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Becken B, Dousa KM, Johnson JL, Holland SM, Bonomo RA. Dual β-lactam for treatment of pulmonary Mycobacterium abscessus in a child. Antimicrob Agents Chemother 2024; 68:e0031924. [PMID: 38757973 PMCID: PMC11232406 DOI: 10.1128/aac.00319-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Treatment of Mycobacterium abscessus infection presents significant challenges, exacerbated by the emergence of macrolide-resistant strains that necessitate the use of multiple antimicrobials in combination and carry the potential for significant toxic effects. Select dual beta-lactam combinations, with or without beta-lactamase inhibitors, have been shown to be highly active in vitro. Herein, we describe a 6-year-old child with underlying mild bilateral lower lobe cylindrical bronchiectatic lung disease who developed pulmonary Mycobacterium abscessus infection and was treated with a multi-drug regimen including two β-lactam antibiotics, achieving both early clinical and microbiological cure. This case highlights the potential benefit of dual β-lactam therapy for the treatment of drug-resistant Mycobacterium abscessus infection.
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Affiliation(s)
- Bradford Becken
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Khalid M. Dousa
- Department of Internal Medicine and Infectious Diseases, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - John L. Johnson
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert A. Bonomo
- Department of Internal Medicine and Infectious Diseases, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Internal Medicine, CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
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2
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Petrone S, Whiteman M, Gupta S. Azithromycin Prescriptions in Children From 2016-2018: Room for Improvement. Clin Pediatr (Phila) 2024; 63:179-182. [PMID: 37882071 DOI: 10.1177/00099228231206200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
| | - Matthew Whiteman
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Shipra Gupta
- School of Medicine, West Virginia University, Morgantown, WV, USA
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3
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Sheppard J, Shen Lee B, Periman LM. Dry eye disease: identification and therapeutic strategies for primary care clinicians and clinical specialists. Ann Med 2023; 55:241-252. [PMID: 36576348 PMCID: PMC9809411 DOI: 10.1080/07853890.2022.2157477] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disorder characterized by loss of tear film homeostasis with an estimated worldwide prevalence of 5% to 50%. In DED, dysfunction of the ocular structures that create and regulate the tear film components-including the lacrimal glands, meibomian glands, cornea, and conjunctiva-causes a qualitative and/or quantitative tear deficiency with resultant tear film instability and hyperosmolarity. This initiates a vicious cycle of ocular surface inflammation and damage that may ultimately impair the quality of life and vision of affected patients. Many factors can contribute to the development of DED, including ocular and systemic diseases, topical and systemic medications, and environmental conditions. Because DED is a chronic disorder, treatment is most often long term and may utilize both pharmacologic and nonpharmacologic interventions to address all etiologic components. The long-term management of DED can be challenging and most often should involve eye care specialist referral. However, primary care clinicians (PCCs) are often the first points of contact for patients with DED and importantly provide initial diagnosis and preliminary patient education about the disease process. Consideration of DED is also vital for the practice of various specialties due to the large number of comorbidities and medications that can contribute to DED pathogenesis and progression. Therefore, it is important that PCCs and clinical specialists be aware of the etiology of DED and its available therapeutic options. This manuscript provides an overview of DED pathophysiology and treatment and discusses specific considerations regarding DED management for PCCs and clinical specialists.Key messagesSuccessful management of dry eye disease often requires the use of various pharmacologic and/or nonpharmacologic therapies, as well as environmental and lifestyle modifications, to mitigate the underlying etiologies and restore tear film homeostasis.Primary care clinicians play an essential role in dry eye disease management by establishing a diagnosis, educating patients about the disorder, and providing referrals to eye care specialists for initiation of specialized treatment and long-term follow-up.Primary care clinicians and clinical specialists should consider prescribing medications with fewer ocular surface effects whenever possible in patients at risk for or with existing dry eye disease.
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Affiliation(s)
- John Sheppard
- Virginia Eye Consultants, Eyecare Partners, Norfolk, VA, USA
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4
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Delghandi PS, Soleimani V, Fazly Bazzaz BS, Hosseinzadeh H. A review on oxidant and antioxidant effects of antibacterial agents: impacts on bacterial cell death and division and therapeutic effects or adverse reactions in humans. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:2667-2686. [PMID: 37083711 DOI: 10.1007/s00210-023-02490-w] [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: 01/24/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
Reactive oxygen species (ROS) are produced in the mitochondrial respiratory pathway and cellular metabolism. They are responsible for creating oxidative stress and lipid peroxidation. In living organisms, there is a balance between oxidative stress and the antioxidant system, but some factors such as medicines disturb the balance and cause many problems. These effects can impact bacterial death and division and also in humans can induce therapeutic or adverse reactions. Web of Science and Pubmed databases were used for searching. This review focuses on the oxidant and antioxidant effects of different classes of antibacterial agents and the mechanisms of oxidative stress. Some of these agents have beneficial effects on killing bacteria due to their antioxidant or oxidant effects. However, some of their side effects may be due to their oxidative effects. Based on the results of this review, minocycline is an antioxidant, but aminoglycosides, chloramphenicol, glycopeptides, antituberculosis drugs, fluoroquinolones, and sulfamethoxazole agents have oxidant effects. Furthermore, cephalosporins, penicillins, metronidazole, and macrolides have both oxidant and antioxidant effects in different studies. It is concluded that some antibacterial agents have oxidant and other antioxidant effects. These activities may affect their therapeutic effects or side effects. Some antioxidants can prevent the adverse effects of antibacterial agents. Clarifying the exact oxidant and antioxidant effects of some antimicrobial agents needs more research projects.
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Affiliation(s)
| | - Vahid Soleimani
- School of Pharmacy, Mashhad University of Medical Science, Mashhad, IR, Iran
| | - Bibi Sedigheh Fazly Bazzaz
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, IR, Iran
| | - Hossein Hosseinzadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, IR, Iran.
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, IR, Iran.
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5
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Zaid Alkilani A, Hamed R, Abdo H, Swellmeen L, Basheer HA, Wahdan W, Abu Kwiak AD. Formulation and Evaluation of Azithromycin-Loaded Niosomal Gel: Optimization, In Vitro Studies, Rheological Characterization, and Cytotoxicity Study. ACS OMEGA 2022; 7:39782-39793. [PMID: 36385887 PMCID: PMC9648136 DOI: 10.1021/acsomega.2c03762] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/20/2022] [Indexed: 05/14/2023]
Abstract
Several novel, innovative approaches for improving transdermal delivery of BCS class III drugs have been proposed. Despite their great aqueous solubility, BCS class III drugs have the drawback of limited permeability. The objective of the current work was to screen the suitability of niosomes as a nanocarrier in permeation enhancement of azithromycin (AZM) transdermal delivery. Niosomes were prepared by an ether injection method using a nonionic surfactant (Span 60) and cholesterol at different concentrations. The ζ potential (ZP), polydispersity index (PDI), and particle size (PS) of AZM-loaded niosomes were evaluated. The size of the niosomes was found to vary between 288 and 394 nm. The results revealed that the niosomes prepared in a ratio of 2:1 (Span 60: cholesterol) had larger vesicle sizes, but all of them were characterized by narrow size distributions (PDI <0.95). Niosomal gel was successfully prepared using different polymers. The appearance, pH, viscosity, and ex vivo drug release of niosomal gel formulations were all examined. The flow curves showed that the niosomal gel displayed lower viscosity values than its corresponding conventional gels. Niosomal and conventional gels exhibited a domination of the elastic modulus (G') over the viscous modulus (G″) (G'>G″) in the investigated frequency range (0.1-100 rad/s), indicating stable gels with more solid-like properties. Ex vivo skin permeation studies for the niosomal gel show 90.83 ± 3.19% of drug release in 24 h as compared with the conventional gel showing significantly lower (P < 0.001) drug release in the same duration (1.25 ± 0.12%). Overall, these results indicate that niosomal gel could be an effective transdermal nanocarrier for enhancing the permeability of AZM, a BCS class III drug. In conclusion, this study suggests that transdermal formulations of AZM in the niosomal gel were successfully developed and could be used as an alternative route of administration.
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Affiliation(s)
- Ahlam Zaid Alkilani
- Department
of Pharmacy, Faculty of Pharmacy, Zarqa
University, Zarqa13110, Jordan
- . Phone: 00962795294329, Fax: 0096253821120
| | - Rania Hamed
- Department
of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah
University of Jordan, Amman11733, Jordan
| | - Hajer Abdo
- Department
of Pharmacy, Faculty of Pharmacy, Zarqa
University, Zarqa13110, Jordan
| | - Lubna Swellmeen
- Department
of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Hashemite University, Zarqa13133, Jordan
| | - Haneen A. Basheer
- Department
of Pharmacy, Faculty of Pharmacy, Zarqa
University, Zarqa13110, Jordan
| | - Walaa Wahdan
- Department
of Pharmacy, Faculty of Pharmacy, Zarqa
University, Zarqa13110, Jordan
| | - Amani D. Abu Kwiak
- Department
of Pharmacy, Faculty of Pharmacy, Zarqa
University, Zarqa13110, Jordan
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6
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Antibiotic susceptibility among non-clinical Escherichia coli as a marker of antibiotic pressure in Peru (2009-2019): one health approach. Heliyon 2022; 8:e10573. [PMID: 36119856 PMCID: PMC9479018 DOI: 10.1016/j.heliyon.2022.e10573] [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: 12/09/2021] [Revised: 06/21/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Antimicrobial resistance is an increasing health problem worldwide with serious implications in global health. The overuse and misuse of antimicrobials has resulted in the spread of antimicrobial-resistant microorganisms in humans, animals and the environment. Surveillance of antimicrobial resistance provides important information contributing to understanding dissemination within these environments. These data are often unavailable in low- and middle-income countries, such as Peru. This review aimed to determine the levels of antimicrobial resistance in non-clinical Escherichia coli beyond the clinical setting in Peru. Methods We searched 2009–2019 literature in PUBMED, Google Scholar and local repositories. Results Thirty manuscripts including human, food, environmental, livestock, pets and/or wild animals’ samples were found. The analysis showed high resistance levels to a variety of antimicrobial agents, with >90% of resistance for streptomycin and non-extended-spectrum cephalosporin in livestock and food. High levels of rifamycin resistance were also found in non-clinical samples from humans. In pets, resistance levels of 70–>90% were detected for quinolones tetracycline and non-extended spectrum cephalosporins. The results suggest higher levels of antimicrobial resistance in captive than in free-ranging wild-animals. Finally, among environmental samples, 50–70% of resistance to non-extended-spectrum cephalosporin and streptomycin was found. Conclusions High levels of resistance, especially related to old antibacterial agents, such as streptomycin, 1st and 2nd generation cephalosporins, tetracyclines or first-generation quinolones were detected. Antimicrobial use and control measures are needed with a One Health approach to identify the main drivers of antimicrobial resistance due to interconnected human, animal and environmental habitats. In livestock and food >90% of streptomycin and cephalosporin resistance was detected. High levels of rifamycin resistance were found in non-clinical samples from humans. High levels to quinolones tetracycline and cephalosporins were detected in pets. Environmental samples showed 50–70% of resistance to cephalosporins and streptomycin. In general, high levels of resistance to ancient antibacterial agents was observed.
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7
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Cai N, Wu X, Lin J, Zou J, Yi JL, Luo X. UHPLC-MS/MS method for the determination of azithromycin in human plasma of pediatric patients. Biomed Chromatogr 2022; 36:e5415. [PMID: 35599440 DOI: 10.1002/bmc.5415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/05/2022]
Abstract
The determination of azithromycin in human plasma of pediatric patients was performed with a ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) assay. A simple sample preparation of protein precipitation was used and the separation was achieved on a C18 column by the gradient mixture of mobile phase A ( 0.1% acetic acid and 3 mM ammonium acetate in water) and the mobile phase B (0.1% acetic acid and 3 mM ammonium acetate in the solution of acetonitrile, methanol and water, 47.5/47.5/5, V/V/V). The multiple reaction monitoring (MRM) mode was adopted to monitor the precursor-to-product ion transitions of m/z 749.6→m/z 591.5 for azithromycin and m/z 753.6→m/z 595.5 for azithromycin-13 C-d3 (IS) at positive ionization mode. The calibration curve ranged between 0.5 ng·mL-1 and 500.0 ng·mL-1 and the correlation coefficient was greater than 0.99. The intra- and inter-batch precision was less than 13.7%. Accuracy determined at four concentrations ranged from 99.5% to 110.8%. The extraction recoveries were more than 95% and the matrix effects were 98% - 100%. The stability under various conditions were acceptable with the accuracy deviation within 9.2%. In conclusion, our method was simple, sensitive and reliable for quantification of azithromycin in plasma among pediatric patients.
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Affiliation(s)
- Ningfang Cai
- Department of Pharmacy, Xiamen Children's Hospital, Xiamen, Fujian, China
| | - Xiuping Wu
- Department of Pharmacy, Xiamen Children's Hospital, Xiamen, Fujian, China
| | - Jiancheng Lin
- Department of Pharmacy, Xiamen Children's Hospital, Xiamen, Fujian, China
| | - Jialiang Zou
- Department of Pharmacy, Xiamen Children's Hospital, Xiamen, Fujian, China
| | | | - Xi Luo
- BE/phase I clinical center, The first affiliated hospital of Xiamen university, Xiamen, Fujian, China
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8
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Zhou P, Wang X, Zhang X, Xu B, Tong X, Zhou W, Shen K, Zhai S. Recommendations on off-label use of intravenous azithromycin in children. Int J Clin Pract 2021; 75:e14010. [PMID: 33421260 DOI: 10.1111/ijcp.14010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/17/2020] [Accepted: 12/08/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Intravenous azithromycin (AZM) has been widely used in children worldwide, but there still remains much concern regarding its off-label use, which urgently needs to be regulated. Therefore, we developed a rapid advice guideline in China to give recommendations of rational use of intravenous AZM in children. METHODS This guideline focuses on antimicrobial therapy with intravenous AZM in children. The Delphi research method was used to select questions. A systematic literature review was also conducted. Data were pooled and ranked according to the GRADE system. Recommendations were developed based on expert clinical experience, patients' values and preferences, and evidence availability. After an external review, the recommendations were revised and approved. RESULTS This guideline included eighteen recommendations that covered four domains: (a) Indications: the treatment of pneumonia caused by atypical but common pathogens, such as Mycoplasma pneumoniae, Chlamydia trachomatis or Chlamydophila pneumoniae and Legionella pneumophila, more typical bacteria as well as the treatment of bronchitis of presumed bacterial aetiologies; (b) Usage and dosage: administration route, infusion concentrations, treatment duration, course of sequential treatment, and dosage stratified by age; (c) Adverse reactions and treatment: the management of gastrointestinal reactions, arrhythmias, pain or phlebitis at the infusion site, and anaphylaxis; and (d) Special population: children with renal or liver dysfunction, congenital heart disease, and obesity. This guideline will hopefully help promote a rational use of intravenous AZM in children worldwide. CONCLUSION This guideline has summarised the evidence and has developed recommendations on the use of intravenous AZM in children worldwide. Further attention and well-designed researches should be conducted on the off-label use of intravenous AZM in children.
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Affiliation(s)
- Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Xiaoling Wang
- National Center for Children's Health, Beijing, China
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xianglin Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Baoping Xu
- National Center for Children's Health, Beijing, China
- Department of Respiration, Beijing Children's Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Respiratory Disease, Beijing, China
- Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association, Beijing, China
| | - Xiaomei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Wei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Kunling Shen
- National Center for Children's Health, Beijing, China
- Department of Respiration, Beijing Children's Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Respiratory Disease, Beijing, China
- Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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9
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Intestinal microbiome analysis demonstrates azithromycin post-treatment effects improve when combined with lactulose. World J Pediatr 2020; 16:168-176. [PMID: 31583533 DOI: 10.1007/s12519-019-00315-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Next-generation sequencing has revolutionized our perspective on the gut microbiome composition, revealing the true extent of the adverse effects of antibiotics. The impact of antibiotic treatment on gut microbiota must be considered and researched to provide grounds for establishing new treatment strategies that are less devastating on commensal bacteria. This study investigates the impact on gut microbiome when a commonly used antibiotic, azithromycin is administered, as well as uncovers the benefits induced when it is used in combination with lactulose, a prebiotic known to enhance the proliferation of commensal microbes. METHODS 16S rRNA gene sequencing analysis of stool samples obtained from 87 children treated with azithromycin in combination with or without lactulose have been determined. Children's gut microbial profile was established at the pre- and post-treatment stage. RESULTS Azithromycin caused an increase in the relative abundance of opportunistic pathogens such as Streptococcus that was evident 60 days after treatment. While few days after treatment, children who also received lactulose started to show a higher relative abundance of saccharolytic bacteria such as Lactobacillus, Enterococcus, Anaerostipes, Blautia and Roseburia, providing a protective role against opportunistic pathogens. In addition, azithromycin-prebiotic combination was able to provide a phylogenetic profile more similar to the pre-treatment stage. CONCLUSION It is suggested that during azithromycin treatment, lactulose is able to reinstate the microbiome equilibrium much faster as it promotes saccharolytic microbes and provides a homeostatic effect that minimizes the opportunistic pathogen colonization.
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10
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Croche Santander B, Campos Alonso E, Sánchez Carrión A, Marcos Fuentes L, Diaz Flores I, Vargas JC, Fernández Domínguez B, Toro Ibañez C. Appropriateness of antibiotic prescribing in paediatric patients in a hospital emergency department. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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11
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Adecuación de la prescripción de antimicrobianos en población pediátrica en un servicio de urgencias hospitalario. An Pediatr (Barc) 2018; 88:259-265. [DOI: 10.1016/j.anpedi.2017.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 11/15/2022] Open
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12
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Djeghout B, Saha S, Sajib MSI, Tanmoy AM, Islam M, Kay GL, Langridge GC, Endtz HP, Wain J, Saha SK. Ceftriaxone-resistant Salmonella Typhi carries an IncI1-ST31 plasmid encoding CTX-M-15. J Med Microbiol 2018; 67:620-627. [PMID: 29616895 DOI: 10.1099/jmm.0.000727] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Ceftriaxone is the drug of choice for typhoid fever and the emergence of resistant Salmonella Typhi raises major concerns for treatment. There are an increasing number of sporadic reports of ceftriaxone-resistant S. Typhi and limiting the risk of treatment failure in the patient and outbreaks in the community must be prioritized. This study describes the use of whole genome sequencing to guide outbreak identification and case management. METHODOLOGY An isolate of ceftriaxone-resistant S. Typhi from the blood of a child taken in 2000 at the Popular Diagnostic Center, Dhaka, Bangladesh was subjected to whole genome sequencing, using an Illumina NextSeq 500 and analysis using Geneious software.Results/Key findings. Comparison with other ceftriaxone-resistant S. Typhi revealed an isolate from the Democratic Republic of the Congo in 2015 as the closest relative but no evidence of an outbreak. A plasmid belonging to incompatibility group I1 (IncI1-ST31) which included blaCTX-M-15 (ceftriaxone resistance) associated with ISEcp-1 was identified. High similarity (90 %) was seen with pS115, an IncI1 plasmid from S. Enteritidis, and with pESBL-EA11, an incI1 plasmid from E. coli (99 %) showing that S. Typhi has access to ceftriaxone resistance through the acquisition of common plasmids. CONCLUSIONS The transmission of ceftriaxone resistance from E. coli to S. Typhi is of concern because of clinical resistance to ceftriaxone, the main stay of typhoid treatment. Whole genome sequencing, albeit several years after the isolation, demonstrated the success of containment but clinical trials with alternative agents are urgently required.
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Affiliation(s)
- Bilal Djeghout
- Laboratory of Microbiology and Virology, Department of Biomedical Sciences, University of Sassari, V. le San Pietro 43/B, 07100 Sassari, Italy
| | - Senjuti Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Mohammad Saiful Islam Sajib
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Arif Mohammad Tanmoy
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Maksuda Islam
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Gemma L Kay
- Medical Microbiology Research Laboratory, Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK
| | - Gemma C Langridge
- Medical Microbiology Research Laboratory, Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Laboratoire des Pathogènes Émergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Lyon, France
| | - John Wain
- Medical Microbiology Research Laboratory, Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK
| | - Samir K Saha
- Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
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13
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Wright H, Skinner AC, Jhaveri R. Evaluating Guideline-Recommended Antibiotic Practices for Childhood Respiratory Infections: Is It Time to Consider Case-Based Formats? Clin Pediatr (Phila) 2016; 55:118-21. [PMID: 25986442 DOI: 10.1177/0009922815587091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to better understand barriers to adherence to published guidelines for respiratory infections among community providers. METHODS A case-based survey was developed and emailed to all members of the state pediatric society. Providers chose their preferred management for acute otitis media, acute bacterial sinusitis, and community-acquired pneumonia. An "answer key" and a follow-up questionnaire were distributed to assess reevaluation of current practices. RESULTS We received 173 completed surveys (15% response rate). While most responders followed guideline recommendations (6 of the 10 questions with ≥ 65% choosing recommended antibiotic), discrepancies existed in several cases. After receiving the answer key, respondents said they reviewed the guidelines (69%), adjusted their practice (26%), used cases for teaching (9%), and discussed guidelines with colleagues (21%). CONCLUSIONS The majority of respondents followed published guidelines, but there was a tendency to overuse azithromycin in certain cases. Future guidelines including case-based discussions may enhance adherence.
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Affiliation(s)
- Heather Wright
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Ravi Jhaveri
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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14
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Moreno-Pérez D, Martín AA, García AT, Montaner AE, Mulet JF, García JG, Moreno-Galdó A, de Liria CRG, Contreras JR, Lozano JS. Community acquired pneumonia in children: Outpatient treatment and prevention. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2014.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Cao B, Qu JX, Yin YD, Eldere JV. Overview of antimicrobial options for Mycoplasma pneumoniae pneumonia: focus on macrolide resistance. CLINICAL RESPIRATORY JOURNAL 2015; 11:419-429. [PMID: 26365811 DOI: 10.1111/crj.12379] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/20/2015] [Accepted: 09/07/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Community-acquired pneumonia (CAP) is a common infectious disease affecting children and adults of any age. Mycoplasma pneumoniae has emerged as leading causative agent of CAP in some region, and the abrupt increasing resistance to macrolide that widely used for management of M. pneumoniae has reached to the level that it often leads to treatment failures. OBJECTIVE We aim to discuss the drivers for development of macrolide-resistant M. pneumoniae, antimicrobial stewardship and also the potential treatment options for patients infected with macrolide-resistant M. pneumonia. METHODS The articles in English and Chinese published in Pubmed and in Asian medical journals were selected for the review. RESULTS M. pneumoniae can develop macrolide resistance by point mutations in the 23S rRNA gene. Inappropriate and overuse of macrolides for respiratory tract infections may induce the resistance rapidly. A number of countries have introduced the stewardship program for restricting the use of macrolide. Tetracyclines and fluoroquinolones are highly effective for macrolide-resistant strains, which may be the substitute in the region of high prevalence of macrolide-resistant M. pneumoniae. CONCLUSION The problem of macrolide resistant M. pneumonia is emerging. Antibiotic stewardship is needed to inhibit the inappropriate use of macrolide and new antibiotics with a more acceptable safety profile for all ages need to be explored.
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Affiliation(s)
- Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jiu-Xin Qu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yu-Dong Yin
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
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Moreno-Pérez D, Andrés Martín A, Tagarro García A, Escribano Montaner A, Figuerola Mulet J, García García JJ, Moreno-Galdó A, Rodrigo Gonzalo de Lliria C, Ruiz Contreras J, Saavedra Lozano J. [Community acquired pneumonia in children: Outpatient treatment and prevention]. An Pediatr (Barc) 2014; 83:439.e1-7. [PMID: 25488029 DOI: 10.1016/j.anpedi.2014.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022] Open
Abstract
There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed.
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Affiliation(s)
- D Moreno-Pérez
- Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - A Andrés Martín
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen Macarena, Departamento de Farmacología, Pediatría y Radiología, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - A Tagarro García
- Servicio de Pediatría, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - A Escribano Montaner
- Unidad de Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Clínico Universitario, Universitat de València, Valencia, España
| | - J Figuerola Mulet
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J J García García
- Servicio de Pediatría, Hospital San Joan de Dèu, Universitat de Barcelona, Barcelona, España
| | - A Moreno-Galdó
- Sección de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d́Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Rodrigo Gonzalo de Lliria
- Unidad de Enfermedades Infecciosas e Inmunología Clínica, Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Ruiz Contreras
- Servicio de Pediatría, Hospital 12 de Octubre, Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - J Saavedra Lozano
- Unidad de Infectología Pediátrica, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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