Mesoporous nano-bioactive glass microspheres as a drug delivery system of minocycline / 北京大学学报(医学版)

OBJECTIVE@#To construct mesoporous nano-bioactive glass (MNBG) microspheres load-release minocycline as an antibacterial drug delivery system.@*METHODS@#Sol-gel method was used to synthesze MNBG microspheres as drug carrier. The MNBG consisted of SiO2, CaO, and P2O5. According to the content of silicon, MNBG microspheres were divided into four groups (60S, 70S, 80S and 90S). Scanning electron microscopy (SEM) was used to observe the surface characteristic and particle size of MNBG; Nitrogen adsorption-desorption experiment was performed to calculate the MNBG's specific surface area and the pore sizes; The Fourier transform infrared spectrum (FT-IR) and the thermogravimetric analysis were conducted to calculate the loading efficiencies of minocycline hydrochloride; UV spectrophotometric was used to determine the cumulative release of minocycline from drug-loaded particles in PBS solution within 21 d. Agar diffusion test (ADT) was performed to evaluate the antibacterial properties on Enterococcus faecalis. The inhibition zone was observed and the diameter was measured.@*RESULTS@#The MNBG microspheres had good dispersion, large surface area, and even particle size. The pore sizes ranged from 4.77 nm to 7.33 nm. The loading experiment results showed that the minocycline hydrochloride loading efficiency of MNBG was related to the pore size of the microspheres. Among 60S, 70S, 80S and 90S, 60S MNBG had the highest loading efficiency of 16.33% due to its high calcium content and large pore sizes. A slow minocycline release rate from MNBG particles in PBS solution until d 21 was observed. It was showed that a burst release of 28% of the total drug for the first 24 h. A cumulative release of 35% was found, and the final concentration of minocycline maintained at about 47 mg/L. ADT showed that mino-MNBG had inhibitory effect on the growth of Enterococcus faecalis. 1 g/L minocycline, 1 g/L mino-MNBG, and 0.1 g/L minocycline presented inhibition zone, however, PBS and 1 g/L MNBG didn't. The diameter of the inhibition zone of minocycline groups was significant larger than that of mino-MNBG group (P<0.05), which was also significant larger than those of PBS and MNBG groups (P<0.05). It showed that mino-MNBG drug delivery system had antibacterial properties on Enterococcus faecalis.@*CONCLUSION@#The 60S MNBG that can effectively load and release minocycline may be an ideal drug carrier.

Pseudotumor cerebral secundario al consumo de minociclina en un paciente pediátrico / Pseudotumor cerebri secondary to consumption of minocycline in a pediatric patient

El pseudotumor cerebral se caracteriza por una elevación de la presión intracraneal mayor de 20 cmH2O, con ventrículos y líquido cefalorraquídeo de características normales. El consumo de minociclina es una de las causas asociadas a este síndrome. Presentamos una paciente de 13 años de edad con antecedentes de acné tratado con minociclina. Comenzó con cefalea intensa, diplopía y visión borrosa. Se constató el diagnóstico de pseudotumor cerebral y se indicó la suspensión inmediata del antibiótico y el inicio del tratamiento con acetazolamida. Aunque la patogénesis de pseudotumor cerebral no es totalmente conocida, se ha observado una asociación con el empleo de minociclina. Este antibiótico es de uso frecuente para el manejo del acné, por lo que es importante considerar sus complicaciones antes de ser prescrito.

Pseudotumor cerebri is a syndrome characterized by an elevated intracranial pressure greater than 20 cmH2O with ventricles and cerebrospinal fluid of normal characteristics. Consumption of minocycline have been described among the causes associated with this syndrome. We present a 13-year old female patient with a history of acne treated with minocycline who began with severe headache, diplopia and blurred vision. The diagnosis of pseudotumor cerebri was made, indicating the immediate antibiotic suspension and the beginning of the treatment with acetazolamide. Although the pathogenesis of pseudotumor cerebri is not fully known, an association with minocycline has been observed. This antibiotic is often used by health professionals for the management of acne, so it is important to consider its complications before being prescribed.

Evaluación de la eficacia y seguridad de tigeciclina en el tratamiento de infecciones del tracto respiratorio: Revisión sistemática de la literatura científica / Evaluation of the efficacy and safety of tigecycline for treatment of respiratory tract infections: Systematic review of literature

Background: Tigecycline is indicated for the treatment of complicated skin infections, soft tissue and intraabdominal infections. Its use could be extended to community-acquired pneumonia (CAP) and hospital pneumonia (HN). The objective was to evaluate the efficacy and safety of tigecycline in the treatment of respiratory infections. Methods: systematic review (2012). Databases used were MEDLINE, EMBASE, Cochrane Library, CRD and WOK. We identified clinical trials of adults with respiratory infection, treated with tigecycline. The quality of the studies was assessed using CASPe checklist. Results: We selected four clinical trials of high-moderate quality. Three studies with patients with CAP and a trial with HN patients. In patients with CAP, efficacy of tigecycline (88.6 to 90.6%) was higher than levofloxacin (85.3 to 87.2%). The non inferiority testing was statistically significant (p < 0.001). In the study of patients with HN tigecycline showed an efficiency of 67.9% versus 78.2% for imipenem/cilastatin. Main adverse effects were gastrointestinal. Conclusions: The efficacy of tigecycline is non inferior than levofloxacin in patients with CAP, but less than imipenem in patients with HN. Tigecycline demonstrates noninferiority versus others tested antibiotics, and it shows a good safety profile.

Introducción: Tigeciclina está indicada en el tratamiento de infecciones complicadas de piel, tejidos blandos e intra-abdominales. Su utilización podría extenderse para neumonías adquiridas en la comunidad (NAC) y neumonías hospitalarias (NH). El objetivo ha sido evaluar la eficacia y seguridad de tigeciclina en el tratamiento de infecciones respiratorias. Material y Métodos: Revisión sistemática (2012). Se realizaron búsquedas en MedLine, Embase, Cochrane Library, CRD y WOK. Se localizaron ensayos clínicos de adultos con infección respiratoria, tratados mediante tigeciclina. La calidad de los estudios se valoró mediante los criterios CASPe. Resultados: Se seleccionaron cuatro ensayos clínicos de calidad alta-moderada. Tres estudios incluyeron pacientes con NAC y un estudio a pacientes con NH. En pacientes con NAC la eficacia de tigeciclina (88,6-90,6%) fue no inferior a la de levofloxacina (85,3-87,2%). El "test de no inferioridad" fue estadísticamente significativo (p < 0,001). En el estudio de pacientes con NH, tigeciclina presentó una eficacia de 67,9% frente a 78,2% de imipenem/cilastatina. Los principales efectos adversos fueron gastrointestinales. Conclusiones: la eficacia de tigeciclina es no inferior a la de levofloxacina en pacientes con NAC, pero inferior a imipenem en pacientes con NH. Tigeciclina ha demostrado no inferioridad frente a los otros antimicrobianos testados. Tigeciclina demuestra tener un buen perfil de seguridad.

Adverse effects of alternative therapy (minocycline, ofloxacin, and clofazimine) in multibacillary leprosy patients in a recognized health care unit in Manaus, Amazonas, Brazil / Efeitos adversos das drogas (minociclina, ofloxacina e clofazimina) utilizadas no esquema alternativo para pacientes com hanseníase multibacilar, em unidade de referência, Manaus, Amazonas, Brasil

BACKGROUND: After the introduction of the multidrug therapy, there was a decline in the coefficients of prevalence and detection of new cases of leprosy. However, the records of drug resistance and relapses are threatening factors in leprosy control. Hence, new alternative schemes and monitoring of adverse effects to avoid treatment abandonment are important considerations. OBJECTIVE: Describe the side effects of a multidrug regimen containing minocycline, ofloxacin, and clofazimine in multibacillary leprosy patients. METHODS: We conducted a prospective, descriptive, and observational study with multibacillary patients, including cases of intolerance to standard MDT and relapses. The study was carried out at Fundação Alfredo da Matta (Alfredo da Matta Foundation), in Manaus, Amazonas, from April 2010 to January 2012. The patients received alternative therapy, which consisted of daily self-administered doses of 100mg of minocycline, 400 mg of ofloxacin, and 50mg of clofazimine and a supervised monthly dose of 300mg of clofazimine for six months, followed by eighteen months of daily doses of ofloxacin 400mg, clofazimine 50mg, and a supervised monthly dose of clofazimine 300mg. Results: Twenty-one cases were included. Mild and transitory side effects occurred in 33.3% of patients. Of the total episodes, 45.9% were attributed to ofloxacin and they included abdominal pain, nausea, vomiting, headache, and insomnia; 21.6% were due to clofazimine, with 100% of patients presenting skin pigmentation. The mean time for the development of adverse effects after beginning the therapy was 15.2 days. CONCLUSION: All patients tolerated the drugs well, and compliance was satisfactory, with no serious events. Unlike other standard MDT studies ...

FUNDAMENTOS: Após introdução do esquema poliquimioterápico padrão, houve declínio nos coeficientes de prevalência e detecção de casos novos; entretanto, os registros de resistência medicamentosa e recidivas representam ameaça para o controle da hanseníase. Dessa forma, a proposição de novos esquemas alternativos e a necessidade de monitorar efeitos adversos são importantes para evitar o abandono do tratamento. OBJETIVO: Descrever efeitos adversos do esquema alternativo contendo clofazimina, ofloxacina e minociclina em pacientes com hanseníase multibacilar. MÉTODOS: Estudo prospectivo, descritivo e observacional de casos multibacilares, incluindo recidivas ou intolerância à poliquimioterapia padrão, realizado na Fundação Alfredo da Matta, Manaus, Amazonas, de abril de 2010 a janeiro de 2012. Os indivíduos receberam a terapia composta de doses diárias auto-administradas de 100mg de minociclina, 400mg de ofloxacina e 50mg de clofazimina e mensais supervisionadas de 300mg de clofazimina por seis meses, seguidas de 18 meses de doses diárias de ofloxacina 400mg, clofazimina 50 mg e supervisionadas mensais de clofazimina 300mg. Resultados: 21 pacientes foram incluídos. Efeitos adversos leves e transitórios foram observados em 33,3% dos pacientes; 45,9% foram atribuídos à ofloxacina, como dor abdominal, náuseas, vômitos, cefaléia e insônia; 21,6% foram associados à clofazimina, com relatos e observação em 100% dos pacientes de hiperpigmentação cutânea. O tempo médio de desenvolvimento das reações adversas a partir do início do esquema foi de 15,2 dias. ...

Minocycline-induced Periarticular Black Bones in Inflamed Joints Which Underwent Arthroplastic Reconstruction

BACKGROUND: Minocycline-induced pigmentation of bone (black bone) is well described in tooth-bearing intra-oral bone, but is less known in periarticular bone in patients who have undergone total joint arthroplasty. On a retrospective basis, we investigated the short-term clinico-radiological results of total joint arthroplasties in which the patient developed minocycline-induced periarticular black bone. METHODS: We found 5 cases (0.08%), in 4 patients, of periarticular bone pigmentation revealed during total joint arthroplasties (2 hips, 2 knees, and 1 ankle) in our series of total joint surgeries (6,548 cases) over a 10-year time period in our 3 institutes. Their mean age was 56 years at surgery. All patients had received long-term minocycline treatment. Mean dosage and duration of minocycline was 160 mg/day and 2.2 years, respectively. Minocycline had been prescribed for reactive arthritis (one), rheumatoid arthritis (two) and late infection after total joint arthroplasty (two patients). Mean follow-up period was 3.4 years after the surgeries. RESULTS: All cases had black or brown pigmentation in the periarticular bones during the surgery. There was no pigmentation in the cartilage or soft tissues of the joints. The mean Japanese Orthopaedic Association (JOA) score or Japanese Society for Surgery of the Foot (JSSF) scale for rheumatoid arthritis foot and ankle joints at latest follow-up (case 1, 66; case 2, 87; case 3, 77; case 4, 77; case 5, 80) improved compared to those of pre-surgery (case 1, 47; case 2, 45; case 3, 55; case 4, 34; case 5, 55). No implant loosening was noted on radiographic examination during the follow-up period. No abnormal bone formation, bone necrosis, hemosiderin deposition, malignancy or metallic debris was found on histological examination. CONCLUSIONS: No clinico-radiological symptoms of total joint arthroplasties showed in the patients with minocycline-induced periariticular black bone in the short-term. Systemic minocycline treatment has the potential to induce significant black pigmentation of many tissues. In particular, minocycline-induced pigmentation of periarticular bone may be accelerated by inflammation due to rheumatic or pyogenic arthritis. Surgeons should recognize the risk of bone pigmentation in inflamed joints due to the systemic treatment of minocycline and explore its influence on periarticular bone and total joint arthroplasty in the long-term.

Pomegranate protects minocycline induced epidermal pigmentation in the extremities of guinea pig

To investigate the protective effects of Pomegranate on Minocycline induced epidermal pigmentation on the extremities of guinea pigs. An experimental observational study. This study was conducted at the Anatomy Department, BMSI, J PMC, Karachi. 60 adult guinea pigs were divided into 3 groups A B and C, A served as control, B given Minocycline, while C given Minocycline with pomegranate for 8 weeks, after which their skin was processed for histological examination and pigmentation was observed in Masson Fontana stained sections under light microscope. The melanin pigmentation deposition observed in Minocycline treated group B, distributed densely and extended till stratum corneum as compared to the control group A, while in the Pomegranate treated group c along with Minocycline, the melanin pigmentation was considerably reduced and was observed to be distributed sparsely extended till stratum spinosum. Based on the present study it is conducted that pigmentary changes induced by Minocycline can be protected by taking pomegranate

A Case of Anaphylaxis to Oral Minocycline

Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. To date, there has been only one case report of anaphylaxis to minocycline. We report here a case of anaphylaxis to oral minocycline. A 56-yr-old woman visited our hospital after three episodes of recurrent anaphylaxis. We performed an oral challenge test, the standard method for diagnosing drug allergies, with minocycline, one of the drugs she had taken previously. She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid. However, she presented similar symptoms at 50 min and at 110 min. In prescribing oral minocycline, physicians should consider the possibility of serious adverse reactions, such as anaphylaxis.

Tigeciclina: Una revisión sistemática de la experiencia clínica en sus primeros años de uso: [revisión] / Tigecycline: A systematic review of clinical experience during first years of prescription: [review]

The available clinical experience with tigecycline is analyzed under the perspective of a systematic review of the literature, so in the already approved indications as in those off label indications reported in the recent literature. The safety profile is checked in the above mentioned clinical trials. The available information allows supporting tigecycline efficiency in the managing of complicated skin and soft tissues infections, complicated intrabdominales infections and community acquired pneumonias. Its usefulness is insinuated in addition in the managing infection by pathogen with high-level of resistance to antimicrobial. Nevertheless it is needed of major evidence in the matter and of a very sensible policy of use in the healthcare institution setting.

Se analiza, bajo la perspectiva de una revisión sistemática de la literatura científica, la experiencia clínica con tigeciclina en las indicaciones ya aprobadas por las entidades reguladoras y en aquellas indicaciones off label reportadas en la literatura médica reciente. Se revisa el perfil de seguridad y tolerabilidad en dichos ensayos clínicos. La información disponible permite avalar su eficacia en el manejo de de infecciones de piel y tejidos blandos complejas, infecciones intrabdominales complicadas y neumonías adquiridas en la comunidad. Se insinúa además su utilidad en el manejo de infecciones por patógenos con alto nivel de resistencia a antimicrobianos. Sin embargo, se requiere de mayor evidencia al respecto y de una muy sensata política de uso en el medio hospitalario.

Uso de antimicrobianos locais em periodontia: uma abordagem crítica / Use of local antimicrobials in periodontics: A critical approach

A presença da placa bacteriana representa o principal fator etiológico envolvido na iniciação e progressão da doença periodontal inflamatória. O tratamento instituído para esta patologia baseia-se essencialmente na eliminação dos patógenos periodontais, através do debridamento mecânico. Entretanto, nem sempre a raspagem e alisamento radicular promovem resultados clínicos satisfatórios, guiando o profissional a buscar meios alternativos para este tratamento. Neste sentido surgiram os antimicrobianos de ação local, sendo atualmente empregados: gel de metronidazol, chip de clorexidina, fibra de tetraciclina, esferas de minociclina e gel de doxiciclina Diversos relatos na literatura sustentam o emprego desses dispositivos e comprovam a sua eficácia clínica.No entanto, aspectos como custo e acessibilidade vêm sendo discutidos a fim de avaliar a real aplicabilidade.O objetivo desta revisão de literatura é fazer uma abordagem crítica a respeito da utilização de antimicrobianos locais no tratamento da doença periodontal enfatizando as suas indicações, vantagens, desvantagens, custo, viabilidade clínica e eficácia terapêutica.

Carcinoma de mama y síndrome de Sweet / Breast carcinoma and Sweet's syndrome

El síndrome de Sweet es una entidad dermatológica poco frecuente, definida como una dermatosis neutrofílica febril aguda. Esta patología presenta características clínicas bien definidad, y en un porcentaje minoritario de pacientes está asociada a neoplasias sólidas. Presentamos el caso de una paciente de 71 años de edad que consulta debido a la aparición de placas eritemato-edematosas infiltradas y dolorosas en miembro superior y región mamaria derechas, extendiéndose a hemiabdomen homolateral y dorso, precedidas por fiebre y escalofríos. Como antecedentes personales de importancia destaca haber padecido cáncer de mama 4 años antes de la aparición de la dermatosis

Tetracycline-induced esophageal ulcer: a condition that probably more common than it appears to be.

Ten cases of tetracycline derivatives related drug induced esophageal ulceration were described. Five cases were due to minocycline and another five were due to doxycycline. Recumbent posture after drug ingestion was one of the predisposing factors. Odynophagia was the main symptom but may not be the presenting symptom. The diagnosis was easily confirmed by endoscopy. Single-contrast barium study was not sensitive for the demonstration of the esophageal ulcers. The recommended treatment includes cessation of the offending drug and symptomatic treatment. All recovered without any sequela within 3 to 11 days. The most important measure to prevent this condition is to instruct patients to take drugs in the upright position with at least 100 ml of water.

Evaluación de la minociclina (minocin) en acné vularis inflamatorio / An evaluation of Minicycline (minocin) in inflamatory acne vulgaris

Se presenta una revisión clínico-terapeútica de la eficacia y tolerancia de la minociclina en relación al acné vulgaris inflamatorio. Se estudiaron un total de 31 pacientes durante 12 semanas. El grupo de estudio fue de 18 varones (58%) y 13 mujeres (42%). La edad promedio fue de 19 años. Las lesiones acneicas que presentaban los pacientes fueron: eritema, edema, infiltración, seborrea, comedones, pápulas, pústulas y quistes. Se concluye que minociclina es una opción para pacientes con problemas acneicos. Los efectos clínicos indeseables fueron mínimos

Púrpura vascular alérgica por minociclina / Allergic vascular purpura caused by minocycline

É apresentado um caso de púrpura vscular alérgica näo-trombocitopénica por minociclina. Após a suspensäo desta tetraciclina o quadro dermatológico regrediu. Houve discreta positividade transitória para FAN e anticorpo anti-DNA (hélice única). Trata-se de uma farmacodemia atípica e rara