Antibiotic sensitivity pattern of bacterial isolates in patients with chronic rhinosinusitis in Kaduna, Nigeria

Introduction: A common practice in the management of patients with chronic rhinosinusitis (CRS), the empirical use of antibiotics may contribute to treatment failure and to the development of antimicrobial resistance. Objective: To determine the antibiotic sensitivity pattern of aerobic and anaerobic bacteria associated with CRS. Methods: This was a prospective cross-sectional study in which endoscopically guided middlemeatal swabs (IBMSpss, version 16.0, Chicago, IL, USA) were aseptically taken from patients diagnosed with CRS after obtaining informed consent and ethical clearance. The samples were sent to the laboratory for qualitative and semiquantitative analysis via gram stain, aerobic, anaerobic cultures and antibacterial sensitivity tests. The collected data was analyzed using SPSS for Windows, version 16 (SPSS Inc, Chicago, IL, USA). Simple statistical parameters and paired sample t-test were used, as appropriate. Results: There were 74 (56.92%) bacterial growths, out of which 55 (74.32%) were aerobic and 19 (25.68%) were anaerobic isolates, from a total of 130 patients. About 13 (17.5%- 18%) of these bacterial growths yielded a mixed growth of aerobic and anaerobic isolates. Themost common bacterial isolates were 26 (35.14%) Staphylococcus aureus, Haemophilus influenzae 9 (12.16%), Streptococcus viridians 8 (10.81%), and Streptococcus pneumoniae 5 (6.76%). Augmentin, ciprofloxacin, and Peflacine were found to bemost effective, followed by levofloxacin, Rocephin, erythromycin and Zinat in that order (AU)

Simultaneous Determination of 2 Main Components in Ticarcillin Disodium and Potassium Clavulanate for Injection by Improved HPLC / 中国药房

OBJECTIVE:To improve the method for the determination of 2 main components in Ticarcillin disodium and potas-sium clavulanate for injection. METHODS:HPLC was performed on the column of Waters XBridgeTM C18 with mobile phase of 0.01 mol/L ammonium dibasic phosphate solution(pH 7.0)-menthol(80:20,V/V)at a flow rate of 1.0 mL/min,the detection wave-length was 220 nm, column temperature was 30 ℃, and injection volume was 20 μL. RESULTS:The linear range was 1.95-195.22 μg/mL for ticarcillin (r=0.9999) and 0.12-12.18 μg/mL for clavulanate(r=0.9999);RSDs of precision,stability (under 4 ℃) and reproducibility tests were lower than 1.0%;recoveries were 99.3%-100.5%(RSD=0.4%,n=9) and 99.2%-101.0%(RSD=0.7%,n=9). CONCLUSIONS:The method is rapid,accurate and reliable,and can be used for the determination of 2 main components in Ticarcillin disodium and potassium clavulanate for injection.

Susceptibilidad antimicrobiana de dos periodontopatógenos a moxifloxacina y amoxicilina ácido clavulánico / Antimicrobial susceptibility of moxifloxacin and amoxicillin clavulanic acid against two periodontopathogens

Fundamento: se ha documentado un aumento importante de la resistencia de algunos perio-dontopatógenos a los antimicrobianos usados de forma tradicional como coadyuvantes en la terapia periodontal. Objetivo: evaluar la susceptibilidad de Aggregatibacter actinomycetemcomitans y Porphyromonas gingivalis a la moxifloxacina y amoxicilina ácido clavulánico en pacientes con periodontitis crónica. Métodos: se realizó un estudio observacional de corte transversal el universo estuvo constitui-do por 30 pacientes con periodontitis crónica. La toma y procesamiento de las muestras microbiológicas se realizaron mediante protocolos descritos de forma previa. Para evaluar la susceptibilidad de A. actinomycetemcomitans y P. gingivalis frente a la moxifloxacina y amoxicilina ácido clavulánico, se usaron pruebas de difusión en disco. Resultados: P. gingivalis fue el microorganismo más prevalente en la población estudiada. Los dos periodontopatógenos cultivados fueron muy sensibles a los dos antimicrobianos evaluados. Conclusiones: A. actinomycetemcomitans y P. gingivalis son muy susceptibles a la moxifloxacina y la amoxicilina ácido clavulánico en la población estudiada, donde se convierte de esta manera en una alternativa coadyuvante para el tratamiento de la periodontitis.

Background: a significant increase in the resistance of some antimicrobial periodontopathogens traditionally used as adjuncts in periodontal therapy has been reported. Objective: to assess the susceptibility of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis to moxifloxacin and amoxicillin clavulanic acid in patients with chronic periodontitis. Methods: an observational cross-sectional study of the universe composed of 30 patients with chronic periodontitis was conducted. Microbiological samples processing were performed following protocols described previously. Disk diffusion tests were used to assess the susceptibility of A. actinomycetemcomitans and P. gingivalis against moxifloxacin and amoxicillin clavulanic acid. Results: P. gingivalis was the most prevalent microorganism in the population studied. The two periodontopathogens grown were highly sensitive to both antimicrobials tested. Conclusions: A. actinomycetemcomitans and P. gingivalis are highly susceptible to moxifloxacin and amoxicillin clavulanic acid in this population, therefore it is an alternative adjuvant for the treatment of periodontitis.

Influence of moisture on stability of amoxicillin and potassium clavulanate granules / 中国药学杂志

OBJECTIVE: To investigate the influence of moisture including water content and water activity on the stability of amoxicillin and potassium clavulanate granules according to the characteristics of the granules, and reveal the key quality control property in the preparation process with stability as an indicator. METHODS: Under the condition of (25±2)℃ and (75±5)% RH, the water content, active ingredient contents, related substances and characteristics of crystal form of amoxicillin and potassium clavulanate granules were studied. RESULTS: The stability of amoxicillin and clavulante potassium granules was positively correlated with water activity in the samples, but was not related to water content closely. The sample with lower water activity was of higher stability. CONCLUSION: The key quality control property of amoxicillin and potassium clavulanate granules is the moisture, and the key process parameter in the preparation is the water activity.

Studies on the formation and synthetic mechanism of related substance G in potassium clavulanate production

The objective of this study was to investigate the formation and synthetic mechanism of related substance G in potassium clavulanate production. The impurity in the potassium clavulanate final product, with a retention time of 13.5 min, was confirmed as related substance G by high performance liquid chromatography-mass spectrometry/mass spectrometry. Related substance G analysis during the production of clavulanic acid showed that this impurity could be synthesized during fermentation, and the amount increased with the fermentation time. Studies on its synthetic mechanism showed that L-tyrosine and succinic acid were the precursors for biosynthesis of related substance G in vivo. The reaction was deduced to be catalyzed by an enzyme. The enzyme was a type of extracellular enzyme present in the fermentation supernatant.

O objetivo deste estudo foi investigar a formação e o mecanismo sintético da substância G relacionada na produção de clavulanato de potássio. A impureza do produto final clavulanato de potássio, com tempo de retenção de 13,5 min, foi confirmada como substância G relacionada por cromatografia líquida de alta eficiência-espectrometria de massas/espectrometria de massas. A análise da substância G relacionada durante a produção do ácido clavulânico mostrou que essa impureza poderia ser sintetizada durante a fermentação e que a quantidade aumenta com o tempo de fermentação. Estudos do seu mecanismo sintético mostraram que a L-tirosina e o ácido succínico foram os precursores in vivo para a biossíntese da substância G relacionada. Deduziu-se que a reação foi catalisada por uma enzima. A enzima foi do tipo extracelular, presente no sobrenadante da fermentação.

Studies on the formation and forming mechanism of the related substance E in potassium clavulanate production by HPLC-MS/MS

The objective of this study was to investigate the formation and forming mechanism of the related substance E in potassium clavulanate production. The impurity with retention time of 11.1 min in potassium clavulanate final product was confirmed as the related substance E by high performance liquid chromatography with tandem mass spectrometric detection (HPLC-MS/MS).The related substance E analysis during the production of clavulanic acid showed that this impurity could be formed during both the fermentation and purification processes, especially in the later fermentation stage, filtration concentration and back-extraction procedure. Clavulanic acid was the precursor of the related substance E. Studies on its forming mechanism showed that the related substance E was formed by the combination of the imino group of one molecule of clavulanic acid with the carboxyl group of another molecule of clavulanic acid with the opening of β-lactam ring. Results of a multi-factor orthogonal test confirmed that the concentration of clavulanic acid was the dominant factor to accelerate the reaction, while the temperature was another contributing factor. The pH 5.0-6.5 had little impact on the generation of the related substance E.

O objetivo deste estudo foi investigar a formação da substância E e o respectivo mecanismo na produção de clavulanato de potássio. Confirmou-se a impureza com tempo de retenção de 11,1 min no produto final, clavulanato de potássio, como substância E, por meio de cromatografia líquida de alta eficiência, em conjunto com detecção por espectrometria de massas (CLAE-MS-MS). A análise da substância relacionada E durante a produção do ácido clavulânico mostrou que essa impureza pode ser formada tanto durante a fermentação quanto durante os processos de purificação, especialmente no estágio final de fermentação, filtração, concentração e procedimento de extração. O ácido clavulãnico foi o precursor da substância E. Estudos no mecanismo de sua formação mostraram que a substância E formou-se pela combinação do grupo imina da molécula do ácido clavulânico com o grupo carboxílico de outra molécula de ácido clavulânico, com a abertura do anel β-lactâmico. Resultados do teste ortogonal multifatorial confirmaram que a concentração do ácido clavulânico foi o fator dominante para acelerar a reação, enquanto a temperatura foi outro fator que contribuiu. O pH de 5,0 a 6,5 teve pouco impacto na geração da substância E.

Efficacy and Safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in Comparison with Cefuroxime Axetil in Patients with Lower Respiratory Tract Infections.

Objectives: To evaluate the efficacy and safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in comparison with Cefuroxime Axetil in patients with Lower Respiratory Tract Infections.Methods:In this open, randomized, and controlled, parallel-group study of 7 days, 57 patients of both gender above 18 years of age with diagnosis of lower respiratory tract infection were randomized to receive Fixed Dose Combination (FDC) of Cefpodoxime Proxetil plus Potassium Clavulanate (Cefchamp), or Cefuroxime Axetil (CA) for a period of 7 days. Efficacy was assessed by symptoms of cough, dyspnoea, wheezing, Rhonchi, and chest pain based on 4-point scale as 0=none,1=mild, 2=moderate, 3=severe. Fever was recorded as the patient’s actual temperature. Safety assessment included adverse events and adverse drug reactions during the study period.Results: Three patients lost to follow up with CA.The improvement in all symptoms except cough was greater with CC as compared to CA group(p, >0.05). Fever improved from 37.18°C at baseline to 37.01 on day 3 with CC, whereas with CA the fever improved from 37.l5 at baseline to 37.05 on day 3 with CA. Fever subsided in all the patients in both treatments by day 5 of study therapy. Clinical cure was seen in 57.14% (16/28) patients on CC, whereas 42.3% patients (11/26) on CA had clinical cure.Conclusions:The fixed dose combination of Cefpodoxime Proxetil 200 mg and Potassium Clavulanate 125mg (Cefchamp) in comparison with Cefuroxime Axetil 500 mg showed improvement in the cure of respiratory tract infections in terms of decreasing the patient’s LRTI symptoms, improving the patient’s general health and with few adverse events and adverse drug reactions. However, further studies of greater sample size and blinded nature are needed to further substantiate this effect.

A Randomized, Double-blinded, Open Label Study of the Efficacy and Safety of Cefcapene Pivoxil and Amoxicillin, Clavulanate in Acute Presumed Bacterial Rhinosinusitis

OBJECTIVES: Currently established first line therapy of acute (presumed bacterial) rhinosinusitis (ARS) consists of 10 to 14 days of oral amoxicillin or cephalosporins. This study compared the clinical efficacy and tolerance of cefcapene pivoxil (CP) and amoxicillin-clavulanate (AMC) in patients with ARS. METHODS: A randomized, open labeled, double-blinded trial of ARS patients over 15 years of age was performed. Patients diagnosed with ARS received paranasal sinus X-rays and nasal endoscopies and 2 weeks of either CP (150 mg, 3 times/ day) or AMC (625 mg, amoxicillin 500 mg, 3 times/day). All patients revisited the clinic on days 7, 14, and 28 for evaluation of changes in symptoms, endoscopy, and monitoring of any adverse reactions. Demographics, clinical characteristics and drug efficacy were also compared between the two groups. RESULTS: Among the 60 initially enrolled patients (CP 30, AMC 30), 5 patients in the CP group and 6 in the AMC group were excluded due to poor compliance. There were no significant differences in demographic data including age, sex, initial signs and symptoms, endoscopic and X-ray findings between the two groups. Rates of improvement after 2 weeks were 96% and 95.8% in the CP and AMC group, respectively. Sinus symptoms were changed significantly after 2 and 4 weeks, however, there was no difference between groups (P=0.41). The most common adverse reaction was gastrointestinal complication, diarrhea occurred in 1 patient in the CP group and 6 in the AMC group (P=0.04). CONCLUSION: CP and AMC were both effective in treating ARS. The difference of treatment outcome was not found between the two groups, however, gastrointestinal complications were less prevalent in the CP group.

Amoxicillin Clavulanic Acid Induced Stevens-Johnson Syndrome / 대한이비인후과학회지

The Stevens-Johnson syndrome is a severe form of erythema multiforme associated with multiple organ involvement that can result in severe mortality. Various etiologic factors have been reported to include drugs, bacteria, virus, etc. We experienced a case of amoxicillin clavulanic acid induced Stevens-Johnson syndrome with the involvement of oral mucosa, skin, and conjunctiva. This patient was treated with steroid and supportive care.

Cost-effectiveness Analysis on Drug Combination of 2 Kinds of Antibiotics in the Treatment of Children's Pneumonia / 中国药房

0.05);The costs of the two were926.40yuan and1370.30yuan respectively(P