Expert perspectives on the clinical use of high-dose amoxicillin with clavulanic acid in pediatric practice in Indian settings

Background: This study was conducted to gather expert opinion regarding the clinical use of a high dose of amoxicillin 600 mg + clavulanic acid 42.9 mg in pediatric practice in Indian settings.Methods: This cross-sectional study comprised 19 questions and gathered perspectives from pediatricians across India regarding the prescription practices of amoxicillin (600 mg) and clavulanic acid (42.9 mg) for various bacterial infections in pediatric patients. Data were analyzed using descriptive statistics.Results: Majority (85.65%) of clinicians opined that the high dose of amoxicillin (600 mg) and clavulanic acid (42.9 mg) was very effective in treating bacterial infections in pediatric patients. About 54% of the respondents reported prescribing 600 mg amoxicillin + 42.9 mg clavulanic acid as the high dose for pediatric patients, while 41% of them prescribed 400 mg amoxicillin + 57 mg clavulanic acid as the high dose for pediatric patients. According to 51% of clinicians, the benefits of prescribing the higher-strength formulation of amoxicillin (600 mg) + clavulanic acid (42.9 mg) compared to the standard-strength formulation of amoxicillin (500 mg) + clavulanic acid (125 mg) include increased effectiveness against resistant bacteria, reduced risk of adverse effects, and reduced frequency of dosing.Conclusions: This study highlighted the clinicians' preference for the high dose of amoxicillin (600 mg) and clavulanic acid (42.9 mg) as an effective treatment for bacterial infections in pediatric patients. The respondents preferred the high dose over other doses of amoxicillin and clavulanic acid due to the lower percentage of adverse effects.

Screening of stable amoxicillin resistant clones of Helicobacter pylori and detection of its gene mutations / 安徽医科大学学报

Objective @# To investigate the phenotype of amoxicillin ( AMX) unstable resistant Helicobacter pylori (Hp) evolving into AMX stable high level resistance and the detection of its mutated genes．@*Methods @#Using the frozen Hp strain H390 as the starting strain，the clones resistant to AMX were continuously cultured on the medium with increasing AMX concentration，and the minimum inhibitory concentration ( MIC) of the resistant clones was detected．After frozen at －80 ℃ for 3 months，the drug resistance was stable according to whether the MIC de- creased after frozen storage． Genome sequencing analysis and efflux pump inhibition assay were performed on cloned H390r and parental strain H390 with the highest AMX MIC value，and gene mutations associated with the high level AMX resistance obtained by H390r were detected and identified. @*Results @#Four AMX high level resistant clones were obtained by AMX screening with MICs of 12，32，64 and ≥ 256 mg / L ，respectively，and none of the MICs were altered after freezing at －80 ℃ . Compared to the parental strain H390，the AMX stable resistant clone H390r had mutations in several genes，including hefC encoding the RND efflux system，hopB and hopC encoding the pore proteins and ftsI encoding the penicillin binding protein ，which were associated with AMX resistance. H390r was substantially reduced in MIC to AMX in the presence of efflux pump inhibitors．@*Conclusion @#AMX can screen stable resistant clones from unstable resistant Hp．H390r had mutations in hefC，hopB，hopC，and ftsI asso- ciated with AMX resistance．These mutations may be the main reason why H390r acquired a stable high level of re- sistance to AMX.

A rare case of patient with severe thrombocytopenia associated with sarcoidosis: a case study

Thrombocytopenia is a problem causing drop in platelet counts through different mechanisms. Patients typically present with petechiae to systemic bleeding, which are indications of a low platelet count. A smaller percentage of drop may be asymptomatic. The major mechanisms include increased sequestration in the spleen, underproduction from the bone marrow, and peripheral destruction. Many etiological factors can cause this. Sarcoidosis is one of the most uncommon etiologies. A careful diagnosis is required because, if the condition is not treated, it can be fatal. Steroid therapy and platelet transfusions remain the mainstay of treatment. Here, we describe a patient who presented with signs and symptoms of severe thrombocytopenia, which further led to the diagnosis of sarcoidosis. An adult male presented to the emergency department with a rash that deteriorated throughout the day. Based on complaints and laboratory testing, severe thrombocytopenia was noted. After a detailed examination and history-taking, he was found to have sarcoidosis. In association with drug administration and sarcoidosis, this could have caused severe thrombocytopenia. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Thrombocytopenia is a disorder where platelet counts drop below 150×109/l due to many different mechanisms. Among different etiological factors, sarcoidosis is the rarest and may present with very severe thrombocytopenia and lead to fatal complications. Such patients require close monitoring and treatment. Corticosteroids and platelet transfusions can be used as treatments. In the presented case, the patient was successfully treated, and on subsequent follow-up, the patient’s condition improved. Manifestations of severe thrombocytopenia can be present even before the diagnosis of sarcoidosis. Further, the history of amoxicillin administration due to infection could have triggered the appearance of thrombocytopenia. Confirmation of sarcoidosis was made via biopsy. Multiple etiological factors that resulted in diagnostic ambiguity in our patient's presentation include the diagnosis of sarcoidosis, a history of infection, amoxicillin, and mild splenomegaly. The patient's treatment and recovery may indicate that corticosteroids, in conjunction with platelet transfusions, are beneficial. This is a novel case report of the presentation of severe thrombocytopenia, which was present even before the diagnosis of sarcoidosis.

A rare case of patient with severe thrombocytopenia associated with sarcoidosis: a case study

Thrombocytopenia is a problem causing drop in platelet counts through different mechanisms. Patients typically present with petechiae to systemic bleeding, which are indications of a low platelet count. A smaller percentage of drop may be asymptomatic. The major mechanisms include increased sequestration in the spleen, underproduction from the bone marrow, and peripheral destruction. Many etiological factors can cause this. Sarcoidosis is one of the most uncommon etiologies. A careful diagnosis is required because, if the condition is not treated, it can be fatal. Steroid therapy and platelet transfusions remain the mainstay of treatment. Here, we describe a patient who presented with signs and symptoms of severe thrombocytopenia, which further led to the diagnosis of sarcoidosis. An adult male presented to the emergency department with a rash that deteriorated throughout the day. Based on complaints and laboratory testing, severe thrombocytopenia was noted. After a detailed examination and history-taking, he was found to have sarcoidosis. In association with drug administration and sarcoidosis, this could have caused severe thrombocytopenia. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Thrombocytopenia is a disorder where platelet counts drop below 150×109/l due to many different mechanisms. Among different etiological factors, sarcoidosis is the rarest and may present with very severe thrombocytopenia and lead to fatal complications. Such patients require close monitoring and treatment. Corticosteroids and platelet transfusions can be used as treatments. In the presented case, the patient was successfully treated, and on subsequent follow-up, the patient’s condition improved. Manifestations of severe thrombocytopenia can be present even before the diagnosis of sarcoidosis. Further, the history of amoxicillin administration due to infection could have triggered the appearance of thrombocytopenia. Confirmation of sarcoidosis was made via biopsy. Multiple etiological factors that resulted in diagnostic ambiguity in our patient's presentation include the diagnosis of sarcoidosis, a history of infection, amoxicillin, and mild splenomegaly. The patient's treatment and recovery may indicate that corticosteroids, in conjunction with platelet transfusions, are beneficial. This is a novel case report of the presentation of severe thrombocytopenia, which was present even before the diagnosis of sarcoidosis.

Absceso en dedo por Escherichia vulneris tras traumatismo con una rama

Introducción: Es importante considerar la posible implicación de microorganismos poco frecuentes en infecciones de piel y partes blandas si la muestra obtenida para cultivo es de buena calidad, y además se aísla en cultivo puro, como ocurre con Escherichia vulneris. Caso Clínico: Presentamos en caso de una mujer de 34 años, sin antecedentes mórbidos, quien desarrolló un absceso en el 4° dedo de la mano tras un traumatismo con una rama y que requirió drenaje quirúrgico y tratamiento antibiótico para su resolución. En el contenido del absceso, se aisló E. vulneris en cultivo puro, con un perfil antibiótico multisensible. Discusión y Conclusión: E. vulneris es una enterobacteria cuya patogenicidad ha estado clásicamente discutida, pero que se ha visto que puede tener participación en infección de heridas, especialmente aquellas relacionadas con material vegetal. Este microorganismo, muy relacionado con E. harmannii, presenta buena sensibilidad a los aminoglucósidos, con excepción a la penicilina y al cotrimoxazol. En las infecciones de piel y tejidos blandos causadas por E. vulneris y que cursen como un absceso, es importante realizar desbridamiento quirúrgico, si es necesario para la resolución completa del cuadro, además del tratamiento con amoxicilina/ácido clavulánico que parece adecuado.

Introduction: It is important to assess the possible involvement of rare microorganisms in skin and soft tissue infections if the sample obtained for culture is of good quality, and is isolated in pure culture, as occurs with Escherichia vulneris. Case Report: We present the case of a 34-year-old woman, with no history of morbidity, who developed an abscess in the 4th finger of the hand after trauma with a branch and which required surgical drainage and antibiotic treatment for its resolution. In the content of the abscess, E. vulneris was isolated in pure culture, with a multisensitive antibiotic profile. Discusion: E. vulneris is an Enterobacteriaceae whose pathogenicity has been classically discussed, but it has been seen that it may have participated in the infection of wounds, especially those related to plant material. This organism, closely related to E. harmannii, shows good sensitivity to aminoglycosides, with the exception of penicillin, and cotrimoxazole. In skin and soft tissue infections caused by E. vulneris and that present as an abscess, it is important to perform surgical debridement if necessary for complete resolution of the condition, in addition to treatment with amoxicillin/clavulanic acid, which seems appropriate.

A Multicenter Clinical Trial of Pudilan Anti-inflammatory Oral Liquid of Different Doses in Treatment of Acute Pharyngitis/Tonsillitis Caused by Bacterial Infection in Adults / 中国实验方剂学杂志

ObjectiveThrough a randomized， double-blind， double-simulation， positive-control， multicenter design， this study aimed to analyze the relationship between the dosage， efficacy， and safety of Pudilan anti-inflammatory oral liquid in treating acute pharyngitis/tonsillitis in adults caused by bacterial infection and validate the regulatory effect of Pudilan anti-inflammatory oral liquid on inflammatory markers such as serum amyloid A （SAA）， C-reactive protein （CRP）， white blood cells （WBC）， neutrophil percentage （NE%）， and erythrocyte sedimentation rate （ESR）， thereby exploring the feasibility of using Pudilan anti-inflammatory oral liquid as a substitute for antibiotics in the treatment of infectious diseases and providing a basis for rational clinical medication. MethodUsing a stratified randomized， double-blind， double-simulation， positive-control， multicenter design， 220 participants were enrolled from nine centers. The participants were randomly divided into three groups at 1∶1∶1 — a Pudilan anti-inflammatory oral liquid 20 mL group （73 cases）， a Pudilan anti-inflammatory oral liquid 10 mL group （73 cases）， and a control group （amoxicillin group， 74 cases）. The treatment course was 7 days. The study observed parameters including the total effective rate of sore throat， onset and disappearance time of sore throat， health status score， treatment time， and inflammation markers. Result①Dataset division： The 211 cases were included in the full analysis dataset （FAS）， 208 cases were included in the per-protocol dataset （PPS）， and 218 cases were included in the safety dataset （SS）. ② Efficacy evaluation： There were statistically significant differences （P<0.05） in the comparison of the three groups regarding the total effective rate of sore throat， disappearance time of sore throat， and health status. Both the 20 mL and 10 mL groups were non-inferior to the control group， and there was a statistically significant difference between the 20 mL and 10 mL dosage groups （P<0.05）. There was no statistically significant difference in the comparison of onset time of sore throat among the groups. CRP， WBC， and NE% of patients in all three groups significantly decreased on the 7th day of treatment compared with those before treatment （P<0.01）. ③Safety evaluation： Adverse events mainly occurred in various examination indicators. There were no statistically significant differences in the comparison between groups， and no adverse reactions or serious adverse events occurred. ④Economic evaluation： The increased cost of the 10 mL and 20 mL dosage groups was entirely justified as compared with that in the control group. When comparing the 10 mL and 20 mL dosage groups， the 10 mL dosage group was deemed less advantageous. ConclusionPudilan anti-inflammatory oral liquid can be used alone as an alternative to antibiotics in the treatment of acute pharyngitis/tonsillitis caused by bacterial infection. It demonstrates good safety and can lower inflammation markers such as CRP， WBC， and NE%， suggesting its potential to reduce the body's inflammatory response. Its mechanism of action may be related to its multi-target regulatory mechanism.

Curative effects of omeprazole combined with amoxicillin on chronic gastritis in 175 patients / 中国基层医药

Objective:To investigate the curative effects of omeprazole combined with amoxicillin on chronic gastritis and patients' quality of life.Methods:A total of 350 patients with chronic gastritis who received treatment in Jinan Seventh People's Hospital from May 2018 to August 2020 were included in this study. They were randomly divided into control and observation groups ( n = 175/group). The control group was treated with omeprazole, and the observation group was treated with omeprazole combined with amoxicillin. Curative effects, inflammatory factor levels, gastric motility, quality of life score, and the incidence of adverse reactions were compared between the two groups. Results:The response rate in the observation group was significantly higher than that in the control group [95.43% (167/175) vs. 86.86% (155/175), χ2 = 5.59, P = 0.018). Before treatment, there were no significant differences in C-reactive protein, interleukin-6, and tumor necrosis factor-α levels between the two groups (all P > 0.05). After treatment, C-reactive protein, interleukin-6, and tumor necrosis factor-α levels in the observation group were (47.97 ± 8.59) mg/L, (38.82 ± 6.29) μg/L, and (38.77 ± 5.92) μg/L, respectively, which were significantly lower than (51.34 ± 9.77) mg/L, (41.20 ± 7.53) μg/L, (41.09 ± 6.85) μg/L in the control group ( t = 3.42, 3.20, 3.39, all P < 0.05). Before treatment, there were no significant differences in serum gastrin-17 and motilin levels between the two groups (both P > 0.05). After treatment, serum gastrin-17 and motilin levels in the observation group were (380.49 ± 61.27) ng/L and (514.42 ± 68.73) ng/L, respectively, which were significantly higher than (362.25 ± 50.16) ng/L and (495.43 ± 61.36) ng/L in the control group ( t = 3.04, 2.72, both P < 0.05). After treatment, the quality of life score in the observation group was significantly higher than that in the control group ( P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Omeprazole combined with amoxicillin is highly effective on chronic gastritis. The combined therapy can reduce inflammatory responses, improve gastric motility, improve patients' quality of life, and is highly safe.

Clinical evaluation of the efficacy against helicobacter pylori by amoxicillin from volume-based procurement and potassium amoxicillin clavulanate / 中国临床药理学与治疗学

AIM: To evaluate the clinical efficacy of amoxicillin from volume-based procurement (VBP) and potassium amoxicillin clavulanate in the eradication of helicobacter pylori (Hp) infection, providing basis for the selection of treatment programs. METHODS: Data from the patients who received Hp eradication therapy from May 2021 to May 2022 were recruited from the rational drug use management system. The data from the patients treated by amoxicillin (amoxicillin 1.0 g bid + bismuth potassium citrate 220 mg bid + esomeprazole 20 mg bid + clarithromycin 0.5 g bid, for 14 days) and potassium amoxicillin clavulanate (potassium amoxicillin clavulanate 0.914 g bid + bismuth potassium citrate 220 mg bid + esomeprazole 20 mg bid + clarithromycin 0.5 g bid, for 14 days) were selected and compared. RESULTS: A total of 171 cases were collected in the group treated by Amoxicillin program, and the eradication rate was 87.8% (150/171). A total of 69 cases were collected in the group of potassium amoxicillin clavulanate, and the eradication rate was 76.8% (53/69). There was no significant difference in baseline data between the two groups (P>0.05). There was a significant difference in clinical efficacy between the two groups (P< 0.05). In addition, the cost-effectiveness ratio (C/E) of the Amoxicillin treatment program was lower than that of the potassium amoxicillin clavulanate program CONCLUSION: The clinical efficacy of VBP Amoxicillin program in eradicating Hp infection is better than that of the potassium amoxicillin clavulanate program, which is worthy of clinical recommendation.

Real-world research of vonoprazan and amoxicillin dual therapy for Helicobacter pylori eradication / 中国药房

OBJECTIVE To explore the efficacy， safety and economics of a dual therapy consisting of conventional dose of vonoprazan combined with conventional dose of amoxicillin in patients with primary treatment of Helicobacter pylori （HP） infection. METHODS Using a prospective cohort study， the patients diagnosed with HP infection and receiving initial treatment in Chengdu Xinhua Hospital from July 2021 to July 2022 were collected according to inclusion and exclusion criteria. The patients were given vonoprazan/amoxicillin dual therapy （i.e. VA group， Vonoprazan fumarate tablets 20 mg， once a day+Amoxicillin capsules 1.0 g， twice a day， 14 days） and bismuth-containing quadruple therapy （i.e. LJAF group， Rabeprazole sodium enteric- coated tablets 20 mg， twice a day+Colloidal bismuth pectin capsules 200 mg， twice a day+Amoxicillin capsules 1.0 g， twice a day+ Furazolidone tablets 100 mg， twice a day， for 14 days） according to the patient’s medication willingness. Four weeks after the end of the treatment， HP eradication rates of the two groups were compared by using intention-to-treat （ITT）， modified intention-to- treat （MITT） and per-protocol （PP） analysis. The occurrence of adverse drug reactions （ADR） was recorded， and an economic evaluation was performed for them. RESULTS Among the 58 patients in VA group， 55 completed the trial， 2 were lost to follow- up and one withdrew due to rash； among the 62 patients in LJAF group， 57 completed the trial， 3 were lost to follow-up and 2 withdrew due to rash. Results of ITT， MITT and PP analysis showed that HP eradication rates of VA group were 86.2%， 89.3% and 90.9%， and those of LJAF group were 87.1%，91.5% and 94.7%， respectively； there was no statistical significance among different groups （P＞0.05）. The incidences of ADR in VA group and LJAF group were 6.9% and 14.5%，which were not significantly different （P＞0.05）. The result of cost minimization analysis showed that the treatment cost of VA group was 340.9 yuan， which was lower than 373.5 yuan of LJAF group. CONCLUSIONS In patients with primary treatment of HP infection， the efficacy and safety of dual therapy of conventional dose of vonoprazan combined with conventional dose of amoxicillin is equivalent to the bismuth-containing quadruplex therapy with low cost.

Adherence to guidelines on the use of amoxicillin for treatment of ambulatory pneumonia in children younger than 5 years, Colombia, 2017-2019 / Adherencia a las directrices sobre el uso de amoxicilina para el tratamiento ambulatorio de la neumonía en menores de 5 años, Colombia, 2017-2019 / Adesão às diretrizes sobre uso de amoxicilina para tratamento de pneumonia ambulatorial em crianças menores de 5 anos, Colômbia, 2017-2019

ABSTRACT Objectives. To determine the level of adherence to clinical guidelines in prescribing amoxicillin to children younger than 5 years with pneumonia in outpatient settings in Colombia from 2017 to 2019, and assess the factors associated with adherence Methods. This was a cross-sectional study of secondary data from the Colombian Integrated Social Protection Information System database. Adherence was defined as prescription of oral amoxicillin for bacterial and unspecified pneumonia and non-prescription for viral pneumonia. Variables examined included: age (< 1 year, 1-4 years) of child; sex; cause of pneumonia (bacterial, viral, unspecified); region (Andean, Amazonian, Pacific, Caribbean, Insular, Orinoquian); and payment mechanism (without prior authorization, capitation, direct payment, pay per case, pay for event). Results. Of 215 925 cases of community-acquired pneumonia reported during 2017-2019, 64.8% were from the Andean region, 73.9% were bacterial pneumonia and 1.8% were viral pneumonia. Adherence to guidelines was observed in 5.8% of cases: this was highest for children diagnosed with viral (86.0%) compared with bacterial (2.0%) pneumonia. For children diagnosed with bacterial pneumonia, 9.4% were prescribed any antibiotic. A greater proportion of children covered by capitated payments (22.3%) were given treatment consistent with the guidelines compared with payment for event (1.3%). Conclusion. In this first study from Colombia, adherence to guidelines for outpatient treatment of children with bacterial pneumonia was low and was better for viral pneumonia. Further qualitative studies are needed to explore the reasons for this lack of adherence and why bacterial pneumonia was the most commonly reported etiology.

RESUMEN Objetivos. Determinar el nivel de adherencia a las directrices clínicas al momento de prescribir amoxicilina a menores de 5 años con neumonía en entornos de atención ambulatoria en Colombia entre el 2017 y el 2019, así como evaluar los factores asociados con la adherencia. Métodos. Este fue un estudio transversal de datos secundarios de la base de datos del Sistema Integral de Información de la Protección Social de Colombia. La adherencia se definió como la prescripción de amoxicilina por vía oral para las neumonías bacterianas y no especificadas, y la ausencia de prescripción para las neumonías virales. Las variables examinadas incluyeron: edad (< 1 año, 1 a 4 años); sexo; causa de la neumonía (bacteriana, viral, no especificada); región (andina, amazónica, Pacífico, Caribe, insular, Orinoco); y mecanismo de pago (sin autorización previa, capitación, pago directo, pago por caso, pago por evento). Resultados. De 215 925 casos de neumonía adquirida en la comunidad notificados durante el período 2017-2019, el 64,8% correspondieron a la región andina, el 73,9% a neumonía bacteriana y el 1,8% a neumonía viral. Se observó la adherencia a las directrices en el 5,8% de los casos: esta cifra fue más alta para la población infantil diagnosticada con neumonía viral (86,0%) que para la diagnosticada con neumonía bacteriana (2,0%). En el caso de la población infantil diagnosticada con neumonía bacteriana, al 9,4% se le recetó algún antibiótico. La proporción de población infantil cubierta por pagos capitados (22,3%) que recibió un tratamiento en consonancia con las directrices fue mayor que la de la población cubierta por pagos por evento (1,3%). Conclusión. En este primer estudio de Colombia, la adherencia a las directrices sobre el tratamiento ambulatorio de la población infantil con neumonía bacteriana fue bajo, en tanto que resultó superior en el caso de la neumonía viral. Se necesitan más estudios cualitativos para indagar sobre los motivos de esta falta de adherencia y las razones por las cuales la neumonía bacteriana fue la etiología notificada con mayor frecuencia.

RESUMO Objetivos. Determinar o nível de adesão às diretrizes clínicas para prescrição de amoxicilina em regime ambulatorial para crianças menores de 5 anos com pneumonia na Colômbia, de 2017 a 2019, e avaliar os fatores associados à adesão. Métodos. Estudo transversal de dados secundários do banco de dados do Sistema Integrado de Informação sobre Proteção Social da Colômbia. Definiu-se adesão como prescrição de amoxicilina oral para pneumonia bacteriana e não especificada, e não prescrição para pneumonia viral. As variáveis examinadas incluíram: idade da criança (< 1 ano, 1-4 anos), sexo, etiologia da pneumonia (bacteriana, viral, não especificada), região (Andina, Amazônica, Pacífica, Caribenha, Insular, Orinoco) e mecanismo de pagamento (sem autorização prévia, capitação, pagamento direto, pay-per-case, pay-for-event). Resultados. Dos 215.925 casos de pneumonia adquirida na comunidade notificados nos anos 2017-2019, 64,8% ocorreram na região Andina, 73,9% foram pneumonia bacteriana e 1,8% foram pneumonia viral. A adesão às diretrizes foi observada em 5,8% dos casos. Foi maior para crianças com diagnóstico de pneumonia viral (86,0%) em comparação com pneumonia bacteriana (2,0%). Para as crianças com diagnóstico de pneumonia bacteriana, 9,4% receberam algum antibiótico. Uma proporção maior de crianças cobertas por pagamentos capitados (22,3%) recebeu tratamento compatível com as diretrizes, contra apenas 1,3% no esquema de pay-for-event. Conclusão. Neste primeiro estudo da Colômbia, a adesão às diretrizes para tratamento ambulatorial de crianças com pneumonia bacteriana foi baixa, sendo melhor para pneumonia viral. Mais estudos qualitativos são necessários para explorar as razões dessa falta de adesão e por qual motivo a pneumonia bacteriana foi a etiologia mais comumente notificada.

Antioxidative potential of propolis on Staphylococcus aureus infected BALB/c mice: A biochemical study

Drug resistance, according to World Health Organization, is one of the most serious threats to public health. This makes antibiotics ineffective and reduces their therapeutic potential. One of the most prevalent multidrug-resistant bacteria is Staphylococcus aureus which is considered to be the most common pathogen and mortality factor in both hospital and non-hospital environments worldwide. Due to an unprecedented increase in reports of drug resistance in pathogens, and also due to adverse and severe side effects of drugs, there is an urgent need to redirect scientific efforts towards search for anti-oxidative natural substances and other alternative sources having therapeutic potential against microbes. Natural products such as propolis seem to exhibit most promising therapeutic potential against microorganisms. Thus, present study is focused on antioxidative potential of propolis in combination with standard antibiotics ampicillin and amoxicillin against S. aureus infected BALB/c mice. For this, mice were divided into seven groups, they were decapitated after suitable experimental periods, then their liver, kidney and spleen were excised from control and experimental groups, which were homogenized and then used for different biochemical estimations following the standard protocols. Results showed that S. aureus caused severe biochemical alterations by 5th day of infection that is, lipid peroxidation increased significantly (P <0.05), reduced glutathione level and activity of antioxidant enzymes (SOD, CAT, GPx, GR, GST) decreased significantly (P <0.05) in liver, kidney and spleen of S. aureus infected mice. Ethanolic extract of propolis at a dose of 250 mg/kg body weight of mice when used alone to treat S. aureus infection gave significantly good results by 15th day of treatment. Better results were observed when propolis was used along with antibiotics. The levels of antioxidant molecules and enzymes along with liver and kidney function enzymes were restored to near normal after 15 days of treatment. So it can be concluded that propolis along with antibiotics acts as a potent free radical scavenger and can be used as a potential therapeutic agent against staphylococcal infection.

Therapeutic effect of propolis on Staphylococcus aureus induced oxidative stress in kidney of BALB/c mice. A biochemical and histopathological study

Due to emerging drug resistance in pathogenic organisms, most of the second generation antibiotics are not effective in controlling the disease. As a consequence, the dosage and duration of drug intake has increased leading to drug induced toxicity and various side effects. A large number of natural products are being reported to ameliorate the toxicity and oxidative stress caused by antibiotics. Here, we explored the antioxidative potential of honey bee product propolis alone as well as in combination with antibiotics in Staphylococcus aureus infected BALB/c mice. For experimental design, mice were divided in to seven groups and decapitated after experimental period. Kidney was excised, homogenized and then used for different biochemical and histopathological estimations. Results observed after treatment with propolis and antibiotics were compared with those of S. aureus infected group. Results showed increase in lipid peroxidation, decrease in reduced glutathione levels and antioxidant enzymes such as; catalase, superoxide dismutase, glutathione-S-transferase, glutathione peroxidase and glutathione reductase. On the contrary, treatment with propolis, led to reduction in levels of LPO and increase in activities of antioxidant enzymes. Also, histopathology of kidney and all kidney function enzymes were restored to near normal.

Sustained release of drug loaded nanofibers for wound dressing applications

Global burden of chronic wounds has increased drasticallyas they are vulnerable to bacterial infections that causes inflammation, thereby leads to a delay in the healing process. Furthermore, wound care and dressing industry is subjected to a global market of $30.4 billion by 2024. Our work entails fabrication of polymeric electrospun nanofibers loaded with different concentration of the amoxicillin (AMX) antibiotic. Biodegradable and biocompatible poly (vinyl) alcohol (PVA)/poly(meth)(methacrylate)(PMMA) polymerswere blended with different AMX concentration (100, 150, 200 and 250 mg) and fabricated by electrospinning technique. Morphology, structural properties and drug release from electrospun nanofibers depend on the different concentrations of drug incorporated in PVA:PMMA blend of polymer. Furthermore, these studies revealed drug-excipient compatibility and drug encapsulation within the nanofiber. In-vitro release study showed the AMX release time from PVA: PMMA: AMX was extended up to 7 days for AMX-250 with an initial burst release of 70% and further sustained drug release. Electrospun nanofibers of PVA:PMMA:AMX showed greater zone of inhibition of S. aureus as 2.1±0.4 cm for 100-AMX, 2.3±0.5 cm for 150-AMX, 2.4±0.1 for 200-AMX and 3.4±0.3 cm for 250-AMX. These results demonstrate that AMX retains the anti-bacterial activity and hence can be used as a potential wound dressing candidate.

Detection and analysis of two drug-induced antibodies in suspicious blood samples from pre-transfusion compatibility tests / 中国输血杂志

【Objective】 To detect the piperacillin and amoxicillin antibodies in suspicious blood samples from pre-transfusion compatibility tests in Wuxi and analyze the general characteristics of them, so as to eliminate the interference of drug-induced antibodies with compatibility tests and provide reference for safe and effective blood transfusion, 【Methods】 Drug-sensitized RBCs and low-ion anti-globulin microcolumn gels were used to detect piperacillin and amoxicillin antibodies in 128 plasma samples which were initially undetermined in pre-transfusion compatibility tests. Data were analyzed by Chi-square test or fisher′s exact test. P<0.05 was statistically significant. 【Results】 Among these 128 undetermined samples, including 31 cases of type A, 48 type B, 14 type AB and 35 type O, the overall positive rate of piperacillin and amoxicillin antibodies was 28.9%(37/128), in which the positive rates of piperacillin and amoxicillin antibodies were 20.3%(26/128) and 8.6%(11/128), respectively. The difference between these two drug-induced antibodies was significant(P<0.05). Further analysis showed that the piperacillin antibodies in patients over 50 years old was 25.3%(24/95), while under 50 years old was 6.1%(2/33)(P<0.05). In contrast, the amoxicillin antibodies in patients over 50 years old was 5.3%(5/95), while under 50 years old was 18.2%(6/33), with statistically significant differences between each other(P<0.05). 【Conclusions】 In patients with suspicious antibodies in pre-transfusion detection, except for the allotype antibodies, drug-induced antibodies should be more considered in combination with medication history to better ensure the safety and effectiveness of blood transfusion.

Treatment regimens used in the management of Helicobacter pylori in Colombia

Abstract Background Helicobacter pylori infection can cause gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. Its treatment involves different medications, but resistance to these treatments is increasing. It is currently considered a public health problem. Aims to identify regimens used for H. pylori eradication by age group, year of treatment and geographical region of Colombia. Methods A cross-sectional study that identified regimens used H. pylori eradication in outpatient consultations over a 6-year period based on a medication dispensing database of 8.5 million people affiliated to the Colombian Health System. The appropriate regimens were those that included a proton pump inhibitor, associated with two antibiotics recommended by clinical practice guidelines (amoxicillin, clarithromycin, levofloxacin, moxifloxacin, tetracycline, doxycycline, metronidazole, tinidazole, and furazolidone). Results A total of 12,011 patients with a diagnosis of acid-peptic disease and H. pylori infection were identified, who had undergone 12,426 eradication treatment courses. Of these, 98.0% used a proton pump inhibitor (PPI), and 91.1% used amoxicillin. A total of 56.1% of the regimens were considered adequate; of these, 42.0% were a combination of PPI, amoxicillin/clarithromycin. This regimen predominated between 2015 and 2017 for all age groups. Conclusions The management of H. pylori infection in the majority of patients is heterogeneous and inconsistent with current recommendations based on evidence of antimicrobial resistance.

The efficacy of dual therapy for eradicating H. pylori in a Colombian population

Abstract Background: Helicobacter pylori (H. pylori) affects 50% of the human population. The efficacy of the usual treatments has decreased due to increased antibiotic resistance, except for that of amoxicillin, tetracycline, furazolidone and bismuth. Recently, there has been a new interest in dual therapy with high-dose proton pump inhibitors (PPI) and amoxicillin as initial and rescue treatment. There are no studies on this topic in our setting. Objective: to determine the efficacy of dual therapy with high-dose IPP and amoxicillin for eradicating H. pylori. Materials and methods: this was a quasi-experimental study carried out from December 2019 to July 2020 in people over the age of 18 with histologically confirmed H. pylori. All received 40 mg of esomeprazole half an hour before breakfast, lunch and dinner, plus 1 gram of oral amoxicillin every eight hours for 14 days. Eradication was determined by fecal antigens (OnSiteTM H. pylori Biotech Inc.) after four weeks of treatment. Results: 108 patients with an average age of 67 years were included, 70% of whom were women. Eradication per protocol (PP) and intention to treat (ITT) was 86% (95%CI 79.4-92.5%) for both. In previously treated patients (26%) the efficacy was 85.7% (95%CI 71.8-99.5%). Adverse events were mild in 31%, especially nausea (16%) and abdominal distension (14%). Treatment was not suspended in any patient. Conclusion: Dual therapy is effective, easy to administer, and has few adverse effects. It would be a good option in our setting as initial or rescue therapy. Larger studies are needed to confirm our results. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2091).

Actinomicosis ósea del antepié izquierdo. Presentación de un caso / Bone actinomycosis of the left forefoot. Presentation of a case

RESUMEN Se presentó el caso de una actinomicosis ósea, que se manifestó como una lesión de la piel en la zona correspondiente al segundo metatarsiano izquierdo. Por el antecedente de ser la paciente operada de un tumor de células gigantes, se pensó en una recidiva tumoral. Fue intervenida quirúrgicamente y se realizó exéresis del segundo metatarsiano y de la piel afectada. La biopsia informó actinomicosis. Se trató a la paciente con amoxicilina; evolucionando satisfactoriamente, y dando seguimiento en consulta (AU).

ABSTRACT The authors presented the case of a bone actinomycosis expressed as a skin lesion in the area of the second left metatarsals. Due to the antecedent of having undergone a surgery of a giant cell tumor, a tumor recurrence was thought. Surgical intervention was performed and the excision of the second metatarsals and affected skin was performed. The biopsy reported Actinomycosis. The patient was treated with amoxicillin. She had a satisfactory evolution and is still followed up in consultation (AU).

Caracterización de Escherichia coli D7111 productora de ß-LACTAMASA TEM-176 / Characterization of Escherichia coli D7111 producing the ß-LACTAMASA TEM-176

RESUMEN El presente reporte es la descripción original de bla TEM-176. Se caracterizaron los mecanismos de resistencia a antimicrobianos de un aislamiento de Escherichia coli enterotoxigénica, determinándose la resistencia a 22 antimicrobianos categorizados en 15 grupos diferentes mediante difusión en agar, estableciéndose grupo filogenético, mecanismos de resistencia y presencia de integrones de Clase 1 y 2 mediante PCR. Integrones y genes de resistencia a β-lactámicos fueron secuenciados. El aislamiento del grupo filogenético A, mostró resistencia o sensibilidad disminuida a ampicilina, amoxicilina más ácido clavulánico, ácido nalidíxico, ciprofloxacino, estreptomicina, kanamicina, tetraciclina, trimetoprim, sulfisoxazol, cotrimoxazol, azitromicina y nitrofurantoina, detectándose la presencia de bla TEM, aadA1/2, aphA1, sul3, tet(A) y un integron de Clase 2 conteniendo un gen dfrA1. La resistencia a quinolonas se relacionó con la substitución Ser83Ala. La secuencia de TEM mostró la substitución Ala222Val, la cual a la fecha no había sido descrita, reportándose como una nueva β-lactamasa, con el nombre de bla TEM-176.

ABSTRACT The present report is the original description of bla TEM-176. The mechanisms of resistance to antimicrobial agents were determined in an enterotoxigenic Escherichia coli, determining the susceptibility to 22 antimicrobials classified in 15 different groups by agar diffusion and establishing the phylogenetic group, mechanisms of resistance and presence of Class 1 and 2 integrons. Integrons and β-lactam resistance genes were sequenced. The isolate, belonging to phylogenetic group A, showed the presence of resistance or diminished susceptibility to a ampicillin, amoxicillin plus clavulanic acid, nalidíxic acid, ciprofloxacin, streptomycin, kanamycin, tetracycline, trimethoprim, sulfisoxazole, cotrimoxazole, azithromycin and nitrofurantoin, carrying bla TEM, aadA1/2, aphA1, sul3, tet(A) and a Class 2 integron containing a dfrA1 gene. Quinolone resistance was related to the substitution Ser83Ala. The TEM sequencing showed the presence of the new substitution Ala222Val, which led to the description of the new β-lactamase bla TEM-176.

Caracterización de Escherichia coli D7111 productora de ß-LACTAMASA TEM-176 / Characterization of Escherichia coli D7111 producing the ß-LACTAMASE TEM-176

RESUMEN El presente reporte es la descripción original de bla TEM-176. Se caracterizaron los mecanismos de resistencia a antimicrobianos de un aislamiento de Escherichia coli enterotoxigénica, determinándose la resistencia a 22 antimicrobianos categorizados en 15 grupos diferentes mediante difusión en agar, estableciéndose grupo filogenético, mecanismos de resistencia y presencia de integrones de Clase 1 y 2 mediante PCR. Integrones y genes de resistencia a β-lactámicos fueron secuenciados. El aislamiento del grupo filogenético A, mostró resistencia o sensibilidad disminuida a ampicilina, amoxicilina más ácido clavulánico, ácido nalidíxico, ciprofloxacino, estreptomicina, kanamicina, tetraciclina, trimetoprim, sulfisoxazol, cotrimoxazol, azitromicina y nitrofurantoina, detectándose la presencia de bla TEM, aadA1/2, aphA1, sul3, tet(A) y un integron de Clase 2 conteniendo un gen dfrA1. La resistencia a quinolonas se relacionó con la substitución Ser83Ala. La secuencia de TEM mostró la substitución Ala222Val, la cual a la fecha no había sido descrita, reportándose como una nueva β-lactamasa, con el nombre de bla TEM-176.

ABSTRACT The present report is the original description of bla TEM-176. The mechanisms of resistance to antimicrobial agents were determined in an enterotoxigenic Escherichia coli, determining the susceptibility to 22 antimicrobials classified in 15 different groups by agar diffusion and establishing the phylogenetic group, mechanisms of resistance and presence of Class 1 and 2 integrons. Integrons and β-lactam resistance genes were sequenced. The isolate, belonging to phylogenetic group A, showed the presence of resistance or diminished susceptibility to a ampicillin, amoxicillin plus clavulanic acid, nalidíxic acid, ciprofloxacin, streptomycin, kanamycin, tetracycline, trimethoprim, sulfisoxazole, cotrimoxazole, azithromycin and nitrofurantoin, carrying bla TEM, aadA1/2, aphA1, sul3, tet(A) and a Class 2 integron containing a dfrA1 gene. Quinolone resistance was related to the substitution Ser83Ala. The TEM sequencing showed the presence of the new substitution Ala222Val, which led to the description of the new β-lactamase bla TEM-176.

Research Progress on Dual Therapy in Primary Treatment of Helicobacter pylori Infection / 胃肠病学

At present, the global prevalence of Helicobacter pylori (Hp) infection is still high. Although bismuth-containing quadruple regimens are recommended by international consensus and guidelines as a first-line treatment for Hp infection, the compliance is decreasing due to more drugs needed and higher adverse events. In recent years, many studies on eradication regimen containing high-dose proton pump inhibitor (PPI) and amoxicillin, a low-resistance and acid-labile antibiotic, demonstrated that the dual therapy could achieve high eradication rate equivalent to the mainstream fist-line therapies and had the advantages of less adverse events, simpler drug composition and higher compliance. However, there are discrepancies in dosage and frequencies of drugs in dual therapies, and cannot reach a unified regimen. This article reviewed all kinds of the dual therapy regimens, which might be helpful for determining the optimal dosage, frequencies, and treatment course, so as to standardize the dual therapy.