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Lin L, Xiao J, Wu L, Fan F, Feng W, Wei J, Wang G, Liu G, Zhang W, Lu Y, Li Y, Lu L, Li H, Sun S, Gou J, Dang Y, Sun X, Jiang B, Qin J, Zhen H, Fang Y, Ding J, Huang M, Zhao W, Cai Y, Huang K, Tong X, Chen Y, Zhang H, Lin L. Efficacy and safety of Kegan Liyan oral liquid for patients with acute pharyngitis: A randomized, double-blinded, placebo-controlled, multi-center trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 134:155960. [PMID: 39217655 DOI: 10.1016/j.phymed.2024.155960] [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: 05/19/2024] [Revised: 07/30/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Alleviating the sore throat caused by acute pharyngitis is a primary patient concern. However, antibiotics are not commonly recommended drugs, and abuse can lead to serious consequences such as drug resistance. Therefore, seeking alternative treatments is necessary. PURPOSE To investigate the efficacy and safety of Kegan Liyan (KGLY) oral liquid for patients with acute pharyngitis. STUDY DESIGN Randomized, double-blinded, placebo-controlled, multi-center study. METHODS Participants from 17 hospitals were randomly assigned 1:1 to receive KGLY oral liquid or placebo for five days. Assessments occurred at baseline, day 3, and day 6. The primary outcome was the recovery rate. Secondary outcomes included sore throat and cough visual analogue scale (VAS), the area under the curve (AUC) of sore throat VAS, time to sore throat relief and recovery, proportion of participants with sore throat relief and recovery, traditional Chinese medicine (TCM) syndrome score, single TCM manifestation score and use of acetaminophen. RESULTS Involving 239 participants (120 in KGLY and 119 in placebo group), the study found a significantly higher recovery rate on day 6 in the KGLY group (between-group difference, 27.20 % [15.00 % to 39.40 %], p < 0.001). On day 3 and 6, the KGLY group showed significantly larger reductions in sore throat (-3.02 vs -2.37, p = 0.001; -4.66 vs -3.64, p < 0.001) and cough VAS scores (-1.55 vs -1.05, p = 0.004; -2.28 vs -1.56, p < 0.001) from baseline. KGLY oral liquid lowered the AUC of sore throat VAS score (-2.33 [-4.10 to -0.56], p = 0.011), shortened time to sore throat recovery (hazard ratio, 0.42 [0.30 to 0.59], p < 0.001), increased sore throat recovery rate at day 6 (75.00 % vs 42.86 %, p < 0.001), decreased the TCM syndrome score (-2.03 [-2.69 to -1.37], p < 0.001), and improved individual TCM symptoms compared to placebo. No significant differences between the groups in acetaminophen usage. KGLY oral liquid was safe and tolerated. CONCLUSION KGLY oral liquid may be a beneficial and safe alternative treatment for acute pharyngitis, which can alleviate symptoms such as sore throat, swollen throat, cough, and phlegm production.
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Affiliation(s)
- Luoqi Lin
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, PR China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, PR China
| | - Jingmin Xiao
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, PR China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Lei Wu
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, PR China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Feiting Fan
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Wenjie Feng
- Qinhuangdao Hospital of Traditional Chinese Medicine, Hebei, PR China
| | - Jun Wei
- Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Hubei, PR China
| | - Guangen Wang
- Handan Hospital of Traditional Chinese Medicine, Hebei, PR China
| | - Gang Liu
- The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Anhui, PR China
| | - Wei Zhang
- Shandong Provincial Hospital of Traditional Chinese Medicine, Shandong, PR China
| | - Yun Lu
- Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, PR China
| | - Yunhui Li
- The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
| | - Lijun Lu
- Wuhan Hospital of Traditional Chinese Medicine, Hubei, PR China
| | - Huimin Li
- Search North China Medical and Health Group Fengfeng General Hospital, Hebei, PR China
| | | | - Jian Gou
- The First People's Hospital of Xianyang City, Shanxi, PR China
| | - Yuqi Dang
- Yinchuan Hospital of Traditional Chinese Medicine, Ningxia, PR China
| | - Xuwu Sun
- Mudanjiang Hospital of Traditional Chinese Medicine, Heilongjiang, PR China
| | - Baihua Jiang
- Heilongjiang Provincial Hospital of Traditional Chinese Medicine, Heilongjiang, PR China
| | - Jiangbo Qin
- Changzhi People's Hospital, Shanxi, PR China
| | - Hui Zhen
- Respiratory Disease Research Committee of China Association of Traditional Chinese Medicine, Beijing, PR China
| | - Yun Fang
- Beijing Yaohai Ningkang Pharmaceutical Technology Co., LTD, Beijing, PR China
| | - Junping Ding
- Harbin Kangsaisi Medical Technology Development Co., LTD, Heilongjiang, PR China
| | - Minling Huang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Wenhan Zhao
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Yan Cai
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Kaifeng Huang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Xiaoping Tong
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China
| | - Yuanbin Chen
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, PR China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China.
| | | | - Lin Lin
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, PR China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, PR China.
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Stjepanovic AN, Todorovic NB, Tesic TZ, Komazec ZS, Canji-Panic JM, Lalic-Popovic MN. Pharmaceutical excipients with potential to cause adverse effects in paediatric nasal medicines. Regul Toxicol Pharmacol 2022; 133:105225. [PMID: 35817211 DOI: 10.1016/j.yrtph.2022.105225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
Some pharmaceutical excipients may cause adverse reactions, excipient-related interactions and/or contraindications. Due to the unique characteristics of the paediatric population, adverse effects may occur to substances generally thought safe. The proportion of topical nasal medicines approved for paediatric use and the prevalence and labelling of excipients with known effect (EKE) in these products were compared in Serbia as a non-EU country and Croatia and Slovenia as EU countries. The study was designed as a post-authorization safety study and safety of excipients was considered in accordance with recommendations of the European Medicines Agency (EMA). More than 90% of topical nasal medicines registered in the three countries were approved for paediatric use and more than half of these paediatric medicines contained EKE that may cause adverse effects. Benzalkonium chloride was found in 52.38%, 55.81% and 59.09% of these products in Serbia, Croatia and Slovenia, respectively. Propylene glycol, benzyl alcohol, ethanol, methyl paraben, propyl paraben and boric acid were also present in a few analysed preparations. A significant number of EKE labelling deficiencies were detected in all three countries, hindering healthcare professionals' access to information needed for adequate patient counselling. A revision of the nasal paediatric medicines' PLs and SmPCs is recommended.
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Affiliation(s)
- Ana N Stjepanovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia
| | - Nemanja B Todorovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia
| | - Tamara Z Tesic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Otorhinolaryngology, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Ear, Nose and Throath Diseases, Novi Sad, Serbia
| | - Zoran S Komazec
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Otorhinolaryngology, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Ear, Nose and Throath Diseases, Novi Sad, Serbia
| | - Jelena M Canji-Panic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia
| | - Mladena N Lalic-Popovic
- University of Novi Sad, Faculty of Medicine Novi Sad, Department of Pharmacy, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine Novi Sad, Centre for Medical and Pharmaceutical Investigations and Quality Control (CEMPhIC), Novi Sad, Serbia.
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van Rensburg W, Rautenbach M. Creating Robust Antimicrobial Materials with Sticky Tyrocidines. Antibiotics (Basel) 2022; 11:antibiotics11020174. [PMID: 35203778 PMCID: PMC8868332 DOI: 10.3390/antibiotics11020174] [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] [Received: 12/31/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 12/10/2022] Open
Abstract
Modified antimicrobial and antifouling materials and surfaces can be used to limit the propagation of microorganisms on various surfaces and minimise the occurrence of infection, transfer, and spoilage. Increased demand for ‘green’ solutions for material treatment has pushed the focus towards to naturally produced antimicrobials. Tyrocidines, cyclo-decapeptides naturally produced by a soil bacterium Brevibacillus parabrevis, have a broad spectrum of activity against Gram-positive and Gram-negative bacteria, filamentous fungi, and yeasts. Continual losses in tyrocidine production highlighted the possible association of peptides to surfaces. It was found in this study that tyrocidines readily associates with many materials, with a selectivity towards polysaccharide-type materials, such as cellulose. Peptide-treated cellulose was found to remain active after exposure to a broad pH range, various temperatures, salt solutions, water washes, and organic solvents, with the sterilising activity only affected by 1% SDS and 70% acetonitrile. Furthermore, a comparison to other antimicrobial peptides showed the association between tyrocidines and cellulose to be unique in terms of antimicrobial activity. The robust association between the tyrocidines and various materials holds great promise in applications focused on preventing surface contamination and creating self-sterilising materials.
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Gurov AV, Dubovaya TK, Ermolaev AG, Murzakhanova ZV, Makhmudova NR, Dombalagyan AK. [Possibilities of modern forms of antimicrobial peptides in the treatment of inflammatory pathology of the pharynx]. Vestn Otorinolaringol 2022; 87:43-49. [PMID: 36404690 DOI: 10.17116/otorino20228705143] [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] [Indexed: 06/16/2023]
Abstract
Inflammatory diseases of the pharynx occupy one of the leading places in the structure of otorhinolaryngological pathology. Acute and chronic inflammatory processes in the pharynx, as well as exacerbations of the latter, are faced by doctors of a wide range of specialties. Oropharyngeal swab laboratory testing is required to identify a specific pathogen, which takes time. In this regard, of particular interest are local drugs with the necessary spectrum of action, the use of which is possible, both as monotherapy and in combination with systemic therapy. The combination of tyrothricin (tyrothricin), benzalkonium chloride (benzalkonium chloride), and benzocaine (benzocaine) (dorithricin) is highly effective in the treatment of bacterial, viral and fungal infections of the pharynx, and microorganisms consistently demonstrate high sensitivity to the components of the drug.
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Affiliation(s)
- A V Gurov
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - T K Dubovaya
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A G Ermolaev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Z V Murzakhanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N R Makhmudova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A Kh Dombalagyan
- Pirogov Russian National Research Medical University, Moscow, Russia
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The antimicrobial and immunomodulatory effects of Ionophores for the treatment of human infection. J Inorg Biochem 2021; 227:111661. [PMID: 34896767 DOI: 10.1016/j.jinorgbio.2021.111661] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 12/18/2022]
Abstract
Ionophores are a diverse class of synthetic and naturally occurring ion transporter compounds which demonstrate both direct and in-direct antimicrobial properties against a broad panel of bacterial, fungal, viral and parasitic pathogens. In addition, ionophores can regulate the host-immune response during communicable and non-communicable disease states. Although the clinical use of ionophores such as Amphotericin B, Bedaquiline and Ivermectin highlight the utility of ionophores in modern medicine, for many other ionophore compounds issues surrounding toxicity, bioavailability or lack of in vivo efficacy studies have hindered clinical development. The antimicrobial and immunomodulating properties of a range of compounds with characteristics of ionophores remain largely unexplored. As such, ionophores remain a latent therapeutic avenue to address both the global burden of antimicrobial resistance, and the unmet clinical need for new antimicrobial therapies. This review will provide an overview of the broad-spectrum antimicrobial and immunomodulatory properties of ionophores, and their potential uses in clinical medicine for combatting infection.
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Meskina ER, Stashko TV. [How to reduce the antibacterial load in the treatment of acute tonsillitis and pharyngitis? Possible tactics and practical approaches]. Vestn Otorinolaringol 2021; 85:90-99. [PMID: 33474925 DOI: 10.17116/otorino20208506190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute tonsillopharyngitis is one of the most frequent reasons for visiting a doctor and prescribing inappropriate antibiotic therapy (ABT). There are several reasons for this - from the difficulties of etiological diagnosis and the development of relapses and possible severe complications to the personal attitude of doctors and patients to the choice of treatment. At the same time, the issue of antibiotic resistance and other aspects associated with the prescription of ABT is one of the most important problems of modern healthcare worldwide. The purpose of this review is to demonstrate the best practical approaches to the choice of treatment tactics for acute tonsillitis (AT) in the treatment of children and adults, with an emphasis on reducing the load of ABT. The review examines the indications and disadvantages of clinical and laboratory diagnosis of AT. There are no highly sensitive clinical and laboratory instruments that differentiate viral and bacterial AT. Exudativeis AT in children is not an underlying symptom of streptococcal etiology. Despite the limitations, the modified Centor/McIsaac score ≥3 (taking into account age and the presence of respiratory symptoms) should be used as an indication for ABT in conjunction with a rapid streptotest and subsequent bacteriological culture for S. pyogenes if the screening test is negative. Additional examinations (determination of leukocytosis, CRP and procalcitonin test) are not required for most patients. ABT should not be given to low-risk patients for the treatment and prevention of rheumatic fever and acute glomerulonephritis. Prevention of purulent complications (paratonsillitis and retropharyngeal abscess, acute otitis media, cervical lymphadenitis, mastoiditis, or acute sinusitis) is not a specific indication for ABT in AT and is not required in most patients. The strategy of «delayed antibiotic prescriptions» with monitoring the patient's condition for 2-3 days is appropriate and highly effective in doubtful cases. The drugs of choice for treatment of AT are amoxicillin and oral forms of I and II generation cephalosporins. Macrolides are not indicated as first-line treatment for AT. The course of ABT for streptococcal AT is 10 days, which reduces the risk of recurrent episode. Topical drugs can be the only means of etiopathogenetic treatment with viral AT, or additional for bacterial AT. Their use not only relieves sore throat, but also shortens the duration of the disease, and also improves the patients prognosis. Benzalkonium chloride + tyrothricin + benzocaine (Dorithyrcin) may be a rational drug of choice for topical therapy due to the available clinical evidence. There is a significant reserve for reducing the load of ABT during AT. Further clinical trials are needed to assess the efficacy of short courses of ABT in the treatment of AT in high-income countries and provide a basis for strong recommendations for topical drug use. This can reduce the frequency of ABT prescribing and increase the level of interaction between specialists and patients.
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Affiliation(s)
- E R Meskina
- Moscow Regional Research and Clinical Institute (MONIKI), Moskow, Russia
| | - T V Stashko
- Moscow Regional Research and Clinical Institute (MONIKI), Moskow, Russia
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Asmanov AI, Pivneva ND. [Use of complex preparations of cationic peptides in the treatment of acute pharyngitis]. Vestn Otorinolaringol 2020; 85:57-60. [PMID: 33140935 DOI: 10.17116/otorino20208505157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute respiratory infections (ORI) consistently occupy one of the leading places among infectious and inflammatory diseases in children. Most often, antibacterial drugs are used to stop the inflammatory process in the pharynx. Cationic peptides have an extremely broad antimicrobial spectrum, rendering the effect not only in bacterial infections and mycoses, and protozoans. THE PURPOSE OF THE STUDY To demonstrate that the test drug is effective and safe for the treatment of acute viral pharyngitis in childhood. MATERIALS AND METHODS In the period from September 2019 to January 2020, 120 patients aged 6 to 18 years were treated with the drug «Doritricin» for viral pharyngitis. RESULTS According to the research results it can be concluded that «Diretrizes» provides fast and high effect in pediatric practice.
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Affiliation(s)
- A I Asmanov
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russia
| | - N D Pivneva
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow, Russia
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Ovchinnikov AY, Miroshnichenko NA, Nikolaeva YO. [Sore throat. Recent trends in treatment]. Vestn Otorinolaringol 2020; 85:35-39. [PMID: 32885634 DOI: 10.17116/otorino20208504135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
According to WHO almost half of the population undergoing infectious diseases of the upper respiratory tract one third of which is inflammatory diseases of the pharynx. This article presents the therapy issue of patients with sore throat due to acute pharyngitis and/or acute tonsillitis of non-streptococcal etiology based on our own experience and literature data. Observational study was carried out at the Otorhinolaryngology department of MSUMD n.a. A.I. Evdokimov in order to evaluate efficacy and tolerability of complex local drug Doritricin. The study involved 52 patients, objective and subjective manifestations of the disease were evaluated. Obtained data indicate the effectiveness and safety of Doritricin, as well as the possibility of reducing the number of drugs used during treatment.
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Affiliation(s)
- A Yu Ovchinnikov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - N A Miroshnichenko
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Yu O Nikolaeva
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Abstract
Despite efforts to develop new antibiotics, antibacterial resistance still develops too fast for drug discovery to keep pace. Often, resistance against a new drug develops even before it reaches the market. This continued resistance crisis has demonstrated that resistance to antibiotics with single protein targets develops too rapidly to be sustainable. Most successful long-established antibiotics target more than one molecule or possess targets, which are encoded by multiple genes. This realization has motivated a change in antibiotic development toward drug candidates with multiple targets. Some mechanisms of action presuppose multiple targets or at least multiple effects, such as targeting the cytoplasmic membrane or the carrier molecule bactoprenol phosphate and are therefore particularly promising. Moreover, combination therapy approaches are being developed to break antibiotic resistance or to sensitize bacteria to antibiotic action. In this Review, we provide an overview of antibacterial multitarget approaches and the mechanisms behind them.
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Affiliation(s)
- Declan Alan Gray
- Newcastle University
Biosciences Institute, Newcastle University, NE2 4HH Newcastle
upon Tyne, United Kingdom
| | - Michaela Wenzel
- Division of Chemical
Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, 412 96 Gothenburg, Sweden
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Shephard A, Kulasekaran A, Fawkes N, Smith A, Targett D. Letter re: Article by Palm J et al Int J Clin Pract. 2018 Oct 17; 72:e13272. Int J Clin Pract 2020; 74:e13440. [PMID: 31633267 DOI: 10.1111/ijcp.13440] [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: 11/30/2022] Open
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Kryukov AI, Gurov AV, Yushkina MA, Izotova GN. [Peculiarities of clinical course of inflammatory diseases of the oropharynx of various etiologies and possibilities of local therapy]. Vestn Otorinolaringol 2019; 84:68-72. [PMID: 31793530 DOI: 10.17116/otorino20198405168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article covers the problems of diagnosis and treatment of inflammatory diseases of the oropharynx. The authors consider the main nosological forms of focal inflammation in the throat, discuss the role of β-hemolytic streptococcus group A in the genesis of angina and chronic tonsillitis and their complications. The authors discuss the influence of irritants - smoking, alcohol, cold air, gastroesofareal reflux on the development of chronic inflammation of the oropharynx mucosa. Leading clinical symptoms in oropharyngeal diseases and the main methods of their treatment are presented. The authors conclude that the most effective treatment of focal inflammation in the throat is the use of combined topical drugs. As a choice for local therapy of pharyngeal diseases, the authors offer a combined drug Doritiricin, effectively and safely relieving pain syndrome and local inflammatory response.
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Affiliation(s)
- A I Kryukov
- Pirogov Russian National Research Medical University, Moscow, Russia, 117997; L.I. Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A V Gurov
- Pirogov Russian National Research Medical University, Moscow, Russia, 117997; L.I. Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - M A Yushkina
- Pirogov Russian National Research Medical University, Moscow, Russia, 117997; L.I. Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - G N Izotova
- L.I. Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
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A Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Safety of Ambroxol Hard-Boiled Lozenges in Patients with Acute Pharyngitis. Pulm Ther 2019; 5:201-211. [PMID: 32026411 PMCID: PMC6966982 DOI: 10.1007/s41030-019-00100-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction The aim of this study was to evaluate the efficacy and safety of a new hard-boiled lozenge formulation containing ambroxol 20 mg versus placebo for the relief of sore throat in patients with acute pharyngitis. Methods This was a phase 3, randomized, double-blind, placebo-controlled, parallel-group multicenter trial conducted between June and September 2018 in South Africa. Patients with a diagnosis of acute pharyngitis, onset ≤ 72 h, and sore throat pain of at least moderate intensity were randomized to receive either ambroxol 20 mg or placebo hard-boiled lozenges. The primary efficacy endpoint was the normalized time-weighted sum of pain intensity differences (SPID) from baseline over 3 h following administration of the first lozenge (SPIDnorm,0–3h). Secondary efficacy endpoints included SPID 24 h after the first lozenge intake (SPIDnorm,0–24h) and patient assessment of efficacy at 3 and 24 h after the first lozenge. Results Of 422 patients from 11 centers, 390 were randomized to one of the two treatment groups (n = 196, ambroxol; n = 194, placebo) and 388 were analyzed (modified intention-to-treat). The mean ± standard deviation SPIDnorm,0–3h values were −0.386 (0.259) and −0.366 (0.243) in the ambroxol and placebo groups, respectively, and the adjusted mean ± standard error SPIDnorm0–3h difference between ambroxol and placebo was −0.020 (0.025) (p = 0.443). Comparable results between treatment groups were also found for SPIDnorm,0–24h and patient assessment of efficacy at 3 and 24 h after the first lozenge. The incidence of treatment-emergent adverse events (TEAEs) was similar between treatment groups (11.7% for ambroxol versus 9.3% for placebo). Conclusion Although marked pain relief was observed over the first 3 h of treatment, superiority of ambroxol 20 mg hard-boiled lozenges versus placebo was not demonstrated in this study. Trial Registration NCT03583658. Funding Sanofi-Aventis Group. Electronic supplementary material The online version of this article (10.1007/s41030-019-00100-w) contains supplementary material, which is available to authorized users.
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Palm J, Fuchs K, Stammer H, Schumacher‐Stimpfl A, Milde J. Efficacy and safety of a triple active sore throat lozenge in the treatment of patients with acute pharyngitis: Results of a multi-centre, randomised, placebo-controlled, double-blind, parallel-group trial (DoriPha). Int J Clin Pract 2018; 72:e13272. [PMID: 30329199 PMCID: PMC6282512 DOI: 10.1111/ijcp.13272] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/15/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this multi-centre, randomised, double-blind, placebo-controlled trial was to compare the efficacy and safety of the fixed combination of 0.5 mg tyrothricin, 1.0 mg benzalkonium chloride, and 1.5 mg benzocaine (study drug marketed as Dorithricin® ) in repeat dosing for 3 days to match placebo lozenges in the treatment of acute pharyngitis in adults. METHODS Patients (pts, aged ≥18 years) with acute pharyngitis, ie, non-streptococcal sore throat and moderate-to-severe pain (intensity NRS ≥ 7; VAS ≥ 50) were assigned to study drug (n = 160) or matching placebo (n = 161). Efficacy was assessed by investigator for 2 hours post initial dose (p.i.d.), and 3 days later (Visit 2). Primary efficacy endpoint was the complete resolution of throat pain and difficulty in swallowing at Visit 2 (3 days p.i.d.). Safety and local tolerability were also assessed. RESULTS Seventy-two hours (p.i.d.), complete resolution of throat pain and difficulty in swallowing were achieved by 44.6% patients on study drug compared with 27.2% patients on placebo (difference 17.4% (CI [5.8%; 29.7%]; 64% improvement [GEE, P = 0.0022]). Until 2 hours p.i.d., reduction in symptoms was better with study drug (P < 0.005). Treatment satisfaction was higher with study drug (patients'/investigators' assessment (78.9%/78.9% vs 55.0%/55.6% for placebo) and was well tolerated, overall safety profile was comparable to placebo. CONCLUSION The strength of this randomised controlled trial lies in the endpoint of complete remission after 3 days p.i.d., especially in the light of other trials addressing acute pharyngitis. The results of this study show a significant benefit of the study drug over placebo in the treatment of acute pharyngitis. Local treatment with the fixed combination (0.5 mg tyrothricin, 1.0 mg benzalkonium chloride, and 1.5 mg benzocaine) provides a rapid analgesic effect and is effective in relieving both severe throat pain as well as difficulty in swallowing associated with acute pharyngitis leading to a 64% improved complete remission within 72 hours. The triple active combination is a suitable treatment option for patients in the self-management of acute pharyngitis and sore throat. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03323528.
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Affiliation(s)
| | - Katharina Fuchs
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
| | - Holger Stammer
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
| | | | - Jens Milde
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
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