- MeSH
- Antiprotozoal Agents therapeutic use MeSH
- Azithromycin therapeutic use MeSH
- Adult MeSH
- Humans MeSH
- Toxoplasmosis, Ocular * drug therapy pathology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
OBJECTIVES: To evaluate the efficacy and tolerability of a single dose of oral cefixime 800 mg plus oral doxycycline 100 mg twice a day for 7 days, compared with a recommended single dose of ceftriaxone plus single dose of oral azithromycin, for treatment of uncomplicated urogenital, rectal, or pharyngeal gonorrhoea. METHODS: A noninferiority, open-label, multicentre randomized controlled trial was conducted in Prague, Czech Republic. Some 161 patients, 18-65 years of age diagnosed with uncomplicated urogenital, rectal, or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with single dose of cefixime 800 mg plus doxycycline 100 mg twice a day for 1 week or a single dose of ceftriaxone 1 g intramuscularly plus single dose of azithromycin 2 g. The primary outcome was the number of participants with negative culture and NAAT at 1 week and 3 weeks, respectively, after treatment initiation. RESULTS: In all, 161 patients were randomized and 152 were included in per-protocol analyses. All 76 (100%; 95% CI, 0.95-1.00) patients treated with ceftriaxone plus azithromycin achieved negative cultures and NAAT after treatment. In the cefixime plus doxycycline arm at week 1, culture was negative in all 76 (100%) patients; at week 3, culture was negative in 70 of the 76 patients (92%; 95% CI, 0.84-0.97) and NAAT negative in 66 of the 76 patients (87%; 95% CI, 0.77-0.94). At week 3, culture and NAAT were negative in 65 of the 76 patients (86%; 95% CI, 0.76-0.93). Per-protocol risk difference was 14.5%; 95% CI, 6.56-22.38. All treatment failures observed in the cefixime arm were pharyngeal gonorrhoea cases. DISCUSSION: The combination of cefixime and doxycycline did not achieve noninferiority to ceftriaxone and azithromycin for treatment of gonorrhoea when including pharyngeal gonorrhoea. It did, however, show high efficacy for urogenital and rectal gonorrhoea.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Azithromycin therapeutic use MeSH
- Cefixime therapeutic use MeSH
- Ceftriaxone * MeSH
- Adult MeSH
- Doxycycline therapeutic use MeSH
- Gonorrhea * drug therapy microbiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Neisseria gonorrhoeae MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Equivalence Trial MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
Haemophilus ducreyi (HD) is an important cause of cutaneous ulcers in several endemic regions, including the Western Pacific Region, especially among children. An HD sequence typing on swab samples taken from 1,081 ulcers in the Namatanai district of Papua New Guinea, during the pilot study for treatment of yaws, has been performed using the Grant typing system. Of the 363 samples that tested positive for the 16S rDNA of HD, the dsrA sequences of 270 samples were determined. Altogether they revealed 8 HD strain types circulating in Namatanai, including seven strain types of Class I (I.3, I.4, I.5, I.9, I.10, I.11, I.12) and one strain of Class II (II.3); four Class I types (I.9, I.10, I.11, I.12) were novel. The southern region of Namatanai (Matalai Rural) was identified as the region with the lowest genotype diversity and with most infections caused by HD Class II. The middle and northern subdistricts were affected mainly by HD Class I. Analysis of patient characteristics revealed that Class II HD infections were more often represented by longer-lasting ulcers than Class I HD infections. An increase in the prevalence of the I.10 strain was found after azithromycin administration compared to the untreated population at baseline likely reflecting higher infectivity of HD Class I, and more specifically strain type I.10.
- MeSH
- Anti-Bacterial Agents * therapeutic use pharmacology MeSH
- Azithromycin * therapeutic use MeSH
- Child MeSH
- DNA, Bacterial genetics MeSH
- Adult MeSH
- Yaws microbiology epidemiology drug therapy MeSH
- Phylogeny MeSH
- Genotype * MeSH
- Haemophilus ducreyi * genetics isolation & purification drug effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Chancroid * microbiology epidemiology drug therapy MeSH
- Adolescent MeSH
- Young Adult MeSH
- Pilot Projects MeSH
- Child, Preschool MeSH
- RNA, Ribosomal, 16S genetics MeSH
- Sequence Analysis, DNA MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Papua New Guinea MeSH
OBJECTIVES: To characterize the genetic basis of azithromycin resistance in Escherichia coli and Salmonella collected within the EU harmonized antimicrobial resistance (AMR) surveillance programme in 2014-18 and the Danish AMR surveillance programme in 2016-19. METHODS: WGS data of 1007 E. coli [165 azithromycin resistant (MIC > 16 mg/L)] and 269 Salmonella [29 azithromycin resistant (MIC > 16 mg/L)] were screened for acquired macrolide resistance genes and mutations in rplDV, 23S rRNA and acrB genes using ResFinder v4.0, AMRFinder Plus and custom scripts. Genotype-phenotype concordance was determined for all isolates. Transferability of mef(C)-mph(G)-carrying plasmids was assessed by conjugation experiments. RESULTS: mph(A), mph(B), mef(B), erm(B) and mef(C)-mph(G) were detected in E. coli and Salmonella, whereas erm(C), erm(42), ere(A) and mph(E)-msr(E) were detected in E. coli only. The presence of macrolide resistance genes, alone or in combination, was concordant with the azithromycin-resistant phenotype in 69% of isolates. Distinct mph(A) operon structures were observed in azithromycin-susceptible (n = 50) and -resistant (n = 136) isolates. mef(C)-mph(G) were detected in porcine and bovine E. coli and in porcine Salmonella enterica serovar Derby and Salmonella enterica 1,4, [5],12:i:-, flanked downstream by ISCR2 or TnAs1 and associated with IncIγ and IncFII plasmids. CONCLUSIONS: Diverse azithromycin resistance genes were detected in E. coli and Salmonella from food-producing animals and meat in Europe. Azithromycin resistance genes mef(C)-mph(G) and erm(42) appear to be emerging primarily in porcine E. coli isolates. The identification of distinct mph(A) operon structures in susceptible and resistant isolates increases the predictive power of WGS-based methods for in silico detection of azithromycin resistance in Enterobacterales.
- MeSH
- Anti-Bacterial Agents * pharmacology MeSH
- Azithromycin * pharmacology MeSH
- Genes, Bacterial MeSH
- Drug Resistance, Bacterial * genetics MeSH
- Epidemiological Monitoring MeSH
- Escherichia coli * drug effects genetics MeSH
- Genotype MeSH
- Escherichia coli Infections microbiology MeSH
- Macrolides pharmacology MeSH
- Meat * microbiology MeSH
- Microbial Sensitivity Tests * MeSH
- Plasmids genetics MeSH
- Swine MeSH
- Salmonella * drug effects genetics isolation & purification MeSH
- Whole Genome Sequencing MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
Primary ciliary dyskinesia (PCD) is a genetic disorder associated with recurrent and chronic respiratory infections due to functional defects of motile cilia. In this study, we aimed to elucidate inflammatory and proliferative responses in PCD respiratory epithelium and evaluate the effect of Azithromycin (AZT) on these responses. Airway basal cells (BCs) were isolated from nasal samples of Wild-type (WT) epitope of healthy donors and PCD donors with bi-allelic mutations in DNAH5, DNAH11 and CCDC39. Cells were expanded in vitro and stimulated with either Lipopolysaccharide (LPS) or vehicle control. Post stimulation, cells were treated with either Azithromycin (AZT) or vehicle control. Cell proliferation was imaged in real-time. Separately, BCs from the same donors were expanded and grown at an air-liquid interface (ALI) to generate a multi-ciliated epithelium (MCE). Once fully mature, cells were stimulated with LPS, AZT, LPS + AZT or vehicle control. Inflammatory profiling was performed on collected media by cytokine Luminex assay. At baseline, there was a significantly higher mean production of pro-inflammatory cytokines by CCDC39 BCs and MCEs when compared to WT, DNAH11 and DNAH5 cells. AZT inhibited production of cytokines induced by LPS in PCD cells. Differences in cell proliferation were noted in PCD and this was also corrected with AZT treatment.
- MeSH
- Azithromycin * pharmacology MeSH
- Cytokines MeSH
- Epithelial Cells MeSH
- Humans MeSH
- Lipopolysaccharides toxicity MeSH
- Ciliary Motility Disorders * MeSH
- Cell Proliferation MeSH
- Inflammation drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Introduction: Coronavirus pandemic is currently a global health concern with no established treatment guidelines. The aim of the present study was to determine the therapeutic effectiveness of hydroxychloroquine combined with azithromycin in patients with positive coronavirus disease 2019 (COVID-19) admitted to the hospital with severe dyspnea, as well as the incidence of occurrence of adverse effects.Methods: It was intended to utilize a retrospective clinical study of approximately 250 adult patients admitted to the ALSALAM Teaching Hospital in Mosul city with mild to moderate COVID-19 in order to evaluate treatment efficacy in combination with clinical and biochemical findings. Two groups were involved in the research. The first patient group consisted of 250 people who got hydroxychloroquine in conjunction with azithromycin, while the second untreated control group consisted of 100 individuals who received no medication as part of the research.Results: Baseline parameters (clinical and biochemical assays) did not vary substantially among the two groups. Patients in the treatment group were hospitalized at a rate of 30%, compared to 27% in the untreated control group (P<0.001). Between groups, there were no statistically significant changes in mortality,non-invasive oxygen demand, or hospitalization duration. Biochemical and Clinical outcomes were comparable between those receiving hydroxychloroquine with azithromycin and those do not receive any medication.Conclusion: This treatment regimen was shown to be not affective in mild to severe positve COVID-19 hospitalized patients and was associated with a small number of mild to moderate clinical adverse effects.
BACKGROUND: Treponema pallidum subspecies pertenue causes yaws. Strategies to better control, eliminate, and eradicate yaws are needed. METHODS: In an open-label, cluster-randomized, community-based trial conducted in a yaws-endemic area of Papua New Guinea, we randomly assigned 38 wards (i.e., clusters) to receive one round of mass administration of azithromycin followed by two rounds of target treatment of active cases (control group) or three rounds of mass administration of azithromycin (experimental group); round 1 was administered at baseline, round 2 at 6 months, and round 3 at 12 months. The coprimary end points were the prevalence of active cases of yaws, confirmed by polymerase-chain-reaction assay, in the entire trial population and the prevalence of latent yaws, confirmed by serologic testing, in a subgroup of asymptomatic children 1 to 15 years of age; prevalences were measured at 18 months, and the between-group differences were calculated. RESULTS: Of the 38 wards, 19 were randomly assigned to the control group (30,438 persons) and 19 to the experimental group (26,238 persons). A total of 24,848 doses of azithromycin were administered in the control group (22,033 were given to the participants at round 1 and 207 and 2608 were given to the participants with yaws-like lesions and their contacts, respectively, at rounds 2 and 3 [combined]), and 59,852 doses were administered in the experimental group. At 18 months, the prevalence of active yaws had decreased from 0.46% (102 of 22,033 persons) at baseline to 0.16% (47 of 29,954 persons) in the control group and from 0.43% (87 of 20,331 persons) at baseline to 0.04% (10 of 25,987 persons) in the experimental group (relative risk adjusted for clustering, 4.08; 95% confidence interval [CI], 1.90 to 8.76). The prevalence of other infectious ulcers decreased to a similar extent in the two treatment groups. The prevalence of latent yaws at 18 months was 6.54% (95% CI, 5.00 to 8.08) among 994 children in the control group and 3.28% (95% CI, 2.14 to 4.42) among 945 children in the experimental group (relative risk adjusted for clustering and age, 2.03; 95% CI, 1.12 to 3.70). Three cases of yaws with resistance to macrolides were found in the experimental group. CONCLUSIONS: The reduction in the community prevalence of yaws was greater with three rounds of mass administration of azithromycin at 6-month intervals than with one round of mass administration of azithromycin followed by two rounds of targeted treatment. Monitoring for the emergence and spread of antimicrobial resistance is needed. (Funded by Fundació "la Caixa" and others; ClinicalTrials.gov number, NCT03490123.).
- MeSH
- Anti-Bacterial Agents administration & dosage MeSH
- Azithromycin administration & dosage MeSH
- Drug Resistance, Bacterial MeSH
- Child MeSH
- Yaws drug therapy epidemiology MeSH
- Haemophilus ducreyi isolation & purification MeSH
- Infant MeSH
- Skin Ulcer microbiology MeSH
- Humans MeSH
- Mass Drug Administration * MeSH
- Adolescent MeSH
- Polymerase Chain Reaction MeSH
- Child, Preschool MeSH
- Prevalence MeSH
- Treponema isolation & purification MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Geographicals
- Papua New Guinea MeSH
- MeSH
- Azithromycin administration & dosage therapeutic use MeSH
- Ceftriaxone administration & dosage therapeutic use MeSH
- Chlamydia trachomatis pathogenicity MeSH
- Child MeSH
- Adult MeSH
- Pharyngitis MeSH
- Gonorrhea * diagnosis drug therapy transmission MeSH
- Humans MeSH
- Polymerase Chain Reaction MeSH
- Child, Preschool MeSH
- Disease Transmission, Infectious MeSH
- Sexually Transmitted Diseases diagnosis drug therapy transmission MeSH
- Urethritis MeSH
- Vaginitis MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Anti-Bacterial Agents pharmacology therapeutic use MeSH
- Antimicrobial Stewardship * MeSH
- Drug Resistance, Microbial MeSH
- Azithromycin administration & dosage pharmacology therapeutic use MeSH
- Drug Resistance, Bacterial MeSH
- Ceftriaxone administration & dosage pharmacology therapeutic use MeSH
- Ciprofloxacin administration & dosage therapeutic use MeSH
- Gonorrhea epidemiology drug therapy MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Microbial Sensitivity Tests MeSH
- Neisseria gonorrhoeae pathogenicity MeSH
- Sexually Transmitted Diseases MeSH
- Check Tag
- Humans MeSH
- MeSH
- Adapalene therapeutic use MeSH
- Azithromycin therapeutic use MeSH
- Diagnosis, Differential MeSH
- Doxycycline administration & dosage MeSH
- Isotretinoin administration & dosage MeSH
- Ivermectin administration & dosage MeSH
- Drug Therapy, Combination MeSH
- Middle Aged MeSH
- Humans MeSH
- Metronidazole administration & dosage MeSH
- Face * pathology MeSH
- Prednisolone administration & dosage MeSH
- Disease Progression MeSH
- Pyoderma * drug therapy MeSH
- Rosacea history etiology drug therapy pathology MeSH
- Drug Administration Schedule MeSH
- Sunbathing MeSH
- Treatment Outcome MeSH
- Rare Diseases drug therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
