RESUMEN
BACKGROUND: This case report presents an exceptionally rare and atypical presentation of diphtheria in a 17-year-old female of Hausa ethnicity residing in an area with an elevated incidence within Kano State, Nigeria. By the end of 39th epidemiological week of 2023, only two cases of cutaneous diphtheria have been reported among 5,811 cases managed at MMSH diphtheria treatment center (DTC), representing approximately 0.035% of all diphtheria cases during that time period. CASE PRESENTATION: A 17-year-old Hausa female presented with a 3-day history of throat discomfort, malaise, and muffled speech. Physical examination revealed a pseudomembrane covering the tonsillar pillars, grade 3 tonsillar enlargement, and an unusual genital manifestation characterized by extensive vulval edema, severe pain, and a large, greyish patch extending into the vaginal introitus. Her medical history was significant for recent exposure to diphtheria and the emotional impact of her sibling's death from the same disease. Diagnostic tests, including throat swab culture and histocytology, confirmed diphtheria in the throat and vulvovaginal regions. The patient was promptly initiated on diphtheria antitoxin, Azithromycin, and innovative sitz baths with hydrogen peroxide. After 4 days of Sitz bath therapy, complete pseudomembrane clearance was observed, and the patient's symptoms resolved. CONCLUSION: This case underscores the complexity of diphtheria presentations, particularly with rare pseudomembranes in both throat and vaginal regions. The successful management, combining traditional and innovative therapies, highlights the importance of recognizing and addressing unusual manifestations promptly. The potential role of auto-inoculation and the efficacy of interventions like hydrogen peroxide sitz baths warrant further investigation. Overall, this case contributes to the understanding of diverse diphtheria presentations, guiding future clinical strategies for management of diphtheria cases and emphasizing the imperative of comprehensive vaccination efforts.
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Difteria , Humanos , Femenino , Adolescente , Difteria/diagnóstico , Difteria/tratamiento farmacológico , Antitoxina Diftérica/uso terapéutico , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Nigeria , Corynebacterium diphtheriae/aislamiento & purificaciónRESUMEN
BACKGROUND: Mycoplasma genitalium (MG), a sexually transmitted infection (STI), has emerged as a common cause of non-gonococcal urethritis and cervicitis worldwide, with documented resistance to commonly used antibiotics including doxycycline and azithromycin. Data in Ghana regarding the prevalence of MG is limited. METHODS: This retrospective study investigated MG presence and macrolide resistance among patients who previously reported to selected clinics for STI symptoms between December 2012 and June 2020. Samples were screened for MG and mutations associated with azithromycin resistance were investigated using Nucleic Acid Amplification Testing (NAAT) including the Resistance Plus MG® kit from SpeeDx and the LightMix® kit for MG, combined with the Modular Mycoplasma Macrolide from TIB Molbiol. RESULTS: A total of 1,015 samples were screened, out of which MG infection rate by TIB Molbiol and SpeeDx were 3.1% and 3.4%, respectively. The mutation responsible for macrolide resistance was detected in one MG positive sample by both assays. Both diagnostic tests revealed no significant association between MG infection and socio-demographic characteristics, clinical symptoms, gonorrhea, and chlamydia infection status. There was no significant difference in the mycoplasma percentage positivity rate detected using SpeeDx (3.4%) and TIB Molbiol (3.1%). CONCLUSIONS: While not commonly tested as a cause of STI symptoms, MG is widespread in Ghana, exhibiting symptoms and prevalence comparable to those in other countries and linked to antimicrobial resistance. Future research using various molecular techniques is essential to monitor resistance trends and guide future antibiotic choices.
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Antibacterianos , Farmacorresistencia Bacteriana , Macrólidos , Infecciones por Mycoplasma , Mycoplasma genitalium , Mycoplasma genitalium/efectos de los fármacos , Mycoplasma genitalium/genética , Mycoplasma genitalium/aislamiento & purificación , Humanos , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/microbiología , Ghana/epidemiología , Femenino , Masculino , Adulto , Estudios Retrospectivos , Prevalencia , Macrólidos/farmacología , Macrólidos/uso terapéutico , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana/genética , Adulto Joven , Adolescente , Persona de Mediana Edad , Salud Sexual , Azitromicina/farmacología , Azitromicina/uso terapéutico , Mutación , Pruebas de Sensibilidad MicrobianaRESUMEN
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.
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Antibacterianos , Azitromicina , Chancroide , Genotipo , Haemophilus ducreyi , Humanos , Haemophilus ducreyi/genética , Haemophilus ducreyi/aislamiento & purificación , Haemophilus ducreyi/efectos de los fármacos , Azitromicina/uso terapéutico , Papúa Nueva Guinea/epidemiología , Femenino , Masculino , Niño , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Adolescente , Chancroide/microbiología , Chancroide/epidemiología , Chancroide/tratamiento farmacológico , Adulto , Preescolar , Adulto Joven , ARN Ribosómico 16S/genética , Buba/microbiología , Buba/epidemiología , Buba/tratamiento farmacológico , Persona de Mediana Edad , Análisis de Secuencia de ADN , ADN Bacteriano/genética , Proyectos Piloto , FilogeniaRESUMEN
Amidst the COVID-19 pandemic, hydroxychloroquine (HCQ) was widely administered despite limited data on its safety and efficacy. This study assesses the acute and chronic impacts of HCQ on electrocardiography (ECG) parameters alongside the effects of azithromycin and levofloxacin coadministration in patients with COVID-19. A comprehensive analysis was conducted on 109 COVID-19 patients receiving HCQ, with or without Azithromycin and/or Levofloxacin, and 51 long-term HCQ-treated Sjogren's syndrome (SS) patients. ECG parameters, including QTc interval, were meticulously evaluated against a control group of 109 COVID-19 patients without HCQ treatment. HCQ monotherapy, in combination with Levofloxacin, significantly prolonged the QTc interval in COVID-19 patients compared to controls. Notably, the combination of HCQ and Azithromycin demonstrated a mitigated impact on QTc prolongation. Long-term HCQ use in SS patients did not significantly affect QTc intervals, illustrating a distinct safety profile from short-term use in COVID-19 treatment. HCQ's impact on QTc prolongation is influenced by therapeutic context, coadministered drugs, and patient demographics. The findings underscore the necessity of cautious HCQ use, particularly in acute settings like COVID-19, where monitoring and consideration of drug interactions and patient-specific factors are critical.
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Azitromicina , Tratamiento Farmacológico de COVID-19 , Electrocardiografía , Hidroxicloroquina , Síndrome de QT Prolongado , Humanos , Hidroxicloroquina/efectos adversos , Hidroxicloroquina/uso terapéutico , Hidroxicloroquina/administración & dosificación , Electrocardiografía/efectos de los fármacos , Femenino , Masculino , Persona de Mediana Edad , Azitromicina/uso terapéutico , Azitromicina/efectos adversos , Azitromicina/administración & dosificación , Síndrome de QT Prolongado/inducido químicamente , Anciano , Síndrome de Sjögren/tratamiento farmacológico , Quimioterapia Combinada , Levofloxacino/uso terapéutico , Levofloxacino/administración & dosificación , Levofloxacino/efectos adversos , Adulto , SARS-CoV-2 , COVID-19Asunto(s)
Antibacterianos , Asma , Azitromicina , Humanos , Azitromicina/uso terapéutico , Azitromicina/economía , Azitromicina/administración & dosificación , Asma/tratamiento farmacológico , Antibacterianos/uso terapéutico , Antibacterianos/economía , Inducción de Remisión , Análisis Costo-BeneficioRESUMEN
The present investigation aimed to quantitatively assess the level of parasitemia in dogs using qPCR.The dogs selected for this study were infected with the haemoprotozoan parasite Babesia gibsoni. In the study, dogs diagnosed with babesiosis were divided into two groups (n = 12) and subjected to distinct treatment strategies. The first group received clindamycin-metronidazole-doxycycline (CMD) therapy, while the second group was treated with a combination of buparvaquone-azithromycin (BPV-AZM). The level of parasitemia in the infected dogs was determined using an absolute quantification-based qPCR method. This assessment was conducted both prior to initiating the treatment and on the 10th day following the commencement of the treatment protocols. On the tenth day after the initiation of treatment, the CMD group exhibited a lower level of parasitemia in comparison to the BPV-AZM group. In the CMD treated groups, the mean parasitemia decreased from 4.9E + 06 to 3.4E + 06, indicating a reduction in parasitic load. Conversely, in the BPV-AZM treatment groups, the mean parasitemia increased from 1.62E + 06 to 2.87E + 06, suggesting an increase in parasitic load. On the 10th day, the CMD-treated group demonstrated a statistically significant decline in the level of parasitemia, with a P-value of ≤0.001. This indicates a strong and significant reduction in parasitic load following the CMD treatment. Therefore, the absolute quantification-based qPCR method could effectively assess the initial treatment response by measuring the level of parasitemia.
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Babesia , Babesiosis , Clindamicina , Enfermedades de los Perros , Carga de Parásitos , Parasitemia , Reacción en Cadena en Tiempo Real de la Polimerasa , Animales , Perros , Enfermedades de los Perros/parasitología , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/tratamiento farmacológico , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Babesia/genética , Babesia/aislamiento & purificación , Parasitemia/parasitología , Parasitemia/veterinaria , Babesiosis/parasitología , Babesiosis/diagnóstico , Clindamicina/uso terapéutico , Carga de Parásitos/métodos , Doxiciclina/uso terapéutico , Azitromicina/uso terapéutico , Metronidazol/uso terapéutico , Antiprotozoarios/uso terapéutico , NaftoquinonasRESUMEN
The COVID-19 pandemic response has been hindered by the absence of an efficient antiviral therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The reason why the previous preventative approach to COVID-19 solely through vaccines has failed could be a lack of understanding of how quickly the SARS-CoV-2 virus evolves. Given the absence of specific treatments for the virus, efforts have been underway to explore treatment options. Drug repurposing involves identifying new therapeutic uses for approved drugs, proving to be a time-saving strategy with minimal risk of failure. In this study, we report the successful use of a multidrug approach in patients with COVID-19. Successful administration of multidrug therapy, such as combinations of hydroxychloroquine and azithromycin, doxycycline and ivermectin, or ivermectin, doxycycline, and azithromycin, has been reported. Multidrug therapy is effective because of the differing mechanisms of action of these drugs, and it may also mitigate the emergence of drug-resistant SARS-CoV-2 strains. The medicines were lopinavir/ritonavir (Kaletra), bamlanivimab (monoclonal antibody), glycopyrrolate-formoterol (Bevespi), ciclesonide (Alvesco), famotidine (Pepcid), and diphenhydramine (Benadryl).
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Antivirales , Azitromicina , Tratamiento Farmacológico de COVID-19 , COVID-19 , Reposicionamiento de Medicamentos , Hidroxicloroquina , Ivermectina , Lopinavir , Ritonavir , SARS-CoV-2 , Humanos , Antivirales/uso terapéutico , SARS-CoV-2/efectos de los fármacos , Hidroxicloroquina/uso terapéutico , Ivermectina/uso terapéutico , Ritonavir/uso terapéutico , Azitromicina/uso terapéutico , Lopinavir/uso terapéutico , Masculino , Quimioterapia Combinada , Doxiciclina/uso terapéutico , Combinación de Medicamentos , Persona de Mediana Edad , Femenino , Anticuerpos Monoclonales Humanizados/uso terapéutico , Resultado del Tratamiento , Anciano , Pregnenodionas/uso terapéuticoRESUMEN
In contrast to the epidemiology 10 years earlier at our hospital when the epidemic restriction endonuclease analysis (REA) group strain BI accounted for 72% of Clostridioides difficile isolates recovered from first-episode C. difficile infection (CDI) cases, BI represented 19% of first-episode CDI isolates in 2013-2015. Two additional REA group strains accounted for 31% of isolates (Y, 16%; DH, 12%). High-level resistance to fluoroquinolones and azithromycin was more common among BI isolates than among DH, Y, and non-BI/DH/Y isolates. Multivariable analysis revealed that BI cases were 2.47 times more likely to be associated with fluoroquinolone exposure compared to non-BI cases (95% confidence interval [CI]: 1.12-5.46). In addition, the odds of developing a CDI after third- or fourth-generation cephalosporin exposure was 2.83 times for DH cases than for non-DH cases (95% CI: 1.06-7.54). Fluoroquinolone use in the hospital decreased from 2005 to 2015 from a peak of 113 to a low of 56 antimicrobial days/1,000 patient days. In contrast, cephalosporin use increased from 42 to 81 antimicrobial days/1,000 patient days. These changes correlated with a decrease in geometric mean MIC for ciprofloxacin (61.03 to 42.65 mg/L, P = 0.02) and an increase in geometric mean MIC for ceftriaxone (40.87 to 86.14 mg/L, P < 0.01) among BI isolates. The BI strain remained resistant to fluoroquinolones, but an overall decrease in fluoroquinolone use and increase in cephalosporin use were associated with a decrease in the prevalence of BI, an increased diversity of C. difficile strain types, and the emergence of strains DH and Y.
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Antibacterianos , Clostridioides difficile , Infecciones por Clostridium , Fluoroquinolonas , Pruebas de Sensibilidad Microbiana , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/aislamiento & purificación , Humanos , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/tratamiento farmacológico , Fluoroquinolonas/farmacología , Fluoroquinolonas/uso terapéutico , Masculino , Femenino , Anciano , Prevalencia , Persona de Mediana Edad , Prohibitinas , Hospitales , Brotes de Enfermedades , Azitromicina/uso terapéutico , Azitromicina/farmacología , Infección Hospitalaria/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/tratamiento farmacológico , Anciano de 80 o más Años , Cefalosporinas/uso terapéutico , Cefalosporinas/farmacologíaRESUMEN
BACKGROUND: Sepsis is a syndrome that occurs following an infection and marked by severe inflammatory responses, and if not treated in time, it can lead to multi-organ failure syndrome and death. This study examines the effects of a novel combination therapy using azithromycin and mesenchymal stem cell-derived extracellular vesicles (EVs) on a cecal ligation and puncture (CLP) model of sepsis. METHODS: Human Wharton's jelly-mesenchymal stem cells were cultured, characterized, and used to extract EVs. The CLP sepsis model was induced in mice, followed by treatments: saline, AZM, EVs, and combination therapy (A+E). Clinical sepsis scores were recorded 24 h post-treatment. Serum, peritoneal fluid, and organ tissues (kidney, liver, lung) were collected and analyzed for biochemical parameters (AST ALT, and creatinine), inflammatory markers, bacterial load, and histopathological changes. RESULTS: The A+E combined treatment improved the clinical scores of septic mice. The administration of A+E reduced bacterial loads in the peritoneum of septic mice, contributing to effective control of infection. Inflammatory markers of neutrophils-to-lymphocytes ratio (NLR) and TNF-α serum levels were significantly lower in the combinational therapy group, indicating significant anti-inflammatory effect of this combination. Additionally, combination of AZM and EVs alleviated organ damage mainly within liver, kidneys and lungs. Based on histopathological assessments and biochemical parameters, there was diminished tissue damage as well as reduced inflammation, which is correlated with improved functions of these vital organs. CONCLUSION: The combined use of azithromycin and EVs offers a promising therapeutic approach for sepsis by effectively controlling infection and modulating the inflammatory response.
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Azitromicina , Modelos Animales de Enfermedad , Vesículas Extracelulares , Células Madre Mesenquimatosas , Sepsis , Animales , Azitromicina/uso terapéutico , Azitromicina/farmacología , Sepsis/tratamiento farmacológico , Sepsis/terapia , Humanos , Ratones , Masculino , Antibacterianos/uso terapéutico , Ciego/cirugía , Ligadura , Trasplante de Células Madre Mesenquimatosas , Células CultivadasRESUMEN
Single-dose azithromycin is being considered by the WHO as an intervention for prevention of child mortality. However, concerns have emerged related to longer term unintended consequences of early life antibiotic use, particularly among infants. We conducted a long-term follow-up in a random sample of children who had been enrolled in a trial of neonatal azithromycin versus placebo for prevention of mortality to assess whether neonatal azithromycin exposure led to differences in child growth up to 4 years of age. We found no evidence of a difference in any anthropometric outcome among children who had received a single oral dose of azithromycin compared with placebo during the neonatal period. These results do not support long-term growth-promoting or deleterious effects of early life azithromycin exposure.
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Antibacterianos , Azitromicina , Humanos , Azitromicina/uso terapéutico , Azitromicina/administración & dosificación , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antibacterianos/efectos adversos , Recién Nacido , Femenino , Lactante , Estudios de Seguimiento , Preescolar , Masculino , Desarrollo Infantil/efectos de los fármacos , Mortalidad del NiñoRESUMEN
BACKGROUND AND OBJECTIVES: There were 82.4 million new gonorrhoea cases worldwide in 2020. Dual treatment with ceftriaxone or cefixime and azithromycin or doxycycline is currently recommended for gonorrhoea in Indonesia. However, reduced susceptibility and resistance to cephalosporins and azithromycin are increasing. We evaluated the susceptibility pattern of Neisseria gonorrhoeae to cefixime, ceftriaxone, azithromycin and doxycycline. METHOD: N. gonorrhoeae isolates were obtained from 19 male participants with clinically and laboratory-confirmed gonorrhoea. Antibiotic susceptibility testing was conducted by disc diffusion and interpreted according to Clinical and Laboratory Standards Institute and Centers for Disease Control and Prevention criteria. RESULTS: Reduced susceptibility or resistance was observed against doxycycline in 19 isolates (100%), cefixime in six (31.6%), ceftriaxone in three (15.8%) and azithromycin in zero (0%) isolates. DISCUSSION: A dual treatment regimen with ceftriaxone and azithromycin can still be recommended as first-line therapy for gonorrhoea in Indonesia. Antibiotic susceptibility surveillance of N. gonorrhoeae should be routinely conducted.
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Antibacterianos , Azitromicina , Ceftriaxona , Doxiciclina , Gonorrea , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae , Humanos , Indonesia , Neisseria gonorrhoeae/efectos de los fármacos , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Gonorrea/tratamiento farmacológico , Masculino , Pruebas de Sensibilidad Microbiana/métodos , Azitromicina/uso terapéutico , Doxiciclina/uso terapéutico , Ceftriaxona/uso terapéutico , Ceftriaxona/farmacología , Adulto , Cefixima/uso terapéutico , Cefixima/farmacología , Atención Primaria de Salud/estadística & datos numéricos , Farmacorresistencia Bacteriana/efectos de los fármacos , Quimioterapia Combinada/métodosRESUMEN
This is a protocol for PPROM-AZM Study, phase II, nonblinded, randomized controlled trial. Bronchopulmonary dysplasia (BPD) at a postmenstrual age of 36 weeks (BPD36) is often observed in infants with preterm premature rupture of the membranes (pPROM). A regimen of ampicillin (ABPC) intravenous infusion for 2 days and subsequent amoxicillin (AMPC) oral administration for 5 days plus erythromycin (EM) intravenous infusion for 2 days followed by EM oral administration for 5 days is standard treatment for pPROM. However, the effect on the prevention of moderate/severe BPD36 using the standard treatment has not been confirmed. Recently, it is reported that ampicillin/sulbactam (ABPC/SBT) plus azithromycin (AZM) was effective for the prevention of moderate/severe BPD36 in pPROM patients with amniotic infection of Ureaplasma species. Therefore, our aim is to evaluate the occurrence rate of the composite outcome of "incidence rate of either moderate/severe BPD36 or intrauterine fetal death, and infantile death at or less than 36 weeks 0 days" comparing subjects to receive ABPC/SBT for 14 days plus AZM for 14 days (intervention group) and those to receive ABPC/SBT for 14 days plus EM for 14 days (control group), in a total of 100 subjects (women with pPROM occurring at 22-27 weeks of gestation) in Japan. The recruit of subjects was started on April 2022, and collection in on-going. We also investigate the association between the detection of Ureaplasma species and occurrence of BPD36. In addition, information on any adverse events for the mother and fetus and serious adverse events for infants are collected during the observation period. We allocate patients at a rate of 1:1 considering two stratification factors: onset of pPROM (22-23 or 24-27 weeks) and presence/absence of a hospital policy for early neonatal administration of caffeine. Trial registration: The trial number in the Japan Registry of Clinical Trials is jRCTs031210631.
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Ampicilina , Antibacterianos , Azitromicina , Displasia Broncopulmonar , Eritromicina , Rotura Prematura de Membranas Fetales , Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Amoxicilina/uso terapéutico , Amoxicilina/administración & dosificación , Ampicilina/administración & dosificación , Ampicilina/uso terapéutico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Azitromicina/administración & dosificación , Azitromicina/uso terapéutico , Displasia Broncopulmonar/prevención & control , Displasia Broncopulmonar/tratamiento farmacológico , Quimioterapia Combinada , Eritromicina/uso terapéutico , Eritromicina/administración & dosificación , Rotura Prematura de Membranas Fetales/tratamiento farmacológico , Edad Gestacional , Japón/epidemiología , Sulbactam/administración & dosificación , Sulbactam/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como Asunto , Ensayos Clínicos Fase II como AsuntoRESUMEN
PURPOSE: In the early stages of the COVID-19 pandemic, preliminary results that later proved to be incorrect suggested the possible efficacy of anti-infective drugs such as azithromycin for the treatment of SARS-CoV-2 infection. These preliminary data may have influenced the prescription of azithromycin. However, no individual-level data linking the use of this antibiotic to acute SARS-CoV-2 infection are available. The present analysis aims to fill this gap. METHODS: A retrospective population-based cohort design was used including patients diagnosed with SARS-CoV-2 infection in the period ranging from February 2020 to February 2022. The data source for antibiotic consumption was the drug database of outpatient prescriptions of Emilia-Romagna Region (Italy). Antibiotics were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. Consumption rates and percentages of azithromycin DDDs (defined daily doses) during the acute phase of the infection were compared with a previous control period and with the post-acute phase. Analyses were stratified by four groups according to the prevalent virus variant at time of diagnosis. RESULTS: Comparing the previous control period with the acute phase of infections, the rates of azithromycin consumption (DDD per 1000 individuals per day) increased from 1.17 to 23.11, from 0.80 to 33.03, from 0.81 to 21.01, and from 1.02 to 9.76, in the pre-Alpha, Alpha, Delta, and Omicron periods, respectively. Similarly, the percentages of individuals receiving azithromycin, and the azithromycin DDDs percentages over total systemic antibiotics DDDs increased in acute phases of infection compared with control periods. The consumption rates and percentages returned to preinfection levels in the post-acute phase. In the study period, 12.9% of the use of azithromycin in the entire adult population of Emilia-Romagna was attributable to acute SARS-CoV-2 infection. CONCLUSIONS: Considering the low likelihood of bacterial coinfections, the increased azithromycin consumption in the acute phase of SARS-CoV-2 infection suggests inappropriate prescribing of this antibiotic.
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Antibacterianos , Azitromicina , Tratamiento Farmacológico de COVID-19 , COVID-19 , Azitromicina/uso terapéutico , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Italia/epidemiología , Anciano , Adulto , COVID-19/epidemiología , SARS-CoV-2 , Adulto Joven , Anciano de 80 o más Años , Adolescente , Enfermedad Aguda , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios de CohortesRESUMEN
Since 2022, Europe has had 4 cases of extensively drug-resistant Neisseria gonorrhoeae, sequence type 16406, that is resistant to ceftriaxone and highly resistant to azithromycin. We report 2 new cases from France in 2023 involving strains genetically related to the 4 cases from Europe as well as isolates from Cambodia.
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Antibacterianos , Farmacorresistencia Bacteriana Múltiple , Gonorrea , Neisseria gonorrhoeae , Adulto , Femenino , Humanos , Masculino , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Azitromicina/farmacología , Azitromicina/uso terapéutico , Ceftriaxona/farmacología , Ceftriaxona/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/genética , Francia/epidemiología , Gonorrea/tratamiento farmacológico , Gonorrea/microbiología , Gonorrea/epidemiología , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae/efectos de los fármacos , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/aislamiento & purificaciónRESUMEN
BACKGROUND: Chronic lung disease (CLD) is common among children with HIV (CWH) including in those taking antiretroviral therapy (ART). Azithromycin has both antimicrobial and anti-inflammatory effects and has been effective in improving lung function in a variety of lung diseases. We investigated lung function trajectories among CWH with CLD on ART enrolled in a randomized controlled trial of adjuvant azithromycin. We also investigated factors that modified the effect of azithromycin on lung function. METHODS: The study used data from a double-blinded placebo-controlled trial conducted in Malawi and Zimbabwe of 48 weeks on azithromycin (BREATHE: ClinicalTrials.gov NCT02426112) among CWH aged 6 to 19 years taking ART for at least six months who had a forced expiratory volume in one second (FEV1) z-score <-1.0. Participants had a further follow-up period of 24 weeks after intervention cessation. FEV1, forced vital capacity (FVC) and FEV1/FVC were measured at baseline, 24, 48 and 72-weeks and z-scores values calculated. Generalized estimating equations (GEE) models were used to determine the mean effect of azithromycin on lung-function z-scores at each follow-up time point. RESULTS: Overall, 347 adolescents (51% male, median age 15 years) were randomized to azithromycin or placebo. The median duration on ART was 6.2 (interquartile range: 3.8-8.6) years and 56.2% had an HIV viral load < 1000copies/ml at baseline. At baseline, the mean FEV1 z-score was - 2.0 (0.7) with 44.7% (n = 155) having an FEV1 z-score <-2, and 10.1% had microbiological evidence of azithromycin resistance. In both trial arms, FEV1 and FVC z-scores improved by 24 weeks but appeared to decline thereafter. The adjusted overall mean difference in FEV1 z-score between the azithromycin and placebo arms was 0.004 [-0.08, 0.09] suggesting no azithromycin effect and this was similar for other lung function parameters. There was no evidence of interaction between azithromycin effect and baseline age, lung function, azithromycin resistance or HIV viral load. CONCLUSION: There was no observed azithromycin effect on lung function z-scores at any time point suggesting no therapeutic effect on lung function. TRIAL REGISTRATION: ClinicalTrials.gov NCT02426112. First registered on 24/04/2015.
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Azitromicina , Infecciones por VIH , Enfermedades Pulmonares , Humanos , Azitromicina/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/complicaciones , Masculino , Adolescente , Femenino , Niño , Método Doble Ciego , Volumen Espiratorio Forzado/efectos de los fármacos , Enfermedad Crónica , Capacidad Vital , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/fisiopatología , Antibacterianos/uso terapéutico , Adulto Joven , Malaui , Pulmón/fisiopatología , Pulmón/efectos de los fármacos , Zimbabwe , Pruebas de Función Respiratoria , Estudios LongitudinalesRESUMEN
BACKGROUND: Macrolide antibiotics, including azithromycin, can reduce under 5 years of age mortality rates and treat various infections in children in sub-Saharan Africa. These exposures, however, can select for antibiotic-resistant bacteria in the gut microbiota. METHODS: Our previous randomized controlled trial (RCT) of a rapid-test-and-treat strategy for severe acute diarrheal disease in children in Botswana included an intervention (3-day azithromycin dose) group and a control group that received supportive treatment. In this prospective matched cohort study using stools collected at baseline and 60 days after treatment from RCT participants, the collection of antibiotic resistance genes or resistome was compared between groups. RESULTS: Certain macrolide resistance genes increased in prevalence by 13%-55% at 60 days, without differences in gene presence between the intervention and control groups. These genes were linked to tetracycline resistance genes and mobile genetic elements. CONCLUSIONS: Azithromycin treatment for bacterial diarrhea for young children in Botswana resulted in similar effects on the gut resistome as the supportive treatment and did not provide additional selective pressure for macrolide resistance gene maintenance. The gut microbiota of these children contains diverse macrolide resistance genes that may be transferred within the gut upon repeated exposures to azithromycin or coselected by other antibiotics. CLINICAL TRIALS REGISTRATION: NCT02803827.
Asunto(s)
Antibacterianos , Azitromicina , Diarrea , Microbioma Gastrointestinal , Humanos , Azitromicina/uso terapéutico , Azitromicina/administración & dosificación , Botswana , Diarrea/microbiología , Diarrea/tratamiento farmacológico , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Preescolar , Lactante , Estudios Prospectivos , Femenino , Masculino , Microbioma Gastrointestinal/efectos de los fármacos , Microbioma Gastrointestinal/genética , Farmacorresistencia Bacteriana/genética , Heces/microbiología , Bacterias/efectos de los fármacos , Bacterias/genética , Bacterias/clasificación , Bacterias/aislamiento & purificaciónAsunto(s)
Atovacuona , Azitromicina , Babesiosis , Humanos , Atovacuona/uso terapéutico , Atovacuona/efectos adversos , Babesiosis/tratamiento farmacológico , Azitromicina/uso terapéutico , Azitromicina/efectos adversos , Azitromicina/administración & dosificación , Fluorenos/uso terapéutico , Fluorenos/efectos adversos , Fluorenos/administración & dosificación , Quimioterapia Combinada , Antibacterianos/uso terapéutico , Antibacterianos/efectos adversos , Antibacterianos/administración & dosificación , Resultado del Tratamiento , Hospitalización , AminoquinolinasRESUMEN
Objective: This study aims to examine the frequency of Salmonella Paratyphi found in blood cultures and evaluate the antibiotic susceptibility pattern of Salmonella isolates to different antibiotics. Additionally, the study aims to assess the paradigm shift in the trend of enteric fever caused by Salmonella Typhi (S. Typhi) to Salmonella Paratyphi(S. Paratyphi) . Study Design: Retrospective study. Participant: The study enrolled patients aged 12 years and above diagnosed with enteric fever (positive blood culture) and admitted to Peelamedu Samanaidu Govindasamy Naidu (PSG) Hospital. Interventions: The study analyzed demographic and antibiotic susceptibility profiles of Salmonella isolates collected from 106 enteric fever patients in the hospital between 2010 and 2022. The susceptibility profiles of Salmonella isolates to multiple antibiotics were assessed. Results: There were 106 participants, and 95 (89.62%) of them had enteric fever linked to Salmonella Typhi, while only 11 (10.38%) had enteric fever linked to Salmonella Paratyphi A. From 2010 to 2022, the study discovered a general decline in the prevalence of enteric fever caused by Salmonella species. But between 2014 and 2022, the incidence of enteric fever linked to S. Typhi rapidly increased. Azithromycin (100% , n = 106) and ceftriaxone (99% , n = 105) were highly effective against the Salmonella isolates, whereas nalidixic acid was resisted by 3 isolates (4.72%, n = 3). Conclusion: The study observed a higher incidence of Salmonella Typhi in comparison to Paratyphi A and a greater susceptibility of males to enteric fever. Funding: None declared.
Asunto(s)
Antibacterianos , Pruebas de Sensibilidad Microbiana , Salmonella paratyphi A , Salmonella typhi , Fiebre Tifoidea , Humanos , Masculino , Femenino , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Fiebre Tifoidea/epidemiología , Fiebre Tifoidea/microbiología , Fiebre Tifoidea/tratamiento farmacológico , Estudios Retrospectivos , Salmonella typhi/efectos de los fármacos , Salmonella typhi/aislamiento & purificación , Salmonella paratyphi A/efectos de los fármacos , Salmonella paratyphi A/aislamiento & purificación , Adulto , Adolescente , Niño , Persona de Mediana Edad , Adulto Joven , Fiebre Paratifoidea/epidemiología , Fiebre Paratifoidea/microbiología , Fiebre Paratifoidea/tratamiento farmacológico , Incidencia , Farmacorresistencia Bacteriana , Azitromicina/uso terapéutico , Azitromicina/farmacología , Ceftriaxona/uso terapéutico , Ceftriaxona/farmacología , Anciano , PrevalenciaAsunto(s)
Antibacterianos , Azitromicina , Farmacorresistencia Bacteriana , Macrólidos , Sífilis , Treponema pallidum , Humanos , Antibacterianos/farmacología , Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana/genética , Macrólidos/farmacología , Macrólidos/uso terapéutico , América del Norte , Sífilis/tratamiento farmacológico , Sífilis/genética , Sífilis/microbiología , Treponema pallidum/efectos de los fármacos , Treponema pallidum/genética , Treponema pallidum/aislamiento & purificación , Azitromicina/farmacología , Azitromicina/uso terapéutico , Estados Unidos , Canadá , Penicilina G Benzatina/farmacología , Penicilina G Benzatina/provisión & distribución , Penicilina G Benzatina/uso terapéutico , Doxiciclina/farmacología , Doxiciclina/provisión & distribución , Doxiciclina/uso terapéuticoRESUMEN
BACKGROUND: An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy. METHODS: This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42023452139). A PRISMA-compliant systematic review and meta-analysis was performed. Six English and four Chinese databases were comprehensively searched up to June, 2023. RCTs of azithromycin sequential therapy plus inhaled terbutaline were selected. The revised Cochrane risk of bias tool for randomized trials (RoB2) was used to evaluate the methodological quality of all studies, and meta-analysis was performed using Stata 15.0 with planned subgroup and sensitivity analyses. Publication bias was evaluated by a funnel plot and the Harbord' test. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. RESULTS: A total of 1,938 pediatric patients from 20 RCTs were eventually included. The results of meta-analysis showed that combined therapy was able to significantly increase total effectiveness rate (RR = 1.20, 95%CI 1.15 to 1.25), forced expiratory volume in one second (SMD = 1.14, 95%CIs, 0.98 to 1.29), the ratio of forced expiratory volume in one second/forced vital capacity (SMD = 2.16, 95%CIs, 1.46 to 2.86), peak expiratory flow (SMD = 1.17, 95%CIs, 0.91 to 1.43). The combined therapy was associated with a 23% increased risk of adverse reactions compared to azithromycin therapy alone, but no significant differences were found. Harbord regression showed no publication bias (Pâ = 0.148). The overall quality of the evidence ranged from moderate to very low. CONCLUSIONS: This first systematic review and meta-analysis suggested that azithromycin sequential therapy plus inhaled terbutaline was safe and beneficial for children with MPP. In addition, the combined therapy represented significant improvement of PVF. Due to lack of high-quality evidence, our results should be confirmed by adequately powered RCTs in the future.