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Antibiotics, Volume 3, Issue 2 (June 2014), Pages 109-243

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Research

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Open AccessArticle Clinical Efficacy of a Single Two Gram Dose of Azithromycin Extended Release for Male Patients with Urethritis
Antibiotics 2014, 3(2), 109-120; doi:10.3390/antibiotics3020109
Received: 10 February 2014 / Revised: 26 February 2014 / Accepted: 4 March 2014 / Published: 2 April 2014
Cited by 1 | PDF Full-text (601 KB) | HTML Full-text | XML Full-text
Abstract
To clarify the clinical efficacy of a single oral 2 g dose of azithromycin extended-release for heterosexual male patients with urethritis, and the current antimicrobial sensitivity of Neisseria gonorrhoeae to azithromycin, a prospective clinical trial was conducted from 2011–2013. In patients with [...] Read more.
To clarify the clinical efficacy of a single oral 2 g dose of azithromycin extended-release for heterosexual male patients with urethritis, and the current antimicrobial sensitivity of Neisseria gonorrhoeae to azithromycin, a prospective clinical trial was conducted from 2011–2013. In patients with gonococcal urethritis, the eradication rate was 90.9% (30 of 33). The susceptibility rates of isolated Neisseria gonorrhoeae strains to ceftriaxone, spectinomycin, cefixime and azithromycin were 100%, 100%, 95.3% (41/43) and 37.2% (16/43), respectively. In the patients with nongonococcal urethritis, the eradication rate was 90.0% (45 of 50). The microbiological eradication rates for the pathogens were 90.9% (30/33) for Neisseria gonorrhoeae, 91.5% (43/47) for Chlamydia trachomatis, 71.4% (5/7) for Mycoplasma genitalium, and 100% (13/13) for Ureaplasma urealyticum. The main adverse event was diarrhea and its manifestation rate was 35.2% (32 of 120). The symptom of diarrhea was mostly temporary and resolved spontaneously. The conclusion was that the treatment regimen with a single oral 2 g dose of azithromycin extended-release would be effective for patients with urethritis. However, the antimicrobial susceptibilities of Neisseria gonorrhoeae and Mycoplasma genitalium should be carefully monitored because of possible treatment failure. Full article
(This article belongs to the Special Issue Antibiotics and Urinary Tract Infections) Print Edition available
Open AccessArticle Anti-Adhesion Activity of A2-type Proanthocyanidins (a Cranberry Major Component) on Uropathogenic E. coli and P. mirabilis Strains
Antibiotics 2014, 3(2), 143-154; doi:10.3390/antibiotics3020143
Received: 27 January 2014 / Revised: 19 March 2014 / Accepted: 24 March 2014 / Published: 3 April 2014
Cited by 4 | PDF Full-text (2099 KB) | HTML Full-text | XML Full-text
Abstract
Urinary tract infections (UTIs) are relatively common in women and may be classified as uncomplicated or complicated, depending upon the urinary tract anatomy and physiology. Acute uncomplicated cystitis (AUC) occurs when urinary pathogens from the bowel or vagina colonize the periurethral mucosa [...] Read more.
Urinary tract infections (UTIs) are relatively common in women and may be classified as uncomplicated or complicated, depending upon the urinary tract anatomy and physiology. Acute uncomplicated cystitis (AUC) occurs when urinary pathogens from the bowel or vagina colonize the periurethral mucosa and reach the bladder. The vast majority of episodes in healthy women involving the same bacterial strain that caused the initial infection are thought to be reinfections. About 90% of AUC are caused by uropathogenic Escherichia coli (UPEC), but Proteus mirabilis also plays an important role. Several studies support the importance of cranberry (Vaccinium macrocarpon) proanthocyanidins in preventing adhesion of P-fimbriated UPEC to uroepithelial cells. In this study, we evaluated the in vitro anti-adhesion activity of A2-linked proanthocyanidins from cranberry on a UPEC and Proteus mirabilis strains and their possible influence on urease activity of the latter. A significant reduction of UPEC adhesion (up to 75%) on the HT1376 cell line was observed vs. control. For the strains of P. mirabilis there was also a reduction of adhesion (up to 75%) compared to controls, as well as a reduction in motility and urease activity. These results suggest that A2-type cranberry proanthocyanidins could aid in maintaining urinary tract health. Full article
(This article belongs to the Special Issue Antibiotics and Urinary Tract Infections) Print Edition available
Open AccessArticle Value of Provoked or Spontaneous Flank Pain in Men with Febrile Urinary Tract Infections
Antibiotics 2014, 3(2), 155-162; doi:10.3390/antibiotics3020155
Received: 16 January 2014 / Revised: 11 March 2014 / Accepted: 17 March 2014 / Published: 14 April 2014
Cited by 1 | PDF Full-text (479 KB) | HTML Full-text | XML Full-text
Abstract
Background: Our objective was to identify the clinical, laboratory and radiological characteristics of febrile urinary tract infections (UTI) in men and to focus on the value of flank pain in these men managed in an ambulatory care system. Methods: A network was [...] Read more.
Background: Our objective was to identify the clinical, laboratory and radiological characteristics of febrile urinary tract infections (UTI) in men and to focus on the value of flank pain in these men managed in an ambulatory care system. Methods: A network was designed to manage men with febrile UTI without hospitalization according to an algorithm designed with different specialists. The patients’ characteristics were prospectively recorded and each patient was followed up until completely cured. We artificially divided patients into two groups. Group 1: men without flank pain diagnosed as prostatitis and a second group (Group 2) of men with flank pain or provoked flank pain more likely to have a pyelonephritis. Groups were compared to find arguments to differentiate prostatitis to pyelonephritis. Results: 350 men were included in the study, half of these men reported urinary symptoms (dysuria, urgency and burning urination). The negative predictive values of the nitrite and leukocytes test were poor alone or in combination. The renal ultrasound was never informative. None of the patients failed to respond to the treatment. No difference was found between groups. Conclusions: Laboratory test results and radiological features had a poor predictive value. Men with suspected pyelonephritis did not evolve differently from those with suspected prostatitis. Monitoring and treatment of men with febrile UTI does not seem to depend on the existence of a pyelonephritis suspected after the presence of a lumbar pain. Ambulatory management of febrile UTI is feasible and safe, requiring an efficient network for patient’s surveillance. Full article
(This article belongs to the Special Issue Antibiotics and Urinary Tract Infections) Print Edition available
Open AccessArticle Adult and Pediatric Intra-Institutional Trends of Ciprofloxacin Susceptibility in E. coli Positive Urinary Cultures
Antibiotics 2014, 3(2), 163-173; doi:10.3390/antibiotics3020163
Received: 13 February 2014 / Revised: 3 April 2014 / Accepted: 4 April 2014 / Published: 21 April 2014
Cited by 1 | PDF Full-text (969 KB) | HTML Full-text | XML Full-text
Abstract
Antimicrobial drug resistance in treatment of urinary tract infection (UTI) continues to rise worldwide. To examine contributions of physician prescribing patterns to fluoroquinolone (ciprofloxacin, CP) resistance, we examined Escherichia coli (E. coli) resistance patterns in urinary cultures. Since CP usage [...] Read more.
Antimicrobial drug resistance in treatment of urinary tract infection (UTI) continues to rise worldwide. To examine contributions of physician prescribing patterns to fluoroquinolone (ciprofloxacin, CP) resistance, we examined Escherichia coli (E. coli) resistance patterns in urinary cultures. Since CP usage is limited in children, we compared CP resistance trends in adults and children to those of more commonly used trimethoprim-sulfamethoxazole (TMP-SMX) and nitrofurantoin (NF). Our data show that although the general pediatric population has lower resistance to ciprofloxacin, resistance levels are rising with increased usage. While NF susceptibility is historically stable, TMP-SMX resistance is slightly higher in children compared to adults. In both adults and children, antimicrobial resistance patterns vary according to clinical practice site, with ambulatory urology patients showing the highest resistance. This suggests that physician’s prescribing patterns contribute to antimicrobial resistance. Full article
(This article belongs to the Special Issue Antibiotics and Urinary Tract Infections) Print Edition available
Figures

Open AccessArticle Preparation and Microbiological Evaluation of Amphiphilic Kanamycin-Lipoamino Acid Ion-Pairs
Antibiotics 2014, 3(2), 216-232; doi:10.3390/antibiotics3020216
Received: 18 February 2014 / Revised: 29 April 2014 / Accepted: 14 May 2014 / Published: 26 May 2014
Cited by 1 | PDF Full-text (1134 KB) | HTML Full-text | XML Full-text
Abstract
Amphiphilic ion-pairs of kanamycin (KAN) were prepared by evaporation of a water-ethanol co-solution of KAN base and a lipoamino acid bearing a 12-carbon atoms alkyl side chain (LAA12), at different molar ratios. Infrared spectroscopy confirmed the structure of ion-pairs, while differential scanning [...] Read more.
Amphiphilic ion-pairs of kanamycin (KAN) were prepared by evaporation of a water-ethanol co-solution of KAN base and a lipoamino acid bearing a 12-carbon atoms alkyl side chain (LAA12), at different molar ratios. Infrared spectroscopy confirmed the structure of ion-pairs, while differential scanning calorimetry (DSC) and powder X-ray diffractometry (PXRD) studies supported the formation of new saline species with a different crystalline structure than the starting components. The solubility pattern shown in a range of both aqueous and organic solvents confirmed that the ion-pairs possess an amphiphilic character. The LAA12 counter-ion showed not to improve the antibacterial activity of KAN, suggesting that such chemical strategy is not able to favor the penetration of this drug inside the bacteria cells. Nevertheless, a slight improving, i.e., a one-fold dilution, was observed in E. coli. The present study can also serve as the basis for a further evaluation of LAA ion-pairing of antibiotics, as a means to improve the loading of hydrophilic drugs into lipid-based nanocarriers. Full article
Open AccessArticle Understanding Antibiotic Use in Minya District, Egypt: Physician and Pharmacist Prescribing and the Factors Influencing Their Practices
Antibiotics 2014, 3(2), 233-243; doi:10.3390/antibiotics3020233
Received: 27 February 2014 / Revised: 4 May 2014 / Accepted: 13 May 2014 / Published: 20 June 2014
Cited by 4 | PDF Full-text (561 KB) | HTML Full-text | XML Full-text
Abstract
Overuse of antibiotics has contributed to the emergence of antibiotic-resistant bacteria globally. In Egypt, patients can purchase antibiotics without a prescription, and we hypothesized frequent inappropriate antibiotic prescribing and dispensing. We interviewed physicians (n = 236) and pharmacists (n = 483) and [...] Read more.
Overuse of antibiotics has contributed to the emergence of antibiotic-resistant bacteria globally. In Egypt, patients can purchase antibiotics without a prescription, and we hypothesized frequent inappropriate antibiotic prescribing and dispensing. We interviewed physicians (n = 236) and pharmacists (n = 483) and conducted focus groups in Minya, Egypt, to assess attitudes and practices regarding antibiotic prescribing for outpatient acute respiratory infections (ARI). Antibiotics were reportedly prescribed most of the time or sometimes for colds by 150 (64%) physicians and 326 (81%) pharmacists. The most commonly prescribed antibiotics were β-lactams. Macrolides were the second most commonly prescribed for colds and sinusitis. The prescription of more than one antibiotic to treat pneumonia was reported by 85% of physicians. Most respondents thought antibiotic overuse contributes to resistance and reported “patient self-medication” as the biggest driver of overuse. Fifty physicians (21%) reported that they had prescribed antibiotics unnecessarily, citing patient over-the-counter access as the reason. Physicians <40 years of age and those who treat adults were more likely to prescribe antibiotics for colds. Overall, we found a high rate of unwarranted outpatient antibiotic prescribing and dispensing for ARIs. Patient access to OTC antibiotics contributes to over-prescribing. National guidelines for ARI treatment, provider education and national policy requiring a physician’s prescription for antibiotics may improve appropriate antibiotic use in Egypt. Full article

Review

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Open AccessReview Molecular Targets of β-Lactam-Based Antimicrobials: Beyond the Usual Suspects
Antibiotics 2014, 3(2), 128-142; doi:10.3390/antibiotics3020128
Received: 31 December 2013 / Revised: 24 February 2014 / Accepted: 25 February 2014 / Published: 3 April 2014
Cited by 4 | PDF Full-text (919 KB) | HTML Full-text | XML Full-text
Abstract
The common practice in antibacterial drug development has been to rapidly make an attempt to find ever-more stable and broad-spectrum variants for a particular antibiotic, once a drug resistance for that antibiotic is detected. We are now facing bacterial resistance toward our [...] Read more.
The common practice in antibacterial drug development has been to rapidly make an attempt to find ever-more stable and broad-spectrum variants for a particular antibiotic, once a drug resistance for that antibiotic is detected. We are now facing bacterial resistance toward our clinically relevant antibiotics of such a magnitude that the conversation for antimicrobial drug development ought to include effective new antibiotics with alternative mechanisms of action. The electrophilic β-lactam ring is amenable for the inhibition of different enzyme classes by a suitable decoration of the core scaffold. Monocyclic β-lactams lacking an ionizable group at the lactam nitrogen exhibit target preferences toward bacterial enzymes important for resistance and virulence. The present review intends to draw attention to the versatility of the β-lactams as antimicrobials with “unusual” molecular targets. Full article
(This article belongs to the Special Issue Mechanisms of Antibiotic Resistance)
Open AccessReview Antimicrobial Stewardship and Urinary Tract Infections
Antibiotics 2014, 3(2), 174-192; doi:10.3390/antibiotics3020174
Received: 14 March 2014 / Revised: 10 April 2014 / Accepted: 21 April 2014 / Published: 5 May 2014
Cited by 3 | PDF Full-text (597 KB) | HTML Full-text | XML Full-text
Abstract
Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients [...] Read more.
Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections. Full article
(This article belongs to the Special Issue Antibiotics and Urinary Tract Infections) Print Edition available
Open AccessReview β-Lactam Antibiotics Renaissance
Antibiotics 2014, 3(2), 193-215; doi:10.3390/antibiotics3020193
Received: 5 March 2014 / Revised: 30 April 2014 / Accepted: 4 May 2014 / Published: 9 May 2014
Cited by 8 | PDF Full-text (1041 KB) | HTML Full-text | XML Full-text
Abstract
Since the 1940s β-lactam antibiotics have been used to treat bacterial infections. However, emergence and dissemination of β-lactam resistance has reached the point where many marketed β-lactams no longer are clinically effective. The increasing prevalence of multidrug-resistant bacteria and the progressive withdrawal [...] Read more.
Since the 1940s β-lactam antibiotics have been used to treat bacterial infections. However, emergence and dissemination of β-lactam resistance has reached the point where many marketed β-lactams no longer are clinically effective. The increasing prevalence of multidrug-resistant bacteria and the progressive withdrawal of pharmaceutical companies from antibiotic research have evoked a strong reaction from health authorities, who have implemented initiatives to encourage the discovery of new antibacterials. Despite this gloomy scenario, several novel β-lactam antibiotics and β-lactamase inhibitors have recently progressed into clinical trials, and many more such compounds are being investigated. Here we seek to provide highlights of recent developments relating to the discovery of novel β-lactam antibiotics and β-lactamase inhibitors. Full article
(This article belongs to the Special Issue Mechanisms of Antibiotic Resistance)
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Other

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Open AccessMeeting Report International Conference “Urogenital Infections and Tuberculosis” in Novosibirsk, Russia, Has Opened New Perspectives in the Fight against Tuberculosis
Antibiotics 2014, 3(2), 121-127; doi:10.3390/antibiotics3020121
Received: 3 February 2014 / Revised: 4 March 2014 / Accepted: 5 March 2014 / Published: 2 April 2014
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Abstract
The first International Conference “Urogenital Infections and Tuberculosis” was held in Novosibirsk 24–26 October 2013. Three hundred and twelve delegates from 73 cities in 16 countries took part in the conference. Actual problems of urogenital tract infection (UTI) including tuberculosis (TB) as [...] Read more.
The first International Conference “Urogenital Infections and Tuberculosis” was held in Novosibirsk 24–26 October 2013. Three hundred and twelve delegates from 73 cities in 16 countries took part in the conference. Actual problems of urogenital tract infection (UTI) including tuberculosis (TB) as a specific infection were discussed, including: nosocomial infections in urology, various aspects of prostate biopsy, epidemiology and diagnosis of urogenital tuberculosis, gender and age related characteristics of urinary tract infections, and male infertility, etc. Full article
(This article belongs to the Special Issue Antibiotics and Urinary Tract Infections) Print Edition available

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