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Transdermal drug delivery systems (TDDS) for antibiotics have seen significant advances in recent years that aimed to improve the efficacy and safety of these drugs. TDDS offer many advantages over other conventional delivery systems such as non-invasiveness, controlled-release pattern, avoidance of first-pass metabolism. The objective of this review is to provide an overview on the recent advances in the TDDS of different groups of antibiotics including β-lactams, tetracyclines, macrolides, and lincosamides, utilized for their effective delivery through the skin and to explore the challenges associated with this field. The majority of antibiotics do not have favorable properties for passive transdermal delivery. Thus, novel strategies have been employed to improve the delivery of antibiotics through the skin, such as the use of nanotechnology (nanoparticles, solid-lipid nanoparticles, nanoemulsions, vesicular carriers, and liposomes) or the physical enhancement techniques like microneedles and ultrasound. In conclusion, the transdermal delivery systems could be a promising method for delivering antibiotics that have the potential to improve patient outcomes and enhance the efficacy of drugs. Further research and development are still needed to explore the potential of delivering more antibiotic drugs by using various transdermal drug delivery approaches. [ABSTRACT FROM AUTHOR]

Introduction: Rhodococcus equi causes life-threatening respiratory disease in foals. The standard treatment typically involves a combination of rifampicin and a macrolide antibiotic. Although previous studies have demonstrated the in vitro activity of these antibiotics against Rhodococcus equi , the tested concentrations often do not reflect those achievable in foals. Material and Methods: Therefore, this study was performed to evaluate the in vitro bactericidal activity of rifampicin, doxycycline, and four macrolides (clarithromycin, azithromycin, gamithromycin and tulathromycin) individually and in combination, at concentrations observed at the target site of infection in foals. Additionally, we investigated the efficacy of these antibiotics at different pH levels to replicate the conditions in the pulmonary epithelial lining fluid and within macrophages, where R. equi can reside. We assessed the activity of antibiotics against a virulent strain of R. equi by determining the minimum inhibitory concentration (MIC) and performing checkerboard and time-kill curve assays with drugs both alone and in combination. Results: Time-kill curves with rifampicin or doxycycline demonstrated a reduction in R. equi counts by more than 3 log10 CFU/mL. Among the macrolides, tulathromycin was ineffective, while clarithromycin achieved bacterial elimination within 24 h under both extracellular and intracellular conditions. Gamithromycin and azithromycin exhibited bactericidal activity only in extracellular conditions, with no effect on the bacteria at pH 5.8. The checkerboard assay did not reveal any strong synergistic or antagonistic effects for rifampicin or doxycycline when combined with macrolides. In time-kill curves performed with maximal local concentrations achievable in foals, the combinations of rifampicin or doxycycline with macrolides did not increase the bacterial killing rate compared with the drugs alone, except for the combination of rifampicin with azithromycin, which showed slightly faster activity. However, the lower concentrations of doxycycline and clarithromycin that might be present 24 h after treatment in foals were effective in killing bacteria under intracellular conditions only when used in combination, and not when used alone. Conclusion: Our study suggests that clarithromycin can be used either alone or with doxycycline and that its use in combination with rifampicin should be reconsidered. Nevertheless, further studies are required to assess the clinical efficacy and potential side effects of doxycycline in foals. [ABSTRACT FROM AUTHOR]

Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results. Moreover, broad-spectrum antibiotics are inappropriately prescribed for this condition. In this regard, an intersociety consensus conference was issued to promote the judicious use of antibiotic therapy in paediatric outpatient settings. A systematic review of the literature was performed, and updated recommendations were developed according to the GRADE methodology. Antibiotic treatment with amoxicillin (50 mg/kg/day) for 10 days is recommended in all children with proven streptococcal pharyngitis. Benzathine-penicillin could be prescribed in children with impaired intestinal absorption or inability to tolerate enteral intake and in those at high risk of suppurative complications with low compliance to oral therapy. In children with suspected amoxicillin allergy, third-generation cefalosporins for five days are recommended in low-risk patients, and macrolides are recommended in high-risk ones. Candidates for tonsillectomy due to recurrent pharyngitis could be treated with amoxicillin-clavulanic acid, clindamycin, or combined therapy with amoxicillin plus rifampicin for four days, in an attempt to avoid surgery. [ABSTRACT FROM AUTHOR]

Background Effective management of drug–food interactions is crucial for enhancing antibiotics' efficacy/safety. Adhering to PRISMA guidelines, we conducted a systematic review to assess the impact of dietary interventions on the bioavailability of 15 macrolides and 10 tetracyclines. Methods We included studies examining the influence of food, beverages, antacids, and mineral supplements on the pharmacokinetic parameters of orally administered macrolides and tetracyclines. We searched Medline (via PubMed), Embase and Cochrane Library databases up to December 2022. Risk of bias was assessed using Cochrane and NIH tools. Quantitative analyses were conducted if two or more comparable food-effect studies were available; otherwise, a qualitative summary was provided. Results We included 120 studies from 97 reports. Meta-analyses were conducted for 8 macrolides and 4 tetracyclines, with qualitative synthesis for 10 and 9, respectively. About 64% of the studies were open-label, crossover designs. Our assessment found that 37% of the studies had a high risk of bias, while only 6% had low risk. Food significantly affected 10 of 13 macrolides (77%) and 6 of 7 tetracyclines (86%). High positive effects on bioavailability were seen with extended-release azithromycin and clarithromycin, and erythromycin estolate. High negative impacts were observed with erythromycin propionate and stearate, azithromycin capsules, demeclocycline and omadacycline. Antacids and mineral supplements significantly decreased tetracyclines absorption. Milk and grapefruit juice showed variable impacts on absorption. Discussion Interactions depend on antibiotics' physicochemical characteristics, intervention type, drug formulation and potential patient factors. The quality of evidence was rated low due to outdated studies, methodological diversity and unequal data availability. [ABSTRACT FROM AUTHOR]

Background: Acute rhinosinusitis (ARS) is one of the most encountered conditions in primary care and otolaryngology clinics. However, little is known about how antibiotic prescription practices following a diagnosis of ARS compare to guidelines set forth by the American Academy of Otolaryngology in 2015. Objective: To investigate the epidemiology of ARS and the corresponding antibiotic prescribing practices by physicians and compare to published guidelines. Methods: Using the TriNetX Live database, we identified all patients diagnosed with ARS using the ICD10 code J01 between April 2015 and December 2022 across the state of Tennessee. After investigating the demographics of this cohort, we compared the first prescribed antibiotic within one day of ARS diagnosis to published guidelines. Antibiotics were grouped into their respective classes. Results: Of 81 310 patients diagnosed with ARS identified in the specified time frame, 66% were Female, 49% were African American, 44% were White, and the mean age was 47 ± 20 years. The six most common initial antibiotics prescribed for ARS were erythromycins/macrolides [14 609 (25.8%)], amoxicillin/clavulanate [14 322 (25.3%)], amoxicillin [9300 (16.4%)], third generation cephalosporins [7733 (13.6%)], quinolones [3648 (6.4%)] and tetracyclines [2235 (3.9%)]. Of this cohort, 56 719 patients (69.8%) of patients were prescribed an antibiotic within one day of diagnosis. Conclusion: Despite published guidelines recommending amoxicillin with or without clavulanic acid as first-line treatment for ARS, only 42.2% of prescribed antibiotics followed this guideline in our cohort. While accounting for patients with penicillin allergy, the second-most represented antibiotics were erythromycins/macrolides, which are specifically recommended against due to high rates of S. Pneumonia e resistance. Our results suggest that further investigation into the causes of erythromycin/macrolide prescriptions as first line treatment for ARS and practices at other institutions should be conducted. In addition, building awareness around published ARS guidelines for physicians may be useful in improving antibiotic stewardship in treatment of ARS. [ABSTRACT FROM AUTHOR]

Background: Hypersensitivity reactions (HSR) are reported for the macrolides, lincosamides, and streptogramins (MLS) antibiotic family. Data about cross‐reactivity among and between MLS remain scarce or controversial. Objectives: The aim of this study was to provide an overview of hypersensitivity cross‐reactions among MLSs based on data extracted from the French National Pharmacovigilance Database (FPVD). Methods: Cases of HSR to MLSs reported between January 1985 and December 2019 were extracted from the FPVD using standardized MedDRA queries (SMQ). Cases including an allergological test involving multiple MLSs and giving at least one positive result were included. Results: Of the 8394 cases reviewed, 149 were included. HSR mainly involved pristinamycin (n = 83; 53.2%) and spiramycin (n = 31; 19.9%). HSR to MLS was immediate in 54 cases and delayed in 94 cases. Skin tests represented the majority of the allergological tests performed (n = 728; 84.7%), followed by reintroduction tests (n = 79; 9.2%). Eighty‐six cross‐reactivities among MLS were identified in 62 cases (41.6%). All the 25 explorations performed for streptogramins showed cross‐reactivities, but only 30/253 among macrolides (11.9%). Cross‐reactivities between the three MLS were observed in 31/322 (9.6%) of the allergological explorations. Conclusion: This study highlights the possibility of cross‐reactivity among and between MLSs. Dermatologists and allergologists managing patients with HSR to MLSs should be aware of a risk of cross‐reactivity among the macrolides and between the different classes of MLS and to perform MLSs allergological testing before recommending an alternative antibiotic, especially in severe drug hypersensitivity from the MLS family. [ABSTRACT FROM AUTHOR]

Background Over the years, reports have associated fluoroquinolones (FQ) with seizures. The incidence and whether FQ compared to non-epileptogenic antibiotic are associated with increased risk of seizures has yet to be examined. Methods A retrospective observational study of hospitalized patients treated with FQ (ofloxacin, ciprofloxacin, levofloxacin, moxifloxacin) or macrolides (MA: azithromycin or roxithromycin) between January 2009 and January 2021 in a large tertiary academic medical centre. The outcome was the occurrence of a seizure during treatment. The Naranjo scale was used to assess causality between FQ treatment and seizures. Comparative analysis was conducted using propensity score matching to correct for possible bias due to non-random selection, followed by inverse probability weighting (IPW) to estimate the difference in seizure risk between FQ and MA. Results Overall, 52 722 patients were treated with FQ during a total of 178 982 days. Mean age was 65 (±19) years and 47% were females. Thirty-three patients (0.06%) experienced a seizure, yielding an incidence of 1:5422 treatment days. Causality was deemed probable and possible among 9/33 and 24/33, respectively. The MA group composed of 8522 patients treated during 17 954 treatment days. Mean age was 65 (±21) years, 49% were females. Six (0.07%) patients experienced each a single seizure. IPW estimated OR for seizures among the FQ versus MA group was 1.44 (95%CI 0.59–3.5, P  = 0.42). Discussion The incidence of FQ associated seizures among hospitalized patients is low and the risk did not significantly exceed that under macrolides. Our results provide evidence for clinicians and decision-makers when balancing fluoroquinolones risks and benefits. [ABSTRACT FROM AUTHOR]

Background: The strategies to control scabies in highly endemic populations include individual case/household management and mass drug administration (MDA). We used a decision-analytic model to compare ivermectin-based MDA and individual case/household management (referred to as "usual care") for control of scabies in Ethiopia at different prevalence thresholds for commencing MDA. Methods: A decision-analytic model was based on a repeated population survey conducted in Northern Ethiopia in 2018-2020, which aimed to evaluate the secondary impact of single-dose ivermectin MDA for the control of onchocerciasis on scabies prevalence. The model estimates the number of scabies cases and costs of two treatment strategies (MDA and usual care) based on their effectiveness, population size, scabies prevalence, compliance with MDA, medication cost, and other parameters. Results: In the base-case analysis with a population of 100,000 and scabies prevalence of 15%, the MDA strategy was both more effective and less costly than usual care. The probability of MDA being cost-effective at the current costeffectiveness threshold (equivalent to the cost of usual care) was 85%. One-way sensitivity analyses showed that the MDA strategy remained dominant (less costly and more effective) in 22 out of 26 scenarios. MDA was not cost-effective at scabies prevalence <10%, MDA effectiveness <85% and population size <5,000. An increase in the cost of ivermectin from 0 (donated) to 0.54 US$/dose resulted in a decrease in the probability of MDA being cost-effective from 85% to 17%. At 0.25 US$/dose, the MDA strategy was no longer cost-effective. Conclusions: The model provides robust estimates of the costs and outcomes of MDA and usual care and can be used by decision-makers for planning and implementing scabies control programmes. Results of our analysis suggest that single-dose ivermectin MDA is cost-effective in scabies control and can be initiated at a scabies prevalence >10%. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is a common syndrome associated with smoking and environmental exposures coupled with genetic susceptibility. Recent major advancements in the treatment of COPD patients have become available. Areas covered: New data on the role of classic bronchodilators, including short-acting and long-acting beta2-agonists and anti-muscarinic antagonists, in the treatment of COPD patients are discussed. Data promoting a more targeted approach to inhaled and systemic corticosteroid use in COPD are reviewed. Phosphodiesterase (PDE) inhibitors, including the recently approved PDE 3/4 inhibitor inhaled ensifentrine, are noted. Selective use of antibiotics can play a role in complex COPD patients. COPD patients with evidence of asthma-COPD overlap syndrome and type-two lymphocytic inflammatory-mediated airway constriction appear to respond to biologics, particularly the anti-IL-4/IL-3 antagonist monoclonal antibody, dupilumab. Expert opinion: New therapeutic options have made the approach and treatment of the COPD patient much more complicated. These options tend to be very expensive. Attention to identifying the endotype and phenotype will help direct the pharmacotherapy. [ABSTRACT FROM AUTHOR]

In recent years, the widespread application of antibiotics has raised global concerns, posing a severe threat to ecological health. In this study, the occurrence, source, and ecological risks of 39 antibiotics belonging to 5 classes in mangrove sediments from Lianzhou Bay, China, were assessed. The total concentrations of the antibiotics (∑39 antibiotics) ranged from 65.45 to 202.24 ng/g dry weight (dw), with an average of 142.73 ± 36.76 ng/g dw. The concentrations of these five classes of antibiotics were as follows: Sulfonamides (SAs) > Tetracyclines (TCs) > Fluoroquinolones (QUs) > Penicillin (PCs) > Macrolides (MLs). The spatial distribution of antibiotics varied as high tidal zone > middle tidal zone > low tidal zone. The total organic carbon (TOC), pH, nitrate (NO3−-N), and nitrite (NO2−-N) of the sediment significantly influenced the distribution of antibiotics (p < 0.05). A source analysis identified untreated sewage from aquaculture as the primary source of antibiotics in the local mangrove. A risk assessment revealed that ciprofloxacin, norfloxacin, ofloxacin of QUs, and tetracycline of TCs exhibited medium risks to algae in certain sampling sites, while other antibiotics exhibited low or no risks to all organisms. Nevertheless, the total risk of all the detected antibiotics to algae was medium in 95% of the sites. The overall ecological risk level of antibiotics in the middle tidal zone was slightly lower than in the high tidal zone and the lowest in the low tidal zone. In summary, the experimental results provided insights into the fate and transport behaviors of antibiotics in mangrove sediments from Lianzhou Bay. [ABSTRACT FROM AUTHOR]

Antibiotic contamination poses a significant global concern due to its far-reaching impact on public health and the environment. This comprehensive review delves into the prevalence of various antibiotic classes in environmental pollution and their interactions with natural ecosystems. Fluoroquinolones, macrolides, tetracyclines, and sulphonamides have emerged as prevalent contaminants in environmental matrices worldwide. The concentrations of these antibiotics vary across diverse environments, influenced by production practices, consumer behaviours, and socio-economic factors. Low- and low-middle-income countries face unique challenges in managing antibiotic contamination, with dominant mechanisms like hydrolysis, sorption, and biodegradation leading to the formation of toxic byproducts. Ecotoxicity reports reveal the detrimental effects of these byproducts on aquatic and terrestrial ecosystems, further emphasizing the gravity of the issue. Notably, monitoring the antibiotic parent compound alone may be inadequate for framing effective control and management strategies for antibiotic pollution. This review underscores the imperative of a comprehensive, multi-sectoral approach to address environmental antibiotic contamination and combat antimicrobial resistance. It also advocates for the development and implementation of tailored national action plans that consider specific environmental conditions and factors. Thus, an approach is crucial for safeguarding both public health and the delicate balance of our natural ecosystems. [ABSTRACT FROM AUTHOR]

AbstractBovine mastitis is a mammary gland inflammation that can occur due to infectious pathogens, Staphylococcus aureus and Escherichia coli, which are, respectively, the most prevalent Gram-positive and Gram-negative bacteria associated with this disease. Currently, antibiotic treatment has become more complicated due to the presence of resistant pathogens. This review, therefore, aims to identify the most common resistance genes reported for these strains in the last four years. During the review, it was noted that blaZ, blaSHV, blaTEM, and blaampC are the most reported genes for S. aureus and E. coli, associated with drug inactivation, mainly β-lactamases. They are characterized by generating bacterial resistance to β-lactam antibiotics, the most common treatment in animal and human bacterial treatments (penicillins and cephalosporins, among others). Genes associated with efflux systems were also present in the two strains and included norA, tetA, tetC, and tetK, which generate resistance to macrolide and tetracycline antibiotics. Additionally, the effects of spreading resistance between animals and humans through direct contact (such as consumption of contaminated milk) or indirect contact (through environmental contamination) has been deeply discussed, emphasizing the importance of having adequate sanitation and antibiotic control and administration protocols. [ABSTRACT FROM AUTHOR]

Antibiotics are routinely added to ornamental fish tanks for treating bacterial infection or as a prophylactic measure. However, the overuse or subtherapeutical application of antibiotics could potentially facilitate the selection of antibiotic resistance in bacteria, yet no studies have investigated antibiotic use in the retail ornamental fish sector and its impact on microbial communities. The present study analyzed the concentrations of twenty antibiotics in the carriage water (which also originates from fish tanks in retail shops) collected monthly from ten local ornamental fish shops over a duration of three months. The antibiotic concentrations were correlated with the sequenced microbial community composition, and the risk of resistance selection in bacteria was assessed. Results revealed that the detected concentrations of tetracyclines were the highest among samples, followed by fluoroquinolones and macrolides. The concentrations of oxytetracycline (44.3 to 2,262,064.2 ng L−1) detected across three months demonstrated a high risk for resistance selection at most of the sampled shops. Zoonotic pathogens (species of Rhodococcus, Legionella, and Citrobacter) were positively correlated with the concentrations of oxytetracycline, tetracycline, chlortetracycline, and enrofloxacin. This suggests that antibiotic use in retail shops may increase the likelihood of selecting for zoonotic pathogens. These findings shed light on the potential for ornamental fish retail shops to create a favorable environment for the selection of pathogens with antibiotics, thereby highlighting the urgent need for enhanced antibiotic stewardship within the industry. [ABSTRACT FROM AUTHOR]

Purpose: Vanishing bile duct syndrome (VBDS) is a rare, but potentially fatal adverse reaction triggered by certain medications. Few real-world studies have shown association between antibiotics and VBDS. We sought to quantify the risk and evaluate the clinical features of VBDS associated with antibiotics. Methods: Data from 2004 to 2022 on VBDS events induced by antibiotics were retrieved from the FDA Adverse Event Reporting System (FAERS) database and disproportionality analyses were conducted. Furthermore, case reports from 2000 to 31 December 2022 on antibiotics-induced VBDS were retrieved for retrospective analysis. Results: We collected 132 VBDS reports from the FAERS database. Fluoroquinolones had the greatest proportion and highest positive signal values of VBDS. The RORs (95% CIs) for antibiotics were fluoroquinolones 23.68 (18.12–30.95), macrolides 19.37 (13.58–27.62), carbapenems 17.39 (7.77–38.96), beta-lactam 13.28 (9.69–18.20), trimethoprim/sulfamethoxazole 9.05 (5.57–14.7), and tetracycline 4.02 (1.50–10.77). Twenty-three cases from 22 studies showed evidence of VBDS, beta-lactam (52.2%) was the most frequently reported agent. The median age was 45 years, the typical initial symptoms included rash (30.4%), fatigue/asthenia (26.1%), dark urine (21.7%) and Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) (21.7%). The median time to onset of VBDS was 2 weeks. All cases had abnormal liver function test, and the median level of total bilirubin was 23.6 mg/dl (range 3.2–80 mg/dl). Cessation of culprit drugs and treatment with ursodeoxycholic acid (83.3%) were not associated with improved outcomes (57.1%). Conclusion: This study identified thirteen antibacterial agents with significant reporting associations with VBDS. Fluoroquinolones may be a neglected agent of inducing VBDS. [ABSTRACT FROM AUTHOR]

Background: The objective of this network meta-analysis was to compare rates of clinical response and mortality for empiric oral antibiotic regimens in adults with mild-moderate community-acquired pneumonia (CAP). Methods: We searched PubMed, Cochrane, and the reference lists of systematic reviews and clinical guidelines. We included randomized trials of adults with radiologically confirmed mild to moderate CAP initially treated orally and reporting clinical cure or mortality. Abstracts and studies were reviewed in parallel for inclusion in the analysis and for data abstraction. We performed separate analyses by antibiotic medications and antibiotic classes and present the results through network diagrams and forest plots sorted by p-scores. We assessed the quality of each study using the Cochrane Risk of Bias framework, as well as global and local inconsistency. Results: We identified 24 studies with 9361 patients: six at low risk of bias, six at unclear risk, and 12 at high risk. Nemonoxacin, levofloxacin, and telithromycin were most likely to achieve clinical response (p-score 0.79, 0.71, and 0.69 respectively), while penicillin and amoxicillin were least likely to achieve clinical response. Levofloxacin, nemonoxacin, azithromycin, and amoxicillin-clavulanate were most likely to be associated with lower mortality (p-score 0.85, 0.75, 0.74, and 0.68 respectively). By antibiotic class, quinolones and macrolides were most effective for clinical response (0.71 and 0.70 respectively), with amoxicillin-clavulanate plus macrolides and beta-lactams being less effective (p-score 0.11 and 0.22). Quinolones were most likely to be associated with lower mortality (0.63). All confidence intervals were broad and partially overlapping. Conclusion: We observed trends toward a better clinical response and lower mortality for quinolones as empiric antibiotics for CAP, but found no conclusive evidence of any antibiotic being clearly more effective than another. More trials are needed to inform guideline recommendations on the most effective antibiotic regimens for outpatients with mild to moderate CAP. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is a global public health concern that has been exacerbated by the overuse and misuse of antibiotics, leading to the emergence of resistant bacteria. The gut microbiota, often influenced by antibiotic usage, plays a crucial role in overall health. Therefore, this study aimed to investigate the prevalence of antibiotic resistant genes in the gut microbiota of Indonesian coastal and highland populations, as well as to identify vancomycin-resistant bacteria and their resistant genes. Methods: Stool samples were collected from 22 individuals residing in Pacet, Mojokerto, and Kenjeran, Surabaya Indonesia in 2022. The read count of antibiotic resistant genes was analyzed in the collected samples, and the bacterium concentration was counted by plating on the antibiotic-containing agar plate. Vancomycin-resistant strains were further isolated, and the presence of vancomycin-resistant genes was detected using a multiplex polymerase chain reaction (PCR). Results: The antibiotic resistant genes for tetracycline, aminoglycosides, macrolides, beta-lactams, and vancomycin were found in high frequency in all stool samples (100%) of the gut microbiota. Meanwhile, those meant for chloramphenicol and sulfonamides were found in 86% and 16% of the samples, respectively. Notably, vancomycin-resistant genes were found in 16 intrinsically resistant Gram-negative bacterial strains. Among the detected vancomycin-resistant genes, vanG was the most prevalent (27.3%), while vanA was the least prevalent (4.5%). Conclusion: The presence of multiple vancomycin resistance genes in intrinsically resistant Gram-negative bacterial strains demonstrated the importance of the gut microbiota as a reservoir and hub for the horizontal transfer of antibiotic resistant genes. [ABSTRACT FROM AUTHOR]

Antibiotic residues and antibiotic resistance genes (ARGs) in sludge pose high risks to human health and the ecological environment. Hyper-temperature aerobic bio-drying system (HTAB) has the potential for higher degradation efficiency of antibiotics and ARGs due to high-temperature and rapid organic matter degradation. This study firstly reports two sludge HTAB processes, hyperthermophilic aerobic bio-drying (HAB) and electro-assisted heating bio-drying (EHAB), for the removal efficiency of four types of antibiotics, quinolones, tetracyclines, macrolides, and sulfonamide antibiotics, and ARGs, as well as the relationship between antibiotics and ARGs. The microbial communities of the two HTAB processes showed significant differences compared to the conventional bio-drying process (CAB). Compared to the CAB, the HTAB significantly improved the removal efficiency of antibiotics and ARGs and shortened the half-life of antibiotics. In the two HTAB processes, the total antibiotic removal of the HAB and EHAB processes was 78.11 and 74.15%, respectively. Compared with the EHAB process, the HAB process had higher removal for all four types of antibiotics, especially significantly improving the removal efficiency of tetracyclines. Compared to the CAB, both HTAB processes significantly enhanced the removal efficiency of ARGs and mobile genetic elements (MGEs). In the two HTAB processes, the HAB showed a higher removal efficiency of ARGs and MGEs compared to the EHAB. The relevant mechanisms indicated that temperature and changes in microbial communities jointly affected the removal efficiency of antibiotics and ARGs. [ABSTRACT FROM AUTHOR]

Microplastics (MPs) and antibiotics are emerging pollutants widely found in aquatic environments, potentially causing environmental harm. MPs may act as carriers for antibiotics, affecting their environmental distribution. This study investigates the adsorption of four macrolide antibiotics and a metabolite onto two types of MPs: polyethylene terephthalate (PET) and polyethylene (PE). Results revealed a linear isotherm adsorption model, with higher adsorption to PET than to PE (R2 > 0.936 for PE and R2 > 0.910 for PET). Hydrophobic interactions and hydrogen bonding could be the main adsorption mechanisms, with pore filling potentially involved. Reduced particle size enhances adsorption due to the increase of active adsorption sites. This increasement is more pronounced in PE than in PET, leading to an 11.6% increase in the average adsorption of all macrolides to PE, compared to only 5.1% to PET. Dissolved organic matter inhibits adsorption (azithromycin adsorption to PE was reduced from 12% to 5.1%), while salinity enhances it just until 1% salinity. pH slightly influences adsorption, with maximal adsorption at neutral pH. Results in real samples showed that complexity of the matrix decreased adsorption. Overall, these findings indicate that PE and PET MPs can be a vector of macrolides in aquatic environments. [ABSTRACT FROM AUTHOR]

Objectives To compare the differences in antibiotic use between COPD and non-COPD residents, and to explore the effect of COPD on antibiotic use. Methods Participants aged 40 years old or over from the Songjiang Adult Cohort were included. Information on prescription and baseline survey was collected based on the health information system. A logit-negative binomial Hurdle model was used to explore correlations between COPD and percentage of antibiotic use and average rate of antibiotic prescribing of different types of antibiotic. Multinomial logistic regression was used to assess the association between COPD and antimicrobial combination therapy and routes of administration. Results A total of 34576 individuals were included and 1594 (4.6%) were COPD patients. During the 6 years' follow-up, the percentage of antibiotic use for COPD patients was 98.4%, which was 7.88 (95%CI: 5.24–11.85) times of that for non-COPD patients after adjusting for potential confounders. The prescribing rate was 3220 prescriptions (95%CI: 3063.6–3385.2) per 1000 person-years for COPD patients, which was 1.96 (95%CI: 1.87–2.06) times of that for non-COPD patients. Other beta-lactam antibacterials, Macrolides, lincosamides and streptogramins, and quinolone antibacterials were the most commonly used types of antibiotic. Except for aminoglycoside antibacterials, both percentage of antibiotic use and rate of antibiotic prescription were increased in COPD patients. COPD patients were more likely to be prescribed a maximum of two antibiotics (OR=1.34, 95%CI: 1.20–1.50); and were more likely to use antibiotics intravenously (OR=2.77, 95%CI: 2.47–3.11). Conclusion COPD patients were more likely to have increased antibiotic use in a large-scale population-based adult cohort, suggesting COPD patients are a high-priority group for the management of antibiotic use in communities. [ABSTRACT FROM AUTHOR]

Azithromycin is a macrolide antibiotic that is commonly prescribed to treat infections of the skin, soft tissues, and the upper and lower respiratory tracts. Many antibiotics, including azithromycin, are overprescribed, leading to elevated concentrations of these drugs in bodies of water; this phenomenon is referred to as antibiotic pollution. Antibiotic pollution is increasingly concerning, due to its implications for the development of antibiotic resistance and its potential ecotoxicity. Rapid detection of azithromycin in wastewater could be important for addressing antibiotic pollution. This research highlights the development of a direct electrochemical surface-enhanced Raman spectroscopy method for the detection of azithromycin in synthetic wastewater. The coupling of electrochemistry and surface-enhanced Raman spectroscopy allowed enhanced detection of azithromycin and its derivatives in wastewater. To the best of our knowledge, this is the first report of direct detection of azithromycin using electrochemical surface-enhanced Raman spectroscopy. This novel detection method has promising application in future research concerning antibiotic pollution. [ABSTRACT FROM AUTHOR]

Purpose: To review the efficacy and safety of oral doxycycline antibiotics versus macrolides in the treatment of meibomian gland dysfunction (MGD). Design: Systematic review and meta‐analysis. Methods: We performed a systematic search of electronic databases for all peer‐reviewed published studies which included clinical outcomes of oral antibiotic MGD treatment. Individual study data were extracted and evaluated in a weighted pooled analysis, including total sign and symptom scores, meibomian gland secretion score, tear break‐up time (TBUT), fluorescein staining score and rate of complications. Results: Two thousand nine hundred and thirty‐three studies were found, of which 54 were eligible for the systematic review, and six prospective studies were ultimately included for analysis, reporting on 563 cases from three countries. Age of affected patients ranged between 12 and 90 years. Overall, both treatment methods induced improvement in MGD signs and symptoms. In pooled analysis, macrolides were significantly superior in the total signs score (pooled standardized mean difference (SMD) −0.51, 95% confidence interval (CI): −0.99 to −0.03), meibomian gland secretion score (pooled SMD −0.25, 95%CI: [−0.48, −0.03]), TBUT (SMD −0.31, 95%CI: [−0.50, −0.13]) and fluorescein staining score (SMD −1.01, 95%CI: [−1.72, −0.29]). Moreover, while no severe complications were reported for both treatments, the macrolide group exhibited significantly less adverse events (pooled odds ratio 0.24 with a 95% CI of 0.16 to 0.34). Conclusions: Both macrolides and tetracyclines are effective treatments for MGD. In this study, macrolides exhibited better efficacy and safety profile compared to tetracyclines. [ABSTRACT FROM AUTHOR]

Macrolides and tetracyclines are antibiotics that have a range of anti‐inflammatory properties beyond their microbial capabilities. Although these antibiotics have been in widespread use, the long‐term safety profiles are limited. We performed a systematic review and meta‐analysis of randomized clinical trials that compared macrolides or tetracyclines with placeboes to provide long‐term safety information. We searched Medline and EMBASE from inception to October 2022 and identified studies that reported study drug‐related death, serious adverse events (SAEs), or withdrawal rates, and common adverse effects of each drug. Relative risk (RR) and number needed to harm were calculated. Of the 52 randomized clinical trials included, there are 3151 participants on doxycycline, 2519 participants on minocycline, 3049 participants on azithromycin, 763 participants on clarithromycin, 262 participants on erythromycin, and 100 participants on roxithromycin. There was no death related to any study drugs and rates of SAE were not significantly different from placebo in any drug. Overall withdrawal rates were slightly higher than placebo in doxycycline (RR, 1.30; 95% CI, 1.12‐1.52) and minocycline (RR, 1.29; 95% CI, 1.15‐1.46). Withdrawal rates due to adverse events were higher in doxycycline (RR, 2.82; 95% CI, 1.88‐4.22), minocycline (RR, 1.48; 95% CI, 1.09‐1.98), and azithromycin (RR, 1.53; 95% CI, 1.13‐2.08). Gastrointestinal disturbances are the most common tolerable adverse effects for every drug. Photosensitivity and rash are the second most common adverse effects for doxycycline and minocycline. We found no evidence that long‐term use up to 2 years of macrolides or tetracyclines was associated with increased risk of SAEs. [ABSTRACT FROM AUTHOR]

Nowadays, incorrect apply of antibiotics to treat infections in honey has led to health risks for humans and antibiotic resistance. Current systematic review and meta-analysis conducted to study antibiotic residues in honey. Data were obtained through searching the databases, including Scopus, Web of Science, PubMed, and other internal databases. The pooled concentration of antibiotic residues was 5.032 (µg/kg) that ranged from 4.72 to 5.33 (µg/kg). The ranking of antibiotics concentration was found in order of fluoroquinolone (8.59 µg/kg) > tetracycline (5.68 µg/kg) > sulfonamides (5.54 µg/kg) > macrolides (4.19µg/kg), respectively. Liquid chromatography–mass spectrometry (LC–MS) method (37.9.7%), high-performance liquid chromatography (HPLC) method (34.4%), and enzyme-linked immunosorbent assay (ELISA) method (27.5.8%) were the most used methods in various studies. In order to avoid contamination, proper use of antibiotics, placement of hives at a suitable distance from agricultural environment, and regular control of antibiotic residues in honey seems to be necessary. [ABSTRACT FROM AUTHOR]

Documentation of adverse drug reactions (ADRs) is a key factor in guiding future prescribing. However, incomplete documentation is common and often fails to distinguish implicated drugs as true allergies. This in turn leads to unnecessary avoidance of implicated drug classes and may result in sub-optimal prescribing. Pharmacovigilance (PV) programs utilize a systematic approach to clarify ADR documentation and are known to improve patient safety. Yet it remains unclear if PV alters prescribing. Or, if the existence of the ADR documentation itself continues to prompt avoidance of implicated drugs. To address this, our work presents a retrospective cohort study assessing if clarification of antibiotic ADRs by a hospital-wide PV team was associated with future, safe, re-prescribing at a freestanding pediatric hospital in the midwestern United States. First, we compared the likelihood of future prescribing in an antibiotic class with an active ADR, as compared to alternative drug classes, between PV-clarified and non-clarified patients. Second, we assessed differences in adverse event rates 30-days after future prescribing based on PV clarification status. For robustness, analyses were performed on patients with ADRs in four antibiotic classes: penicillin-based beta-lactams (n = 45,642), sulfonamides/trimethoprim (n = 5,329), macrolides (n = 3,959), and glycopeptides (n = 622). Results illustrate that clarification of an ADR by PV was associated with an increased odds of future prescribing in the same drug class (Odds Ratio [95%-CI]): penicillin-based beta-lactams (1.59 [1.36–1.89]), sulfonamides/trimethoprim (2.29 [0.89–4.91]), macrolides (0.77 [0.33–1.61]), and glycopeptide (1.85 [1.12–3.20]). Notably, patients clarified by PV experienced no increase in the rate of adverse events within 30-days following the prescribing of antibiotics in the same class as an active ADR. Overall, this study provides strong evidence that PV reviews safely increase the rate of re-prescribing antibiotics even in the presence of an existing implicated drug ADR. [ABSTRACT FROM AUTHOR]

Background: Nontuberculous mycobacteria are mycobacteria other than those that cause tuberculosis and leprosy and can cause infections in various parts of the body, predominantly the lungs. Of approximately 200 species of nontuberculous mycobacteria, only about 10 are linked to pulmonary infections, with Mycobacterium avium complex (MAC) being the most common. Current Concepts: The standard treatment for pulmonary diseases caused by the MAC is combination therapy, including macrolide antibiotics and other antibiotics such as ethambutol and rifampin. Among macrolide antibiotics, azithromycin and clarithromycin are commonly used for managing MAC pulmonary diseases, and in cases with extensive lesions, amikacin injections are administered concurrently during the initial stages of treatment. Ensuring an overall treatment duration of an additional 12 months after negative culture conversion is recommended in affected patients. However, despite an extended treatment period, the cure rate remains at 60~70%. Recently, an inhalable liposomal form of amikacin, marketed as ARIKAYCE, has been developed. It has been approved by the US Food and Drug Administration as an effective treatment for refractory MAC pulmonary diseases. When ARIKAYCE was used for an additional 6 months or more in patients with refractory MAC pulmonary diseases, approximately 29% of patients achieved additional treatment success. However, it has yet to be officially imported into South Korea, and a high monthly cost restricts its practical use in the country. Therefore, the treatment of MAC pulmonary disease in South Korea will remain a challenge, unless a more effective treatment emerges. Discussion and Conclusion: MAC pulmonary disease requires long-term combination antibiotic therapy, usually with macrolides, ethambutol, and rifampin, and amikacin injections are recommended for cases with extensive lesions. The lack of effective drugs hampers treatment, increasing the burden of antibiotic side effects. Therefore, more research is urgently needed for better treatment of MAC pulmonary disease. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010–2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010–2019) and a prediction interval was set up to assess whether the pandemic years' observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary. [ABSTRACT FROM AUTHOR]

This document discusses the usage of antibiotics in special clinical situations. It emphasizes the importance of patient-tailored diagnostics and therapy, as well as antimicrobial stewardship. The document highlights specific clinical situations such as osteomyelitis, vancomycin-resistant Enterococcus faecium infections, diverticular disease, Acinetobacter infections, the impact of macrolides on children's gut flora, and antibiotics for diabetic foot infections. Each section provides evidence-based information on treatment options, limitations, and potential future research. The document aims to review current clinical practices and advance knowledge in the field of infectious diseases. [Extracted from the article]

Introduction: Antibiotic arbitrary use by increasing resistance changed to a growing issue in the 21st century and its optimal use in hospital could be essential for reducing health system costs and drug side effects. Objectives: The aim of this study was to investigate the pattern of antibiotic use in prescribed prescription. Patients and Methods: This was a cross-sectional study that has been done on 300 prescriptions which selected randomly form Ardabil city hospitals. The anatomical therapeutic chemical classification system with defined daily doses (ATC/DDD) standard measurement method recommended by World Health Organization (WHO) was conducted in the study. The amount uses rate of each medication calculated by DDD/100 bed days. Data collected by a checklist and analyzed by statistical methods in SPSS version 21. Results: The highest prescribed antibiotic was ciprofloxacin with 32% and the total antibiotics uses rate during study period was 44/95 DDD/100 Bed days. The mean number of drugs and prescribed antibiotics in intensive care unit (ICU) ward was more than other wards. However, comparing the rate of antibiotics use between wards based on ATC/DDD method showed that the infection ward with 62.9 was more than other wards. The most form of used antibiotics with 69% was in the form of Ampule and in intravenously method with 64% in all wards. Conclusion: The results of this study showed that the most used antibiotics by considering the studied method, prescribed dose and the hospitalized days were in internal and surgery ward respectively but according ATC/DDD method the most used antibiotics was in infection ward. [ABSTRACT FROM AUTHOR]

Antibiotics, which hit the market with astounding impact, were once called miracle drugs, as these were considered the ultimate cure for infectious diseases in the mid-20th century. However, today, nearly all bacteria that afflict humankind have become resistant to these wonder drugs once developed to stop them, imperiling the foundation of modern medicine. During the COVID-19 pandemic, there was a surge in macrolide use to treat secondary infections and this persistent use of macrolide antibiotics has provoked the emergence of macrolide resistance. In view of the current dearth of new antibiotics in the pipeline, it is essential to find an alternative way to combat drug resistance. Antibiotic potentiators or adjuvants are non-antibacterial active molecules that, when combined with antibiotics, increase their activity. Thus, potentiating the existing antibiotics is one of the promising approaches to tackle and minimize the impact of antimicrobial resistance (AMR). Several natural and synthetic compounds have demonstrated effectiveness in potentiating macrolide antibiotics against multidrug-resistant (MDR) pathogens. The present review summarizes the different resistance mechanisms adapted by bacteria to resist macrolides and further emphasizes the major macrolide potentiators identified which could serve to revive the antibiotic and can be used for the reversal of macrolide resistance. [ABSTRACT FROM AUTHOR]

Periodic assessment of bacterial contamination is necessary as it allows proper guidance in cases of eye infections through the use of appropriate antibiotics. Due to the extensive use of antibiotic treatment, many strains of the microbiota that cause infections are resistant to the usual ophthalmic antibiotics. The present study provides an updated assessment of the susceptibility of Gram-positive and Gram-negative bacteria found on the ocular surface to the most commonly used antibiotic agents in patients undergoing cataract surgery. A total of 993 patients were included in the study with ages between 44 and 98 years old. Conjunctival cultures were collected 7 days before cataract surgery. The response of Gram-positive and Gram-negative bacteria to various antibiotic classes, such as glycopeptides, cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, phenicols, tetracyclines, rifamycins, macrolides and penicillins, was assessed. From the tested antibiotics, vancomycin had 97.8% efficacy on Gram-positive bacteria. In the cephalosporin category, we observed a high level of resistance of the cefuroxime for both Gram-positive and negative bacteria. Antibiotics that have more than 90% efficacy on Gram-positive bacteria are meropenem, imipenem, netilmicin, amikacin and rifampicin. On Gram-negative bacteria, we found 100% efficacy of all tested fluoroquinolones, i.e., aminoglycosides (except for tobramycin), doxycycline, azithromycin, clarithromycin and chloramphenicol. The current study illustrates patterns of increased resistance in certain bacteria present on the ocular surface to some of the commonly used antibiotics in ophthalmological clinical practice. One such revealing example is cefuroxime, which has been highly used as an intracameral antibiotic for the prevention of bacterial endophthalmitis after cataract surgery. [ABSTRACT FROM AUTHOR]

Apple proliferation, caused by 'Candidatus Phytoplasma mali', is one of the most important economic threats in the field of apple production. Especially at a young age, infected trees can be affected by excessive bud proliferation and general decline. The fruit quality is also significantly reduced by this disease. To investigate treatment options, we applied a clarithromycin chemotherapy to infected in vitro cultures of 'Golden Delicious'. With increasing concentrations of clarithromycin in the media, the phytoplasma load decreased rapidly after one month of treatment, but phytotoxicity led to a pronounced mortality at 40 mg/L, which was the highest dose used in our experiment. Out of 45 initial explants, we obtained one negative mericlone and two mericlones with a concentration of phytoplasma DNA at the detection limit of PCR. The culture propagated from the mericlone that tested negative remained phytoplasma-free after 18 months of subculturing. Our results suggest the applicability of macrolide antibiotics against phytoplasma infections in vitro; however, it might be challenging to find the threshold zone where the concentration is sufficient for pathogen elimination, but not lethal for the plant material of different cultivars. [ABSTRACT FROM AUTHOR]

The growing global apprehension towards multi-drug resistant (MDR) bacteria necessitates the development of innovative strategies to combat these infections. Berberine (BER), an isoquinoline quaternary alkaloid derived from various medicinal plants, has surfaced as a promising antibiotic adjuvant due to its ability to enhance the effectiveness of conventional antibiotics against drug-resistant bacterial strains. Here, we overview the augmenting properties and mechanisms of BER as an adjunctive antibiotic against MDR bacteria. BER has been observed to exhibit synergistic effects when co-administered with a range of antibiotics, including β-lactams, quinolones, aminoglycosides, tetracyclines, macrolides, lincosamides and fusidic acid. The adjunctive properties of BER led to an increase in antimicrobial effectiveness for these antibiotics against the corresponding bacteria, a decrease in minimal inhibitory concentrations, and even the reversal from resistance to susceptibility sometimes. The potential mechanisms responsible for these effects included the inhibition of antibiotic efflux, the disruption of biofilm formation, the modulation of host immune responses, and the restoration of gut microbiota homeostasis. In brief, BER demonstrated significant potential as an antibiotic adjuvant against MDR bacteria and is a promising candidate for combination therapy. Further research is necessary to fully elucidate its mechanism of action and address the challenges associated with its clinical application. [ABSTRACT FROM AUTHOR]

Introduction: Legionnaires' Disease is a pneumonia caused by Legionella spp., currently treated empirically with fluoroquinolones and macrolides. In this study, we aim to describe the antibiotic susceptibility pattern of environmental Legionella recovered in the south of Portugal. Methods: Minimal inhibitory concentration (MIC) determination of 57 Legionella isolates (10 Lp sg 1, 32, Lp sg 2-14 15 L. spp) was achieved by broth microdilution, as described by EUCAST, for azithromycin, clarithromycin, ciprofloxacin, levofloxacin, and doxycycline. Results: Fluoroquinolones were the most active antibiotic, displaying the lowest MIC values in contrast to doxycycline which had the highest. MIC90 and epidemiological cut-off (ECOFF) values were, respectively, 0.5/1 mg/L for azithromycin, 0.125/0.25 mg/L for clarithromycin, 0.064/0.125 mg/L for ciprofloxacin, 0.125/0.125 mg/L for levofloxacin and 16/32 mg/L for doxycycline. Discussion: MIC distributions were higher than reported by EUCAST for all antibiotics. Interestingly, two phenotypically resistant isolates with high-level quinolone resistance were identified. This is the first time that MIC distributions, lpeAB and tet56 genes have been investigated in Portuguese environmental isolates of Legionella. [ABSTRACT FROM AUTHOR]

Objectives A decrease in community antibiotic consumption in Europe has been observed during the COVID-19 pandemic. The magnitude of this decrease, how fast after the outbreak it occurred, whether it was sustained during the pandemic and whether the seasonal variation in antibiotic consumption was affected, have not yet been evaluated in detail. Methods Data on community antibiotic consumption were available from the European Surveillance of Antimicrobial Consumption Network for 28 EU/European Economic Area (EEA) countries between 2010 and 2021. Antibiotic consumption was expressed as DDDs per 1000 inhabitants per day (DID). The impact of the pandemic on antibiotic consumption was investigated using descriptive statistics and non-linear mixed changepoint models for quarterly and yearly data. Results The decrease in overall antibiotic consumption between 2019 and 2020 (−3.4 DID; −18.6%) was mainly due to a decrease in the consumption of penicillins [Anatomical Therapeutic Chemical (ATC) code J01C] (−1.9 DID; −23.0%), other β-lactam antibacterials (J01D) (−0.6 DID; −25.8%) and macrolides, lincosamides and streptogramins (J01F) (−0.5 DID; −17.4%) and was sustained during 2021. The changepoint analysis of yearly data (28 countries) estimated a decrease of 3.3 DID in overall antibiotic consumption (J01) between 2019 and 2020. The analysis of quarterly data (16 countries) estimated a decrease in overall antibiotic consumption (J01) of 4.0 DID and a decrease in seasonal variation of 1.2 DID between the first and second quarters of 2020. Conclusions The changepoint analysis indicated a significant, sudden and steep decrease in community antibiotic consumption in the EU/EEA immediately after the start of the COVID-19 outbreak in Europe, as well as a decrease in its seasonal variation. [ABSTRACT FROM AUTHOR]

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Background: The management and control of gonorrhea are hampered by the widespread resistance to the diverse strains of Neisseria gonorrhea. Resistance to sulfonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and early cephalosporins has emerged rapidly. Purpose: This systematic review aimed to assess what antibiotics can be used as an alternative therapy for gonorrhea infections that are resistant to antibiotics. Methods: The study was conducted using the Web of Science, PubMed, Embase, and CENTRAL databases, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. Risk of Bias for Randomized Trials (RoB2) was utilized to evaluate study quality. Results: This review included 28 articles from randomized controlled trials between 2013 and 2023, distributed across five nations. The studies included 2.380 patients and clinical isolates from men and women diagnosed with gonorrhea infection at various sites. Sample testing by treatment with alternative antibiotics. Discussion: Zoliflodacin, tigecycline, and ertapenem in single or dual therapy with ceftriaxone could be considered as a potential option in treating gonorrhea resistant to antibiotics. Gentamicin cannot be recommended to replace ceftriaxone as first-line therapy. Gepotidacin is effective for the Gyr A A92T mutation in gonorrhea infection. Summary: The effectiveness of these antibiotics, zoliflodacin, ceftriaxone, gentamicin, gepotidacin, solithromycin, tigecycline, and ertapenem is considered a solution to gonorrhea resistance. Researchers should study how to provide antibiotics with intervening multidrug efflux pumps to overcome gonococcal antimicrobial resistance. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the antimicrobial susceptibility of Staphylococcus aureus isolates originated from bovine mastitis belonging to 37 herds in the northwest of Portugal. Moreover, genes encoding resistance markers in Staphylococcus aureus isolates were also evaluated. Antimicrobial susceptibility tests were performed for aminosides (gentamicin, tobramycin, amikacin, and kanamycin), penicillins (methicillin), tetracyclines (tetracycline), macrolides (erythromycin), lincosamides (clindamycin and trime thopr im-su lfame thoxa zole), and glycopeptides (vancomycin) families of antibiotics by the disk diffusion method. The detection of aph(3!)-IIIa-, ant(4!)-Ia- and aac(6!)-aph(2")-, mecA-, tet(M)-, tet(K)-, erm(T)-, van(A)-, lnu(C)-, sal(A)-, vga(C)-, and dfrK-associated resistance genes were performed by polymerase chain reaction. In this study, a higher phenotypic resistance to tetracycline (75.0%), erythromycin (67.3%), and amikacin (42.3%) antibiotics were observed for the tested antibiotics. Moreover, the higher percentages of antibiotic resistance were detected for the ant(4!)-Ia- (63.5%), tet(M)- (57.7%), and aph(3!)-IIIa (30.8%)-related tested genes. Globally, obtained results suggest an alarming situation in Staphylococcus aureus bovine mastitis therapy in the northwest region of Portugal and could contribute for designing a new more specific Staphylococcus aureus therapy program supporting bovine mastitis disease control in this region. [ABSTRACT FROM AUTHOR]

Background: One of the challenges in medicine has been the exaggerated use of antibiotics. The purpose of this study was to investigate the prevalence of antibiotic usage in children in Arak, Iran (2019-2020) to determine the factors related to antibiotic prescription and consumption in children. Methods: This was a population based, cross-sectional study conducted in Arak, the capital city of Markazi Province, Iran. Stratified random sampling was applied to recruit children who were up to five years old, and registered in the healthcare system between Jan. 2019 and Jan. 2020. A response rate of 85% was obtained from the subjects' parents. Face-to-face interviews were used to collect the data from the children's mothers. Univariate and adjusted linear regression analyses were applied to assess the determinants of antibiotic consumption in these children. Results: A total of 1483 children were enrolled in the study; most of them were boys with the mean age of 2.1±1.5 years old. The annual prevalence of antibiotic consumption in Arak was found to be 62.4% for at least one antibiotic. The most consumed antibiotic was azithromycin (24.2%). Among antibiotic groups, the most consumed group was macrolides (26.9%). Upon multiple logistic regression analyses, a lower consumption rate was observed among the younger children with older mothers, and children whose fathers had permanent jobs than other children groups. A higher consumption rate was observed among families with higher parity. Conclusion: The annual prevalence of antibiotic consumption in this study was very high, with the most consumed drug being azithromycin. We recommend that the use of antibiotics be reconsidered by drawing future healthcare policies, aiming at reducing the heavy antibiotics consumption in children. [ABSTRACT FROM AUTHOR]

This review highlights various experimental and mathematical modeling strategies to investigate the fate and transport of antibiotics that elucidate antimicrobial selective pressure in aquatic environments. Globally, the residual antibiotic concentrations in effluents from bulk drug manufacturing industries were 30- and 1500-fold greater than values reported in municipal and hospital effluents, respectively. The antibiotic concentration from different effluents enters the waterbodies that usually get diluted as they go downstream and undergo various abiotic and biotic reactive processes. In aquatic systems, photolysis is the predominant process for antibiotic reduction in the water matrix, while hydrolysis and sorption are frequently reported in the sediment compartment. The rate of antibiotic reduction varies widely with influencing factors such as the chemical properties of the antibiotics and hydrodynamic conditions of river streams. Among all, tetracycline was found to more unstable (log Kow = − 0.62 to − 1.12) that can readily undergo photolysis and hydrolysis; whereas macrolides were more stable (log Kow = 3.06 to 4.02) that are prone to biodegradation. The processes like photolysis, hydrolysis, and biodegradation followed first-order reaction kinetics while the sorption followed a second-order kinetics for most antibiotic classes with reaction rates occurring in the decreasing order of Fluoroquinolones and Sulphonamides. The reports from various experiments on abiotic and biotic processes serve as input parameters for an integrated mathematical modeling to predict the fate of the antibiotics in the aquatic environment. Various mathematical models viz. Fugacity level IV, RSEMM, OTIS, GREAT-ER, SWAT, QWASI, and STREAM-EU are discussed for their potential capabilities. However, these models do not account for microscale interactions of the antibiotics and microbial community under real-field conditions. Also, the seasonal variations for contaminant concentrations that exert selective pressure for antimicrobial resistance has not been accounted. Addressing these aspects collectively is the key to exploring the emergence of antimicrobial resistance. Therefore, a comprehensive model involving antimicrobial resistance parameters like fitness cost, bacterial population dynamics, conjugation transfer efficiency, etc. is required to predict the fate of antibiotics. [ABSTRACT FROM AUTHOR]

Despite limited biomonitoring studies suggesting extensive antibiotic exposure in general population, the body burden of antibiotics in young children and their potential health risks remain unclear. To assess the antibiotic exposure levels in young children, 508 preschoolers aged 3–6 years were recruited from eastern China in 2022, and a total of 50 representative antibiotics from 8 categories, including 17 human antibiotics (HAs), 4 antibiotics preferred as HAs (PHAs), 16 veterinary antibiotics (VAs), and 13 antibiotics preferred as VAs (PVAs), were analyzed by UPLC-MS/MS. Hazard quotient (HQ) and hazard index (HI) were calculated to evaluate the health risks, and multivariate logistic regression was applied to examine diet with antibiotic exposure. Our results showed that there were 41 antibiotics detected in children's urine, and the overall detection frequency was as high as 100%. Sulfonamides, macrolides, β-lactams, quinolones, and azoles were the predominant categories of antibiotic detected. Among the studied children, 6.5% had a sum of estimated daily intake (EDI) of all VAs and PVAs larger than 1 μg/kg/day. Notably, 10.0% of the children had a microbiological HI value exceeding 1, primarily contributed by ciprofloxacin. Children with higher consumption of seafood had a relatively increased exposure to multiple categories of antibiotics, including HAs, VAs, quinolones, azoles, and others. Principal component analysis suggested that "Aquatic products and viscera preferred dietary pattern" scores were positively correlated with the exposure levels of ciprofloxacin (OR: 1.23; 95% CI: 1.02–1.47) and carbadox (OR: 1.32; 95% CI: 1.10–1.59), and a relatively increased exposure of PHAs was realized in children with higher "Meat-egg preferred dietary pattern" scores (OR: 1.24; 95% CI: 1.03–1.50). In conclusion, there was a widespread exposure to antibiotics among preschool children from eastern China, and children who consumed more animal-derived foods may had an increased exposure to antibiotics. [ABSTRACT FROM AUTHOR]

The removal of antibiotics from the environment have become a critical issue due to their toxicity and persistence. Among various approaches, microalgae-based technology has emerged as a promising, cost-effective, and eco-friendly option. Unfortunately, a systematic and quantitative analysis of the antibiotic removal efficiency by microalgae is still lacking. Therefore, this study conducted a meta-analysis including 27 peer-reviewed publications to address this gap. The study analyzed the overall antibiotic removal efficiency and influencing factors (antibiotic type, microalgae genus, temperature, hydraulic retention time (HRT), and light intensity), and identified appropriate microalgae for specific antibiotic removal, using the effect size of response ratio. Results showed that microalgae had a significant positive effect on the removal of antibiotics, and antibiotic type, microalgae genus, HRT, and light intensity significantly impacted the overall antibiotic removal efficiency. Haematococcus exhibited better removal efficacy than the commonly used Chlorella and Scenedesmus. For specific antibiotic removal, Chlamydomonas and Chlorella were recommended for macrolide antibiotic, Chlorella for beta-lactam antibiotic, and Haematococcus for sulfa antibiotic. This study offers valuable insights for future research and can help locate the most appropriate microalgae for removing specific antibiotics. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Macrolide antibiotics are widely used to treat various infections such as pneumonia and sinusitis, and previous exposure to macrolides is presumed to be a risk factor for standard triple therapy failure in Helicobacter pylori (H. pylori) eradication. We aimed to determine whether previous use of macrolide antibiotics could affect clarithromycin resistance of H. pylori. Materials and methods: From the Korea National Health Insurance Service (NHIS2021‐1‐775) database, a total of 46,160 patients who were tested for clarithromycin resistance of H. pylori from 2016 to 2019 in Korea were identified. Their history of antibiotics in the past 10 years and history of respiratory comorbidity in the past 1 year were investigated. Results: Clarithromycin resistance rate of H. pylori in Korea was 16.2%. A multivariate analysis revealed that female sex (OR: 1.472, p <.001), age > 50 years (OR: 1.340, p <.001), previous use of macrolide antibiotics (clarithromycin, OR: 2.902, p <.001; azithromycin, OR: 1.930, p <.001; erythromycin, OR: 2.060, p =.001; roxithromycin, OR: 2.022, p <.001), and history of respiratory comorbidity (sinusitis, OR: 1.271, p <.001; laryngopharyngitis, OR: 1.135, p =.032; bronchitis, OR: 1.245, p =.001; pneumonia, OR: 1.335, p =.026) were independent risk factors of clarithromycin resistance in H. pylori. Conclusions: The use of macrolide antibiotics and a recent diagnosis of respiratory disease might increase clarithromycin resistance of H. pylori. [ABSTRACT FROM AUTHOR]

Introduction Bordetella bronchiseptica is a rare cause of hemorrhagic bronchopneumonia. Important to the clinician is a clear understanding that the treatment of this rare organism differs greatly from the successful antibiotic treatment of the more common Bordetella species, pertussis and parapertussis. Case report A 64-year-old female presented to the emergency department after experiencing one week of worsening hemoptysis. Upon admission, she was afebrile and all initial laboratory test results were normal. Bronchoalveolar hemorrhage suggested by radiographic imaging was confirmed by bronchoscopy. Bronchoalveolar lavage (BAL) cultures contained unspeciated Bordetella. Rapid worsening of the hemoptysis led to intubation and the decision to perform bronchial artery embolization. However, the intensity of the hemoptysis persisted. Septic shock ensued despite treatment with broad spectrum antibiotics including azithromycin, vancomycin, and cefepime. The microbiological speciation results finalized shortly after the patient’s death. The identified organism was B. bronchiseptica. Conclusions Although macrolide antibiotics are first line treatment for B. pertussis and parapertussis, macrolide antibiotics are generally not effective against B. bronchiseptica. Clinical suspicion of B. bronchiseptica infection should prompt consideration of alternative antibiotics known to be effective against this rare species, including carbapenems and fluoroquinolones. The use of these latter antibiotics may advisably be considered as an empirical treatment during the delay of microbiological speciation. [ABSTRACT FROM AUTHOR]

The present study aims to investigate the impact of the COVID-19 pandemic on community antibiotic consumption and the resistance of invasive Streptococcus pneumoniae (2015–2022) to penicillin in Slovenia. During the pandemic in 2020 and 2021, the total use of antibiotics for systemic use decreased by 23.5% and 24.3%, expressed in defined daily doses per 1000 inhabitants per day (DID), while the use of penicillins, macrolides and broad-spectrum penicillins decreased by 30%, 20% and by 17.5%, respectively, and that of broad-spectrum macrolides fell by 17.1%. The incidence of invasive pneumococcal diseases (IPD) in Slovenia had a large decline during the pandemic. Decreased resistance to macrolides was significantly associated with decreased use of macrolides, while for penicillins the correlation could not be statistically confirmed. The proportion of PCV13 serotypes in IPD in Slovenia decreased after the introduction of the vaccine in the national programme, falling from 81.6% in 2015 to 45.5% in 2022. We noticed a decrease in the serotypes 1, 14, 9V, 7F, 4, 6A and an increase in the serotypes 3, 8, 22F, 11A, 23A and 15A. National interventions during the COVID-19 pandemic substantially decreased outpatients' antibiotic consumption, as well as incidence and resistance of invasive S. pneumoniae. [ABSTRACT FROM AUTHOR]

Bacterial lineages that populate the human gut microbiota contend with spatial and temporal fluctuations in numerous environmental variables, including bouts of extreme selective agents such as antibiotics. Oscillations in the adaptive landscape can impose balancing selection on populations, leaving characteristic signatures in the sequence variation of functionally significant genomic loci. Despite their potential importance for gut bacterial adaptation, the metagenomic targets of balancing selection have not been identified. Here, I present population genetic evidence that balancing selection maintains allelic diversity in multidrug efflux pumps of multiple predominant gut bacterial species. Metagenome‐wide scans of 566,958 genes from 287 bacterial species represented by 118,617 metagenome‐assembled genomes indicated that most genes have been conserved by purifying selection. However, dozens of core open reading frames (CORFs) displayed positive Tajima's D values that deviated significantly from their species' genomic backgrounds, indicating the action of balancing selection. Multidrug efflux pumps (MEPs) from a diversity of bacterial species were significantly enriched among the CORFs with Tajima's D values >3 in industrialized, but not nonindustrialized, human populations. The AcrB subunit of an MEP from Bacteroides dorei displayed the highest Tajima's D of any CORF. Divergent haplotypes of this CORF displayed evidence of positive selection and homology to an Escherichia coli AcrB subunit that binds tetracycline and macrolide antibiotics, suggesting functional significance and implicating medical antibiotics as an agent of selection acting on this locus. Other proteins identified as targets of balancing selection included peptidoglycan/LPS O‐acetylases and ion transporters. Intriguingly, the degree of balancing selection acting on gut bacterial species was associated with species abundance in the gut based on metagenomic data, further suggesting fitness benefits of the allelic variation identified. [ABSTRACT FROM AUTHOR]

Aim: We evaluated antibiotic prescriptions issued for Finnish children with acute sinusitis by a nationwide private outpatient clinic network from 2014–2020. Data were compared before and after updated guidelines in 2018. Methods: The study comprised data on 45 296 children aged 2–17 years with acute sinusitis, namely diagnoses, ages, dates, the doctor's specialty and any antibiotics. We measured compliance with the updated 2018 Finnish guidelines, which recommended amoxicillin or amoxicillin‐clavulanic acid for children under 12 years old, with doxycycline as an alternative for 12 years plus. Results: There were 6621–7585 visits per year for acute sinusitis in 2014–2019 and 2954 in 2020. Antibiotics were prescribed for 37.9%–41.6% of patients during the study years. Amoxicillin, including penicillin, accounted for 35.9% of prescriptions, followed by amoxicillin‐clavulanic acid (26.9%). Macrolides accounted for 20.6% and, encouragingly, decreased by 38% from 2014–2019. Doxycycline accounted for 5.3%. Paediatricians, general practitioners (GPs) and ear, nose and throat specialists followed the guidelines in 75.1%, 73.8% and 66.7% of cases, respectively. GPs prescribed antibiotics more often than other physicians. Conclusion: Antibiotics were prescribed for about 40% of acute sinusitis visits by Finnish children from 2014–2019. Specialities differed with regard to prescribing rates and whether they followed the guidelines. [ABSTRACT FROM AUTHOR]

Introduction: The key objective of this research was to describe the prescription rate of various antibiotics for dental problems in India and to study the relevance of the prescriptions by analysing antibiotic types associated with different dental diagnoses, using a large-scale nationally representative dataset. Methods: We used a 12-month period (May 2015 to April 2016) medical audit dataset from IQVIA (formerly IMS Health). We coded the dental diagnosis provided in the medical audit data to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) and the prescribed antibiotics for the diagnosis to the Anatomic Therapeutic Chemical (ATC) -2020 classification of the World Health Organization. The primary outcome measure was the medicine prescription rate per 1,000 persons per year (PRPY1000). Results: Our main findings were—403 prescriptions per 1,000 persons per year in the year 2015 -2016 for all dental ailments. Across all ATC level 1 classification, 'Diseases of hard tissues' made up the majority of the prescriptions. 'Beta-lactam', 'Penicillin,' and 'Cephalosporins' were the most commonly prescribed antibiotics for dental diagnoses followed by 'Macrolides' and 'Quinolones'. 'Dental caries', 'Discoloration of tooth', and 'Toothache' were the most common reasons for 'Beta-Lactams' and 'Penicillin' prescriptions. Conclusion: To conclude our study reports first ever country (India) level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-11 classification for dental ailments. [ABSTRACT FROM AUTHOR]

To our knowledge, ours is the first study to investigate the annual fluxes, environmental fate, and ecological risks of five categories of antibiotics from the Wuhan section of the Yangtze River (China). All the 24 antibiotics we tested for were detected in water, with total concentrations of 17.11–867.2 ng/L (mean: 63.69 ng/L), and 19 antibiotics were detected in sediment, at 0.02–287.7 ng/g (mean: 16.54 ng/g). Sulfonamides, amphenicols, and macrolides were the three most prominent antibiotic classes in water, and fluoroquinolones were the most prominent in sediment. Farming activities (animal husbandry and aquaculture) are proposed as the largest contributors to antibiotic pollution in the Wuhan section of the Yangtze River according to the Unmix model, followed by municipal wastewater and mixed sources. Higher pollution levels were observed downstream (combined discharge of these sources). Monthly monitoring data (12 months) were used to estimate antibiotic annual fluxes, with 101.5 t (uncertainty: 5.6%) in the Wuhan section of the Yangtze River. Risk assessments showed that erythromycin, clarithromycin, and azithromycin posed medium and high ecological risks and were found in 9%–35% and 1.8%–3.7% of all water samples, respectively; enrofloxacin, clarithromycin, azithromycin, florfenicol, and thiamphenicol posed medium resistance risks in 1.9%–16.7% of waters in the Wuhan section of the Yangtze River. Our results have filled data gaps on antibiotic sources, annual fluxes, and resistance risk in the Wuhan section of the Yangtze River and demonstrated the importance of further management of antibiotic use in the studied areas. Environ Toxicol Chem 2023;42:605–619. © 2022 SETAC [ABSTRACT FROM AUTHOR]

Purpose Myasthenia gravis (MG) is not commonly covered in pharmacy school curricula. However, many medications that have been reported to cause exacerbations of MG are among the top 200 most prescribed drugs. The purpose of this therapeutic update is to provide pharmacists with a general understanding of the pathophysiology and treatment of MG and describe common medications with the potential to cause new onset or acute worsening of this disease. Summary MG is an autoimmune disorder in which patients develop autoantibodies to a component of the neuromuscular junction, most frequently the acetylcholine receptor, resulting in impairment of skeletal muscle contraction. Although MG is not highly prevalent, there are up to 60,000 individuals with MG in the US, making it a disease that many pharmacists will likely encounter at least once in their career. Immunosuppressant medications and acetylcholinesterase inhibitors are the mainstays of treatment, although there is limited evidence as to which agents are most efficacious. Medications that activate the immune system, such as immune checkpoint inhibitors, may cause new onset of disease, while those with actions on the neuromuscular junction, such as macrolides and fluoroquinolones, can cause acute worsening of disease. Conclusion MG, although not frequently covered in pharmacy school curricula, is a disease state for which it is not uncommon for pharmacists to provide care. Treatment tends to be patient specific, and evidence is often weak. Many medications that cause new onset or worsening of MG are among the most prescribed. Key classes of medications to use with caution include macrolides, fluoroquinolones, β-blockers, and magnesium. [ABSTRACT FROM AUTHOR]