Whole-process individualized pharmaceutical care for a case of melioidosis sepsis / 中国药房

OBJECTIVE To provide reference for the adjustment of antibiotic treatment regimens， identification of adverse reactions， and individualized pharmaceutical care for melioidosis sepsis （MS）. METHODS Clinical pharmacists participated in the intensive and eradicating therapeutic processes for an MS patient by using blood concentration and gene detection. Based on the literature， antibiotic treatment regimens of MS were adjusted by determining the blood concentrations of β-lactam and trimethoprim/ sulfamethoxazole （TMP/SMZ） and calculating PK/PD parameters. The causes of adverse drug reactions were analyzed and addressed by detecting drug-related gene polymorphisms through high-throughput sequencing. RESULTS Clinical pharmacists used blood concentration and genetic testing methods to propose adjustments to imipenem-cilastatin sodium dosage and analyze the causes of various adverse drug reactions. PK/PD targets were calculated by measuring the blood concentrations of β-lactam and TMP/SMZ. Clinical pharmacists explained to clinical doctors the compliance status of patients with melioidosis in sepsis and non- sepsis stages through reviewing guidelines and literature； the results of blood concentration and genetic test were used to analyze the correlation of neurotoxicity of MS patients with B14） IMP cmin， and it was found that nephrotoxicity was not related to the cmax of TMP/SMZ， but to the patient’s water intake. After whole-process antibiotic treatment， the patient’s condition improved and was discharged， and the adverse reactions were effectively treated. CONCLUSIONS Clinical pharmacists use blood concentration and genetic tests to assist clinicians in formulating MS treatment regimens， and provide whole-course pharmaceutical care for a MS patient. This method has improved the safety and effectiveness of clinical drug therapy.

In vitro anti-MRSA effect of clove oil combined with β-lactam antibiotics against methicillin-resistant Staphylococcus aureus / 中草药

Objective To investigate the antimicrobial activities of clove oil alone and in combination with three kinds of β-lactam antibiotics (amoxicillin, cephalexin, and cefepime) against methicillin-resistant Staphylococcus aureus (MRSA). Methods The minimum inhibitory concentrations (MICs) of clove oil alone and in combination with three kinds of β-lactam antibiotics against two standard MRSA and 32 MRSA isolated from clinic were determined by 96-well plate micro-dilution method. The fractional inhibitory concentrations (FICs) of clove oil and three kinds of β-lactam antibiotics were determined by using the micro-chessboard method. The growth curve of MRSA ATCC43300 effected by clove oil or clove oil combined with cephalexin was analyzed. Results Clove oil showed significant anti-MRSA activity in vitro, with MIC of 0.25 mg/mL and 0.51 mg/mL. The FICs were mainly distributed in the range of ≤ 0.5 and 0.5 to 1, and the synergy rates were 58.8%, 97.0%, and 64.7%, when the clove oil was combined with amoxicillin, cephalexin and cefepime, respectively. Clove oil enhanced the activity of β-lactam antibiotics against MRSA significantly, and reduced the dosage of it. The growth curve showed that the clove oil significantly inhibited the growth of MRSA, and prolonged its lag phase. And the effect showed a significant dose-effect relationship. The growth of MRSA was nearly inhibited when 1/4 MIC cefepime combined with 1/4 MIC clove oil. Conclusion Clove oil not only could exhibit strong anti-MRSA activity itself, but could enhance the activity of β-lactam antibiotics against MRSA. Hence, clove oil would be a potential new drug, which can be used as a new drug for preventing and treating MRSA infection.

Role of β−lactamase in the susceptibility of clinical isolates to β−lactam antibiotics.

Combination of β−lactam antibiotic with β−lactamase inhibitor has been proven to overcome resistance caused by β−lactamase production. An evaluation to the MIC of some β−lactam antibiotics to β−lactamase producing isolates will be reported. A. anitratus, E. coli, K. pneumoniae, Proteus sp, Pseudomonas sp, S. aureus, S. epidermidis, S. pneumoniae, S. viridans, and β−hemolytic Streptococcus, were challenged to Ampicillin/Sulbactam (AMS), Amoxicillin/Clavulanic acid (AMC), Cefoperazone (CFP), Cefoperazone/Sulbactam (CSL), Ceftriaxone (CRO), dan Cefotaxime (CTX) using ETest techniques. β−lactamase production was identified using Cefinase disk. Sixtyfour percent of isolates were capable of producing β−lactamase. All E. coli and K. pneumoniae tested were β−lactamase producer, none of Proteus sp, Pseudomonas sp, and S. epidermidis tested produced β−lactamase. In β−lactamase producing group, Sulbactam was able to reduce resistance to CFP from 25% to 5%. About 20% of β−lactamase producing isolates which were resistant to CFP, were susceptible to CSL. Susceptibility of S.viridans to AMS, AMC, CFP, and CSL was higher than 80%, but less than 50% to CRO and CTX. S. pneumoniae was less susceptible to tested antibiotics, 50 to 60% susceptibility was shown to AMC, CFP, and CSL. S.aureus was 60 to 70% susceptible, while β−haemolytic Streptococcus showed good response to the tested antibiotics. Only 30% or less of K. pneumoniae and E. coli was susceptible to AMS and AMC. A. anitratus showed good susceptibility only to AMS (78%) and CSL (89%). Sixtyfour percent of isolate studied produced β−lactamase. β−lactamase inhibitor could reduce resistance of β−lactamase producing organism to β−lactam antibiotic from 25 to 5 percent.