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Purpose: To compare the surgical and microbiological characteristics of fracture related infection (FRI) that had union and those requiring additional surgery to promote bone healing. We hypothesized that FRIs with MRSA will have higher risk for reoperation to promote bone healing. Methods: This is a retrospective study on 247 patients over 18 who underwent bone fixation for pelvis, upper, and lower extremities fractures between 2013 and 2021 at a level I trauma center. All cases had an FRI and at least 6 months of follow-up after diagnosis. Patients with pathologic fracture due to underlying malignancy and patients with spinal fractures were excluded. We compared surgical and microbiological characteristics of fractures between cases that required reoperation to promote bone healing and those who did not. Results: Of 247 patients, 55 (22.2%) required reoperations to promote bone healing after diagnosis of FRI. Patients that received topical antibiotics at closure during initial fixation had higher risk for reoperations to promote bone healing (30.8% vs. 15.2%, p = 0.049). Infection with Pseudomonas aeruginosa was associated with a lower risk for reoperations to promote bone healing (0%, p = 0.040). Rates of patients requiring reoperations to promote bone healing in infections with MRSA were similar to infections with MSSA (19.6% vs 20.9%, p = 1.000) and other pathogens (19.6% vs 23%; p = 0.539). Open fracture (OR 0.785, p = 0.534), tobacco use (OR 0.557, p = 0.126), upper extremity (OR 0.730, p = 0.534) or use of topical antibiotic at closure (OR 0.439, p = 0.067) did not increase risk for reoperation to promote bone healing. Conclusion: Using topical antibiotics for skin closure during initial fixation for bone fractures may increase the risk of reoperation to promote bone healing, while infection with P. aeruginosa decreases the risk. Infection with MRSA or MSSA did not increase risk for requiring reoperation to promote bone healing after FRI diagnosis. Further studies should examine the impact of topical antibiotics during fracture surgery on development of FRI. [ABSTRACT FROM AUTHOR]

Introduction and objective: Acne vulgaris is a common chronic inflammatory skin disease affecting hair and sebaceous follicles, characterized by skin lesions most commonly appearing on the face. Several factors predispose individuals to the development of acne, including hormonal imbalances, genetic predisposition, and the use of certain medications. This review aims to evaluate and summarize first-line and advanced pharmacological treatments for acne vulgaris, highlighting their efficacy, safety, and emerging therapies for optimal management. Review methods: The literature review utilized databases covering sources from PubMed, Google Scholar, Scopus, and Web of Science using the search terms encompassing the following keywords: 'acne vulgaris' and 'topical retinoid therapy', 'benzoyl peroxide', 'azelaic acid', 'topical antibiotics', 'oral antibiotics', 'contraceptive agents', 'antiandrogen therapy', 'isotretinoin'. Brief description of the state of knowledge: Current treatment methods range from topical therapies (i.e. antibiotics and retinoids) for mild cases to systemic medications (i.e. antibiotics, retinoids, and hormonal) for moderate to severe acne. In most cases, treatment should start with topical therapy. Summary: Early intervention is crucial to mitigate the risk of scarring and psychosocial consequences. Emerging therapeutic strategies have the potential to enhance treatment outcomes. [ABSTRACT FROM AUTHOR]

Topical antibiotic application and occlusive dressings stand as the current standard of care for partial thickness burn (PTB) treatment. Silver sulfadiazine (SSD) is the most widely used topical antimicrobial agent for acute burn management worldwide. Despite its antimicrobial benefits, there is emerging evidence that SSD might delay wound reepithelialization. We hypothesized that when compared with a topical antibiotic ointment, wound reepithelialization with SSD would be delayed. We created 21 partial thickness burns on the backs of 3 anesthetized female domestic pigs (30kg) using an established vertical progression model. The burns were randomly assigned to topical treatment with SSD, triple antibiotic ointment, or petrolatum ointment applied daily for two weeks, followed by twice weekly for another 2 weeks with intermittent dressing changes. The primary outcome was percentage wound reepithelialization at day 21. Our study had 80% power to detect a 25-percentage difference in wound reepithelialization at day 21. All wounds were completely reepithelialized within 28 days of burn creation. At day 21 the mean (SD) percentages for wound reepithelialization were 73.6 (38.2), 93.2 (16.3), and 65.0 (48.9) in wounds treated with SSD, triple antibiotic, and petrolatum respectively, P=0.049. There was no significant difference among treatment groups in scar depth at day 28. Pseudoeschar formation and erythematous hypersensitivity reactions were common findings on gross analysis with SSD and topical antibiotics respectively. We conclude that SSD delayed reepithelialization of partial thickness porcine burns when compared with triple antibiotic ointment. There were no significant differences in scar depth among the groups. [ABSTRACT FROM AUTHOR]

Abstract Surgical site infection (SSI) continues to be a common complication of surgery. The real benefit of using topical antibiotics for the prevention of SSI in abdominal hernia repair surgery is still unknown. This study aimed to evaluate the usefulness of topical gentamicin in SSI prophylaxis in incisional hernia repair with mesh. A randomized controlled trial was conducted in patients undergoing open incisional hernia repair. Patients were randomly assigned to one of two groups: in the gentamicin group, each layer of the abdominal wall was irrigated with gentamicin solution before wound closure, and in the saline solution group (placebo), each layer of the abdominal wall was irrigated with normal saline solution. The incidence of SSI and other surgical site complications was compared between both groups, and the presence of adverse effects with the use of topical gentamicin. Data from 146 patients were included for analysis: 74 in the gentamicin group and 72 in the saline solution group. SSI was observed in six patients (8.1%) in the gentamicin group and eight patients (11.1%) in the saline solution group, with no significant differences (p = 0.538) between both groups. No statistically significant differences were observed in the presentation of seroma, hematoma, and surgical wound dehiscence between both groups. No adverse effects were reported from topical application of gentamicin. In this clinical trial, the use of topical gentamicin in incisional hernia repair with mesh did not significantly reduce the incidence of SSI. EU Clinical Trials Register: EudraCT 2018-001860-45 (04/07/2019).

Aims: This study aimed to assess the risk of acute kidney injury (AKI) associated with combined intravenous (IV) and topical antibiotic therapy in patients undergoing treatment for periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA), utilizing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for classification. Methods: We conducted a retrospective analysis of 162 knees (162 patients) that received treatment for PJI post-TKA with combined IV and topical antibiotic infusions at a single academic hospital from 1 January 2010 to 31 December 2022. The incidence of AKI was evaluated using the KDIGO criteria, focussing on the identification of significant predictors and the temporal pattern of AKI development. Results: AKI was identified in 9.26% (15/162) of the cohort, predominantly presenting as stage 1 AKI, which was transient in nature and resolved prior to discharge. The analysis highlighted moderate anaemia and lower baseline serum creatinine levels as significant predictors for the development of AKI. Notably, the study found no instances of severe complications such as wound dehiscence, skin erosion, or the need for haemodialysis following treatment. Conclusion: The findings suggest that the combined use of IV and topical antibiotic therapy in the management of PJIs post-TKA is associated with a low incidence of primarily transient stage 1 AKI. This indicates a potentially favourable renal safety profile, advocating for further research to confirm these outcomes and potentially influence treatment protocols in PJI management. Cite this article: Bone Joint Res 2024;13(10):525–534.

AIM: To describe the practice patterns of intravitreal injections (IVIs) among ophthalmologists in China. METHODS: This was a cross-sectional online survey. Ophthalmologists who had performed accumulated more than 100 injections were contacted by the Brightness Center, a hospital-based national network, to complete an anonymous, 24-question, internet-based survey. They were surveyed on practices in injection techniques, pre-, and post-injections procedures. RESULTS: A total of 333 ophthalmologists from 28 provinces/municipalities/autonomous regions responded to the survey (50.68% response rate). The 91.29% of the respondents evaluated systemic risk factors by medical history, electrocardiogram (ECG) and blood test. All the respondents used pre-injection prophylactic antibiotics. Most checked intraocular pressure (IOP, 99.1%) and blood pressure (96.1%) before injections. A majority of the respondents performed injections in the operating room (98.8%), wore masks (99.7%), gloves (99.4%) and sterile surgical clothing (96.1%), performed topical anesthetics (97.9%), and applied povidone-iodine (95.8%) pre-injection. The 61.26% of the respondents dilated pupil. About half of the respondents (51.05%) performed bilateral injections in the same setting. Superior temporal quadrant (40.54%) was the most frequent site of injection. Around three quarters used 30-gauge needles. Most respondents (97.9%) measured the site of injection from limbus. More than half (53.45%) performed conjunctiva displacement prior to injection. The 32.43% of the respondents checked IOP post-injection and 87.99% physicians checked hand motion (HM) or counting fingers (CF) after injection, while 36.94% observed optic nerve perfusion. All participants used topical antibiotics post-injections. Most physicians (91.89%) reviewed patients on the following day. CONCLUSION: This study provides a description of the real-world practice patterns in IVIs in China and offers critical information regarding education and training of ophthalmologists and amendment of local society guidelines.

Surgical site infection (SSI) continues to be a common complication of surgery. The real benefit of using topical antibiotics for the prevention of SSI in abdominal hernia repair surgery is still unknown. This study aimed to evaluate the usefulness of topical gentamicin in SSI prophylaxis in incisional hernia repair with mesh. A randomized controlled trial was conducted in patients undergoing open incisional hernia repair. Patients were randomly assigned to one of two groups: in the gentamicin group, each layer of the abdominal wall was irrigated with gentamicin solution before wound closure, and in the saline solution group (placebo), each layer of the abdominal wall was irrigated with normal saline solution. The incidence of SSI and other surgical site complications was compared between both groups, and the presence of adverse effects with the use of topical gentamicin. Data from 146 patients were included for analysis: 74 in the gentamicin group and 72 in the saline solution group. SSI was observed in six patients (8.1%) in the gentamicin group and eight patients (11.1%) in the saline solution group, with no significant differences (p = 0.538) between both groups. No statistically significant differences were observed in the presentation of seroma, hematoma, and surgical wound dehiscence between both groups. No adverse effects were reported from topical application of gentamicin. In this clinical trial, the use of topical gentamicin in incisional hernia repair with mesh did not significantly reduce the incidence of SSI. EU Clinical Trials Register: EudraCT 2018-001860-45 (04/07/2019). [ABSTRACT FROM AUTHOR]

Introduction and objective: Acne vulgaris is a common chronic inflammatory skin disease affecting hair and sebaceous follicles, characterized by skin lesions most commonly appearing on the face. Several factors predispose individuals to the development of acne, including hormonal imbalances, genetic predisposition, and the use of certain medications. This review aims to evaluate and summarize first-line and advanced pharmacological treatments for acne vulgaris, highlighting their efficacy, safety, and emerging therapies for optimal management. Review methods: The literature review utilized databases covering sources from PubMed, Google Scholar, Scopus, and Web of Science using the search terms encompassing the following keywords: ‘acne vulgaris’ and ‘topical retinoid therapy’, ‘benzoyl peroxide’, ‘azelaic acid’, ‘topical antibiotics’, ‘oral antibiotics’, ‘contraceptive agents’, ‘antiandrogen therapy’, ‘isotretinoin’. Brief description of the state of knowledge: Current treatment methods range from topical therapies (i.e. antibiotics and retinoids) for mild cases to systemic medications (i.e. antibiotics, retinoids, and hormonal) for moderate to severe acne. In most cases, treatment should start with topical therapy. Summary: Early intervention is crucial to mitigate the risk of scarring and psychosocial consequences. Emerging therapeutic strategies have the potential to enhance treatment outcomes.

ABSTRACT Harlequin ichthyosis is a rare skin disorder affecting newborns characterized by a scaly skin, flexed limbs, ectropium, and eclabium. The overall incidence of HI is 1 in 300,000 births, with approximately only 200 cases reported worldwide. Some studies uncovered a TH17 immune skewing in patients with HI, which is also seen in psoriasis. We herein present a case of a newborn found to have harlequin ichthyosis, whom his mother is known to have psoriasis. The baby was treated with topical antibiotics and retinoid creams. The baby then exhibited smoother skin with less scaling and flatter fissures.

Evidence has been mixed regarding the effect of topical vancomycin (VCM) powder in reducing surgical site infection (SSI). To clarify the effect of topical VCM powder for the prevention of SSI in major orthopaedic surgeries. The MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov databases were searched from their inception to September 25th, 2023. Randomized controlled trials comparing topical VCM powder and controls for the prevention of SSI in major orthopaedic surgeries were included. Two reviewers independently screened the title and abstract and extracted relevant data, followed by the assessment of the risk of bias and the certainty of the evidence. Main outcome measures were overall SSI, reoperation, and adverse events. Summary results were obtained using random-effects meta-analysis. Trial sequential analysis (TSA) was performed. Eight randomized controlled trials yielded data on 4307 participants. VCM powder showed no difference in reducing overall SSI. The cumulative number of patients did not exceed the required information size of 19,233 in our TSA, and the Z -curves did not cross the trial sequential monitoring or futility boundary, suggesting an inconclusive result of the meta-analysis. No difference was found for reoperation. Among SSIs, VCM powder showed a statistically significant difference in reducing Gram-positive cocci SSI. However, the certainty of this evidence was very low. This systematic review and meta-analysis suggests inconclusive results regarding the effect of VCM powder in reducing SSI in major orthopaedic surgeries. Further trials using rigorous methodologies are required to elucidate the effect of this intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Commercial tobramycin ophthalmic solution is frequently used empirically to treat ocular disorders in equines, despite being primarily formulated for use in humans. It has been noted that tobramycin MIC90 concentration (minimal inhibitory concentration to 90% of microbial growth) rapidly declined following topical administration. It is hypothesized that adjustment of the pH of the empirically used tobramycin ophthalmic solution -prepared for human use- with the pH of the tears of donkeys, could increase the bioavailability of the drug and subsequently improve its penetration to the aqueous humor. Therefore, this study aimed to evaluate the impact of pH adjustment of the empirically used tobramycin ophthalmic solution on MIC90 concentration in tears and aqueous humor of donkeys (Equus asinus). The study was conducted on six (n = 6) clinically healthy donkeys. In each donkey, one eye was randomly selected to receive 210 µg tobramycin of the commercial tobramycin (CT) and used as a positive control (C group, n = 6). The other eye (treated eye) received 210 µg of the modified tobramycin ophthalmic solution (MT) (T group, n = 6). Tears and aqueous humor samples were collected 5-, 10-, 15-, 30- min, and 1-, 2-, 4-, and 6 h post-instillation. Results Modifying the pH of the empirically used commercial tobramycin ophthalmic solution in donkeys at a pH of 8.26 enhanced the drug’s bioavailability. The MIC90 of the most hazardous bacteria isolated from equines’ eyes such as Pseudomonas aeruginosa (MIC90 = 128 µg/ml) and Staphylococcus aureus (MIC90 = 256 µg/ml) was covered early (5 min post-instillation) and over a longer period in donkey tears (239–342 min) and aqueous humor (238–330 min) with the modified tobramycin solution. Conclusions Adjustment of the pH of the commercial tobramycin ophthalmic solution, empirically used by veterinarians to treat donkeys’ ophthalmic infections at a pH of 8.26, isotonic with the donkeys’ tears pH, resulting in higher concentrations of tobramycin in tears and aqueous humor for a longer time.

Background: Commercial tobramycin ophthalmic solution is frequently used empirically to treat ocular disorders in equines, despite being primarily formulated for use in humans. It has been noted that tobramycin MIC90 concentration (minimal inhibitory concentration to 90% of microbial growth) rapidly declined following topical administration. It is hypothesized that adjustment of the pH of the empirically used tobramycin ophthalmic solution -prepared for human use- with the pH of the tears of donkeys, could increase the bioavailability of the drug and subsequently improve its penetration to the aqueous humor. Therefore, this study aimed to evaluate the impact of pH adjustment of the empirically used tobramycin ophthalmic solution on MIC90 concentration in tears and aqueous humor of donkeys (Equus asinus). The study was conducted on six (n = 6) clinically healthy donkeys. In each donkey, one eye was randomly selected to receive 210 µg tobramycin of the commercial tobramycin (CT) and used as a positive control (C group, n = 6). The other eye (treated eye) received 210 µg of the modified tobramycin ophthalmic solution (MT) (T group, n = 6). Tears and aqueous humor samples were collected 5-, 10-, 15-, 30- min, and 1-, 2-, 4-, and 6 h post-instillation. Results: Modifying the pH of the empirically used commercial tobramycin ophthalmic solution in donkeys at a pH of 8.26 enhanced the drug's bioavailability. The MIC90 of the most hazardous bacteria isolated from equines' eyes such as Pseudomonas aeruginosa (MIC90 = 128 µg/ml) and Staphylococcus aureus (MIC90 = 256 µg/ml) was covered early (5 min post-instillation) and over a longer period in donkey tears (239–342 min) and aqueous humor (238–330 min) with the modified tobramycin solution. Conclusions: Adjustment of the pH of the commercial tobramycin ophthalmic solution, empirically used by veterinarians to treat donkeys' ophthalmic infections at a pH of 8.26, isotonic with the donkeys' tears pH, resulting in higher concentrations of tobramycin in tears and aqueous humor for a longer time. [ABSTRACT FROM AUTHOR]

Introduction: Bacterial infection secondary to eczema and dermatitis occurs frequently. However, due to the inconvenience of clinical bacterial culture procedure, clinical diagnosis of bacterial infection following eczema is typically based on the appearance of skin lesions. To date, no surveys on the use of topical antibiotics for treating eczema and dermatitis in China have been carried out. Methods: The present study investigated the factors influencing the use of topical antibiotics to treat eczema and dermatitis in China. Logistic regression model and chi-square test were employed to examine whether topical antibiotics cause contact irritation. Results: It was found that the proportion of patients with eczema and dermatitis who were previously treated with topical antibiotics was 72.40%. The patients' residence regions (southern vs northern territories, p <.001), hospital levels (secondary-level and below vs third-level hospitals, p =.004), itching degrees (no itching, itching does not require scratching, itching requires scratching, and scratching affects sleep and life quality, p <.001), skin infection status (no obvious infection phenomenon, possible infection, and clear infection, p =.001), and skin lesion infection severity (mild, moderate, and severe, p <.001) all showed statistically significant differences in the univariate analysis of antibiotic ointment treatment factors. The percentage of patients experiencing contact irritation reactions resulting from the use of topical antibiotics was 2.60%. The incidence of exposure to irritation was higher in patients who used more than two types of topical antibiotics compared to patients treated with only one type of topical antibiotic (% vs %, chi-square test, p <.001). Conclusion: The number of individuals who used topical antibiotics for eczema and dermatitis was relatively high in China. The degree of itching, infection possibility, and degree of skin lesion infection were positively correlated with the patients' previous topical antibiotic treatment. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) estimates that 20–50% of antibiotics are misused in society. In addition to the development of antimicrobial resistance, topical antibiotics have been associated with adverse effects such as allergic contact dermatitis (ACD) and inadequate wound healing. This study investigated the appropriateness of topical antibiotic prescriptions among primary care providers in Saudi Arabia. Methods: A cross-sectional survey was conducted among Saudi Arabian primary care providers (physicians (general, family, and internal medicine)) employed in governmental and non-governmental healthcare facilities (primary care centers and outpatient clinics). Results: In total, 222 participants were included in the analysis. A total of 73% agreed that inappropriate topical antibiotic use puts patients at risk, and 43% reported antibiotic resistance in daily practice. Many respondents lacked knowledge of the proper indications for topical antibiotics, and 66.2% attributed this to a lack of updated knowledge, while 45% blamed inadequate supervision. Conclusion: Antibiotic prescription patterns deviated from the standards recommended by WHO. This calls for continuous review at all levels of healthcare, providing more physician education and ensuring that antibiotic therapy guidelines are easily accessible and effectively used to avoid the negative consequences of inappropriate antibiotic prescription. [ABSTRACT FROM AUTHOR]

This umbrella review aim to explore the effect of topical antibiotics in infection prevention after primary joint arthroplasty, and provide a specific theoretical basis for clinical treatment. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We searched PubMed, EMBASE, Medline, and the Cochrane Library on infection prevention by topical antibiotics from inception to 10 April 2023. The two researchers individually and strictly screened the literature according to the inclusion and exclusion criteria, performed the literature quality evaluation and data extraction, and used Stata 17 for data analysis. This study included six studies with one systematic review and five meta‐analyses. The pooled analysis showed that topical antibiotic administration effectively reduced the incidence of overall infection and periprosthetic joint infection. However, it does not reduce the risk of superficial infection. Besides, the topic of antibiotics significantly increases the incidence of other sterile complications of the incision. According to the current evidence, topical application of antibiotics can reduce the incidence of overall infection and periprosthetic joint infection after primary joint arthroplasty. Although it increases the incidence of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision making. However, they should not be discarded due to side effects. [ABSTRACT FROM AUTHOR]

Acne vulgaris is a common, chronic inflammatory skin disease affecting up to 80% of young adults and adolescents. The pathogenesis of acne is multifactorial and involves the pilosebaceous units of the skin. As a result of the disease process, skin lesions such as open and closed comedones, nodules, pustules, and papules appear on the skin. In recent years, acne has been increasingly observed in younger patients, which is associated with the earlier onset of puberty. Moreover, acne is increasingly diagnosed in individuals over 20 years of age, particularly in women, which is referred to as adult female acne (AFA). Effective and rapid implementation of treatment is crucial to prevent complications such as post-inflammatory hyperpigmentation and acne scars, as well as to mitigate the negative psychological impact of the disease on patients. The article discusses both topical treatment and aesthetic medicine procedures in the management of acne vulgaris. Topical treatments include the use of retinoids, antibiotics, benzoyl peroxide, clascoterone, dapsone, azelaic acid, and combination therapies. Aesthetic procedures such as chemical peels, microdermabrasion, photodynamic therapy, blue light therapy, and laser therapies can be beneficial as adjunctive treatments. The article also addresses the issue of acne as a comorbid condition in patients seeking aesthetic medicine treatments, even if it is not the primary reason for their visit.

BACKGROUND: Wound-related infections and complications are rare after day care laparoscopic cholecystectomy (LC). They can have a significant adverse impact on the postoperative course after an uneventful elective LC. The use of topical antibiotics over the port site may prevent such complications. MATERIALS AND METHODS: This trial was conducted from January 2018 to June 2019. Two hundred and fifty patients who met the inclusion and exclusion criteria were included in the study. They were randomized into the topical antibiotic group (Group A, n = 125) and control group (Group B, n = 125). All patients underwent four-port LC. Mupirocin 2% topical antibiotic ointment was applied to all four-port sites in Group A, whereas no topical antibiotic was used in Group B. One dose of prophylactic systemic antibiotics was given to all patients in both groups. RESULTS: The mean age was 43.22 ± 12.7 years in Group A and 43.44 ± 12.5 years in Group B. The comorbidities and the other variables were comparable between the two groups. The port-site infection (PSI) was observed in one patient in Group A and three patients in Group B, which was statistically nonsignificant (P = 0.622). The mean time of detection of infection was 4.75 ± 1.7 days. All the infections were superficial surgical site infections. Microbiological swabs culture of the infected wounds yielded no growth of bacteria. CONCLUSION: The PSI after LC is very less. The use of topical antibiotics to prevent PSIs after LC could not be established. [ABSTRACT FROM AUTHOR]

Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include biofilm, surgical site infections, history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Though bacterial contamination of breast protheses is associated with adverse sequelae, there are not universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix, leukotriene inhibitors, surgical techniques, and others. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. The objective of this review was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 [ABSTRACT FROM AUTHOR]

Background: Allergic sensitization to topical antimicrobial treatments is a well-known problem. Furacin® is one of the most widely used in our environment. It contains 0.2% nitrofurazone and polyethylene glycol (PEG) as a vehicle. Case report: 57-year-old male with no history of interest. He presented skin rash, blisters, and serous exudate 2-3 days after starting treatment with Furacin® (applied to an infected skin wound). Epicutaneous tests were performed with a true test battery, nitrofurantoin 1% in petrolatum, PEG15000 and 4000 1% in petrolatum, pure PEG 400, PEG monomethyl ether 350 1% in water. Positive result at 96 hours for nitrofurantoin. Conclusion: Nitrofurazone is widely used as a topical antibiotic because of its bactericidal spectrum. It (including its excipients) should be considered in case of adverse reactions after application. [ABSTRACT FROM AUTHOR]

Background: Otitis externa is a condition causing inflammation of the outer ear canal, which presents with itching, discharge and pain. Most cases of acute otitis externa are caused by bacterial infection and are thus treated with antibiotics. This systematic review and meta‐analysis of randomised controlled trials aims to assess the effectiveness of topical non‐antibiotic treatments compared to topical antibiotic treatment for the treatment of acute otitis externa. Methods: Systematic review and meta‐analysis databases searched: Cochrane Library including ClinicalTrials.gov; MEDLINE; World Health Organisation International Clinical Trials Registry Platform and Web of Science to identify randomised clinical trials evaluating topical antibiotics and topical non‐antibiotic agents in adults and children with acute otitis externa. Non‐antibiotic therapeutics for comparison with topical antibiotics included antiseptics, steroids, non‐pharmaceuticals and astringents. Results: Seventeen trials were eligible for inclusion, with 10 combined in meta‐analysis. Data could be pooled comparing antiseptic and steroid monotherapies with topical antibiotic agents. There were no significant differences in cure rates in any pairwise comparisons. Individually, the majority of studies favoured topical antiseptics or steroids over antibiotics, however these differences were not significant when pooled in meta‐analysis. Conclusion: Antiseptic, steroid and antibiotic monotherapies are all effective for the management of acute otitis externa. There is insufficient evidence to suggest that topical antiseptic or steroid agents are superior or inferior to topical antibiotics. [ABSTRACT FROM AUTHOR]

Objective Despite the application of aseptic protocols and the technical improvements of intraocular surgery, acute endophthalmitis is still noticed after cataract surgery. Presurgical prophylaxis was suggested to reduce the incidence of postcataract endophthalmitis. However, there is no clear protocol to follow. Aim The current study aimed to investigate the effect of preoperative topical antibiotics on anterior segment contamination in patients with cataract after phacoemulsification or phacotrabeculectomy. Patients, methods, and analysis The study enrolled 55 patients who underwent phacoemulsification or phacotrabeculectomy and intraocular lens implantation; 28 patients have used preoperative antibiotic drops (moxifloxacin 0.3%), and 27 patients did not use antibiotics. Anterior chamber (AC) aspirates were collected to determine the anterior segment microbial profile using microscopic examination and microbial cultures. Results All AC aspirates (100%) of the first group did not show any microbial growth on any culture media. However, bacterial growth was noted in three (11.1%) aspirates of the second group when cultured on blood, chocolate agar, and thioglycolate broth. Microscopic examination revealed Klebsiella pneumoniae, Escherichia coli, and Bacillus subtilis. All aspirates did not show any growth on Sabouraud dextrose agar. All patients were followed up after 1 day, 1 week, 1 month, and 3 months. Their ophthalmologic examinations were free of any abnormities. Conclusion Despite taking all the precautionary measures dictated by best practice guidelines for cataract surgery, there is minimal risk of AC bacterial contamination. Thus, the application of preoperative topical antibiotic drops is recommended for all cases.

Objective Despite the application of aseptic protocols and the technical improvements of intraocular surgery, acute endophthalmitis is still noticed after cataract surgery. Presurgical prophylaxis was suggested to reduce the incidence of postcataract endophthalmitis. However, there is no clear protocol to follow. Aim The current study aimed to investigate the effect of preoperative topical antibiotics on anterior segment contamination in patients with cataract after phacoemulsification or phacotrabeculectomy. Patients, methods, and analysis The study enrolled 55 patients who underwent phacoemulsification or phacotrabeculectomy and intraocular lens implantation; 28 patients have used preoperative antibiotic drops (moxifloxacin 0.3%), and 27 patients did not use antibiotics. Anterior chamber (AC) aspirates were collected to determine the anterior segment microbial profile using microscopic examination and microbial cultures. Results All AC aspirates (100%) of the first group did not show any microbial growth on any culture media. However, bacterial growth was noted in three (11.1%) aspirates of the second group when cultured on blood, chocolate agar, and thioglycolate broth. Microscopic examination revealed Klebsiella pneumoniae, Escherichia coli, and Bacillus subtilis. All aspirates did not show any growth on Sabouraud dextrose agar. All patients were followed up after 1 day, 1 week, 1 month, and 3 months. Their ophthalmologic examinations were free of any abnormities. Conclusion Despite taking all the precautionary measures dictated by best practice guidelines for cataract surgery, there is minimal risk of AC bacterial contamination. Thus, the application of preoperative topical antibiotic drops is recommended for all cases. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of professionally administered chemical agents as an adjunctive treatment to sub‐marginal instrumentation (SMI) in the therapy of peri‐implant mucositis. Materials and Methods: The primary outcome criteria were reduction in bleeding on probing (BOP), whereas resolution of disease, elimination of suppuration, including suppuration on probing, reduction of peri‐implant probing pocket depth, reduction of plaque, and patient‐reported outcome measures were considered as secondary outcome parameters. A literature search was performed on three electronic databases (01/1980 to 05/2022) focused on clinical studies with at least 3 months of follow‐up, and meta‐analyses were performed when appropriate. Results: From a total of 139 publications, 40 articles were identified for full‐text reading, and 5 randomized controlled clinical trials (RCTs) on antimicrobial photodynamic therapy (aPDT), 1 RCT on chlorhexidine (CHX), and 1 RCT on sodium hypochlorite (NaOCl) were included. Three studies had a low risk of bias and four had a mid‐level (some concerns) risk of bias. The application of aPDT, 0.95% NaOCl, or 0.12% CHX as an adjunctive treatment to SMI showed no difference in changes in BOP and PD compared with SMI alone (p >.05). Conclusions: Within the limitations of this review and based on a low level of evidence from seven RCTs, it is concluded that the professional adjunctive topical application of aPDT, 0.95% NaOCl, and 0.12% CHX may not be effective to improve changes for BOP and PD when compared with SMI alone. [ABSTRACT FROM AUTHOR]

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) imposes a major challenge for the treatment of infectious diseases with existing antibiotics. MRSA associated with superficial skin and soft tissue infections (SSTIs) is one of them, affecting the skin's superficial layers, and it includes impetigo, folliculitis, cellulitis, furuncles, abscesses, surgical site infections, etc. The efficient care of superficial SSTIs caused by MRSA necessitates local administration of antibiotics, because oral antibiotics does not produce the required concentration at the local site. The topical administration of nanocarriers has been emerging in the area of drug delivery due to its advantages over conventional topical formulation. It enhances the solubility and permeation of the antibiotics into deeper layer of the skin. Apart from this, antibiotic resistance is something that needs to be combated on multiple fronts, and antibiotics encapsulated in nanocarriers help to do so by increasing the therapeutic efficacy in a number of different ways. The current review provides an overview of the resistance mechanism in S. aureus as well as various nanocarriers reported for the effective management of MRSA-associated superficial SSTIs. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) estimates that 20–50% of antibiotics are misused in society. In addition to the development of antimicrobial resistance, topical antibiotics have been associated with adverse effects such as allergic contact dermatitis (ACD) and inadequate wound healing. This study investigated the appropriateness of topical antibiotic prescriptions among primary care providers in Saudi Arabia. Methods: A cross-sectional survey was conducted among Saudi Arabian primary care providers (physicians (general, family, and internal medicine)) employed in governmental and non-governmental healthcare facilities (primary care centers and outpatient clinics). Results: In total, 222 participants were included in the analysis. A total of 73% agreed that inappropriate topical antibiotic use puts patients at risk, and 43% reported antibiotic resistance in daily practice. Many respondents lacked knowledge of the proper indications for topical antibiotics, and 66.2% attributed this to a lack of updated knowledge, while 45% blamed inadequate supervision. Conclusion: Antibiotic prescription patterns deviated from the standards recommended by WHO. This calls for continuous review at all levels of healthcare, providing more physician education and ensuring that antibiotic therapy guidelines are easily accessible and effectively used to avoid the negative consequences of inappropriate antibiotic prescription.

Background: The oral cavity is a unique environment where wound healing needs to occur in the presence of heavily contaminated oral fluid often leading to infections at the suture site. Topical antimicrobial agents have proven to be effective in controlling intraoral infections. One such antimicrobial combination is Metronidazole-Chlorhexidine which has commonly been used to treat oral ulcers and gingival inflammation; however, there are no studies of its use in the healing of oral incisions. Methodology: This split-mouth study comprised of 15 participants who received 30 intraoral incisions. Incisions were placed either simultaneously (Group 1) or at spaced intervals (Group 2) for various minor and major surgical procedures. Metronidazole -Chlorhexidine gel was applied to the study sites while the control sites were allowed to heal naturally. Pain, inflammation, and healing were assessed using visual analogue scale and healing index by Landry et al. Results: The study sites showed better wound healing and decreased postoperative inflammation. There was a statistically significant decrease in post-operative pain in the study site in Group 1 but not in Group 2. Conclusion: Metronidazole-Chlorhexidine combination gel is a cost-effective, readily available, and safe medicament to improve healing of intraoral incisions and reduce post-operative inflammation and pain. [ABSTRACT FROM AUTHOR]

Using electronic data from a large population-based network of Family Paediatricians (Pedianet), we aimed to describe the use of topical antimicrobials, including ozenoxacin 1% cream, in impetigo in children in Italy. We included 2929 children aged 6 months–14 years from 2016 to 2019 with at least one episode of impetigo treated with topical antimicrobials. Overall, 3051 cases of impetigo were included in the analysis. Treatment started in most cases on the same day as the impetigo diagnosis and lasted around eight days. In about 8% of the cases, a systemic antibiotic was prescribed after the topical antimicrobial, usually after 4–14 days. In this study, ozenoxacin was used in 8% of the cases. Treatment duration was significantly shorter for patients prescribed ozenoxacin compared to the whole study population (median of six vs. seven days, respectively). In contrast, the rate of treatment failure was similar. Very few adverse reactions were identified. [ABSTRACT FROM AUTHOR]

Aims There is increasing evidence to support the use of topical antibiotics to prevent surgical site infections. Although previous research suggests a minimal nephrotoxic risk with a single dose of vancomycin powder, fracture patients often require multiple procedures and receive additional doses of topical antibiotics. We aimed to determine if cumulative doses of intrawound vancomycin or tobramycin powder for infection prophylaxis increased the risk of drug-induced acute kidney injury (AKI) among fracture patients. Methods This cohort study was a secondary analysis of single-centre Program of Randomized Trials to Evaluate Pre-operative Antiseptic Skin Solutions in Orthopaedic Trauma (PREP-IT) trial data. We included patients with a surgically treated appendicular fracture. The primary outcome was drug-induced AKI. The odds of AKI per gram of vancomycin or tobramycin powder were calculated using Bayesian regression models, which adjusted for measured confounders and accounted for the interactive effects of vancomycin and tobramycin. Results Of the 782 included patients (mean age 48 years (SD 20); 59% male), 83% (n = 648) received at least one vancomycin dose (cumulative range 1 to 12 g). Overall, 45% of the sample received at least one tobramycin dose (cumulative range 1.2 to 9.6 g). Drug-induced AKI occurred in ten patients (1.2%). No association was found between the cumulative dose of vancomycin and drug-induced AKI (odds ratio (OR) 1.08 (95% credible interval (CrI) 0.52 to 2.14)). Additional doses of tobramycin were associated with a three-fold increase in the adjusted odds of drug-induced AKI (OR 3.66 (95% CrI 1.71 to 8.49)). Specifically, the risk of drug-induced AKI rose substantially after 4.8 g of tobramycin powder (7.5% (95% CrI 1.0 to 35.3)). Conclusion Cumulative doses of vancomycin were not associated with an increased risk of drug-induced AKI among fracture patients. While the risk of drug-induced AKI remains less than 4% with three or fewer 1.2 g tobramycin doses, the estimated risk increases substantially to 8% after four cumulative doses. Level of evidence: Therapeutic Level III Cite this article: Bone Jt Open 2022;3(4):284–290.

Natural polysaccharides being investigated for use in the field of drug delivery commonly require the addition of sugars or pretreated biomass for fabrication. Geobacillus sp. strain WSUCF1 is a thermophile capable of secreting natural polymers, termed exopolysaccharides (EPSs), cultivated from cost-effective, non-treated lignocellulosic biomass carbon substrates. This preliminary investigation explores the capabilities of a 5% wt/wt amikacin-loaded film constructed from the crude EPS extracted from the strain WSUCF1. Film samples were seen to be non-cytotoxic to human keratinocytes and human skin-tissue fibroblasts, maintaining cell viability, on average, above 85% for keratinocytes over 72-h during a cell viability assay. The drug release profile of a whole film sample revealed a steady release of the antibiotic up to 12 h. The amikacin eluted by the EPS film was seen to be active against Staphylococcus aureus, maintaining above a 91% growth inhibition over a period of 48 h. Overall, this study demonstrates that a 5% amikacin-EPS film, grown from lignocellulosic biomass, can be a viable option for preventing or combating infections in clinical treatment. [ABSTRACT FROM AUTHOR]

Many indications in dermatology can be effectively managed with topical antibiotics, including acne vulgaris, wound infections, secondarily infected dermatitis, and impetigo. Dermatologists must be familiar with the wide spectrum of topical antibiotics available, including indications, mechanisms of action, adverse events, and spectra of activity. Dermatologists must also keep antibiotic resistance in mind when utilizing these medications. Due to the widespread use of topical antibiotics and their importance in dermatology, a literature review was performed using a systematic search of PubMed and Google Scholar with the terms topical antibiotics, skin infections, dermatology, antimicrobials, and inflammatory dermatoses to identify English-language articles published between 1965–2022 from any country. Relevant publications were manually reviewed for additional content. The following literature review will summarize the common topical antibiotics used in dermatology. [ABSTRACT FROM AUTHOR]

Along with the increasing global burden of diabetes, diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO) remain major challenges for patients and society. Despite progress in the development of prominent international guidelines, the optimal medical treatment for DFI and DFO remains unclear as to whether local antibiotics, that is, topical agents and local delivery systems, should be used alone or concomitant to conventional systemic antibiotics. To better inform clinicians in this evolving field, we performed a narrative review and summarized key relevant observational studies and clinical trials of non-prophylactic local antibiotics for the treatment of DFI and DFO, both alone and in combination with systemic antibiotics. We searched PubMed for studies published between January 2000 and October 2022, identified 388 potentially eligible records, and included 19 studies. Our findings highlight that evidence for adding local antibiotic delivery systems to standard DFO treatment remains limited. Furthermore, we found that so far, local antibiotic interventions have mainly targeted forefoot DFO, although there is marked variation in the design of the included studies. Suggestive evidence emerging from observational studies underscores that the addition of local agents to conventional systemic antibiotics might help to shorten the clinical healing time and overall recovery rates in infected diabetic foot ulcers, although the effectiveness of local antibiotics as a standalone approach remains overlooked. In conclusion, despite the heterogeneous body of evidence, the possibility that the addition of local antibiotics to conventional systemic treatment may improve outcomes in DFI and DFO cannot be ruled out. Antibiotic stewardship principles call for further research to elucidate the potential benefits of local antibiotics alone and in combination with conventional systemic antibiotics for the treatment of DFI and DFO. [ABSTRACT FROM AUTHOR]

Topical antibiotic application and occlusive dressings stand as the current standard of care for partial thickness burn (PTB) treatment. Silver sulfadiazine (SSD) is the most widely used topical antimicrobial agent for acute burn management worldwide. Despite its antimicrobial benefits, there is emerging evidence that SSD might delay wound reepithelialization. We hypothesized that when compared with a topical antibiotic ointment, wound reepithelialization with SSD would be delayed. We created 21 partial thickness burns on the backs of 3 anesthetized female domestic pigs (30kg) using an established vertical progression model. The burns were randomly assigned to topical treatment with SSD, triple antibiotic ointment, or petrolatum ointment applied daily for two weeks, followed by twice weekly for another 2 weeks with intermittent dressing changes. The primary outcome was percentage wound reepithelialization at day 21. Our study had 80% power to detect a 25-percentage difference in wound reepithelialization at day 21. All wounds were completely reepithelialized within 28 days of burn creation. At day 21 the mean (SD) percentages for wound reepithelialization were 73.6 (38.2), 93.2 (16.3), and 65.0 (48.9) in wounds treated with SSD, triple antibiotic, and petrolatum respectively, P=0.049. There was no significant difference among treatment groups in scar depth at day 28. Pseudoeschar formation and erythematous hypersensitivity reactions were common findings on gross analysis with SSD and topical antibiotics respectively. We conclude that SSD delayed reepithelialization of partial thickness porcine burns when compared with triple antibiotic ointment. There were no significant differences in scar depth among the groups., (© 2024 Euro-Mediterranean Council for Burns and Fire Disasters.)

Abstract Purpose Animal models implicate candida colonization facilitating invasive bacterial infections. The clinical relevance of this microbial interaction remains undefined and difficult to study directly. Observations from studies of anti-septic, antibiotic, anti-fungal, and non-decontamination-based interventions to prevent ICU acquired infection collectively serve as a natural experiment. Methods Three candidate generalized structural equation models (GSEM), with Candida and Pseudomonas colonization as latent variables, were confronted with blood culture and respiratory tract isolate data derived from 464 groups from 279 studies including studies of combined antibiotic and antifungal exposures within selective digestive decontamination (SDD) interventions. Results Introducing an interaction term between Candida colonization and Pseudomonas colonization substantially improved GSEM model fit. Model derived coefficients for singular exposure to anti-septic agents (− 1.23; − 2.1 to − 0.32), amphotericin (− 1.78; − 2.79 to − 0.78) and topical antibiotic prophylaxis (TAP; + 1.02; + 0.11 to + 1.93) versus Candida colonization were similar in magnitude but contrary in direction. By contrast, the model-derived coefficients for singular exposure to TAP, as with anti-septic agents, versus Pseudomonas colonization were weaker or non-significant. Singular exposure to amphotericin would be predicted to more than halve candidemia and Pseudomonas bacteremia incidences versus literature benchmarks for absolute differences of approximately one percentage point or less. Conclusion GSEM modelling of published data supports the postulated interaction between Candida and Pseudomonas colonization towards promoting bacteremia among ICU patients. This would be difficult to detect without GSEM modelling. The model indicates that anti-fungal agents have greater impact in preventing Pseudomonas bacteremia than TAP, which has no impact.

Background and objectivesBacterial biofilm formation within chronic wound beds, which provides an effective barrier against antibiotics, is a known cause of recalcitrant infections and a significant healthcare burden, often requiring repeated surgical debridements. Laser-generated shockwaves (LGS) is a novel, minimally invasive, and nonthermal modality for biofilm mechanical debridement which utilizes compressive stress waves, generated by photonic absorption in thin titanium films to mechanically disrupt the biofilm. Prior studies have demonstrated LGS monotherapy to be selectively efficacious for biofilm disruption and safe for host tissues. In this study, we sought to determine if LGS can enhance the antimicrobial activity and biofilm disruption capability of topical antibiotic therapy.Study design/materials and methodsStaphylococcus epidermidis biofilms grown in vitro on glass were treated with topical gentamicin (31, 62, and 124 μg/ml) with and without LGS (n = 3-11/treatment group). Mechanical shockwaves were generated with a 1,064 nm Nd:YAG laser (laser fluence 110.14 mJ/mm2 , pulse duration 5 ns, spot size 3 mm). Following a 24-hour incubation period, bacterial viability was assessed by determining the number of colony-forming units (CFU) via the Miles and Misra method. Residual biofilm bioburden was analyzed using the crystal violet biofilm assay.ResultsWith gentamicin monotherapy, CFU density (CFU/mm2 ) at 31, 62, and 124 μg/ml were (282 ± 84) × 104 , (185 ± 34) × 104 , and (113 ± 9) × 104 , respectively. With LGS and gentamicin therapy, CFU density decreased to (170 ± 44) × 104 , (89 ± 24) × 104 , and (43 ± 3) × 104 , respectively (P = 0.1704, 0.0302, and 0.0004 when compared with gentamicin alone). Biofilm burden as measured by the assay in the gentamicin 31, 62, and 124 μg/ml groups was reduced by 80%, 95%, and 98% when LGS was added (P = 0.0102, >0.0001, and 0.0001 for all groups when compared with gentamicin alone). Furthermore, samples treated with LGS saw an increase in susceptibility to gentamicin, in terms of reduced biofilm bioburden and CFU densities.ConclusionLGS enhances the efficacy of topical antibiotics in an in vitro model. This has significant implications for clinical applications in the management of chronic soft tissue infections and recalcitrant chronic rhinosinusitis. Lasers Surg. Med. 49:539-547, 2017. © 2017 Wiley Periodicals, Inc.

Antibiotics have been used as a prophylaxis for dermatologic procedures. We will review the various procedures that specific antibiotics with dosages are used for, depending on the procedure, diagnosis, and circumstance of the patient. We will examine the current and updated guidelines used in dermatologic surgery and the overlapping guidelines across other fields. Physicians must consider the side effects of antibiotics and the resistance that may occur as a result before using the class or level of prophylaxis. Initial evaluation for alcohol, chlorhexidine, or iodine should be measured as well. Updated guidelines aim to address the contraindications of antibiotics, yet further research is needed to avoid antibiotic resistance and to explore alternative methods of antibiotic application, such as intranasal and intravenous. [ABSTRACT FROM AUTHOR]

Background: Labial synechiae is a fairly common gynaecological problem that occurs as a result of inflammation leading to fusion between the labia minora. Being in a developing country with limited resources and poor compliance of patients to prolonged treatments, we are faced with immense challenges in the management of these girls. Aims: We wanted to evaluate the efficacy and the cost-effectiveness of manual separation and topical antibiotics with perineal hygiene in the management of pre-pubertal girls with labial synechiae. Materials and Methods: Design: Prospective, non-randomised interventional study. Participant: Pre-pubertal girls presenting with the diagnosis of labial synechiae in the period from September 2015 to January 2018. Interventions: Manual separation followed by topical antibiotic ointment application for 1 week with local hygiene. Outcomes measure: Complete release of the synechiae and no recurrence up to 6 months. Results: Out of the total 55 patients, only 48 patients were included, their age ranged from 3 months to 7 years (mean 2.8 years). Almost half of our patients were asymptomatic, and other half had symptoms (urinary tract infection, dripping of urine and itching). Majority of our patients belong to low middle class status. We had 100% complete release of synechiae and no recurrence on 6 months follow-up. Conclusion: Manual separation followed by topical antibiotics is a cost-effective method of the treatment of labial synechiae with immediate response and low recurrence rate.

India is among the largest consumers of antibiotics. Easy availability and growing sales of Fixed Dose Combinations (FDCs) of antibiotics can worsen Antimicrobial Resistance (AMR). There is lack of comprehensive data on available antibiotic FDC formulations, their dose strengths and adequacy of scientific evidence regarding their efficacy, safety and suitability for human use. In the present work, we aimed at addressing this knowledge gap. Availability of FDCs was ascertained from the Current Index of Medical Specialties (CIMS) [Issue Jan-April 2020]. Customized data abstraction form was used to capture pertinent information for these FDCs. Assessment of rationality was done based on standard parameters. More than 90% of the existing FDCs were found to be irrational; with two third of them being unapproved and or banned from use in the country. Although the regulatory agency has already taken cognizance of the seriousness of the matter; there is an urgent need to revisit these FDCs to promote prudent antibiotic use. High antibiotic use is associated with antimicrobial resistance; it is imperative that all factors which lead to high antibiotic use are adequately addressed. Easy availability of fixed dose combinations (FDCs) has begun to catch the attention of regulators in developing economies like India leading to a ban of 330 FDCs of which 19% were antibiotic combinations. The continuing presence and increasing sales of these irrational FDCs is a concern for effective antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) are a common result of a complex secondary complication of diabetes mellitus. More than half of DFUs become infected due to frequent colonization with Staphylococcus aureus. The use of topical antibiotics is proposed, especially in combination with natural adjuvants, to minimize the negative impacts caused by generalized use of systemic antibiotics. In this study, 13 different phytochemicals—namely chalcone, juglone, cinnamic acid, trigonelline, Furvina—and four nitrovinylfuran derivatives—guaiazulene, α-bisabolol, farnesol and nerolidol—were selected to be tested as antibiotic enhancers. After minimum inhibitory and bactericidal concentration (MIC and MBC) determination of each molecule against different strains of S. aureus, including clinical isolates from diabetic foot wounds (CECT 976, Xu212, SA 1199B, RN4220, MJMC102, MJMC109, MJMC110 and MJMC111), their potentiation effects on the antibiotics fusidic acid, mupirocin, gentamicin, oxacillin and methicillin were evaluated through the disc diffusion method. Farnesol at sub-MIC was able to restore the activity of methicillin and oxacillin on the MJMC102 and MJMC111 strains, as well as two MRSA clinical isolates, and potentiated the effect of the remaining antibiotics. The results obtained demonstrate the great potential for the topical application of phytochemicals and derivatives as antibiotic resistance modifier agents to combat multidrug resistance in bacterial wound infections. [ABSTRACT FROM AUTHOR]

Conjunctivitis, caused by bacterial infections, represents health concern and diagnosis of the disease is pivotal for the proper selection of the treatment. The main causes of bacterial conjunctivitis vary in different countries. The current study investigated the common bacterial causes of bacterial conjunctivitis from eye clinics' attendants and evaluated the effectiveness of different therapeutic approaches. Eye swabs from patients, diagnosed with conjunctivitis, were assessed microbiologically and the isolated bacteria were identified using the standard biochemical identification and sequencing of the 16S rRNA gene. Antibiotics' susceptibility of the conjunctivitis-associated bacterial pathogens was evaluated against nineteen broad-spectrum antibiotics. In the meanwhile, cell-free preparations from probiotic Lactobacillus and Bifidobacterium strains were used to evaluate their antagonistic activities. Findings from this study showed that out of 52 specimen, 17 eye swabs from patients with conjunctivitis were bacterial culture-positive. The identity of the bacterial species, using the biochemical identification system, was Staphylococcus aureus (4 isolates) and S. epidermidis (13 isolates). Staphylococcus spp. showed susceptibility to linezolid, vancomycin, novobiocin, and fluoroquinolones (norfloxacin, ofloxacin, ciprofloxacin and levofloxacin). However, isolates from the two Staphylococcus spp. expressed resistance to penicillin G, oxacillin, and cephalexin. As alternatives to antibiotics, the growth of Staphylococcus spp., including isolates with antibiotic resistance, was inhibited by cell-free preparations of the 4 probiotic Lactobacillus and the 2 Bifidobacterium strains. These findings provide evidence that topical antibiotics such as fluoroquinolones are still effective antimicrobial agents against staphylococci associated with conjunctivitis whereas probiotic preparations could be promising for further research to pave the way for their therapeutic applications against ophthalmic diseases.