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The spread of antibiotic-resistant bacteria and exhausted drug leads render some infections untreatable now and in the future. To deal with these "new challenges", scientists tend to re-pick up "old antibiotics". Fusidane-type antibiotics have been known for nearly 80 years as potent antibacterial agents against gram-positive bacteria, especially Staphylococci, and represent the only triterpene-derived antibiotic class in clinical setting. These attractive characteristics have drawn renewed attention on fusidane-type antibiotics in recent decades. Isolation, characterization, biological evaluation, as well as chemical modifications of fusidane-type antibiotics are increasingly being reported. Combinatorial biosynthesis of this type of antibiotics has been successfully utilized not only for elucidating the biosynthetic pathways, but also for expanding their structural diversity. Some isolated and synthetic compounds exhibit comparable or even more potent biological activity than fusidic acid. This review provides an overview of progress on the studies of structure and biology of fusidane-type antibiotics from 1943 to April 2021. The informative structure-activity relationship is also highlighted.
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Anti-Bacterial Agents/pharmacology , Bacteria , Biology , Structure-Activity RelationshipABSTRACT
AIM: To explore the antibacterial activity and underlying mechanism of ursolic acid combined with fusidic acid against Staphylococcus aureus (SA) ATCC29213 and Methicillin-Resistant Staphylococcus aureus (MRSA) ATCC43300 in vitro. METHODS: The minimum inhibitory concentration (MIC) of the combined use of ursolic acid and fusidic acid on SA, MRSA was determined by the micro broth dilution method and the micro checkerboard method, and the partial inhibitory concentration index (FICI) was calculated to determine the combined effect. And the bactericidal effect of fusidic acid combined with ursolic acid was studied by the time-killing curves. The agar double dilution method was used to determine the anti-drug resistance mutation concentration (MPC) and anti-drug resistance mutation selection window (MSW) of fusidic acid alone and in combination with ursolic acid. The viable count of biofilm carrier were determined by serial dilution method and the semi-quantitative biofilm by crystal violet staining method. RESULTS: The combined use of ursolic acid and fusidic acid for SA and MRSA FICI were 0.312 5 and 0.375, respectively. The time-killing curve showed that 1MIC ursolic acid combined with 1MIC fusidic acid has a synergistic bactericidal effect on SA and MRSA. The MPC of fusidic acid to MRSA was 256 μg/mL and the MSW was 256. After fusidic acid combined with ursolic acid, the MPC decreased to 8 μg/mL. The combined group was significantly reduced compared to the fusidic acid group. The semi-quantitative and biofilm bacterial counts of combined group were markedly decreased compared to the fusidic acid group after the biofilm cultivate for 48 h and 72 h.CONCLUSION: The combined use of UA and FA has a synergistic effect on SA and MRSA.
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Background: Impetigo is a contagious bacterial skin infection that affects both adults and children. Topical antibacterials such as mupirocin and fusidic acid are the most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of retapamulin in the treatment of secondary impetigo. However, its use in primary impetigo is limited. To this purpose, we compared the safety, efficacy and adherence to treatment of fusidic acid with retapamulin in primary impetigo.Methods: A total of 50 patients with a clinical diagnosis of primary impetigo, between 2-12 years of age, having <10 lesions, 3/5 signs and symptoms, skin infection rating score ?4 and pus score ? one were involved. Patients who were having secondary impetigo leions were excluded. Twenty-five patients received 2% fusidic acid cream three times a day, and the remaining 25 patients received 1% retapamulin ointment two times a day for seven days. Skin Infection Rating Scale (SIRS) was used to assess the severity of disease at baseline and end of treatment. Clinical success was considered when SIRS score of zero each for pus, crust and pain and 0/1 each for erythema and itching. Clinical failure is a SIRS score of ?1 for pus.Results: Baseline disease characteristics such as a number of lesions, the severity of disease (SIRS) and pus scores were statistically similar between the two groups. The clinical improvement observed with both fusidic acid and Retapamulin (20/25, 80%) and (21/25, 84%) treatments was not statistically different (p>0.05). Both drugs were well tolerated.Conclusions: Both fusidic and retapamulin showed similar clinical success in patients with primary impetigo. Since fusidic acid has anti-inflammatory property and its treatment is cost-effective, it can be considered as first-line treatment and retapamulin in fusidic acid-resistant impetigo.
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Fusidic acid is the only fusidane-type antibiotic that has been clinically used. However, biosynthesis of this important molecule in fungi is poorly understood. We have recently elucidated the biosynthesis of fusidane-type antibiotic helvolic acid, which provides us with clues to identify a possible gene cluster for fusidic acid ( cluster). This gene cluster consists of eight genes, among which six are conserved in the helvolic acid gene cluster except and . Introduction of the two genes into the NSAR1 expressing the conserved six genes led to the production of fusidic acid. A stepwise introduction of and revealed that the two genes worked independently without a strict reaction order. Notably, we identified two short-chain dehydrogenase/reductase genes and in the cluster, which showed converse stereoselectivity in 3-ketoreduction. This is the first report on the biosynthesis and heterologous expression of fusidic acid.
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Objective@#To investigate fusidic acid resistance in Staphylococcus aureus (S.aureus) strains and to analyze their molecular characteristics.@*Methods@#A total of 1 333 strains of S. aureus isolated in the First Affiliated Hospital of Wenzhou Medical University from October 2013 to March 2016 were collected. Fusidic acid resistance in these strains was detected by K-B method. Minimum inhibitory concentrations (MIC) of fusidic acid were measured by agar dilution method. Resistance genes of fusB, fusC and fusD and S. aureus A protein-coding gene (spa) were detected by PCR. Strains that did not carry fusB, fusC or fusD were detected for mutations in fusA by sequencing. Housekeeping genes were detected by PCR and analyzed by multilocus sequence typing (MLST).@*Results@#Among the 1 333 strains of S. aureus, 52 were resistant to fusidic acid, accounting for 3.90%. From 2013 to 2016, fusidic acid-resistant strains accounted for 5.3% (7/132), 3.5% (20/571), 4.1% (21/510) and 3.3% (4/120), respectively. The MIC values of fusidic acid against S. aureus were 2, 4, 8, 64 and >64 μg/ml, which inhibited the growth of 26.9% (14/52), 34.6% (18/52), 13.5% (7/52), 1.9% (1/52) and 23.1% (12/52) of strains, respectively. MLST revealed that there were 13 sequence types (STs), among which ST630 was the predominant type accounting for 50% (26/52), followed by ST5 accounting for 17.3% (9/52). There were 19 spa types, among which t4549 (11/52), t2460 (8/52), t377 (8/52) were the predominant types. Nine strains carried drug resistance genes accounting for 17.3% (9/52), including seven fusB-positive and two fusD-positive strains. No fusc-positive strains were detected. Mutations in fusA gene were detected in 11 strains (21.2%, 11/52) and the MIC values against them were all >64 μg/ml. The predominant type of the strains with fusA gene mutations was ST5-t2460.@*Conclusion@#Fusidic acid shows a good and relatively stable in vitro antibacterial activity against S. aureus. The mechanism of high resistance to fusidic acid is closely related to fusA gene mutation.
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OBJECTIVE: To explore the antibacterial activity and mechanism of fusidic acid combined with aztreonam on 12 clinical isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA). METHODS: Broth dilution method was used to determine the minimum inhibitory concentration(MIC) of the fusidic acid and aztreonam combination.The MIC of two drugs combination were measured by the checkerboard method and partial inhibitory concentration index (FIC) was calculated to determine the combined effect.The synergistic effect of two drugs was assessed by the disk diffusion susceptibility test and the time-killing curves.Extracellular enzyme activity assay was used to detect the strains extracellular enzyme activity changes of fusidic acid alone and combined with aztreonam. The probable mechanism of the combined use of two drugs was discussed. RESULTS: Fusidic acid and aztreonam combination displayed synergistic and additive activity on 61.54% and 38.46% isolates, no antagonism activity was observed.The bacteriostasis circle was obviously increased in two drugs combination, of which 41.67% of the strains were changed from drug resistance to sensitive. The time-killing curves showed that the combined of two drugs had bactericidal effect on the isolate PA 320.Extracellular aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) activity were all increased in a significant difference with the combination of two drugs. CONCLUSION: Fusidic acid combined with aztreonam on CRPA is showed synergistic and additive activity in vitro. The mechanism of two drugs in combination may concern with aztreonam help the fusidic acid to overcome the natural hydrophobic antibiotic permeability barriers of gram-negative bacteria.
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To identify the related substances of fusidic acid by LC-MS,separation was performed on an Agilent Extend-C18column(150 mm ×4. 6 mm,3. 5 μm)by linear gradient elution with a mobile phase consisting of methanol,acetonitrile and formic acid. Electrospray positive ionization high resolution TOF/MS was used for the determination of the accurate mass and elemental composition of parent ions of the related substances;triple qua-drupole tandem mass was employed for the mass spectra determination of the product. The structures of the related substances were then figured out through the elucidation of the fragment ions. Fusidic acid and its related sub-stances were adequately separated under the established HPLC conditions. Nineteen major related substances of fusidic acid were detected and speculated by hyphenated techniques. Eleven of them were recorded in European Pharmacopoeia,while the others have not been previously reported. The established LC-MS method is effective for the separation and identification of the related substances of fusidic acid and the results are useful for its storage conditions and quality assurance.
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Objective To investigate the antibacterial effect of Fusidic acid on Mycoplasma pneumoniae and antibiotic resistant Mycoplasma pneumoniae in vitro.Methods Twenty-eight clinical strains of Mycoplasma pneumoniae isolated from patients with respiratory tract infection at Beijing Friendship Hospital Affiliated to the Capital University of Medical Sciences from January to December 2016 and 2 Mycoplasma pneumoniae reference strains were enrolled.The minimum inhibitory concentration (MIC) of Fusidic acid and Azithromycin were determined by using micro-dilution ration method.The chessboard method was used to check the antibacterial effect of combination between Fusidic acid and Azithromycin.The antibacterial activity of the Fusidic acid was evaluated by measuring the antibacterial rate of different concentrations.Results One isolate showed no mutation in 23SrRNA,26 isolates had one point mutation in loci 2063 and 1 isolate had one point mutation in loci 2064 among the 28 clinical isolates.The findings by micro-dilution method results showed that the MIC values of all the clinical isolates with mutations associated with macrolide resistance to Azithromycin were ＞ 1.000 0 mg/L,and the MIC values of all the clinical isolates with no mutations to azithromycin were ＜ 0.500 0 mg/L.The findings by micro-dilution method results showed that the MIC value of Fusidic acid for Mycoplasma pneumonia and drug resistance Mycoplasma pneumoniae was 1.000 0 mg/L.The Fractional Inhibitory Concentration index of Fusidic acid and Azithromycin combination was ≤0.500 0 mg/L.When the concentration of the Fusidic acid was lower than or equal to 32 MIC,the antibacterial effect of Fusidic acid against Mycoplasma pneumoniae increased with its higher concentration.When the concentration of the Fusidic acid was lower than or equal to 8 MIC,the longer the strain was exposed to the drug,the stronger antibacterial effect was against Mycoplasma pneumoniae.Conclusion If the treatment of Mycoplasma pneumoniae infection is not effective or the infection of patient is combined with bacteria,the application or combination of Fusidic acid may inhibit pathogenic bacteria effectively.Of course,how to use Fusidic acid in clinical treatment needs further study and discussion.
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La tricomicosis es una infección superficial causada por Corynebacterium flavescens, que afecta por lo regular pelos axilares, en menor grado los púbicos, los escrotales e interglúteos y excepcionalmente los de la cabeza o tricomicosis capitis (TC). Esta infección se caracteriza por formación de nódulos pilosos. Clínicamente se confunde con infecciones como piedra blanca y pediculosis. El diagnóstico se realiza por microscopia y dermatoscopia de masas bacterianas y confirmado por cultivo. OBJETIVO: Presentar un caso de TC en un infante, y mostrar las características microscópicas, dermatoscópicas y ultraestructurales. CASO CLÍNICO: Niño sano de 6 meses de edad, con dermatosis que afectó los pelos de la cabeza en forma de múltiples nódulos-pilosos amarillentos. Se comprobó TC mediante fluorescencia amarilla a la luz de Wood; a la dermatoscopia se observaron cadenas blanco-amarillentas, como "rosarios de piedras cristalinas"; al examen directo se distinguieron masas bacterianas y al cultivo se identificó Corynebacterium flavescens. A la microscopia electrónica se observó infección superficial, sin perforación de los pelos. Se realizó tratamiento con aplicación de ácido fusídico por 3 semanas y se obtuvo curación clínica y microbiológica. CONCLUSIÓN: La TC es una entidad rara que se presenta en niños, y que suele confundirse con otros padecimientos del pelo como la pediculosis e infecciones micóticas.
Trichomycosis is a superficial infection caused by Corynebacterium flavescens, which regularly affects axillary, and to a a lesser extent, pubic, scrotal and intergluteal, and exceptionally, head hairs or trichomycosis capitis (TC). This condition is characterised by the formation of bacterial nodules. Clinically, it can be confused with white piedra or pediculosis. The diagnosis is made by microscopic and dermoscopic observation and confirmed by culture. OBJECTIVE: To present a case of TC in an infant and illustrate the microscopic, dermoscopic, and ultrastructural characteristics. CLINICAL CASE: A 6 month-old boy, otherwise healthy, with multiple yellowish concretions on the hairs of the head. TC was confirmed by yellow fluorescence with Woods light; white-yellowish beads, like "rosaries of crystalline stones" were observed on dermoscopy, direct examination showed bacterial masses, and Corynebacterium flavescens was identified by culture. A superficial infection, without perforation of the hairs, was confirmed by electron microscopy. Treatment with fusidic acid for 3 weeks achieved a clinical and microbiological cure. CONCLUSION: TC is a rare condition that affects children, and tends to be mistaken for other diseases of the hair, such as pediculosis and mycotic infections.
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Humans , Male , Infant , Corynebacterium Infections/diagnosis , Dermoscopy/methods , Fusidic Acid/therapeutic use , Lice Infestations/diagnosis , Treatment Outcome , Corynebacterium/isolation & purification , Corynebacterium Infections/microbiology , Corynebacterium Infections/drug therapy , Hair/microbiology , Hair Diseases/diagnosis , Hair Diseases/microbiology , Hair Diseases/drug therapy , Microscopy , Anti-Bacterial Agents/therapeutic useABSTRACT
Objective To examine the change of bilirubin level in neonates and infants after administration of fusidic acid.Methods The data of serum bilirubin,alanine aminotransferasese (ALT),aspartate aminotransferase (AST) and adverse drug reaction were collected retrospectively in neonates and infants and compared statistically before and after administration of fusidic acid.Results Emerging jaundice or exacerbation of the existing jaundice was not found in all the 138 patients after administration of fusidic acid in this analysis.Biochemical markers were measured before and after use of fusidic acid in 64 of the patients.ALT,AST and albumin did not show significant difference before and after use of fusidic acid.However,the ratio between indirect bilirubin and total bilirubin decreased by about 8％ after use of fusidic acid.Conclusions Fusidic acid did not show significant effect on serum bilirubin level in the neonates and infants following fusidic acid treatment.
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Objective To investigate the clinical efficacy of topical corticosteroids combined with fusidic acid cream in treating infantile eczema.Methods Four hundreds cases of infantile eczema in the outpatient department of our hospital from March 2012 to January 2015 were collected and divided into observation group (220 cases) and control group (180 cases).The observation group received topical corticosteroids combined with fusidic acid cream,while the control group was treated only by topical corticosteroid.The medication time reaching to clinical cure,effect maintenance time during 30 d observation period and recurrence rate were recorded in the two groups.Results During the 30 days of observation, 50 cases of infantile eczema withdrew from the study,17 cases in the observation group and 33 cases in the control group.The average medication time in the observation group was (2.2±0.9)d,which was shorter than (3.2±1.1)d in the control group.The effect maintenance time during observation period in the observation group was (11.7±5.4) d,which was longer than (7.2±4.0)d in the control group,the difference was statistically significant(P<0.05);74.0% of recurrent cases during the observation period in the observation group manifested by mild eczema,while 57.8% in the control group manifested by mild eczema and had no need to use corticosteroid,the improvement of symptoms during recurrent period for the patients in the observation group was better than that for the patients in the control group,the difference was statistically significant (P<0.05).Conclusion Topical corticosteroids combined with fusidic acid cream for treating infantile eczema can reduce the medication time,prolong the effect maintenance time,and alleviate the recurrent symptoms.
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Objective:To analyze the clinical efficacy of compound honeysuckle decoction hot and humid joint fusidic acid cream in the treatment of targeted drugs-induced rash.Methods:80 cases of patients with targeted drugs-induced rash admitted in our hospitalfrom August 2014 to August 2016 were selected and divided into two groups with 40 cases in each group according to the drawing method.The control group was treated by fusidic acid cream,while the observation group was treated by compound honeysuckle decoction hot and humid joint fusidic acid cream,the changes of symptom score,quality of life after treatment,clinical efficacy and incidence of adverse reactions were compared between two groups.Results:After treatment,the symptoms score of observation group ((6.87± 1.25) points) was lower than that of the control group ((10.29± 2.74) points)(P＜0.05),the quality of life score ((3.15± 0.57)points) of observation group was lower than that of the control group ((6.42± 1.20) points)(P＜0.05).The effective rate of observation group(95.00％) was higher than that of the control group(77.50％)(P＜0.05),no statistical difference was found in the incidence of adverse reactions was observed between two groups (P＞0.05).Conclusion:Compound honeysuckle decoction hot and humid joint fusidic acid cream was effective in the treatment of targeted drugs-induced rash,it could effectively relieve the clinical symptoms,improve the quality of life.
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ABSTRACT Fusidic acid is an antibiotic steroid indicated for the treatment of infections caused by the genus Staphylococcus, including methicillin resistant Staphylococcus aureus strains, and other Gram-positive bacteria. In the present study, a stability-indicating reversed-phase liquid chromatography (RP-LC) method was developed and validated for the determination of fusidic acid in dermatological cream as an alternative to existing methods. Analyses were performed using a C18 column and guard column at room temperature, eluting with an isocratic mobile phase of acetonitrile and water (72:28, v/v), adjusted to pH 3.5 with acetic acid, pumped at a flow rate of 1.0 mL min-1, detection at 210 nm and 20 µL of injection volume. The forced degradation study was conducted under acidic, alkaline, neutral, photolytic, and oxidative stress conditions. The method was validated according to ICH and FDA guidelines; it was linear, precise, accurate, selective, and robust over concentrations of 5-95 µg mL-1, with detection and quantification limits of 0.43 and 1.31 μg mL-1, respectively. Therefore, we conclude that this method is suitable for quantifying fusidic acid in pharmaceutical dermatological creams and determining its stability, representing a more economical and practical alternative for routine analysis in quality control.
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Chromatography, High Pressure Liquid/methods , Fusidic Acid/pharmacokinetics , Dermatology/methods , Cosmetic Stability , Chromatography, Reverse-PhaseABSTRACT
Background: Primary pyodermas are one of the most common dermatological diseases. Staphylococcus aureus (S. aureus) is frequently isolated. It has developed resistance to many antimicrobials and Methicillin Resistant Staphylococcus aureus (MRSA) is a major problem. The precipitous usage of topical antimicrobials especially Mupirocin and Fusidic acid has increased the development of multi-resistant strains of S. aureus and in India, few studies have shown susceptibility profile to these drugs. Aim: This study aimed at the clinical and bacteriological profile in primary pyoderma patients, prevalence of MRSA and the resistance pattern of S. aureus to Mupirocin and Fusidic acid. Materials and methods: Patients with primary pyodermas from community were recruited. Gram stain and culture sensitivity was done with swabs taken from the lesions. Antibiotic susceptibility for Sethi P, Betkerur J, Sethi P, Adhlakha B, Kulkarni M, Murthy KC. A study on community associated Staphylococcus aureus and its susceptibility pattern to Mupirocin and Fusidic acid in primary pyoderma patients. IAIM, 2016; 3(11): 27-35. Page 28 S. aureus was tested using VITEK- 2. Mupirocin and Fusidic acid susceptibility was determined by Estrip method. Observations: A total of 107 patients of primary pyodermas were included. Pyoderma were common in young age group (P = 0.001). Poor hygiene was the main predisposing factor. Furunculosis (45.8%) was the most common pyoderma followed by impetigo and folliculitis (16.8% each). Culture was positive in all except 3. S. aureus was isolated in 61.7% and polymicrobial flora in 13.1%. Prevalence of MRSA was 39.5% (P= 0.066). All strains of S. aureus demonstrated 100% susceptibility to Mupirocin and Fusidic acid. Conclusions: Furunculosis still has the highest incidence in adult population with a high prevalence of MRSA (39.5%). Despite extensive usage of Mupirocin and Fusidic acid, no resistance was found in this part of India.
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Objective To evaluate the efficacy of topicalJinhuang unction combined with oralSangqin mixture forthe patients with moderate to severe acnevulgaris.Methods A total of 72 patients with moderate to severe acne (Pills bury grade 2 or grade 3) were included and divided into a study group and a control group by random number table method, 36 in each group. The patients were treated for 2 months in the study group with topicalJinhuang unction combined with oralSangqin mixture, and in the control group with topical fusidic acid combined with oralSangqin mixture. The number of lesions and the Global Acne GradingSystem (GAGS) score for each patient were obtained and evaluated. The number offollicularPropionibacterium acnes was determined with real-time fluorescence quantitative polymerase chain reaction.Results After treatment, the number of papule (28.69 ± 10.50vs. 36.61 ± 10.10;t=3.262,P=0.002) was significantly less than that in the control group. The pustules was 1(0, 3) and the nodules was 0 (0, 1) in the study group, which were significantly less than those of 3(0, 15) and 0 (0, 4) in the control group (P<0.01). The GAGS scores was 13(6, 24), which was significantly less than those of 20(17, 32) in the control group significantly lower (Z=-6.482,P<0.01). The number reduction rate of follicular Propionibacterium acnes per unit area in the study group were 43.07% (-57.14%, 86.23%), which was significantly higher than that of 12.68% (-34.52%, 51.11%) in the control group (Z=-2.705,P=0.007). Conclusions TopicalJinhuang unction combined with oralSangqin mixture may reduce the damage of the skin, decrease the numbers of papule, pustules and nodules, depressPropionibacterium acnes in patients with moderate to severe acne vulgaris. TopicalJinhuang unction combined with oralSangqin mixture is superior to topical fusidic acid combined with oralSangqin mixture for the treatment of moderate to severe acne vulgaris.
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Objective To observe the efficacy and safety of fusidic acid cream and halometasone cream in the treatment of psoriasis vulgaris.Methods Fifty-four patients with psoriasis vulgaris were enrolled in this study and were divided into observation group and control group.26 patients in observation group were treated with halometasone cream,28 patients in control group were treated with fusidic acid cream combined with halometasone cream.The psoriasis area and severity index (PASI) and abverse events of treatment were recorded.At the same time,34 normal people taking physical examination were selected as health group,the infections of pathogenic microorganism were compared between psoriasis vulgaris patients and normal people.Results The pathogenic infection rate of patients with psoriasis vulgaris was 72.22％,the infection rate was 75.00％ in observation group and 69.23％ in control group.The infection rate in health group was 38.24％,the difference in the pathogenic infection rate was statistically significant between paitents with psoriasis vulgaris and normal people (P ＜0.05).After treatment,the rate of negative infections was 95.24％ in observation group and 72.22％ in control group,there was significant difference between two groups (P＜0.05).The PASI scores and VAS scores of observation group were significantly lower than those of control group (P＜0.05).The total effective rate of treatment was 71.43％ in observation group and 34.62％ in control group,the difference was statistically significant (P＜0.05).There was no significant difference in rate of adverse events between observation group and control group (P ＞0.05)Conclusion The pathogenic infection is closely correlated with psoriasis vulgaris,fusidic acid cream combined with halometasone cream has good efficacy and safety in treatment of psoriasis vulgaris and worth of popularization and application.
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BACKGROUND: The in vitro activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) from Korea are not well understood. OBJECTIVE: This study aimed to determine the activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant MRSA. METHODS: Clinical isolates of mupirocin-resistant MRSA were collected from two tertiary hospitals. The minimal inhibitory concentrations of mupirocin, fusidic acid, and retapamulin were determined using agar dilution method. Polymerase chain reaction was used to confirm the identity of the species and the presence of resistance genes. Pulsed-field gel electrophoresis (PFGE) patterns of chromosomal DNA were used to determine the genetic similarity of high-level mupirocin-resistant isolates. RESULTS: Of the 497 MRSA isolates tested, 22 (4.4%) were mupirocin-resistant. Of these, 9 (1.8%) and 13 (2.6%) had high-level and low-level mupirocin resistance, respectively. Analysis of the PFGE patterns of the high-level mupirocin-resistant MRSA isolates identified five clusters. All 13 of the low-level mupirocin-resistant isolates were resistant to fusidic acid but susceptible to retapamulin. However, among the 9 high-level mupirocin-resistant isolates, 56% were resistant to fusidic acid, and all were susceptible to retapamulin. CONCLUSION: Retapamulin is highly active in vitro against Korean clinical isolates of high-level mupirocinand methicillin-resistant Staphylococcus aureus with different genetic backgrounds. Fusidic acid is more active against high-level mupirocin-resistant MRSA than low-level mupirocin-resistant MRSA.
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Agar , DNA , Electrophoresis, Gel, Pulsed-Field , Furosemide , Fusidic Acid , Korea , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Microbial Sensitivity Tests , Mupirocin , Polymerase Chain Reaction , Tertiary Care CentersABSTRACT
BACKGROUND: The in vitro activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) from Korea are not well understood. OBJECTIVE: This study aimed to determine the activities of retapamulin and fusidic acid against clinical isolates of mupirocin-resistant MRSA. METHODS: Clinical isolates of mupirocin-resistant MRSA were collected from two tertiary hospitals. The minimal inhibitory concentrations of mupirocin, fusidic acid, and retapamulin were determined using agar dilution method. Polymerase chain reaction was used to confirm the identity of the species and the presence of resistance genes. Pulsed-field gel electrophoresis (PFGE) patterns of chromosomal DNA were used to determine the genetic similarity of high-level mupirocin-resistant isolates. RESULTS: Of the 497 MRSA isolates tested, 22 (4.4%) were mupirocin-resistant. Of these, 9 (1.8%) and 13 (2.6%) had high-level and low-level mupirocin resistance, respectively. Analysis of the PFGE patterns of the high-level mupirocin-resistant MRSA isolates identified five clusters. All 13 of the low-level mupirocin-resistant isolates were resistant to fusidic acid but susceptible to retapamulin. However, among the 9 high-level mupirocin-resistant isolates, 56% were resistant to fusidic acid, and all were susceptible to retapamulin. CONCLUSION: Retapamulin is highly active in vitro against Korean clinical isolates of high-level mupirocinand methicillin-resistant Staphylococcus aureus with different genetic backgrounds. Fusidic acid is more active against high-level mupirocin-resistant MRSA than low-level mupirocin-resistant MRSA.
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Agar , DNA , Electrophoresis, Gel, Pulsed-Field , Furosemide , Fusidic Acid , Korea , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus , Microbial Sensitivity Tests , Mupirocin , Polymerase Chain Reaction , Tertiary Care CentersABSTRACT
BACKGROUND: Clean dermatologic procedures create wounds with a low risk of infection (usually up to 5%). Whether the use of topical antibiotics is advocated, with regard to its efficacy and safety issues such as antibiotic resistance and sensitizing potential, is controversial. Fusidic acid, a topical antibiotic against gram-positive bacteria, is a rare sensitizer and commonly used in postprocedure care in Korea. OBJECTIVE: This is a retrospective study aimed at comparing the efficacy and safety between fusidic acid and petrolatum for the postprocedure care of clean dermatologic procedures. METHODS: Patients were treated with either fusidic acid or petrolatum ointment, applied on the wound created during clean dermatologic procedures such as biopsy of the punch, incisional, excisional, and shave types. The efficacy, adverse events, and subjective level of satisfaction were retrieved from medical records. RESULTS: A total of 414 patients with a total of 429 wounds were enrolled. The overall rate of adverse events was 0.9%, and the rates of adverse events in the fusidic acid group and the petrolatum group were 1.4% and 0.5%, respectively (p=0.370). There was no wound discharge, pain, tenderness, swelling, induration, or dehiscence in both groups. The patients' self-assessment of the wound was not significantly different between the two treatment groups. CONCLUSION: Our findings support the hypothesis that the routine prophylactic use of topical antibiotics is not indicated for clean dermatologic procedures. We recommend the use of petrolatum in the postoperative care of clean dermatologic procedures because of its equivalent efficacy and superior safety profiles.
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Humans , Anti-Bacterial Agents , Biopsy , Dermatologic Surgical Procedures , Drug Resistance, Microbial , Fusidic Acid , Gram-Positive Bacteria , Korea , Medical Records , Petrolatum , Postoperative Care , Retrospective Studies , Self-Assessment , Wound Healing , Wounds and InjuriesABSTRACT
BACKGROUND: Lepra reactions occur in 10-30% of patients with leprosy. The standard of treatment is prednisone. However , prolonged steroid use may cause side effects such as osteoporosis, hypertension, hyperlipidemia, atherosclerosis and infections. Fusidic acid targets cytokine systems responsible for the production of Type 1 lepra reaction (T1R) and erythema nodosum leprosum (ENL). It may be given as a steroid-sparing agent in treating lepra reactions. OBJECTIVE: To determine the safety and efficacy of fusidic acid as a steroid-sparing agent in the treatment of Type 1 and Type 2 lepra reactions. METHODS: A randomized controlled trial was conducted on 67 subjects with lepra reactions, aged 18-60, each assigned to receive either prednisone or prednisone + fusidic acid for 12 weeks. Severity of lepra reactions were graded quantitatively using a modified scale by Walker et al and van Brakel et al, and qualitatively using modified National Leprosy Control Program (NLCP) Guidelines at baseline, weeks 2,4,6,8,10 and 12. Doses of prednisone needed to control lepra reactions were also noted at each follow up and statistical analyses were done . Adverse reactions were noted. RESULT: Sixty subjects (89.55%) completed the study. The prednisone + fusidic acid group had lower quantitative and qualitative scores compared to the prednisone group. There were significant differences between the two groups for the quantitative severity scores (p=1.44x10-11) and qualitative severity grading (p=9.36x10-14) at week 12. The mean dose of prednisone was 21.5 mg in the prednisone group and 2 mg in the prednisone + fusidic acid group at week 12 (p=1.01x10-12). No adverse reactions were reported. CONCLUSION: Fusidic acid tablet 250mg/tab two tablets three times a day is an effective and safe steroid-sparing agent for the treatment of lepra reactions.