Assessment and Comparison of Microbiological Efficacy of Moxifloxacin plus Vancomycin Combined Therapy with Fortified Vancomycin in Bacterial Conjunctivitis

Background: Bacterial Conjunctivitis or red eye being highly communicable need to be tackle at the earliest. Newer antibiotics may kill bacteria more rapidly. Thus, we aim to assess and compare microbiological efficacy of Moxifloxacin (0.5%) plus Vancomycin (2.5%) combined therapy to Fortified Vancomycin (5%) in relation to organism isolated in positive culture of bacterial conjunctivitis. Methods: The present study was conducted on patients who presented at Ophthalmology OPD, Jawaharlal Nehru Medical College Hospital, Aligarh and Gandhi Eye Hospital, Aligarh. The patients with bilateral conjunctivitis were included in the study. Right eyes were instilled moxifloxacin plus vancomycin combination therapy and Left eyes were instilled fortified vancomycin. Microbiological outcomes were recorded on first visit and on follow up visits during course of treatment. Results: A total of 35 patients were included in the study. At first visit, 14 cases were positive with coagulase negative Staphylococcus (CoNS) being the most common organisms. All the positive smears became negative in first follow-up (3rd day) in both the groups. No significant difference was found in microbiological study outcome between the two-study groups. Conclusions: We conclude that both the drugs, i.e. moxifloxacin (0.5%) plus vancomycin (2.5%) combined therapy and fortified vancomycin (5%) had good efficiency in microbial elimination in cases of bacterial conjunctivitis with equivalent outcome and can be considered as an alternative to other antimicrobial therapy in bacterial conjunctivitis.

Predictors for progression of metastatic prostate cancer to castration-resistant prostate cancer in Indians.

Background & objectives: There is lack of data on natural history and progression of prostate cancer (PC) which have implications in the management of the disease. We undertook this retrospective study to analyze factors predicting progression of metastatic PC to castration-resistant prostate cancer (CRPC) in Indian men. Methods: Complete records of 223 of the 489 patients with metastatic PC were obtained from computerized data based system in a tertiary care hospital in north India between January 2000 to June 2012. Patients with follow up of < 6 months were excluded. Age (≤ and > 65 yr), baseline PSA (< and ≥ 50 ng/ml), bone scan and Gleason score (≤7 and >7) were recorded. Extent of bone disease (EOD) was stratified according to the number of bone lesions i.e., < 5, 5-10, > 10. CRPC was defined as two consecutive PSA rise of > 50 per cent from nadir or an absolute value of > 5 ng/ml. Results: Mean age of patients was 61.5 ± 12.45 yr and their PSA level was 325.6 ± 631.35 ng/dl. Of the 223 patients, 193 (86%) progressed to CRPC at median time of 10.7 (4-124) months. Median follow up was 24 (6-137) months. On univariate and multivariate analyses EOD on bone scan was found to be a significant predictor (P=0.006) for time to CRPC. Median time to CRPC was 10 months (CI 95%, 7.5-12.48) with >10 lesions or super scan versus 16 months (CI 95%, 10.3-21.6) with <10 bone lesion (P=0.01). Ninety (46.6 %) patients of CRPC died with median time to death from time of CRPC 21 (10-120) months. Interpretation & conclusions: Median time for progression of metastatic PC to CRPC ranged from 10-16 months depending on the extent of the bone involvement. In Indians, the aggressive course of advanced prostate cancer warrants further clinical trials to explore the need for additional treatment along with initial castration.

Incidence and transferability of antibiotic resistance in the enteric bacteria isolated from hospital wastewater

This study reports the occurrence of antibiotic resistance and production of β-lactamases including extended spectrum beta-lactamases (ESβL) in enteric bacteria isolated from hospital wastewater. Among sixty-nine isolates, tested for antibiotic sensitivity, 73.9% strains were resistant to ampicillin followed by nalidixic acid (72.5%), penicillin (63.8%), co-trimoxazole (55.1%), norfloxacin (53.6%), methicillin (52.7%), cefuroxime (39.1%), cefotaxime (23.2%) and cefixime (20.3%). Resistance to streptomycin, chloramphenicol, nitrofurantoin, tetracycline, and doxycycline was recorded in less than 13% of the strains. The minimum inhibitory concentration (MIC) showed a high level of resistance (800-1600 µg/mL) to one or more antibiotics. Sixty three (91%) isolates produced β-lactamases as determined by rapid iodometric test. Multiple antibiotic resistances were noted in both among ESβL and non-ESβL producers. The β-lactamases hydrolyzed multiple substrates including penicillin (78.8% isolates), ampicillin (62.3%), cefodroxil (52.2%), cefotoxime (21.7%) and cefuroxime (18.8%). Fifteen isolates producing ESβLs were found multidrug resistant. Four ESβL producing isolates could transfer their R-plasmid to the recipient strain E. coli K-12 with conjugation frequency ranging from 7.0 x 10-3 to 8.8 x 10-4. The findings indicated that ESβL producing enteric bacteria are common in the waste water. Such isolates may disseminate the multiple antibiotic resistance traits among bacterial community through genetic exchange mechanisms and thus requires immediate attention.

Is fine needle aspiration of the tonsil superior to a surface swab for isolating its core flora in recurrent tonsillitis?

This prospective study was designed to explore the possible role of fine needle aspiration of recurrently inflamed tonsils in determining their core flora. Seventy-seven patients undergoing tonsillectomy for recurrent tonsillitis were included. Colonies grown from fine needle aspirate and surface swab were compared with tonsillar core culture obtained after tonsillectomy. The pathogens isolated by fine needle aspiration culture were not greatly different from surface swab results in comparison to core isolates. The results of fine needle aspirate do not appear to confer any advantage over surface swab in representing core flora. These findings would seem to indicate no clinical use for fine needle aspiration in the management of recurrent tonsillitis