Helicobacter Pylori Treatment Eradication in Egypt: Standard Clarithromycin-based Triple versus Quadruple Regimen Therapy

Absence of adequate treatment for Helicobacter pylori (H. pylori) infection leads to prolonged life time colonization which is responsible for complications. Antibiotics resistance is the main cause of eradication failure in H. pylori infection, thus our study aimed to evaluate the efficiency and tolerability of standard triple therapy vs. quadruple regimen therapy in H. pylori eradication in Egypt.

Caractérisation phénotypique des bétalactamases de souches d'enterobacteries multi résistantes isolées de divers produits pathologiques

Introduction: Les entérobactéries constituent les principales causes d'infections bactériennes.Ce sont des Bactéries Multi- résistantes (BMR)fréquentes par production de BLSE(Bêtalactamases à spectre élargi).Ceci constitue un problème de santé publique majeur car cette résistance est à l'origine d'une impasse thérapeutique et conduit à une prescriptiond'antibiotiques à large spectre (carbapénèmes). Notre étude prospective allant du 01 janvier au 31 décembre 2017 a porté sur 50 souches d'entérobactéries isolées au laboratoire et a pour but de caractériser les types de bêtalactamases.Méthodologie : Les souches ont été ré-isolées d'abord sur milieu Mueller Hinton, ensuite identifiées par la morphologie et les caractères biochimiques des entérobactéries. Les méthodes suivantes ont été réalisées pour la mise en évidence des classes de BLSE. - Méthode de rapprochement des disques (synergie entre un disque Amoxicilline + Acide clavulanique (AMC) et les disques de Céphalosporine de 3ieme (C3G) : BLSE de classe A. - Méthode de Dongeun Yong et al. utilisant l'EDTA (Ethylène Diamine Tétra-acétique) 0,5 M, PH 7 (Inhibition du zinc présent sur le site actif de l'enzyme par l'EDTA): BLSE de classe B. Résultat : Les souches d'entérobactéries étaient réparties ainsi : Enterobacter spp : 40%, Escherichia coli : 32%, Klebsiella pneumoniae : 24% et Klebsiella oxytoca : 4%. Cinquante-six pour cent 56% des souches produisaient une BLSE de classe A (image « bouchon de champagne ») et 14% une BLSE de classe B avec restauration de l'activité de l'imipenème après association de l'EDTA. Enterobacter spp était la souche la plus représentée avec 12 souches sécrétrices d'une BLSE de classe A et 5 souches de classe B, suivie d'E. coli avec 08 souches sécrétrices d'une BLSE de classe A et 01 souche de classe B. K. pneumoniae et K. oxytoca comptaient respectivement 06 et 02 souches sécrétrices de BLSE de classe A. Conclusion : L'acquisition par les entérobactéries et la transmission de résistance, par production de BLSE de classe A ou B est un problème majeur de santé publique causant une véritable impasse thérapeutique. Aujourd'hui, la prévalence de la résistance par production de Métallo-bêtalactamase (MBL) est faible comparée à celle de BLSE de classe A. Ainsi, des stratégies de diagnostic et de maîtrise de la diffusion doivent être appliquées rigoureusement

Hépatite aiguë cholestatique à l'amoxicilline-acide clavulanique ; à propos d'un cas au Centre Hospitalier Universitaire Régional de Ouahigouya au Burkina Faso et revue de la littérature

L'hépatotoxicité médicamenteuse idiosyncrasique (en anglais : drug-induced liver injury ou DILI) est un problème majeur de l'hépatologie moderne. Elle reste cependant sous-diagnostiquée et relativement rare. Les antibiotiques sont les substances les plus fréquemment impliquées. Nous rapportons un cas d'hépatite aiguë à l'amoxicilline ­acide clavulanique en milieu hospitalier à Ouahigouya (Burkina Faso). Une femme de 39 ans, agent de crédit dans une institution de microfinance , était hospitalisée en août 2016 pour un syndrome de cholestase clinique après prise d'amoxicilline-acide clavulanique en péri opératoire d'un kyste dermoïde de l'ovaire. Nous avons retrouvé dans les antécédents une hépatite aiguë documentée à une plante médicinale vernonia colorata en 2014 et un ictère non documenté après prise d'amoxicilline en 2013. Il n'y avait pas de notion de consommation d'alcool. L'examen clinique mettait en évidence un ictère flamboyant, la biologie révélait des syndromes de cholestase, de cytolyse et d'insuffisance hépato-cellulaire. Les marqueurs des hépatites virales A, B, et C ainsi que ceux d'auto-immunité étaient négatifs L'échographie hépatobiliaire et des autres organes abdominaux était normale. Sur le plan thérapeutique, et devant la cholestase la patiente a reçu de l'acide ursodésoxycholique (Delursan R) 250 mg à la posologie d'un (01) comprimé 3 fois par jour. L'évolution était favorable au bout de 3 mois avec une normalisation des paramètres cliniques et biologiques. Nous rapportons une observation documentée d'hépatite cholestatique liée à la prise d'amoxicilline-acide clavulanique, d'évolution favorable en l'absence de réexposition au médicament au bout de 3 mois

Comparing Performance of Amoxicillin and Intramuscular Benzathine Penicillin in Relieving Manifestations of Streptococcal Pharyngitis in Children

Objective: To compare clinical and bacteriologic responses to intramuscular benzathine penicillin G (BPG) and single dose of amoxicillin in Group A streptococcal (GAS) pharyngitis. Design: This study included 571 children from 6 to 15 years old age; with pharyngitis; who were admitted to 45 elementary and guidance schools from 7 regions of Education Organization in North-East of Iran; Mashhad. They were screened for enrollment and if he/she presented pharyngitis with clinical criteria of sore throat; erythema; exudate and tender or enlarged anterior cervical lymph nodes. Exclusion criteria included reports of antibiotic use; negative throat culture for GAS and history of allergy to the drugs. Clinical and bacteriologic responses to BPG and once daily orally amoxicillin were considered and compared. Results: In the amoxicillin group; treatment failure was more than the penicillin group (18.9 vs. 6.4; respectively) but the difference was not statistically significant (p 0.05). Both drugs were significantly effective in reducing pharyngitis manifestations but penicillin was significantly more effective in reducing exudate than amoxicillin. Conclusion: Our study was in line with studies comparing the two drugs. The results show that once-daily therapy with amoxicillin is as effective as intramuscular benzathine penicillin G for the treatment of GAS pharyngitis; but penicillin was significantly more effective in reducing exudate and concurrent signs vs. amoxicillin

In vitro interaction between caffeine and some penicillin antibiotics against Staphylococcus aureus

Purpose: The aim of this study is to evaluate the in vitro interaction of some penicillins (amoxicillin; ampicillin and benzylpenicillin) and caffeine against Staphylococcus aureus. Method: The interaction between the penicillins and caffeine was studied using the Overlay Inoculum Susceptibility Disc (OLISD) method. Minimum inhibitory concentrations (MIC) of the drugs were determined separately and in combination with caffeine (5 and 10 mg/ml). Result: At 5 and 10 mg/ml; caffeine decreased the MIC of amoxicillin by 22 and 25 times respectively; while that of ampicillin was decreased by 6 and 8 times. The MIC of benzylpenicillin against Staphylococcus aureus was; however; increased by 59 and 40 times at caffeine concentrations of 5 and 10 mg/ml respectively. The inhibition zone diameter increment above 19(index of synergism in OLISD method) was recorded only for amoxicillin at amoxicillin concentrations of 7.81; 15.3; 31.25 and 62.5 mg/ml. Conclusion: The results of this study revealed that the concomitant use of caffeine and the studied antibiotics may potentiate the antibacterial effect of amoxicillin against Staphylococcus aureus; decrease that of benzylpenicillin and has virtually no effect on that of ampicillin. This implies that the intake of caffeine in form of analgesic combination or as tea; coffee; beverages or from other food sources may affect the effectiveness of a co-administered amoxicillin and bezylpenicillin

Mieux prescrire l'amoxicilline (1ere partie)

N.A.

Mieux prescrire l'amoxicilline (2eme partie)

Nous presentons la 2eme partie de notre systeme sur l'amoxicilline; celle consacree aux aspects pratiques de l'utilisation de cet antibiotique. Nous avons volontairement limite l'utilisation de l'amoxicilline a la voie orale. L'utilisation de l'amoxicilline associee a d'autres antibiotiques; lors d'infections graves chez les sujets ages et / ou alcoolo dependants et / o denutris; ainsi que chez les patients immunodeprimes n'est pas non plus abordee

Post-marketing stability surveillance: Amoxicillin

BackgroundTo ensure the successful treatment of infectious disease using antimicrobial therapy; a sufficient concentration of the stable; active drug is required at the site of infection. For the achievement of this with respect to the Beta-lactam group of antibiotics; of which amoxicillin is a member; the presence of an intact Beta-lactam ring is essential. Destruction of this sensitive ring can lead to the ingestion of an inactive drug. This can contribute to treatment failure and antibiotic resistance. Thus; the aims of this study were to determine whether the types of packaging in which amoxicillin preparations are dispensed and the temperature and humidity conditions under which they are stored by patients are adequate and appropriate to ensure drug stability.Methods A mini-survey of pharmacies and patients was conducted in order to determine the types of packaging in which amoxicillin preparations are dispensed and the temperature and humidity conditions under which they are stored by patients. The amoxicillin preparations in the identified types of packaging were subjected to simulated conditions that represented the identified temperature and humidity stresses that occurred under patient storage conditions for a duration of 14 days. The extent of breakage of the Beta-lactam ring was then chemically determined on day 1; day 7 and day 14; using an iodometric titration method. ResultsThe mini-survey identified four types of packaging in which amoxicillin capsules are dispensed - plastic packets; flip-top amber bottles; flip-top amber bottles with cotton wool and flip-top transparent bottles with cotton wool. The laboratory analyses showed that only those amoxicillin capsules stored between 20 and 25 0C and protected from moisture were stable in all four identified types of packaging for 14 days. The mini-survey also indicated that 47of the patient sample did not store their antibiotic suspensions in the refrigerator. The laboratory analyses showed that only amoxicillin suspensions stored between 2 and 8 0C for seven days showed the lowest level of degradation. ConclusionThe results of this study indicate that reconstituted amoxicillin suspensions should be stored in the temperature range 2 to 8 0C; and that the reconstitution and dispensing of a 14-day supply of amoxicillin suspensions should be discouraged; even if the drug is stored in this temperature range. For amoxicillin capsules; the results obtained in this study indicate that significant breakage of the Beta-lactam ring of amoxicillin capsules can occur in hot and humid climatic conditions if inadequate types of packaging are used and storage occurs under inappropriate conditions. The results of the study point to the importance of drug stability knowledge as a prerequisite for the dispensing of medicines; the importance of the provision of patient counselling with regard to drug storage requirements; as well as a requirement for amoxicillin capsules to be dispensed in the original manufacturers' containers in geographical areas that are hot and humid

Post-Marketing Stability Surveillance: Amoxicillin

Background: To ensure the successful treatment of infectious disease using antimicrobial therapy; a sufficient concentration of the stable; active drug is required at the site of infection. For the achievement of this with respect to the Beta-lactam group of antibiotics; of which amoxicillin is a member; the presence of an intact Beta-lactam ring is essential. Destruction of this sensitive ring can lead to the ingestion of an inactive drug. This can contribute to treatment failure and antibiotic resistance. Thus; the aims of this study were to determine whether the types of packaging in which amoxicillin preparations are dispensed and the temperature and humidity conditions under which they are stored by patients are adequate and appropriate to ensure drug stability.Methods: A mini-survey of pharmacies and patients was conducted in order to determine the types of packaging in which amoxicillin preparations are dispensed and the temperature and humidity conditions under which they are stored by patients. The amoxicillin preparations in the identified types of packaging were subjected to simulated conditions that represented the identified temperature and humidity stresses that occurred under patient storage conditions for a duration of 14 days. The extent of breakage of the Beta-lactam ring was then chemically determined on day 1; day 7 and day 14; using an iodometric titration method.Results: The mini-survey identified four types of packaging in which amoxicillin capsules are dispensed - plastic packets; flip-top amber bottles; flip-top amber bottles with cotton wool and flip-top transparent bottles with cotton wool. The laboratory analyses showed that only those amoxicillin capsules stored between 20 and 25 0C and protected from moisture were stable in all four identified types of packaging for 14 days. The mini-survey also indicated that 47 of the patient sample did not store their antibiotic suspensions in the refrigerator. The laboratory analyses showed that only amoxicillin suspensions stored between 2 and 8 0C for seven days showed the lowest level of degradation.Conclusion: The results of this study indicate that reconstituted amoxicillin suspensions should be stored in the temperature range 2 to 8 0C; and that the reconstitution and dispensing of a 14-day supply of amoxicillin suspensions should be discouraged; even if the drug is stored in this temperature range. For amoxicillin capsules; the results obtained in this study indicate that significant breakage of the Beta-lactam ring of amoxicillin capsules can occur in hot and humid climatic conditions if inadequate types of packaging are used and storage occurs under inappropriate conditions. The results of the study point to the importance of drug stability knowledge as a prerequisite for the dispensing of medicines; the importance of the provision of patient counselling with regard to drug storage requirements; as well as a requirement for amoxicillin capsules to be dispensed in the original manufacturers' containers in geographical areas that are hot and humid

Dispening and quality of Amoxicillin Preparations in Retail Pharmacies on Tanzania Market

A study on dispensing practice and quality of amoxycillin capsules and syrups was conducted in retail pharmacies in 5 regions of Tanzania. Data on dispensing practice was collected by interviewing 75 dispensers through structured questionnaires. Quality of amoxycillin capsule formulations and dry powder for suspension preparations from six different manufacturers was evaluated for chemical content at the Tanzania Food and Drug Authority (TFDA) in Dar es Salaam. The study showed that of all the dispensers only 17.3were pharmacists; 21.3pharmaceutical technicians and 28were nurses of different ranks. Results indicated that the most dispensed amoxicyllin was the locally produced preparation which accounted for 41.3. Affordability determined the most dispensed and lowest priced generic brand; amoxycillin by 68. Results revealed that only 46.6dispensers refused to dispense amoxycillin without a prescription while 53.4dispensed. Out of the ones who dispensed; 42.5gave patients the most expensive preparations and 22.5just dispensed according to the patients' demands. Similarly patients with prescriptions written in a generic name; the dispensers (28) issued them with the most expensive brand while others were issued the brand they specifically demanded by 32of the dispensers. For patients who came to the pharmacy with less money; results revealed that 66.7of the dispensers dispensed incomplete doses and then requested them to come back for the remainder and 13.3just gave out incomplete doses without any further counseling. Responses regarding reconstitution of the dry powder for suspension showed that only 10.7dispensers reconstituted before giving it out to patients and the rest just instructed patients on how to reconstitute at home. Further; 74.7of dispensers instructed the patients to use teaspoons to measure 5ml of the suspension. The results from the assessment of chemical contents showed that all capsules and dry powder for suspensions complied with respect to pharmacopoeial limits. It is concluded that dispensers should continually undergo continuing education on good dispensing practices