Susceptibility in vitro of Helicobacter pylori to cetylpyridinium chloride

Helicobacter pylori and Its Antibiotic Heteroresistance: A Neglected Issue in Published Guidelines

“Heteroresistance” is a widely applied term that characterizes most of the multidrug-resistant microorganisms. In microbiological practice, the word “heteroresistance” indicates diverse responses to specific antibiotics by bacterial subpopulations in the same patient. These resistant subpopulations of heteroresistant strains do not respond to antibiotic therapy in vitro or in vivo. Presently, there is no standard protocol available for the treatment of infections caused by heteroresistant Helicobacter pylori in clinical settings, at least according to recent guidelines. Thus, there is a definite need to open a new discussion on how to recognize, how to screen, and how to eliminate those problematic strains in clinical and environmental samples. Since there is great interest in developing new strategies to improve the eradication rate of anti-H. pylori treatments, the presence of heteroresistant strains/clones among clinical isolates of the bacteria should be taken into account. Indeed, increased knowledge of gastroenterologists about the existence of heteroresistance phenomena is highly required. Moreover, the accurate breakpoints should be examined/determined in order to have a solid statement of heteroresistance among the H. pylori isolates. The primary definition of heteroresistance was about coexistence of both resistant and susceptible isolates at the similar gastric microniche at once, while we think that it can be happened subsequently as well. The new guidelines should include a personalized aspect in the standard protocol to select a precise, effective antibiotic therapy for infected patients and also address the problems of regional antibiotic susceptibility profiles.

Antimicrobial efficiency of mouthrinses versus and in combination with different photodynamic therapies on periodontal pathogens in an experimental study

BACKGROUND AND OBJECTIVE

In the therapy of destructive periodontal disease, chemical antimicrobial agents and increasingly photodynamic therapy (PDT) play an important adjunctive role to standard mechanical anti-infective treatment procedures. However, both antiseptic methods have their shortcomings in terms of eliminating periodontal pathogens. The aim of the study was to compare the antibacterial efficacy of different antiseptic mouthrinses, of a conventional and a new, modified PDT^plus as well as of the different antiseptic mouthrinses combined with either the conventional or the modified PDT^plus against periopathogens.

MATERIAL AND METHODS

Six representative periodontitis-associated bacterial strains were grown for 24 h under anaerobic conditions. After mixing the individual cell pellets they were exposed to 10 different antiseptic mouthrinse formulations: chlorhexidine (0.2%, 0.06%, CHX); CHX + cetylpyridinium chloride (each 0.05%); sodium hypochlorite (0.05%); polyhexanide (0.04%, PHMB1; 0.1%, PHMB2); octenidine dihydrochloride (0.1%); fluoride (250 ppm); essential oils; povidone iodine (10%); and saline (0.9%, NaCl) as control. Furthermore, the bacteria were treated with conventional PDT based on light-emitting diodes and a new modified photodisinfection combining photosensitizer with hydrogen peroxide to PDT^plus also based on light-emitting diodes. In addition to the single treatments, a combined application of antiseptic exposure followed by use of PDT or PDT^plus was performed. The microbial viability was characterized by analyzing colony growth and fluorescence-based vitality proportions.

RESULTS

Nearly all mouthrinses caused a statistically significant growth inhibition. The most effective antiseptics, CHX (0.2%), CHX/cetylpyridinium chloride and octenidine dihydrochloride, inhibited bacterial growth completely. Conventional PDT resulted in moderate reduction of colony growth. The modified PDT^plus achieved maximum antimicrobial effect. The combination of antiseptic exposure and PDT against periopathogens predominantly increased antibacterial efficacy compared to the single applications. The mouthrinse containing essential oil seemed to interfere with PDT.

CONCLUSION

A combination therapy of preceding chemotherapeutical exposure and subsequent photodisinfection may be a more effective and promising antibacterial treatment than single applications of the antiseptic methods. The modified PDT^plus using oxygen-enriched toluidine showed a superior antibacterial effect on periodontal pathogens to conventional PDT and to the majority of the investigated mouthrinses.

Formulation and characterization of cetylpyridinium chloride bioadhesive tablets

PURPOSE

Bioadhesive polymers play an important role in biomedical and drug delivery applications. The aim of this study is to develop a sustained- release tablet for local application of Cetylpyridinium Chloride (CPC). This delivery system would supply the drug at an effective level for a long period of time, and thereby overcome the problem of the short retention time of CPC and could be used for buccal delivery as a topical anti-infective agent.

METHODS

CPC bioadhesive tablets were directly prepared using 7 mm flat-faced punches on a hydraulic press. The materials for each tablet were weighted, introduced into the die and compacted at constant compression pressure. The dissolution tests were performed to the rotation paddle method and the bioadhesive strength of the tablets were measured.

RESULTS

The results showed that as the concentration of polymer increased, the drug release rate was decreased. Also the type and ratio of polymers altered the release kinetic of Cetylpyridinium Chloride from investigated tablets. The bioadhesion strength increased with increasing the concentration of polymer and maximum bioadhesion strength was observed with HPMC K100M.

CONCLUSION

The selected formulation of CPC bioadhesive tablet can be used as a suitable preparation for continuous release of CPC with appropriate bioadhesion strength.

Antimicrobial penetration in a dual-species oral biofilm after noncontact brushing: an in vitro study

OBJECTIVES

Oral biofilm is inevitably left behind, even after powered brushing. As a special feature, powered brushing removes biofilm in a noncontact mode. When the brushing distance becomes too large, biofilm is left behind. We hypothesize that biofilm left behind after brushing has different viscoelastic properties than before brushing, impacting antimicrobial penetration.

MATERIALS AND METHODS

In vitro grown dual-species biofilms were subjected to 20 % mechanical deformation before and after powered brushing at 4-mm brushing distance. Biofilm thickness and stress relaxation were measured for unbrushed and brushed biofilms. Stress relaxation was analyzed with a three-element Maxwell model. Antimicrobial penetration from five mouthrinses was microscopically evaluated for unbrushed and brushed biofilms.

RESULTS

Thicknesses of unbrushed and brushed biofilms were similar. Brushing decreased the prevalence of fast and increased the prevalence of slow relaxation elements, which was accompanied by deeper penetration of chlorhexidine and cetylpyridinium chloride. Penetration of antimicrobials from other mouthrinses was relatively low in unbrushed and brushed biofilms.

CONCLUSIONS

This confirmation of our hypothesis points to an additional advantage of powered toothbrushing in a noncontact mode, changing the viscoelastic properties of biofilm in a direction that increases antimicrobial penetration of chlorhexidine and cetylpyridinium.

CLINICAL RELEVANCE

The biofilm left behind after noncontact powered toothbrushing may have less recalcitrance toward penetration of chlorhexidine and cetylpyridinium chloride than prior to brushing.

A novel approach for removing 2-naphthol from wastewater using immobilized organo-bentonite

The major concern limiting the industrial application of organo-bentonite in powder form (P-Bent) for wastewater treatment is that it is difficult to separate it from treated water by settlement. To address this problem, a novel approach for synthesizing immobilized organo-bentonite in globular form (G-Bent) is proposed. The G-Bent is modified using the cationic surfactant cetylpyridinium chloride (CPC) and immobilized by polyvinyl alcohol (PVA). The removal of 2-naphthol by G-Bent was compared with removal by P-Bent for solid/liquid separation, removal efficiency and desorption of the modifier used in its preparation. Results indicated that G-Bent was easy to recover from treated wastewater, and was effective and reusable in removing 2-naphthol. The percentage of 2-naphthol removed by G-Bent exceeded 90% with the cationic exchange capacity (CEC) loadings ranging from 100% to 150%. This was almost equivalent to the results obtained using P-Bent. In the five rounds of reuse examined, the percentage of 2-naphthol removed was maintained above 50% for 150%-G-Bent. The percentage of CPC desorption was less than 0.75% after five rounds of reuse and no PVA was detected. The results of this work provide novel information for using G-Bent in the treatment of wastewater containing organic contaminants.