reported. The UK Yellow Card scheme is online, and patients can report their own ADRs.
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Affiliation(s)
- R E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital Birmingham and School of Clinical and Experimental Medicine, Birmingham, UK
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Ebrahimzadeh Attari V, Mesgari Abbasi M, Abedimanesh N, Ostadrahimi A, Gorbani A. Investigation of enrofloxacin and chloramphenicol residues in broiler chickens carcasses collected from local markets of tabriz, northwestern iran. Health Promot Perspect 2014; 4:151-7. [PMID: 25648045 PMCID: PMC4300440 DOI: 10.5681/hpp.2014.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/27/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The present study was aimed to determine the residual amounts of chloramphenicol and enrofloxacin in broiler chickens muscle and liver sam-ples gathered from local markets of Tabriz City, northwestern Iran. METHODS Ninety broiler chickens carcasses were collected from different local markets of Tabriz, during July/August 2013. Random samples of thigh and breast muscle and liver were gathered and kept at -80(°)C until analyzes. The samples were then assayed using enzyme-linked immunosorbent assay (ELISA) according to the protocol of each antibiotic kit. Data were statistically analyzed using the computer program SAS 9.1. RESULTS Eighty two samples (91/1 %) contained residues of enrofloxacin, alt-hough mean (±SD)of enrofloxacin concentration was lower than the European Union maximum residue limits(MRLs) value (P<0.001). Moreover, 28 (31/1 %) had detectable concentrations of chloramphenicol while it was not defined any MRLs value for chloramphenicol because its using has been forbidden in food animals. CONCLUSION The frequency of contamination with enrofloxacin was considerable for the analyzed samples. Furthermore, the existence of chloramphenicol in almost one third of samples seems to be a public health threat due to its illegal use in food animals including poultry.
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Affiliation(s)
| | | | - Nasim Abedimanesh
- Department of Nutrition & Biochemistry, Tabriz University of Medical
Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolfazl Gorbani
- Department of Animal Science, Islamic Azad University, Shabestar Branch,
Shabestar, Iran
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Crnogaca K, Bicanic G, Delimar D. Antibiotics in frozen bone grafts can cause allergic reactions in recipient patients. Med Hypotheses 2014; 84:107-8. [PMID: 25539901 DOI: 10.1016/j.mehy.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/06/2014] [Indexed: 12/16/2022]
Abstract
Antibiotic prophylaxis is a routine procedure during total hip arthroplasty (THA), and the vast majority of cadavers within the multitissue procurement receive one or more antibiotics. Upon harvesting, bone grafts are stored in the bone banks on the temperature as low as -80°C for up to 5 years. It is shown in the literature that the antibiotics remain active and viable in the bone grafts even after being exposed to extremely low temperatures in the prolonged periods. Possibility of remnant antibiotic concentrations in the bone grafts and the fact that these antibiotic remnants maintain active even after being exposed to extremely low temperatures create the environment in which the possibility for the allergic reaction in sensitive patient receiving bone graft exists. We hypothesize that harvested bone grafts containing active antibiotic substance have the potential for local and systemic allergic reaction in sensitive recipient patients thus increasing morbidity and the costs of the treatment. Allergic reactions can mimic surgical site infections as well with the consequent substantial pitfalls in the treatment. Following that, in the setting of an assumed but not confirmed surgical site infection, the immunological evaluation on antibiotics for recipients of bone grafts could be added to the standard diagnostic algorithms. In addition, bone banks should be obliged to provide information of all potential drugs that can be found in every specific bone graft to the end users.
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Affiliation(s)
- Kresimir Crnogaca
- University Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia
| | - Goran Bicanic
- University of Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia.
| | - Domagoj Delimar
- University of Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia
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Abstract
PURPOSE Cefaclor is widely prescribed for various infectious diseases. As its consumption increases, the number of hypersensitivity reactions to cefaclor has increased. This study aimed to evaluate the immunologic findings of immediate hypersensitivity to cefaclor. MATERIALS AND METHODS We enrolled 47 patients with immediate hypersensitivity to cefaclor from Ajou University Hospital and Asan Medical Center. Serum specific IgE, IgG1, and IgG4 antibodies to cefaclor-human serum albumin (HSA) conjugate were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS The most common phenotype was anaphylaxis (Group I, 78.7%), followed by urticaria (Group II, 21.3%). The detection of specific IgE, IgG1, and IgG4 to cefaclor-HSA conjugate by ELISA tended to be higher in Group I (40.5%, 41.7%, 21.6%) than in Group II (20.0%, 20.0%, 0%) with no statistical significance. Significant associations were found between specific IgE and IgG1 or IgG4 (p<0.001, p=0.019). ELISA inhibition tests showed significant inhibitions by both free cefaclor and cefaclor-HSA conjugate. For basophil activation tests in patients having no specific IgE antibody, the CD63 expression level on basophils increased with incubations of free cefaclor. CONCLUSION The most common manifestation of immediate hypersensitivity to cefaclor was anaphylaxis, most of which was mediated by IgE; however, a non-IgE mediated direct basophil activation mechanism was suggested in a subset of anaphylaxis patients.
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Affiliation(s)
- Hye-Soo Yoo
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Hyun Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyouk-Soo Kwon
- Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Ferrajolo C, Capuano A, Trifirò G, Moretti U, Rossi F, Santuccio C. Pediatric drug safety surveillance in Italian pharmacovigilance network: an overview of adverse drug reactions in the years 2001 – 2012. Expert Opin Drug Saf 2014; 13 Suppl 1:S9-20. [DOI: 10.1517/14740338.2014.939581] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pichichero ME, Zagursky R. Penicillin and cephalosporin allergy. Ann Allergy Asthma Immunol 2014; 112:404-12. [PMID: 24767695 DOI: 10.1016/j.anai.2014.02.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 12/30/2022]
Affiliation(s)
| | - Robert Zagursky
- Rochester General Hospital Research Institute, Rochester, New York
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Khasawneh FA, Slaton MAR, Katzen SL, Woolbert AA, Anderson SD, Parker MB, Anderson RM, Haase KK, Smalligan RD. The prevalence and reliability of self-reported penicillin allergy in a community hospital. Int J Gen Med 2013; 6:905-9. [PMID: 24348066 PMCID: PMC3857164 DOI: 10.2147/ijgm.s54559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Penicillin (PCN) accounts for most cases of antibiotic allergies. Reported PCN allergy deprives the patient from this class of antibiotics and creates hesitancy in using other beta-lactam antibiotics. The aim of this study is to report the prevalence of self-reported PCN allergy among adult patients admitted to the hospital and to examine the probable validity of these reports. Methods A questionnaire was conducted among 192 patients with self-reported PCN allergy who were admitted to a community hospital between July 25, 2011 and January 25, 2012. Patients admitted with an infection and treated with a beta-lactam were also followed until hospital discharge. Results The mean age of patients at the time of their self-reported allergic reaction was 20.3 years. The most common allergic symptoms reported in decreasing order of frequency were itchy rash, angioedema, and urticaria. Based on analysis of the questionnaires, 121 patients (63.0%) had probable PCN allergy, 54 (28.1%) had possible PCN allergy, and 17 (8.9%) were unlikely to have a PCN allergy. Fifty-one participants (26.6%) had self-reported subsequent exposure to PCN in their life. This subsequent exposure was well tolerated in 86.3% of the participants. Fifty participants (25.9%) had self-reported subsequent exposure to a first generation cephalosporin and it was well tolerated in 78.4% of them. Conclusion Taking a detailed history from patients with self-reported PCN allergy can help to distinguish a true PCN allergy from a false positive report of allergy and hence allow clinicians to use this important class of antibiotics when truly indicated.
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Affiliation(s)
- Faisal A Khasawneh
- Section of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Megan A R Slaton
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Stephen L Katzen
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Ashley A Woolbert
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Sean D Anderson
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Michelle B Parker
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Rachel M Anderson
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Krystal K Haase
- School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Roger D Smalligan
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
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Koliscak LP, Johnson JW, Beardsley JR, Miller DP, Williamson JC, Luther VP, Ohl CA. Optimizing empiric antibiotic therapy in patients with severe β-lactam allergy. Antimicrob Agents Chemother 2013; 57:5918-23. [PMID: 24041892 PMCID: PMC3837866 DOI: 10.1128/aac.01202-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022] Open
Abstract
Antibiotic selection is challenging in patients with severe β-lactam allergy due to declining reliability of alternate antibiotics. Organisms isolated from these patients may exhibit unique resistance phenotypes. The objective of this study was to determine which alternate antibiotics or combinations provide adequate empirical therapy for patients with β-lactam allergy who develop Gram-negative infections at our institution. We further sought to determine the effects of risk factors for drug resistance on empirical adequacy. A retrospective analysis was conducted for adult patients hospitalized from September 2009 to May 2010 who had a severe β-lactam allergy and a urine, blood, or respiratory culture positive for a Gram-negative organism and who met predefined criteria for infection. Patient characteristics, culture and susceptibility data, and predefined risk factors for antibiotic resistance were collected. Adequacies of β-lactam and alternate antibiotics were compared for all infections and selected subsets. The primary outcome was adequacy of each alternate antibiotic or combination for all infections. One hundred sixteen infections (40 pneumonias, 67 urinary tract infections, and 9 bacteremias) were identified. Single alternate agents were adequate less frequently than β-lactams and combination regimens. Only in cases without risk factors for resistance did single-agent regimens demonstrate acceptable adequacy rates; each factor conferred a doubling of risk for resistance. Resistance risk factors should be considered in selecting empirical antibiotics for Gram-negative pathogens in patients unable to take β-lactams due to severe allergy.
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Affiliation(s)
- Lindsey P. Koliscak
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wingate University, School of Pharmacy, Wingate, North Carolina, USA
| | - James W. Johnson
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - James R. Beardsley
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
| | - David P. Miller
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - John C. Williamson
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vera P. Luther
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher A. Ohl
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Yang YL, Hu M, Chang M, Tomlinson B. A high incidence of exanthematous eruption associated with niacin/laropiprant combination in Hong Kong Chinese patients. J Clin Pharm Ther 2013; 38:528-32. [DOI: 10.1111/jcpt.12096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Y.-L. Yang
- Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - M. Hu
- Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - M. Chang
- Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - B. Tomlinson
- Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
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Er B, Onurdağ FK, Demirhan B, Özgacar SÖ, Öktem AB, Abbasoğlu U. Screening of quinolone antibiotic residues in chicken meat and beef sold in the markets of Ankara, Turkey. Poult Sci 2013; 92:2212-5. [DOI: 10.3382/ps.2013-03072] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sartori-Valinotti JC, Kloesel B, Park MA. 76-year-old woman with pruritus [corrected] and lip swelling. Mayo Clin Proc 2013; 88:e79-84. [PMID: 23910421 DOI: 10.1016/j.mayocp.2012.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Julio C Sartori-Valinotti
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
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Cunha B, Hamid N, Krol V, Eisenstein L. Safety of Meropenem in Patients Reporting Penicillin Allergy: Lack of Allergic Cross Reactions. J Chemother 2013; 20:233-7. [DOI: 10.1179/joc.2008.20.2.233] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Prophylactic Postoperative Antibiotics for Enucleation and Evisceration. Ophthalmic Plast Reconstr Surg 2013; 29:281-5. [DOI: 10.1097/iop.0b013e3182916674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kavadas FD, Kasprzak A, Atkinson AR. Antibiotic skin testing accompanied by provocative challenges in children is a useful clinical tool. Allergy Asthma Clin Immunol 2013; 9:22. [PMID: 23767685 PMCID: PMC3687567 DOI: 10.1186/1710-1492-9-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/12/2013] [Indexed: 11/17/2022] Open
Abstract
Background Diagnostic testing to antibiotics other than to penicillin has not been widely available, making the diagnosis of antibiotic allergy difficult and often erroneous. There is often reluctance in performing challenges to antibiotics when standardized testing is lacking. However, while the immunogenic determinants are not known for most antibiotics, a skin reaction at a non-irritating concentration (NIC) may mean that antibodies to the native form are present in the circulation. While the NIC’s for many non penicillin antibiotics have been determined in adults, the use of these concentrations for skin testing pediatric subjects prior to provocative challenge has not been done. Our objective was to determine if we could successfully uncover the true nature of antibiotic allergy in children using these concentrations for testing. Methods Children were included between 2003–2009 upon being referred to the Drug and Adverse Reaction/Toxicology (DART) clinic of the Hospital for Sick Children in Toronto, Ontario Canada. The referral needed to demonstrate that clinical care was being compromised by the limitation in antibiotic options or there was a significant medical condition for which the label of antibiotic allergy may prove detrimental. Patients were not seen if there was a suggestion of serum like sickness, Stevens Johnson Syndrome or Toxic Epidermal Necrolysis. Patients were excluded from testing if there was objective evidence of anaphylaxis. All other patients were consented to receive testing and/or challenges. A retrospective chart review was then performed of the results. Results We were able to exclude an antibiotic allergy in the majority of our patients who had a negative intradermal test result and were then challenged (>90%). Only one patient was challenged with a positive intradermal test to Cotrimoxazole because of a questionable history and this patient failed the provocative challenge. While we did not challenge more patients with positive testing, we did note that 10/11 (91%) patients with positive intradermal testing had some aspect of a Type 1 reaction in their history. Conclusions Through testing with NIC’s of various antibiotics in children and providing provocative challenges based on negative skin testing results, we were able to advance the medical care of the majority of our patients by increasing their antibiotic options in order to successfully treat future infections. While challenging patients with positive testing was not deemed ethically appropriate at this stage of our study, it would be a useful future step to reaching statistical validity of testing to these antibiotics.
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Affiliation(s)
- Fotini D Kavadas
- Section of Clinical Immunology and Allergy, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada.
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