Seropositive HBsAg frequency in Karachi and interior Sindh, Pakistan

Viral hepatitis continues to be a major health problem in Pakistan which encourages appraisal of the current ferquency of HBV surface antigenemia. A total of 35,257 individuals of both sexes presenting at a private diagnostic lab and its branches in key areas of Karachi City were screened for HBsAg during an 8-year period ending June 30, 2006. Also evaluated were 1,776 blood samples collected from residents of Hyderabad, Khairpur, Larkana, Nawabshah, and Sukkur in Sindh province.Detection of HBsAg in all serum samples as a marker of HBV was done using the Roche COBAS CORE HBsAg-II EIA system. A total of 1,735 HBsAg positive cases [4.92%] were detected in those assessed in Karachi, and 39 [2.19%] in the individuals tested in parts of interior Sindh. The youngest seropositive subject was a male 3-month old infant, the eldest a 70-year old man; the majority of carriers [78.9%] were aged 16-49 years, and 70.8% of those testing positive in Karachi were male, as were 69.2% in other Sindh cities. HBsAg positivity in Karachi has steadily increased in frequency in our hands from 2.84% in 1998 to currently 4.92%. A significant majority of those positive in all age groups were male in gender warrants deliberation on the credible modes of infection, including homosexuality

Antibiotic options for enterococcus faecalis infections

Escalating resistance of enterococci to many antimicrobials poses a major therapeutic challenge; vancomycin-resistant enterococci [VRE], in particular, exhibit variation in resistance patterns, demanding tailored drug prescription. Hence we screened the in vitro sensitivity profiles of 112 local clinical isolates using 13 antibiotics for their possible therapy options biased by the site of infection. Specimens yielding enterococci referred by local hospitals [n=103] and private physicians [n=09] were processed during a two-year period ending September 2005 at Dr. Essa's Lab in Karachi, Pakistan. Consecutive Enterococcus faecalis strains cultured from urine [n=78], pus [n=18], blood [n=12], HVS [n=2] and ascitic fluid [n=2] were challenged in vitro with locally available antibiotics using the standard disc diffusion method; MICs of one VRE isolate were also performed. Vancomycin [99.1%] and teicoplanin [99.1%], followed by nitrofurantoin [97.3], fosfomycin [91.0%] and chloramphenicol [78.5%], were more effective than pipericillin-tazobactam [72.3%], ampicillin [54.4%], meropenem [45.5%] and ciprofloxacin [35.7%]. Gentamicin and cotrimoxazole offered ineffective zones of inhibition. Only a single VRE strain, also teicoplanin-resistant, was encountered. Increasing drug resistance of enterococci warrants concern and the search for possible therapeutic options prejudiced by local patterns of resistance and the site of infection. Vancomycin, teicoplanin, nitrofurantoin and chloramphenicol are also significantly effective on our current isolates and fosfomycin, typically considered a urinary drug, but encouraged by reports of its successful use in diverse sites, is discussed as a possible alternative

Ofloxacin: laboratory evaluation of the antibacterial activity of 34 brands representing 31 manufacturers available in Pakistan

Objective: To evaluate the antibacterial effectiveness of 34 competitive Ofloxacin products representing 31 manufacturers available in the local market, on 3 standard Quinolone-sensitive American Type Culture Collection [ATCC] bacterial cultures of E.coli, Proteus vulgaris and Staphylococcus aureus

Design: A blind assessment of 29 Ofloxacin brands in tablet form, and 5 in pre-mixed injectable solution collected by The Network for Consumer Protection in Pakistan, Islamabad, with trade and manufacturers names of the products veiled by blanking

Setting: The appraisal was conducted in Karachi at the Department of Microbiology, Jinnah University for Women, and Dr. Essa's Lab and Diagnostic Centre, in March 2003

Method: Direct aqueous suspensions along with 3 additional serial dilutions of each product were used to challenge the 3 target bacteria by the disc-diffusion method. The resultant inhibition-zone diameters were recorded for comparison of antibacterial activity

Results: Comparatively effective but varying antibacterial results were seen using Proteus and Staph aureus; however, alarming differences were recorded when E.coli was targeted. With this organism, excellent inhibition zone diameters were observed with Eracin [CCL], Ofloxacin [Shin Poong], Oflobid [Hilton] and Oflobiotic [Zafa]; others gave good, moderate or poor zones, while 4 shockingly exerted no visible effect: these included 3 single-vial injectable suspensions purported to represent Brookes [Quinon], Bosch [Tariflox] and Hoechst/Aventis [Tarivid], and the GlaxoSmithKlein's tablet Floxy

Conclusion: A significant variation in antibacterial activity of marketed Ofloxacin brands, some representing pharmaceutical giants, demonstrated by simple disc diffusion zone diameter comparison raises serious questions whether the less effective ones obtained in Islamabad and also purchased in Karachi for comparison were flawed, counterfeit or sub-standard preparations