Using least angular regression to model the antibacterial potential of metronidazole complexes

Imidazole has anti-inflammatory, antituberculotic, antimicrobial, antimycotic, antiviral, and antitumor properties in the human body, to name a few. Metronidazole [1-(2-Hydroxyethyl)-2-methyl-5-nitroimidazole] is a widely used antiprotozoan and antibacterial medication. Using fourier transform infrared spectroscopy, the current study models the antibacterial activity of already synthesised Metronidazole (MTZ) complexes ($$MTZ-Benz$$ M T Z - B e n z , $$MTZ-Benz-Cu$$ M T Z - B e n z - C u , $$MTZ-Benz-Cu-Cl_2CHCOOH$$ M T Z - B e n z - C u - C l 2 C H C O O H , $$MTZ$$ MTZ , $$MTZ-Cu$$ M T Z - C u , $$MTZ-Cu-Cl_2CHCOOH$$ M T Z - C u - C l 2 C H C O O H , $$MTZ-Benz-Ag$$ M T Z - B e n z - A g , $$MTZ-Benz-Ag-Cl_2CHCOOH$$ M T Z - B e n z - A g - C l 2 C H C O O H , $$MTZ-Ag$$ M T Z - A g and $$MTZ-Ag-Cl_2CHCOOH$$ M T Z - A g - C l 2 C H C O O H ) against E. coli, B. bronceptica, S. epidermidis, B. pumilus and S. aureus. To characterise the Metronidazole complexes for antibacterial activity against 05 microbes, the least angular regression and least absolute shrinkage selection operators were used. Asymmetric Least Squares was used to correct the spectrum baseline. Least angular regression outperforms cross-validated root mean square error in the fitted models. Using Least angular regression, influential wavelengths that explain the variation in antibacterial activity of Metronidazole complexes were identified and mapped against functional groups.

Perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital in Tanzania

Background Surgical Site Infections are a major cause of morbidity and mortality among operated patients. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medication for a single patient. Few studies have shown qualitatively factors influencing this and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania. Objective To describe the perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital. Methods A qualitative study involving in-depth interviews with surgeons was conducted in English by the primary investigator. The interviews were audio-recorded and transcribed verbatim. Systematic text condensation by Malterud was used for data analysis. Findings Fourteen surgeons and obstetrics and gynaecologists participated. Their perceptions were summarized into three main categories: Inadequate data to support practice; one who sees the patient decides the antibiotic prophylaxis; prolonged antibiotic use for fear of unknown. The participants perceived that choice of antibiotic should be based on local hospital data for bacterial resistance pattern, however the hospital guidelines and data for surgical site infection rates are unknown. Fear of getting infection and anticipating complications led to prolonged antibiotics use. Conclusion The study provides an understanding of surgical antibiotic prophylaxis use and its implementation challenges. This was partly expressed by unavailability of local data and guidelines to enhance practice. To improve this, there is a need of guidelines that incorporates local resistance surveillance data and enhanced antibiotic stewardship programmes. A strong consideration should be placed into ways to combat the fears of surgeons for complications, as these significantly affect the current practise with use of surgical antibiotic prophylaxis.

Enhanced Surveillance for Histoplasmosis—9 States, 2018–2019

Background Histoplasmosis is often described as the most common endemic mycosis in the United States, but much remains unknown about its epidemiology among the general population. Methods We conducted enhanced surveillance in 9 states during 2018–2019 by identifying cases through routine surveillance and interviewing 301 patients about their clinical features and exposures. Results Before being tested for histoplasmosis, 60% saw a health care provider ≥3 times, and 53% received antibacterial medication. The median time from seeking health care to diagnosis (range) was 23 (0–269) days. Forty-nine percent were hospitalized, and 69% said that histoplasmosis interfered with their daily activities (median [range], 56 [2–3960] days). Possible exposures included handling plants (48%) and bird or bat droppings (24%); 22% reported no specific exposures. Only 15% had heard of histoplasmosis before their illness. Conclusions Histoplasmosis can be severe and prolonged. Additional educational efforts to increase public and provider awareness and reduce delays in diagnosis are needed.

Delayed patch repair of a ruptured mitral subvalvular pseudoaneurysm caused by infective endocarditis: a case report

Background Ruptured subvalvular pseudoaneurysm is a rare but significantly fatal complication of infective endocarditis. We report a successful surgical case of ruptured subvalvular pseudoaneurysm with infective endocarditis. Case summary A 46-year-old man presenting with high fever was admitted to a local hospital. Physical examination revealed small erythema and petechiae on his lower limbs. Transthoracic echocardiogram did not show any visible vegetation and valvular disease; however, magnetic resonance imaging (MRI) showed multiple acute cerebral infractions, and methicillin-susceptible Staphylococcus aureus was detected in the blood culture. Infective endocarditis was suspected, and an antibacterial medication was initiated. Twelve days later, he suffered from a sudden cardiogenic shock due to cardiac tamponade. Bloody pericardial effusion (1600 mL) was drained, and his condition improved substantially. Transoesophageal echocardiography after pericardial drainage revealed severe mitral regurgitation and a subvalvular aneurysm at the posteromedial side of the mitral annulus; these were not detected at the time of admission. He was transferred to our hospital for surgery; however, since fresh cerebral bleeding was observed in MRI, the surgery was delayed. Three weeks later, after confirming that the blood culture was negative for any growth, patch repair of the subvalvular pseudoaneurysm and mitral valve repair were performed. Post-operatively, no complication or arrhythmia was observed; he was discharged 25 days later. Discussion We report a rare case of successful delayed surgery for a ruptured subvalvular pseudoaneurysm at the posteromedial side of the mitral annulus, which presented complications for infective endocarditis by S. aureus.

Effect of Intervention Training on Pharmacists’ Knowledge and Attitude to Antibacterial Counselling

The effectiveness of counselling patients on antibacterial rational use by pharmacists depends on their knowledge and attitude to counselling.This study evaluated the effect of intervention training on pharmacists’ antibacterial therapy knowledge and attitude to counselling. It was a cross-sectional questionnaire-based study among all the pharmacists (n=45) responsible for patients’ antibacterial counselling in seventeen government secondary health care institutions in Ogun state of Nigeria between November 2017 and May 2018. Identified deficits were addressed through intervention and re-assessment was carried out after a month. Twenty four (53.3%) were females. Twenty one (46.7%) had hospital pharmacy experience of over 10 years and mean year of experience was 10.7±6.7. Sixteen (35.6%) and 36 (80.0%) believed that antibacterial resistance may be prevented by taking antibacterial medication at regular intervals at the baseline and post intervention phases respectively. Thirty three (73.3%) and 44 (97.8%) had the opinion that pharmacists and patients are active participants in effective antibacterial counselling at the two phases respectively. Twenty eight (62.2%) and 44 (97.8%) had scores ≥ 70.0% signifying good knowledge pre and post intervention respectively. Disclosure of antibacterial identity to patients was believed to be necessary by thirty six (80.0%) and 43 (95.6%) while 27 (60.0%) and 43 (95.6%) exhibited positive attitude to antibacterial counselling at the two phases respectively. There was significant improvement in antibacterial knowledge and attitude to counselling (p < 0.001) post intervention. Regular antibacterial therapy and counselling training is hereby recommended for pharmacists.

Analysis of the consumption of antibacterial medications in community-acquired pneumonia in children

Objective: The study objective is to analyze the efficacy of antibacterial medication selection to treat community-acquired pneumonia (CAP) in children in an out-patient clinic and in a pulmonology department of an in-patient hospital.Methods: Retrospective descriptive study for 2009–2017 in day-patient departments of pediatric clinics and pediatric pulmonology departments of in-patient hospitals of Primorskiy territory (760 cases).Results: 50 % of children took antibiotics at pre-hospital stage (self-treatment). Penicillins were the most popular – 50.1 % (218 prescriptions), cephalosporins were used in 129 (29.7 %), macrolides – in 86 (18.8 %) of cases. The average duration of antibacterial treatment course of CAP was 10 days at pre-hospital stage. Both in the out-patient clinic and in the in-patient hospital, cephalosporins (58.4 and 58.3 %), macrolides (34.8 and 37.4 %) and aminoglycosides (6.3 and 3.4 %) were used more often.Conclusions: The positive dynamics in the protocols of antibiotic therapy of CAP should be noted. The improvement of regulatory framework has led to the increase of rational prescriptions. It is necessary to continue improving of clinical guidelines and implementing pulmonology hospitals of microbiological monitoring that will allow improving the quality of antibacterial treatment.

Contamination of hen manure with nine antibiotics in poultry farms in Ukraine

The problem of processing, use and utilization of poultry manure contaminated with antibiotics remains unsolved not only Ukraine but around the world, and theatment and prevention of highly contagious infectious diseases among birds requires antibacterial medication use. By liquid chromatography, 293 hen manure samples of 12 Ukrainian industrial flocks of poultry farms were studied. The residual content of 9 antibiotics in the hen manure was found, including 38.2% of tetracycline preparations (doxycycline, oxytetracycline, tetracycline and chlortetracycline), fluoroquinolone (enrofloxacin and norfloxacin) including combinations of incompatible tetracyclines and fluoroquinolones, broad-spectrum penicillins (amoxicillin), fenicols (florfenicol), macrolides (tylosin) and one sulfanilamide preparation (sulfametazine). The most common antibiotics in hen manure of Ukrainian industrial flocks of poultry farms are the antibiotics of the tetracycline group, the main one being doxycycline. A high correlation was determined between the release of doxycycline with eggs and hen manure after the preparation was used perorally in preventive and therapeutic doses. Time of complete excretion of doxycycline from the hen body at the preventive dose (50 mg/L of water for 7 days) was 14 days for manure, 8 days for eggs, following its withdrawal, and at the therapeutic dose (100 mg/L of water for 7 days ) – 20 days for manure, and 9 days for eggs, following its withdrawal. The perspective of using the obtained data about the duration of excretion of doxycycline with hen manure consists in confirmation of the time of the antibiotic’s excretion with manure following its use for preventive or therapeutic purpose, which will help in controlling it as a source of environmental pollution. The time of doxycycline excretion from the body of hens with eggs and manure may be used practically by professionals in veterinary medicine in the case of prescribing or replacing antibiotics for treatment of infectious diseases of poultry to prevent the combination of incompatible preparations in the body and manure. The obtained experimental data may form the basis for the development of national regulations on the processing, usage and utilization of manure of hens under treatment with antibiotics.

Specific Aspects of Endodontic Medication in Chronic Apical Periodontitis

This article presents specific aspects regarding the role of endodontic medication in the conservative treatment in chronic apical periodontitis. Starting from the bacterial microflora, the etiological factor of the periapical lesions, we discuss about the modalities of identification by the means of in vivo and in vitro tests of the microorganisms present inside the root canal. The characteristics of these methods of microbiological evaluations, as well as their clinical relevance, are reviewed. The general characteristics of endodontic antimicrobial medication are presented, as well as the causes of endodontic failures in treatment in chronic apical periodontitis. It is underlined the essential importance of the rigorous biomechanical treatment, in association with endodontic lavage, which makes the antibacterial medication only have a subordinate role in the treatment of chronic apical lesions.

Dapsone-Induced Methemoglobinemia in a Patient with Acute Lymphocytic Leukemia Admitted with Severe Legionella Pneumonia

Dapsone is an antibacterial medication used as an alternative to the first-line therapy (sulfamethoxazole-trimethoprim) for Pneumocystis pneumonia prophylaxis. Methemoglobinemia is a known toxicity of dapsone. However, dapsone-induced methemoglobinemia in an acute lymphocytic leukemia (ALL) patient with severe Legionella pneumonia has not been previously reported. We describe a 37-year-old male with ALL who was admitted for severe Legionella pneumonia sepsis, rhabdomyolysis, and multiple organ failure. The patient was started on broad-spectrum antibiotics and subsequently intubated for respiratory failure. The patient's methemoglobin level was 24.5%. The repeat methemoglobin level was 28.7%; intravenous methylene blue 100 mg was given for a total of 2 doses after which the methemoglobin level decreased to 2.5%. The patient was extubated 4 days after the second dose of methylene blue. He was later discharged home in stable condition. This patient developed severe sepsis with multiorgan failure, which resulted in acute liver and renal insufficiencies. The decreased metabolism and excretion of dapsone and its toxic metabolite is the likely cause of methemoglobinemia in this patient. Immunocompromised oncology patients who develop severe sepsis require careful monitoring for dapsone-induced methemoglobinemia. Liver dysfunction and renal failure may both potentiate toxicity with prophylactic doses of dapsone.