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Chhibber T, Gondil VS, Sinha VR. Development of Chitosan-Based Hydrogel Containing Antibiofilm Agents for the Treatment of Staphylococcus aureus-Infected Burn Wound in Mice. AAPS PharmSciTech 2020; 21:43. [PMID: 31897806 DOI: 10.1208/s12249-019-1537-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/13/2019] [Indexed: 01/22/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is considered a common colonizer of burn wound and accounts for high morbidity and mortality all across the globe. Systemic antibiotic therapy which is generally prescribed for these patients has a number of limitations. These include high drug dose, toxicity, and chances of development of drug resistance. However, local delivery of drug not only addresses these limitations but also provides better efficacy at the site of infection. In the present study, hydrogel preparations were developed for the topical delivery of moxifloxacin for the treatment of S. aureus-infected burn wound. Moxifloxacin was characterized by UV, FTIR, DSC, hot-stage microscopy, NMR, and HPLC and loaded into conventional and Boswellia-containing novel gels. Gels were characterized by visual examination, pH, UV spectroscopy, and release assays. In vivo studies showed that both gels were effective in eradicating the bacteria completely from the wound site when treatment was started during the early stage of infection. On the contrary, delayed treatment of planktonic and biofilm cells with novel gel showed better efficacy as compared with conventional gel in S. aureus-infected burn wound. Histopathological analysis also showed better skin healing efficacy of novel gel than conventional gel. Our results show that moxifloxacin can be efficiently used topically in the management of burn wound infections along with other antibacterial agents. Since biofilm-mediated infections are on the rise especially in chronic bacterial disease, therefore, a preparation containing antibiofilm agent-like Boswellia as one of the excipients would be more meaningful.
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Murphy ME, Wills GH, Murthy S, Louw C, Bateson ALC, Hunt RD, McHugh TD, Nunn AJ, Meredith SK, Mendel CM, Spigelman M, Crook AM, Gillespie SH. Gender differences in tuberculosis treatment outcomes: a post hoc analysis of the REMoxTB study. BMC Med 2018; 16:189. [PMID: 30326959 PMCID: PMC6192317 DOI: 10.1186/s12916-018-1169-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In the REMoxTB study of 4-month treatment-shortening regimens containing moxifloxacin compared to the standard 6-month regimen for tuberculosis, the proportion of unfavourable outcomes for women was similar in all study arms, but men had more frequent unfavourable outcomes (bacteriologically or clinically defined failure or relapse within 18 months after randomisation) on the shortened moxifloxacin-containing regimens. The reason for this gender disparity in treatment outcome is poorly understood. METHODS The gender differences in baseline variables were calculated, as was time to smear and culture conversion and Kaplan-Meier plots were constructed. In post hoc exploratory analyses, multivariable logistic regression modelling and an observed case analysis were used to explore factors associated with both gender and unfavourable treatment outcome. RESULTS The per-protocol population included 472/1548 (30%) women. Women were younger and had lower rates of cavitation, smoking and weight (all p < 0.05) and higher prevalence of HIV (10% vs 6%, p = 0.001). They received higher doses (mg/kg) than men of rifampicin, isoniazid, pyrazinamide and moxifloxacin (p ≤ 0.005). There was no difference in baseline smear grading or mycobacterial growth indicator tube (MGIT) time to positivity. Women converted to negative cultures more quickly than men on Lowenstein-Jensen (HR 1.14, p = 0.008) and MGIT media (HR 1.19, p < 0.001). In men, the presence of cavitation, positive HIV status, higher age, lower BMI and 'ever smoked' were independently associated with unfavourable treatment outcome. In women, only 'ever smoked' was independently associated with unfavourable treatment outcome. Only for cavitation was there a gender difference in treatment outcomes by regimen; their outcome in the 4-month arms was significantly poorer compared to the 6-month treatment arm (p < 0.001). Women, with or without cavities, and men without cavities had a similar outcome on all treatment arms (p = 0.218, 0.224 and 0.689 respectively). For all other covariate subgroups, there were no differences in treatment effects for men or women. CONCLUSIONS Gender differences in TB treatment responses for the shorter regimens in the REMoxTB study may be explained by poor outcomes in men with cavitation on the moxifloxacin-containing regimens. We observed that women with cavities, or without, on the 4-month moxifloxacin regimens had similar outcomes to all patients on the standard 6-month treatment. The biological reasons for this difference are poorly understood and require further exploration.
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Affiliation(s)
- M E Murphy
- UCL Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, England, UK.
| | - G H Wills
- MRC Clinical Trials Unit at UCL, Institute for Clinical Trials and Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, England, UK
| | - S Murthy
- UCL Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, England, UK
| | - C Louw
- Madibeng Centre for Research, Brits, South Africa.,Department of Family Medicine, School of medicine, University of Pretoria, Pretoria, South Africa
| | - A L C Bateson
- UCL Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, England, UK
| | - R D Hunt
- UCL Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, England, UK
| | - T D McHugh
- UCL Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, England, UK
| | - A J Nunn
- MRC Clinical Trials Unit at UCL, Institute for Clinical Trials and Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, England, UK
| | - S K Meredith
- MRC Clinical Trials Unit at UCL, Institute for Clinical Trials and Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, England, UK
| | - C M Mendel
- Global Alliance for Tuberculosis Drug Development, New York, NY, 10005, USA
| | - M Spigelman
- Global Alliance for Tuberculosis Drug Development, New York, NY, 10005, USA
| | - A M Crook
- MRC Clinical Trials Unit at UCL, Institute for Clinical Trials and Methodology, Aviation House, 125 Kingsway, London, WC2B 6NH, England, UK
| | - S H Gillespie
- School of Medicine, Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews, KY16 9TF, Scotland, UK
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