Exploring the hidden potential of fosfomycin for the fight against severe Gram‑negative infections.

Gram‑negative resistance is a serious global crisis putting the world on the cusp of ‘pre‑antibiotic era’. This serious crisis has been catalysed by the rapid increase in carbapenem‑resistant Enterobacteriaceae (CRE). Spurge in colistin usage to combat CRE infections leads to the reports of (colistin and carbapenem resistant enterobacteriaceae) CCRE (resistance to colistin in isolates of CRE) infections further jeopardising our last defence. The antibacterial apocalypse imposed by global resistance crisis requires urgent alternative therapeutic options. Interest in the use of fosfomycin renewed recently for serious systemic infections caused by multidrug‑resistant Enterobacteriaceae. This review aimed at analysing the recent evidence on intravenous fosfomycin to explore its hidden potential, especially when fosfomycin disodium is going to be available in India. Although a number of promising evidence are coming up for fosfomycin, there are still areas where more work is required to establish intravenous fosfomycin as the last resort antibacterial for severe Gram‑negative infections.

An epidemiological survey to assess the clinical use of cephalosporins in community-acquired respiratory tract infections.

Background: In outpatient management of respiratory tract infections, the clinicians’ preferences always have a broad spectrum of antibiotics as an empirical therapy. Clinical use of cephalosporins and fluoroquinolones has been recommended by various international guidelines as a monotherapy or as combination therapy to manage these. This survey was conducted to assess the in-clinic use and preference of cephalosporins or fluoroquinolones as monotherapy or as combination therapy in managing respiratory tract infections by Indian doctors. Methods: A survey questionnaire was drafted to capture the feedback from crossspecialty regarding the preference of using antibiotics in respiratory tract infection in real time clinical settings. Results: Data from 163 physicians were collected and evaluated across India. 79 (48%) clinicians reported pharyngitis/tonsillitis to be the most commonly encountered respiratory tract infection followed by community-acquired pneumonia (CAP) 62 (38%). 100 (61%) clinicians preferred use of cefpodoxime monotherapy as a primary line of treatment for the management of respiratory pharyngitis/ tonsillitis. Use of short course therapy (≤1 week) of cefpodoxime and levofloxacin as combination therapy is preferred by 94 (58%) clinicians, in cases of acute exacerbation of chronic bronchitis (AECB) 85 (52%), and CAP 83 (51%). The clinical preference of levofloxacin was observed with only 16 (10%) clinicians, in lower respiratory tract infections, i.e. AECB and CAP. Conclusion: In-clinic use of cefpodoxime as monotherapy is preferred in upper respiratory tract infections. However, clinicians recommend a combination therapy of cefpodoxime and levofloxacin in lower respiratory tract infections.

Garenoxacin as a prophylactic anti-infective in hydropneumothorax: a case study report.

Pneumothorax appears to be a common clinical state. Iatrogenic pneumothorax occurs commonly after procedures such as transthoracic needle biopsy, pleural biopsy, positive pressure ventilation, etc. Diagnosis of iatrogenic pneumothorax is often delayed. Broad spectrum anti-infectives appear to be benefi cial in reducing the infections, especially when chest drains are inserted. Garenoxacin, a potent quinolone with its unique structural modifi cation appears to have an edge over other respiratory quinolones.

Post-Approval, Observational Study with Garenoxacin a Newer des-fl uoroquinolone in Uncomplicated Urinary Tract Infections in Vadodara, India.

Background: Urinary tract infection (UTI) is one of the most important global health issues, which has raised the morbidity and mortality rates in both the genders. Strategies that are proposed in the management of UTIs include use of empirical antibiotics with a broad spectrum of coverage. Urine specimen culture plays a pivot role to evaluate the organism responsible for the pathogenesis. Methods: This observational study was conducted at Vadodara comprised of 50 patients suffering from UTI. All the patients that included in the study were examined for side-effects during the entire period of the drug therapy. Clinical response was judged by subjective assessment for control of presenting symptoms. Results: Data were obtained from 50 patients. Garenoxacin was prescribed as a fi rst-line therapy to the patients with UTI. Four patients received the drug for 5 days and 44 patients received the drug for 7 days. Escherichia coli was the most common organism obtained from the urine culture, followed by Staphylococcus saprophyticus and Enterobacter species. Clinical cure/improved was established in 98% of cases. One case of therapy failure was reported. Negligible side-effects such as nausea, vomiting, and abdominal pain were reported. Conclusions: Garenoxacin with its superior yet differentiated pharmacodynamic and pharmacokinetic profi le involving low minimum inhibitory concentrations with high target site tissue concentrations defi nitely fi nds a merit for further evaluation. With superior safety profi le, excellent antimicrobial coverage and a convenient once a day dosing garenoxacin appears to improve the patient compliance.

Use of garenoxacin: a new generation antibiotic for surgical infections.

Background: The management of skin and skin structure infections (SSSI) still continues to be global challenge. USFDA has given strong recommendation for adequate empirical antibiotic coverage to avoid further complication of the wounds. Wound complications, especially in the diabetic population, patients with low immunity remains a big challenge though other factors like site of the wound, age of the patients also play an important role. Methods: A retrospective observational study was conducted to analyze clinical utility of garenoxacin for surgical prophylaxis. A total of 100 patients, 30 patients with diabetic foot and 70 patients with post-surgical intraabdominal wounds who were prescribed garenoxacin 2×200 mg as stat dose prophylactically. Swab culture from the wound slough and drain tube samples were sent for culture/sensitivity on day 0, day 5, and day 7. Wound healing was evaluated by estimating slough discharge, size of the wound, vascularity, and overall healing. They were categorized as treatment failure group, when sough/drain-discharge reduction was ≤50%, improved if sough/drain-discharge reduction was 50-75% and cure when sough/drain-discharge reduction was 75-100%. Results: The healthy granulation tissue was observed post 7 days therapy of garenoxacin 2×200 mg in diabetic foot ulcer (DFU) patients when administered empirically before surgical debridement. In patients with post-operative infectious intraabdominal wounds, the most common isolated organisms were Enterococcus, Acinetobacter and Klebsiella. Post garenoxacin therapy used as switch therapy empirically for 5 days resulted in 100% sterile culture. While evaluating slough/draindischarge in DFU patients, 84% patients showed cure and 16% showed improvement at the end of day 7 and in patients with post-operative infectious intra-abdominal wounds cure was observed in 86% patients showed cure and 14% patient showed improvement. No side effects were reported during the study. Conclusions: Administration of garenoxacin used as empirical therapy for surgical prophylaxis and as switch therapy in patients with DFU s and post-surgical infectious wounds for the period of 5-7 days has been found effective indicating its wide spectrum of action.

Garenoxacin in the treatment of community-acquired pneumonia.

Community-acquired pneumonia (CAP) is a major cause of adult mortality in Asia. Empirical use of antibiotics depends on the pathogens that are commonly responsible. Evolution of resistant pathogens in CAP has added to the burden of treating physicians. Microbiological culture and antibiotic sensitivity testing are helpful for the treatment of such respiratory tract infections. Klebsiella pneumoniae though uncommon pathogen of CAP has been reported in many cases. Garenoxacin a newer fluoroquinolone has found its utility in the treatment of respiratory tract infections. Providing symptomatic relief to the patient with the use of analgesics, antipyretics and cough preparations are also an essential part of the management.

Open-label, randomized, crossover comparative bioavailability study of cefixime from two tablet formulations after single oral administration.

Background: Cefixime is an oral extended spectrum third generation cephalosporin, which has marked in vitro bactericidal activity against a wide variety of Gram-positive and Gram-negative organisms, effective in the treatment of community-acquired infections such as respiratory tract infection and urinary tract infection. The objective of this randomized, crossover study was to compare the bioequivalence (BE) of two tablets of test (Milixim® 200 mg, containing 200 mg of cefixime) with Reference formulation (Cefixime, 400 mg). Methods: A total of 12 healthy volunteers were randomly assigned to crossover, single-dose treatment regimens. Serial blood samples were collected, and plasma concentrations of cefixime were analyzed using the high-performance liquid chromatographic technique. Pharmacokinetic parameters and BE limits were calculated using non-compartmental methods. Results: The mean Cmax for the test and reference formulations were 4435.0298±149 and 4408.2150±1021 ng/mL, respectively. The mean area under the serum concentration curve (AUC)0-t were 38108.2614±8583.6535 and 38457.5791±8105.2529 ng/hr/mL The mean ratios (test: reference) for Cmax, AUC0-t, were 99.7% and 98.5%, respectively. There were no significant differences in pharmacokinetic parameters between groups. Overall, the 90% confi dence interval for the intra-individual ratios of the log-transformed Cmax and AUC values of the two formulations were within the BE interval of 80-125%. Conclusion: The study has demonstrated the BE of milixim and reference formulation of cefixime.

Effect of carbonated drink on excisional palatal wound healing: A study on Wistar rats.

Background: Millions of people worldwide consume carbonated drinks every day. The effects of these drinks on hard tissues in the mouth have been proved beyond doubt. Only a little has been done so far to assess the effects of carbonated drinks on oral soft tissues. This study was an attempt to assess the effect of carbonated drinks on oral wound healing. Materials and Methods: Twenty female Wistar rats were considered for the study. A circular wound was created on the palate and the animals were divided into two groups (experimental and control group). The experimental group animals were fed with a commercially available carbonated drink instead of water, and two animals from each group were euthanized at 3, 7, 14 and 21 days. Wound site was assessed morphometrically and histologically. Results: There was a marked difference in the healing pattern between the experimental group and control group animals. Control group animals showed a normal healing pattern with formation of a fibrous connective tissue at the end of 21 days. In the experimental group, healing was delayed and disrupted. The wound site showed a definite palatal perforation in experimental group animals after 14 days, but osteoclasts were not noticed in the histological sections. Conclusion: Consumption of carbonated drinks can disrupt oral wound healing. Results suggest that the bone changes seen in experimental group samples are not mediated by osteoclasts, and acidity of the carbonated drinks could be one of the reasons for these changes.

Spigelion hernia: fascia lata repair is an alternative option in absence of prolene mesh.

Spigelian hernia is rare. Seven cases of Spigelian hernia are presented. These include two recurrent Spigelian hernias. Incisional hernias through Spigelian aponeurosis after Pfannensteil incision are not included. Clinical examination is the mainstay of diagnosis. The true incidence is possibly higher, as a low Spigelian hernia is not recognised and often diagnosed as a direct inguinal hernia. Ultrasound scanning is recommended, as it is non-invasive and easily available and can detect the hernial orifice in the Spigelian fascia at an early stage. Recurrence of Spigelian hernia took place in two cases through the site of prolene stitch of a previous repair. Hernioplasty with tension free fascia lata graft/prolene mesh was carried out in all cases. The cost of fascia lata graft is only a scar in the thigh. In a mean follow-up of 3.1 -year no patient has reported back with recurrence This is the ideal substitute for the patients in developing countries where synthetic meshes are still not freely available.

Comparison and classification of dental arch forms of Indian and Chinese subjects with normal occlusions.

To compare the dental arch forms of Indian and Chinese subjects, 30 untreated Indian and 30 untreated Chinese adults with normal occlusion and symmetrical arches were examined. The arches were classified as narrow, wide, mid, pointed and flat, according to the method developed by Monique Raberin etal., from Lyon, France. For the sample examined the Chinese population was found to have significantly wider arches compared to the Indian population.