BACKGROUND & AIMS: After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS: This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS: Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS: Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.
- MeSH
- amoxicilin MeSH
- antibakteriální látky terapeutické užití MeSH
- bismut MeSH
- chinolony * terapeutické užití MeSH
- dospělí MeSH
- Helicobacter pylori * MeSH
- infekce vyvolané Helicobacter pylori * farmakoterapie MeSH
- inhibitory protonové pumpy MeSH
- klarithromycin terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- levofloxacin MeSH
- lidé MeSH
- moxifloxacin terapeutické užití MeSH
- peniciliny škodlivé účinky MeSH
- prospektivní studie MeSH
- registrace MeSH
- tetracyklin terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Bacteria from wastewater discharged to the sewerage near three hospitals of Islamabad, Rawalpindi, and Faisalabad were examined for resistance to the most commonly prescribed antibiotics in Pakistan. From the selected sites, a total of 109 isolates from 40 different species were identified based on 16S rRNA gene sequence and phylogeny. The isolates were tested for their resistance to ciprofloxacin, levofloxacin, ofloxacin, amoxicillin, and ampicillin. The results indicated that the isolates were resistant with the highest percentage to ampicillin and the lowest percentage to ciprofloxacin. Among the resistant isolates, 91.7% were found resistant to ampicillin, 83.5% to amoxicillin, 67.0% to ofloxacin, whereas only 27.5% to ciprofloxacin and 21.1% to levofloxacin. Among three sampled locations, the most of resistance was observed in Escherichia and Acinetobacter species. More than 30% isolated microorganisms were found resistant to more than three antibiotics. These findings concluded the presence of predominant microbial population resistant to antibiotics in wastewater channels near hospitals and its surroundings, which requires further investigation regarding their existence and spread in other environmental media having potential community health implications.
Nemoc z kočičího škrábnutí je onemocnění nejčastěji způsobené Gram‑negativní bakterií Bartonella henselae. U imunokompetentních pacientů se většinou jedná o klinicky mírně probíhající, lokální, zánětlivé postižení kůže s regionální lymfadenopatií. U starších, oslabených či imunokompromitovaných pacientů může mít atypický klinický obraz i průběh. Popis takového případu je předmětem předkládaného sdělení.
Cat-stratch disease is mostly caused by Gram-negative bacteria Bartonella henselae. In immunocompetent patients, the clinical presentation is generally mild, local, inflammatory skin lesion with regional lymphadenopathy. Among the elderly, debilitated or immunocompromised patients, atypical clinical manifestation and trajectory may occur. A description of such a case is the theme of the presented report.
- MeSH
- Bartonella henselae patogenita MeSH
- biopsie MeSH
- klarithromycin terapeutické užití MeSH
- levofloxacin terapeutické užití MeSH
- lidé MeSH
- nemoc z kočičího škrábnutí * diagnóza terapie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: The aim of this study was comparison the effectiveness of sequential and standard quadruple therapy on eradication of H. pylori infection. METHODS: This clinical trial study was conducted on 160 patients with dyspepsia or gastroduodenal ulcer. Patients were randomly divided into two groups. Group A (standard regimen) received omeprazole, amoxicillin, clarithromycin and bismuth subcitrate for 2 weeks. Group B (sequential regimen) received omeprazole and amoxicillin in 5 days and omeprazole, tinidazole and levofloxacin in 5 days. After the end of treatment regimens, 20 mg omeprazole was administered twice daily for 3 weeks. H. pylori eradication was assessed 2 months after antibiotic treatment via fecal antigen. RESULTS: Frequency of H. pylori eradication in group A and B was observed in 55 (68.8%) and 63 patients (78.8%), respectively. No significant difference was seen between two groups, regarding H. pylori eradication (p = 0.15). The most common side effects in group A, B were bitterness of mouth (63.8%) and nausea (16.2%), respectively (p H. pylori infection, higher rate of H. pylori eradication was seen in group B than group A. Thus, sequential regimen was a more appropriate regimen with fewer complications.
- MeSH
- amoxicilin aplikace a dávkování MeSH
- dospělí MeSH
- Helicobacter pylori MeSH
- infekce vyvolané Helicobacter pylori farmakoterapie MeSH
- klarithromycin aplikace a dávkování MeSH
- kombinovaná farmakoterapie MeSH
- levofloxacin aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- omeprazol aplikace a dávkování MeSH
- organokovové sloučeniny aplikace a dávkování MeSH
- senioři MeSH
- tinidazol aplikace a dávkování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- srovnávací studie MeSH
- MeSH
- antibakteriální látky * aplikace a dávkování klasifikace škodlivé účinky terapeutické užití MeSH
- ciprofloxacin aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- fluorochinolony * aplikace a dávkování klasifikace škodlivé účinky terapeutické užití MeSH
- infekce farmakoterapie klasifikace MeSH
- lidé MeSH
- ofloxacin aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
- MeSH
- antibakteriální látky aplikace a dávkování klasifikace terapeutické užití MeSH
- fluorochinolony * aplikace a dávkování klasifikace terapeutické užití MeSH
- infekce farmakoterapie MeSH
- levofloxacin aplikace a dávkování terapeutické užití MeSH
- lidé MeSH
- moxifloxacin aplikace a dávkování terapeutické užití MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Experience in Helicobacter pylori eradication treatment of patients allergic to penicillin is very scarce. A triple combination with a PPI, clarithromycin (C), and metronidazole (M) is often prescribed as the first option, although more recently the use of a quadruple therapy with PPI, bismuth (B), tetracycline (T), and M has been recommended. AIM: To evaluate the efficacy and safety of first-line and rescue treatments in patients allergic to penicillin in the "European Registry of H pylori management" (Hp-EuReg). METHODS: A systematic prospective registry of the clinical practice of European gastroenterologists (27 countries, 300 investigators) on the management of H pylori infection. An e-CRF was created on AEG-REDCap. Patients with penicillin allergy were analyzed until June 2019. RESULTS: One-thousand eighty-four patients allergic to penicillin were analyzed. The most frequently prescribed first-line treatments were as follows: PPI + C + M (n = 285) and PPI + B + T + M (classic or Pylera® ; n = 250). In first line, the efficacy of PPI + C + M was 69%, while PPI + B + T + M reached 91% (P < .001). In second line, after the failure of PPI + C + M, two rescue options showed similar efficacy: PPI + B + T + M (78%) and PPI + C + levofloxacin (L) (71%) (P > .05). In third line, after the failure of PPI + C + M and PPI + C + L, PPI + B + T + M was successful in 75% of cases. CONCLUSION: In patients allergic to penicillin, a triple combination with PPI + C + M should not be generally recommended as a first-line treatment, while a quadruple regimen with PPI + B + T + M seems to be a better option. As a rescue treatment, this quadruple regimen (if not previously prescribed) or a triple regimen with PPI + C + L could be used but achieved suboptimal (<80%) results.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- bismut terapeutické užití MeSH
- Helicobacter pylori účinky léků MeSH
- infekce vyvolané Helicobacter pylori farmakoterapie MeSH
- inhibitory protonové pumpy terapeutické užití MeSH
- klarithromycin terapeutické užití MeSH
- kombinovaná farmakoterapie * MeSH
- léková alergie * MeSH
- levofloxacin terapeutické užití MeSH
- lidé MeSH
- metronidazol terapeutické užití MeSH
- peniciliny škodlivé účinky terapeutické užití MeSH
- prospektivní studie MeSH
- registrace statistika a číselné údaje MeSH
- tetracyklin terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Due to their structural variability and their commercial availability, cyclodextrins are the most frequently used chiral selectors in capillary electrophoresis. A variety of migration modes can be realized depending on the characteristics of the cyclodextrins and the analytes. The basic considerations regarding the development of a chiral CE method employing cyclodextrins as chiral selectors are briefly discussed. The presented examples illustrate the separation modes of an acidic and a basic analyte with native and charged cyclodextrin derivatives as a function of the pH of the background electrolyte and the concentration of the cyclodextrin.
In order to provide a more detailed view on the structure⁻antimycobacterial activity relationship (SAR) of phenylcarbamic acid derivatives containing two centers of protonation, 1-[2-[({[2-/3-(alkoxy)phenyl]amino}carbonyl)oxy]-3-(dipropylammonio)propyl]pyrrolidinium oxalates (1a⁻d)/dichlorides (1e⁻h) as well as 1-[2-[({[2-/3-(alkoxy)phenyl]amino}carbonyl)oxy]-3-(di-propylammonio)propyl]azepanium oxalates (1i⁻l)/dichlorides (1m⁻p; alkoxy = butoxy to heptyloxy) were physicochemically characterized by estimation of their surface tension (γ; Traube's stalagmometric method), electronic features (log ε; UV/Vis spectrophotometry) and lipophilic properties (log kw; isocratic RP-HPLC) as well. The experimental log kw dataset was studied together with computational logarithms of partition coefficients (log P) generated by various methods based mainly on atomic or combined atomic and fragmental principles. Similarities and differences between the experimental and in silico lipophilicity descriptors were analyzed by unscaled principal component analysis (PCA). The in vitro activity of compounds 1a⁻p was inspected against Mycobacterium tuberculosis CNCTC My 331/88 (identical with H37Rv and ATCC 2794, respectively), M.tuberculosis H37Ra ATCC 25177, M.kansasii CNCTC My 235/80 (identical with ATCC 12478), the M.kansasii 6509/96 clinical isolate, M.kansasii DSM 44162, M. avium CNCTC My 330/80 (identical with ATCC 25291), M.smegmatis ATCC 700084 and M. marinum CAMP 5644, respectively. In vitro susceptibility of the mycobacteria to reference drugs isoniazid, ethambutol, ofloxacin or ciprofloxacin was tested as well. A very unique aspect of the research was that many compounds from the set 1a⁻p were highly efficient almost against all tested mycobacteria. The most promising derivatives showed MIC values varied from 1.9 μM to 8 μM, which were lower compared to those of used standards, especially if concerning ability to fight M.tuberculosis H37Ra ATCC 25177, M.kansasii DSM 44162 or M. avium CNCTC My 330/80. Current in vitro biological assays and systematic SAR studies based on PCA approach as well as fitting procedures, which were supported by relevant statistical descriptors, proved that the compounds 1a⁻p represented a very promising molecular framework for development of 'non-traditional' but effective antimycobacterial agents.
- MeSH
- antituberkulotika chemická syntéza farmakologie MeSH
- azepiny chemická syntéza farmakologie MeSH
- ciprofloxacin chemie terapeutické užití MeSH
- ethambutol chemie terapeutické užití MeSH
- fenylkarbamáty chemická syntéza farmakologie MeSH
- isoniazid chemie terapeutické užití MeSH
- mikrobiální testy citlivosti MeSH
- Mycobacterium avium účinky léků MeSH
- Mycobacterium kansasii účinky léků MeSH
- Mycobacterium smegmatis účinky léků MeSH
- Mycobacterium tuberculosis účinky léků MeSH
- Mycobacterium účinky léků MeSH
- ofloxacin chemie terapeutické užití MeSH
- oxaláty chemie farmakologie MeSH
- počítačová simulace MeSH
- pyrrolidiny chemická syntéza farmakologie MeSH
- racionální návrh léčiv MeSH
- rozpustnost MeSH
- vztahy mezi strukturou a aktivitou MeSH
- Publikační typ
- časopisecké články MeSH
A 23-year-old, HIV-negative woman who had undergone a hematopoietic stem cell transplantation was admitted to the hospital with respiratory failure and symptoms of bronchiolitis obliterans. A chest computed tomography scan revealed diffuse ground-glass opacification and fibrous plugs. Due to worsening respiratory failure despite treatment, ventilation was provided through a tracheostomy tube. Molecular examination of bronchoalveolar lavage and urine revealed Enterocytozoon bieneusi infection. After treatment with albendazole the patient gradually improved, but the pathogen was not eradicated and reappeared on follow-up examination. E. bieneusi belongs to the most clinically important microsporidial species infecting humans, mostly those who are immunocompromised. This fungus tends to infect enterocytes of the intestine, and there are limited studies concerning its extraintestinal location. This is the first report of a case of disseminated respiratory and urinary E. bieneusi infection in a transplant recipient.
- MeSH
- albendazol terapeutické užití MeSH
- bronchoalveolární laváž MeSH
- Enterocytozoon účinky léků izolace a purifikace MeSH
- HIV infekce MeSH
- hostitel s imunodeficiencí účinky léků MeSH
- infekce močového ústrojí diagnóza farmakoterapie MeSH
- levofloxacin terapeutické užití MeSH
- lidé MeSH
- mikrosporidióza diagnóza farmakoterapie MeSH
- mladý dospělý MeSH
- rizikové faktory MeSH
- transplantace hematopoetických kmenových buněk * MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
