Lung penetration and pneumococcal target binding of antibiotics in lower respiratory tract infection.

OBJECTIVES: To achieve the therapeutic effects, antibiotics must penetrate rapidly into infection sites and bind to targets. This study reviewed updated knowledge on the ability of antibiotics to penetrate into the lung, their physicochemical properties influencing the pulmonary penetration and their ability to bind to targets on pneumococci. METHODS: A search strategy was developed using PubMED, Web of Science, and ChEMBL. Data on serum protein binding, drug concentration, target binding ability, drug transporters, lung penetration, physicochemical properties of antibiotics in low respiratory tract infection (LRTI) were collected. RESULTS: It was seen that infection site-to-serum concentration ratios of most antibiotics are >1 at different time points except for ceftriaxone, clindamycin and vancomycin. Most agents have proper physicochemical properties that facilitate antibiotic penetration. In antimicrobial-resistant Streptococcus pneumoniae, the binding affinity of antibiotics to targets mostly decreases compared to that in susceptible strains. The data on binding affinity of linezolid, clindamycin and vancomycin were insufficient. The higher drug concentration at the infection sites compared to that in the blood can be associated with inflammation conditions. Little evidence showed the effect of drug transporters on the clinical efficacy of antibiotics against LRTI. CONCLUSIONS: Data on antibiotic penetration into the lung in LRTI patients and binding affinity of antibiotics for pneumococcal targets are still limited. Further studies are required to clarify the associations of the lung penetration and target binding ability of antibitotics with therapeutic efficacy to help propose the right antibiotics for LRTI.

Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise.

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate-vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

Development of metal adaptation in a tropical marine zooplankton.

Tropical marine ecosystems are highly vulnerable to pollution and climate change. It is relatively unknown how tropical species may develop an increased tolerance to these stressors and the cost of adaptations. We addressed these issues by exposing a keystone tropical marine copepod, Pseudodiaptomus annandalei, to copper (Cu) for 7 generations (F1-F7) during three treatments: control, Cu and pCu (the recovery treatment). In F7, we tested the "contaminant-induced climate change sensitivity" hypothesis (TICS) by exposing copepods to Cu and extreme temperature. We tracked fitness and productivity of all generations. In F1, Cu did not affect survival and grazing but decreased nauplii production. In F2-F4, male survival, grazing, and nauplii production were lower in Cu, but recovered in pCu, indicating transgenerational plasticity. Strikingly, in F5-F6 nauplii production of Cu-exposed females increased, and did not recover in pCu. The earlier result suggests an increased Cu tolerance while the latter result revealed its cost. In F7, extreme temperature resulted in more pronounced reductions in grazing, and nauplii production of Cu or pCu than in control, supporting TICS. The results suggest that widespread pollution in tropical regions may result in high vulnerability of species in these regions to climate change.

Guidelines for the uniform reporting of data for Medical Emergency Teams.

It is more than 15 years since the first Medical Emergency Team (MET) system was introduced to identify patients at risk and prevent serious adverse events in Liverpool Hospital, Sydney, Australia. Since then the MET system has been introduced to many other hospitals in Australia and around the world. Standardised and complete reporting of data related to MET activity is increasingly important to identify the role and benefits of the system and to facilitate quality improvement in health care in general. A uniform method for reporting data related to MET activity will aid interpretation of results, comparisons, review and changes to the MET system. The guidelines for uniform reporting of data in relation to MET activities used in our group of hospitals are presented. Future refinement and consensus agreement on the reporting of MET data internationally should enable comparisons between MET systems in several countries.