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Skip to main content. M T DeSancho, K. Mucormycosis is an opportunistic mycotic infection belonging to the order Mucorales and class Zygomycetes. It occurs in patients with diabetes mellitus, chronic renal failure, hematological disorders and in patients on receiving deferoxamine therapy. We report a case of disseminated Mucormycosis in a patient with myelodysplasia and secondary iron overload treated with deferoxamine.

A year old male was diagnosed with myelodysplastic syndrome in after presenting with pancytopenia. He developed secondary iron overload due to multiple blood transfusions and deferoxamine was added.

On June 97, a bone marrow aspirate and biopsy showed progression to Refractory Anemia with Excess of Blasts in Transformation. He received chemotherapy with partial remission.

In December 97, he was admitted to the hospital with fever, headache, and malaise. Computed tomography CT of the brain was normal. Lumbar puncture showed leukocytosis and increased protein. Broad spectrum antibiotics were given for presumptive bacterial meningitis, but fever persisted. Blood, urine and cerebrospinal fluid cultures were negative. Transthoracic echocardiogram was normal.

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On day 9 after admission, he became disoriented. Neurological examination demonstrated right gaze preference. He developed tachypnea, requiring mechanical ventilation, and was transferred to the intensive care unit. Many molds also synthesise mycotoxins and siderophores which, together with lytic enzymes, inhibit the growth of competing microorganisms. Molds can also grow on stored food for animals and humans, making the food unpalatable or toxic and are thus a major source of food losses and illness.

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  • in the Sofitel Reef Casino Cairns. Coat Check/Bag Store The filamentous fungus Aspergillus nidulans in particular has been used to investigate the regulation of development, cell cycle .. AVR3a from bacterial typeIII and typeII secretion systems was used to demonstrate recognition of AVR3a in the host cell cytoplasm.
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  • The fungus was identified as Aspergillus terreus by sequencing the PCR- amplified ITS fragments of its rRNA-coding genes and by its morphology. The gentamicin removal efficiency exceeded 95% by day 7 under optimized culture conditions. The results showed that both biosorption and biodegradation were involved.
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Molds reproduce by producing large numbers of small spores[6] which may contain a single nucleus or be multinucleate. Mold spores can be asexual the products of mitosis or sexual the products of meiosis ; many species can produce both types.

Some molds produce small, hydrophobic spores that are adapted for wind dispersal and may remain airborne for long periods; in some the cell walls are darkly pigmented, providing resistance to damage by ultraviolet radiation. Other mold spores have slimy sheaths and are more suited to water dispersal. Mold spores are often spherical or ovoid single cells, but can be multicellular and variously shaped.

Spores may cling to clothing or fur; some are able to survive extremes of temperature and pressure.

Although molds can grow on dead organic matter everywhere in nature, their presence is visible to the unaided eye only when they form large colonies. A mold colony does not consist of discrete organisms but is an interconnected network of hyphae called a mycelium.

All growth occurs at hyphal tips, with cytoplasm and organelles flowing forwards as the hyphae advance over or through new food sources. Nutrients are absorbed at the hyphal tip. In artificial environments such as buildings, humidity and temperature are often stable Casino siderophores aspergillus terreus antibiotic to foster the growth of mold colonies, commonly seen as a downy or furry coating growing on food or other surfaces.

When conditions do not enable growth to take place, molds may remain alive in a dormant state depending on the species, within a large range of temperatures. The many different mold species vary enormously in their tolerance to temperature and humidity extremes. Certain molds can survive harsh conditions such as the snow-covered soils of Antarctica, refrigeration, highly acidic solvents, anti-bacterial soap and even petroleum products such as jet fuel. Xerophilic molds are able to grow in relatively Nye casino siderosis mri safety, salty, or sugary environments, where water activity a w is less than 0.

They are used to ferment a soybean and wheat mixture to make soybean paste and soy sauce. Koji molds break down the starch in rice, barley, sweet potatoes, etc. Koji molds are also used in the preparation of Katsuobushi. Red rice yeast is a product of the mold Monascus purpureus grown on rice, and is common in Asian diets.

The yeast contains several compounds collectively known as monacolinswhich are known to inhibit cholesterol synthesis. Some sausagessuch as salamiincorporate starter cultures of molds [12] to improve flavour and reduce bacterial spoilage during curing. Penicillium nalgiovensefor example, may appear as a powdery white coating on some varieties of dry-cured sausage.

Alexander Fleming 's accidental discovery of the antibiotic penicillin involved a Penicillium mold called Penicillium notatum although the species identity is disputed as possibly being Penicillium chrysogenum or Penicillium rubens. This team was also unable to produce the pure compound in any large amount, and found that the purification process diminished its effectiveness and negated the anti-bacterial properties it had.

They managed to purify the solution, increasing its concentration by times, but found that a higher concentration was possible. Experiments were conducted and the results published inthough the quantities of Penicillin produced were not always high enough for the treatments required.

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Several statin cholesterol-lowering drugs such as lovastatinfrom Aspergillus terreus are derived from molds. The immunosuppressant drug cyclosporineused to suppress the rejection of transplanted organs, is derived from the mold Tolypocladium inflatum. Molds are ubiquitous, and mold spores are a common component of household and workplace dust; however, when mold spores are present in large quantities, they can present a health hazard to humans, potentially causing allergic reactions and respiratory problems.

Some molds also produce mycotoxins that can pose serious health risks to humans and animals. Some studies claim that exposure to high levels of mycotoxins can lead to neurological problems and in some cases, death.

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Unisexual reproduction drives meiotic recombination and phenotypic and karyotypic plasticity in Cryptococcus neoformans. Already in the s and s, first investigations of radiolabelled siderophores, including desferrioxamine DFO , were already reported with gamma-emitting radionuclides— 67 Ga and In [ 35 , 36 , 37 , 38 ].

Research on the health impacts of mold has not been conclusive. Mold in the home can usually be found in damp, dark or steamy areas e. Symptoms caused by mold allergy are watery, itchy eyes, a chronic cough, headaches or migraines, difficulty breathing, rashes, tiredness, sinus problems, nasal blockage and frequent sneezing. Molds can also pose a hazard to human and animal health when they are consumed following the growth of certain mold species in stored food. Some species produce toxic secondary metabolites, collectively termed mycotoxins including aflatoxinsochratoxinsfumonisinstrichothecenescitrininand patulin.

These toxic properties may be used for the benefit of humans when the toxicity is directed against other organisms; for example, penicillin adversely affects the growth of Gram-positive bacteria e.

Clostridium speciescertain spirochetes and certain fungi. Mold growth in buildings can lead to a variety of health problems as microscopic airborne reproductive spores, analogous to tree pollen, are inhaled by building occupants. High quantities of indoor airborne spores as compared to exterior conditions are strongly suggestive of indoor mold growth. Conducive to scientific methodology air samples should be drawn from the affected area, a control area, and the exterior.

The air sampler pump draws in air and deposits microscopic airborne particles on a culture medium. The medium is cultured in a laboratory and the fungal genus and species are determined by visual microscopic observation.

Laboratory results also quantify fungal growth by way of a spore count for comparison among samples. The pump operation time was recorded and when multiplied by the operation time results in a specific volume of air obtained.

Although a small volume of air is actually analyzed, common laboratory reporting techniques extrapolate the spore count data to equate the amount of spores that would be present in a cubic meter of air. Various practices can be followed to mitigate mold issues in buildings, the most important of which is to reduce moisture levels that can facilitate mold growth.

A properly functioning AC Casino siderophores aspergillus terreus antibiotic also reduces the relative humidity, or the moisture inherent in the air. Eliminating the moisture source is the first step at fungal remediation. Removal of affected materials may also be necessary for remediation, if materials are easily replaceable and not part of the load-bearing structure. Professional drying of concealed wall cavities and enclosed spaces such as cabinet toekick spaces may be required.

Post-remediation verification of moisture content and fungal growth is required for successful remediation.

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  1. in the Sofitel Reef Casino Cairns. Coat Check/Bag This session welcomes attendees to a series of presentations on fungal pathogens in humans ranging from Aspergillus in high-risk particularly in pregnant women, diabetic mellitus and the patients using multiple antibiotics and contraceptive drugs, demonstrates .:
    A., Nyborg, J., Nissen, P. Crystal Structure of Phe-tRNA:EF-Tu:GTP analog complexed with the antibiotic kirromycin HOLD FOR RELEASE true Beckham, M.L., E.Y., Cane, D.E., Christianson, D.W. Aristolochene Synthase from Aspergillus terreus RELEASE NOW true Lee, D.S., Nioche, P., Raman, C.S. Crystal Structure. A., Nyborg, J., Nissen, P. Crystal Structure of Phe-tRNA:EF-Tu:GTP analog complexed with the antibiotic kirromycin HOLD FOR RELEASE true Lin, S.-C., Lin , E.Y., Cane, D.E., Christianson, D.W. Aristolochene Synthase from Aspergillus terreus RELEASE NOW true Lee, D.S., Nioche, P., Raman, C.S. Crystal Structure. Molecular hybridization might be said to have started with Joshua and Esther Lederberg, who studied bacterial conjugation in , followed by the discovery of the phage plasmid; the The natural enzyme supplement Beano™ contains the enzyme (a-galactosidase) from Aspergillus terreus used for digestive discomfort.
  2. are the recommended treatments for bacterial meningitis in an immunocompetent patient younger than 50 years of age and have no role . Amphotericin is not active against Aspergillus terreus or Aspergillus nidulans. Fluconazole is as a siderophore, directly delivering iron to the fungi. Acidosis also causes dissociation.:
    Further presentations will include data on the in-vitro activity of Basilea's investigational siderophore monosulfactam antibiotic BAL alone and in Molecular Epidemiology and Antifungal Susceptibility of Aspergillus terreus Species Complex: A 6-year Surveillance Study at a Tertiary Care Chest Hospital, Delhi, India. 10 Mar The most common ST bacterial pathogen is Chlamydia trachomatis Aspergillus niger, Penicillium purpurogenum), 10 mg/mL seed coad extract contribute to a better understanding of the signal transduction mechanisms within TCSs. (1) Casino et al. () Cell (2) Müller VS et al. ().
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If acute anxiety, Quinine, quinidine, and beta-blockers may interact with mefloquine to cause significant electrocardiographic abnormalities or cardiac arrest.

Halofantrine must not be administered with mefloquine within 3 weeks because of the potential for fatal QTc prolongation. Mefloquine may also alter ritonavir pharmacokinetics. Transmission is oral—fecal, and the primary manifestation is colitis, often heme positive. At the time of presentation with liver abscess, the primary gastrointestinal infection has usually cleared, and organisms cannot be identi- fied in the stool. Suggestive imaging with a positive serologic test result for E.

Treatment for amebic liver abscess is generally with metronidazole. Luminal infec- tion can be treated with paromomycin or iodoquinol. Campylobacter is a major cause of foodborne infectious diarrhea. Although usually self-limited, it may cause serious enteritis and inflammatory diarrhea but not liver abscess.

A thick and thin preparation of her peripheral blood is indicated to evaluate for trophozoites, and indeed they are found in this case.

Her neuro- logic findings suggest cerebral malaria, a defining feature of severe malaria. She is treated with intravenous quinidine.

Hypoglycemia is a frequent finding in severe malaria; is asso- ciated with a poor prognosis; and may be worsened by quinidine or quinine therapy, which promotes pancreatic insulin secretion.

Quinine causes fewer arrhythmias and hypoten- sion with infusion than quinidine, but it is often not available in U. Malaria itself causes hypoglycemia through failure of hepatic gluconeogenesis as well as increased glucose consumption by the host and parasite.

Nightmares are frequently found with mefloquine, and retinopathy is a complication of prolonged chloroquine dosing. The patient has infection with Plasmodium vivax, which is less likely than Plasmodium falciparum to be associated with severe disease. Artemether and artemotil are given intramuscularly and are not as effective as artesunate.

Although safer and more effective than quinine, artesunate is not available in the United States. In the United States, quinidine or quinine is used as a neces- sary choice. Intravenous quinine is as effective as and safer than IV quinidine. Quinine causes fewer arrhythmias and hypotension with infusion than quinidine, but it is often not available in U.

Chloroquine is only effective for Plasmodium vivax and in Plasmodium ovale and Plasmodium falciparum infection in certain pockets of the Middle East and Caribbean where resistance has not yet developed.

Mefloquine comes only as an oral formulation. It is most commonly used as a prophylactic agent but is also used for treatment of multidrug-resistant malaria. Thick smears take a longer time to process but increase sensitivity in the setting of low parasitemia. Thin smears are more likely to allow for precise morphologic evaluation to differentiate among the four different types of Plasmodium infection and to allow for prognostic calculation of parasitemia.

If clinical suspicion is high, repeat smears should be performed if the results are initially negative. If personnel are not available to rapidly interpret a smear, empiri- cal therapy should be strongly considered to ward off the most severe manifestation of Plasmodium falciparum infection.

Antibody-based diagnostic tests that are sensitive and specific for P. The results will remain positive for weeks after infection and do not allow quantification of parasitemia. Her flulike symp- toms and tick bite make this disease very likely. Patients generally present with these symptoms or occasionally neck stiffness, sore, throat abdominal pain, and weight loss.

Physical examination findings are typically normal with the exception of fever. The pres- ence of erythema chronicum migrans suggests concurrent Lyme disease because a rash is not a feature of babesiosis.

Although thick or thin preparation typically demonstrates the ring form of this protozoan, if these are negative, the 18S rRNA may be demonstrated by polymerase chain reaction. The ring forms are distinguished from Plasmodium fal- ciparum by the absence of central brownish deposit seen in malarial disease. Babesia duncani is typically found on the West Coast of the United States, and Babesia divergens have been reported sporadically in Washington state, Missouri, and Kentucky.

Therapy for severe Babesia microti disease in adults is clindamycin with additional quinine. Red blood cell exchange transfusion may be considered for B. The most commonly used technique for diagnosis of visceral leishmaniasis kala azar is a rapid immunochromatographic test for recombinant anti- gen rK39 from Leishmania infantum.

This is widely available, rapid, and safe, requiring only a fingerprick of blood with results available in approximately 15 minutes. Although splenic aspiration with demonstration of amastigotes in tissue smear is the gold standard for the diagnosis of visceral leishmaniasis and culture may increase the sensitivity, the test is invasive and may be dangerous in inexperienced hands. Polymerase chain reaction for the leishmaniasis nucleic acid is only available at specialized laboratories and is not routinely used clinically.

Leishmaniasis is not diagnosed via stool analysis. The infective form of T. Infection has also been transmitted from blood transfusion, organ transplant, and ingestion of contaminated food or drink.

Acute Chagas disease is typically a mild febrile illness followed by a chronic phase characterized by subpatent parasitemia, antibodies to T. Deer flies are the transmission vector of Loa loa filariasis.

Most acute cases occur in children, but the epidemiology is uncertain because most cases go undiagnosed. The heart is the organ most often involved in chronic Chagas disease with biventricular systolic dysfunction and conduction abnormalities [right bundle branch block and left anterior False-positive results may occur in patients with other para- sitic infections or autoimmune disease.

The World Health Organization recommends a positive test be confirmed with a separate assay. Polymerase chain reaction PCR to detect T.

Right heart catheterization with placement of a Swan-Ganz catheter could quantify left and right heart pressures and cardiac output. Constrictive pericarditis could also be evaluated, but this diagnosis is less likely with the presence of signs of left heart failure. Unfortunately, the only available drugs, benznidazole and nifurtimox, lack efficacy and have notable side effects. In acute Chagas disease, nifurtimox reduces the duration of symptoms and parasitemia and decreases the acute mortality Rate.

Benznidazole is at least as effective as nifurtimox and is generally the treatment of choice in Latin America. Some experts recommend that therapy be offered. In contrast, rand- omized studies have shown benefit of treatment in children. The current antifungal azoles, including voriconazole, do not have adequate efficacy against T. Serologic confirmation with T. Malaria is endemic to Honduras below m elevation, and primaquine is effective therapy in those cases. Thin and thick smears evaluated by experts should not confuse Plasmodium spp.

HAT remains a major public health problem in Africa despite its near-eradication in the s. Humans are the major reservoir of West African trypanosomiasis, and it occurs in rural areas, rarely affecting tourists. Antelope and cattle are the reservoirs for T. A primary lesion trypanosomal chancre typically appears 1 week after the bite of an infected tsetse fly.

This is followed by a systemic illness with fever and lymphadenopathy stage 1 disease. Central nervous system CNS involvement follows stage 2 disease with cerebrospinal fluid CSF pleocytosis, elevated protein, and elevated pressure.

During this stage, trypanosomes may be found in CSF. Symptoms during stage 2 disease include progressive somnolence and indifference sometimes alternating with insomnia and nighttime restlessness.

If untreated, symptoms progress to coma and death. Diagnosis requires demonstration of the protozoa from blood, CSF, lymph node material, bone marrow, or chancre fluid. There are serologic tests for T. There are not yet commercially available polymerase chain reaction tests. Melarsoprol is an arsenical that is highly toxic, with a risk of encephalopathy.

Cats are the definitive host for the sexual phase of Toxoplasma, and oocysts are shed in their feces. Although the central nervous system CNS is the most common site of symptomatic reactivation disease, the lymph nodes, lung, heart, eyes, and gastrointestinal tract may be involved. Toxoplasma usu- ally causes encephalitis, not meningitis; therefore, cerebrospinal fluid CSF findings may be unremarkable or have modest elevations of cell count and protein with normal glu- cose.

The treatment of choice for CNS toxoplasmosis is pyrimethamine plus sulfadiazine. Trimethoprim—sulfamethoxazole is an acceptable alternative. The differential diagnosis of encephalitis in patients with AIDS includes lymphoma, metastatic tumor, brain abscess, progressive multifocal leukoencephalopathy, fungal infection, and mycobacterial infection. In this case, given the classic MRI findings, toxoplasmosis is most likely. Fecal acid-fast testing may be used to diagnose Cryptosporidium, Isospora, and Cyclospora spp.

Microsporidia require special fecal stains or tissue biopsy for diagnosis. Many men are asymptomatic but may have symptoms of urethri- tis, epididymitis, or prostatitis. These symptoms do not distin- guish Trichomonas infection from other forms of vaginitis, such as bacterial vaginosis. Trichomoniasis is not a self-limited infection and should be treated for symptomatic and public health reasons.

Direct immunofluorescent antibody staining of secretions is more sensitive and can also be performed immediately. Culture is not widely available and takes 3 to 7 days. Treatment should consist of metronidazole either as a single 2-g dose or mg doses twice daily for 7 days; all sexual partners should be treated. Because a wide variety of pathogens are responsible for diarrheal illness, some degree of diagnostic testing beyond the history and physical exami- nation is required for definitive diagnosis.

Colonoscopy does not have a role in diagnosing Giardia infection. Giardiasis can persist in symptomatic patients and should be treated. Severe symptoms such as malabsorption, weight loss, growth retardation, and dehydra- tion may occur in prolonged cases.

Additionally, extraintestinal manifestations such as urticarial, anterior uveitis, and arthritis have been associated with potential giardiasis. Paromomycin, an oral poorly absorbed aminoglycoside, can be used for symptomatic patients during pregnancy, but its efficacy for eradicating infection is not known.

Clindamycin and albendazole do not have a role in treatment of giardiasis. Refractory disease with persistent infection can be treated with a longer duration of metronidazole. Outbreaks in immu- nocompetent hosts are caused by ingestion of oocysts. Infectious oocysts are excreted in human feces, causing human-to-human transmission. Waterborne transmission of Infection may be asymptomatic in immunocompetent and immunosuppressed hosts. Diarrhea is typi- cally watery and nonbloody and may be associated with abdominal pain, nausea, fever, and anorexia.

In immunocompetent hosts, symptoms usually subside in 1 to 2 weeks without therapy. Nitazoxanide is approved for treatment of Cryptosporidium but to date has not been shown to be effective in HIV- infected patients. The best available therapy for these patients is antiretroviral therapy to reduce immune suppression. Tinidazole and metronidazole are used to treat giardiasis and trichomoniasis, not cryptosporidiosis.

Because most infections are asymptomatic, this may be an underestimate. Recent outbreaks in North American have been related to ingestion of wild game, particularly bear. Heavy infections can cause enteritis; periorbital edema; myositis; and, infrequently, death.

This infection, caused by ingesting Trichinella cysts, occurs when infected meat from pigs or other carnivorous animals is eaten. Laws that prevent feeding pigs uncooked garbage have been an important public health measure in reducing Trichinella infection in this country.

Person-to-person spread has not been described. The majority of infections are mild and resolve spontaneously. The organism can also be transmitted through the inges- tion of meat from dogs, horses, and bears.

Recent outbreaks in the United States and Canada have been related to consumption of wild game, particularly bear meat. During the first week of infection, diarrhea, nausea, and vomiting are prominent features.

As the parasites migrate from the gastrointestinal GI tract, fever and eosinophilia are often present. Larvae encyst after 2 to 3 weeks in muscle tissue, leading to myositis and weak- ness. Myocarditis and maculopapular rash are less common features of this illness. However, arctic Trichinella nativa larvae in walrus or bear meat are resistant to freezing.

Although both cause GI symptoms and Campylobacter causes fever , neither causes eosinophilia or myositis. Cytomegalovirus has varied presentations but none that lead to this presentation. The answers are D and B, respectively. Toxocara eggs are ingested and begin their life cycle in the small intestine. They migrate to many tissues in the body. Staphylococci will not typically cause eosinophilia.

Trichinellosis, caused by ingesting meat from carnivorous animals that has been infected with Trichinella cysts, does not cause hepatosplenomegaly and is uncommon without eating a suspicious meal.

Giardiasis is characterized by profuse diarrhea and abdominal pain without systemic features or eosinophilia. Cysticercosis typically causes myalgias and can spread to the brain, where it is often asymptomatic but can lead to seizures.

The vast majority of Toxocara infections are self-limited and resolve without therapy. Rarely, severe symptoms may develop with deaths caused by central nervous system, myocardial, or respiratory disease. Severe myocardial involvement manifests as acute myocarditis. In these patients, glucocorticoids are administered to reduce the inflammatory complications.

Antihelminthic drugs such as albendazole, mebendazole, or praziquantel have not been shown conclusively to alter the course of visceral larval migrans. Metronidazole is used for infections caused by Trichomonas, not tissue nematodes.

The infection principally occurs in Southeast Asia and the Pacific Basin, although cases have also been described in Cuba, Australia, Japan, and China. Infective larvae are excreted in rat feces and ingested by land snails and slugs. The larvae migrate to the brain, where they initiate a marked eosinophilic inflammatory response with hemorrhage.

Clinical symptoms develop 2 to 35 days after ingestion of larvae, and the initial presentation typically includes headache indolent or acute , fever, nausea, vomiting, and meningismus. The diagnosis usually relies on the pres- ence of eosinophilic meningitis and compatible epidemiology. There is no specific chemo- therapy for A. Glucocorticoids may reduce inflammation. In most cases, cerebral angiostrongyliasis has a self-limited course with complete recovery.

It also causes migratory cutaneous swellings or eye infections. It is also endemic in Southeast Asia and China and is usually transmitted by eating undercooked fish or poultry som fak in Thai- land and sashimi in Japan. Trichinella murrelli and Trichinella nativa cause trichinosis in North America and the Arctic, respectively. Trichinella cara is the cause of larval migrans. Humans acquire Strongyloides when larvae in fecally contaminated soil penetrate the skin or mucous membranes.

The larvae migrate to the lungs via the bloodstream; break through the alveolar spaces; ascend the respiratory air- ways; and are swallowed to reach the small intestine, where they mature into adult worms.

Adult worms may penetrate the mucosa of the small intestine. Many patients with Strongyloides are asymptomatic or have mild gastrointestinal symptoms or the characteristic cutaneous eruption, larval currens, as described in this case. Small bowel obstruction may occur with early heavy infection.

Eosinophilia is common with all clinical manifestations. In patients with impaired immunity, particularly glucocorticoid therapy, hyperinfection or dissemination may occur. This may lead to colitis, enteritis, meningi- tis, peritonitis, and acute renal failure. Bacteremia or gram-negative sepsis may develop because of bacterial translocation through disrupted enteric mucosa.

Because of the risk of hyperinfection, all patients with Strongyloides infection, even asymptomatic carriers, should be treated with ivermectin, which is more effective than albendazole. Fluconazole is used to treat candidal infections. Mebendazole is used to treat trichuriasis, enterobiasis pinworm , ascariasis, and hookworm. Mefloquine is used for malaria prophylaxis. It resides in tropical and subtropical regions.

In the United States, it is found mostly in the rural Southeast. Transmission is through fecally contaminated soil.

Most commonly, the worm burden is low, and it causes no symptoms. Clinical disease is related to larval migration to the lungs or to adult worms in the gastrointestinal tract. The most common complications occur because of a high gastrointestinal adult worm burden, leading to small bowel obstruction most often in children with a narrow-caliber small bowel lumen or migration leading to obstructive complications such as cholangitis, pancreatitis, or appendicitis.

Rarely, adult worms can migrate to the esophagus and be orally expelled. During the lung phase of larval migration 9—12 days after egg ingestion , patients may develop a nonproductive cough, fever, eosinophilia, and pleuritic chest pain. Meningitis is not a known complication of ascariasis but can occur with disseminated strongyloidiasis in an immunocompromised host. Fluconazole is mostly used to treat Candida infections.

Diethyl- carbamazine DEC is first-line therapy for active lymphatic filariasis. Vancomycin has no effect on nematodes.

This is a nematode infection in which humans are an accidental host. It occurs hours to days after ingesting eggs that previously settled into the muscles of fish.

The main risk fac- tor for infection is eating raw fish. Presentation mimics an acute abdomen. History is critical because upper endoscopy is both diagnostic and curative. There is no medical agent known to cure anisakiasis. It is endemic throughout the tropics and subtropics, including Asia, the Pacific Islands, Africa, parts of South America, and the Caribbean. Lymphatic infection is common and may be acute or chronic. Chronic lower extremity lymphatic infection causes elephantiasis.

Definitive diagnosis requires demonstration of the parasite. Microfilariae may be found in blood, hydrocele, or other body fluid collections by direct microscopic examination. Polymerase chain reaction—based assays have been developed that may be as effective. In cases of acute lymphadenitis, ultrasound examination with Doppler may actually reveal motile worms in dilated lymphatics. Live worms have a distinctive movement pattern filarial dance sign. Stool ova and parasite examination is not useful for demonstration of W.

Albendazole, doxycycline, and ivermectin are also used to treat microfilarial infections not macrofilarial. There is growing consensus that virtually all patients with Wuchereria bancrofti infection should be treated, even if asymptomatic, to prevent lymphatic damage. Many of these patients have microfilarial infection with subclinical hematuria, proteinu- ria, and so on. Albendazole and doxycycline have demonstrated macrofilaricidal efficacy. Combinations of DEC with albendazole, ivermectin, and doxycycline have efficacy in eradication programs.

The World Health Organization established a global program to eliminate lymphatic filariasis in using a single annual dose of DEC plus either alben- dazole non-African regions or ivermectin Africa. Praziquantel is used for treatment of schistosomiasis. It is endemic to the rain forests of Central and West Africa.

Loiasis is often asymptomatic in indigenous regions with recognition, as in this case, only with visualized macrofilarial migration. Angioedema and swelling may occur in affected areas. Diethylcarbamazine DEC is effective treatment for the macro- filarial and microfilarial stages of disease. Multiple courses may be necessary. Albendazole and ivermectin are effective in reducing microfilarial loads but are not approved by the U.

Food and Drug Administration. There are reports of deaths in patients with heavy loads of microfilaria receiving ivermectin. Terbinafine is the treatment for ringworm. Voriconazole is an antifungal with no activity against worms. Whereas Schistosoma mansoni, Schistosoma japonicum, Schistosoma mekongi, There are reportedly up to million individuals infected with Schisto- soma.

Figure IV shows the global distribution. All forms of schistosomiasis are initiated by penetration of infective cercariae released from infected snails into fresh water. After entering the skin, the schistosome migrates via venous or lymphatic vessels to either the intestinal or urinary venous system, depending on the species. Katayama fever, acute schistosomal serum sickness—related to migration, may develop in 4 to 8 weeks. Eosinophilia is common in acute infection.

This has become a more common global health problem because travelers are exposed while swimming or boating in infected fresh water bodies. Chronic schistosomiasis depends on the species and the location of infection. The intestinal species are responsible for portal hyperten- sion.

Immunologic tests are available to diagnose schistosomiasis, and in some cases, stool or urine examination results may be positive. The major endemic countries for S.

Approximately 4 to 8 weeks after exposure, the parasite migrates through the portal and pulmonary circulations. Because there is not a large enteric burden of parasites during this phase of the illness, stool study results may not be positive, and serology may be helpful, particularly in patients from nonendemic areas. Praziquantel is the treatment of choice because Katayama fever may progress to include neurologic complications.

Praziquantel remains the treatment for most helminthic infections, including schisto- somiasis. Chloroquine is used for treatment of malaria; mebendazole for ascariasis, hook- worm, trichinosis, and visceral larval migrans; metronidazole for amebiasis, giardiasis, and trichomoniasis; and thiabendazole for Strongyloides spp. Hepatosplenomegaly, hypersplenism, and esophageal varices develop quite commonly, and schistosomiasis is usually associated with eosinophilia.

The computed tomography CT scan shows a parenchymal cysticercus with enhancement of the cyst and an internal scolex arrow. The cyst represents larval oncospheres that have migrated to the central nervous system CNS. Infections that cause human cystercicosis result from ingestion of T.

Autoinfection may occur if an individual ingests tapeworm eggs excreted in their own feces. Cysticerci may be found anywhere in the body, but clinical manifestations usually arise from lesions in the CNS, cerebrospinal fluid CSF , skeletal muscle, subcutaneous tissue, or eye.

Neurologic manifestations are most common, including generalized or focal seizures from surrounding inflammation, hydrocephalus from CSF outflow occlusion, or arachnoiditis.

As shown in Table IV, neuroradiologic demonstration of a cystic lesion containing a characteristic scolex is absolute criteria for diagnosis of cysticercosis. Intestinal infection may be detected by fecal examination for eggs. More sensitive enzyme-linked immunosorbent assay, polymerase chain reaction, and serologic testing is not currently commercially available. Treatment of neurocysticercosis after neurologic stabilization is with albendazole or praziquantel.

Studies have shown faster resolution of clinical and radiologic findings compared with placebo. Initiation of therapy may be associated with worsening symptoms caused by inflammation that is treated with glucocorticoids. CNS cystic lesions but without the visualized scolex are typical of toxoplasmosis in patients with advanced HIV infection and are treated with pyrimethamine and sulfadiazine. However, in this case, the patient was documented HIV antibody negative, and the CT lesion was typical for cysticercosis.

Viral testing for HIV would not be helpful because toxoplasmosis is seen in advanced cases, not acute infection. Echocardiography would be indicated for suspected staphylococcal or other bacterial endocarditis with systemic embolization. Neuroradiologic demonstration of cystic lesions containing a characteristic scolex 2. E vidence of cysticercosis outside the central nervous system e.

Household contact with an individual infected with Taenia solium aDiagnosis is confirmed by either one absolute criterion or a combination of two major criteria, one minor criterion, and one epidemiologic criterion. ELISA, enzyme-linked immunosorbent assay. Modified from Del Brutto OH et al: Proposed diagnostic criteria for neurocysticercosis.

Echinococcal cysts, most commonly in the liver followed by the lung, are typically slowly enlarging and cause symptoms because of space-occupying effects. Cysts are often inci- dentally discovered on radiologic studies. Compression or leakage into the biliary system may cause symptoms typical for cholelithiasis or cholecystitis. Echinococcal cysts may be characterized by ultrasonography. Demonstration of daughter cysts within a larger cyst is pathognomonic.

Serodiagnosis may be helpful in questionable cases for diagnosis of E. Small cysts may respond to medical therapy with albendazole or praziquantel. Percutaneous aspiration-injection-resaspiration PAIR therapy is recommended for most noncomplex nonsuperficial cysts. Surgical resection is recommended for complex cysts, superficial cysts with risk of leakage, and cysts involving the biliary system. Albendazole therapy is generally administered before and after PAIR or surgical therapy.

Choose the one best response to each question. Electrocardiogram ECG shows atrial fibrillation and left bundle branch block. A year-old woman is seen in clinic for evaluation of graph shows cardiomegaly and bilateral alveolar infiltrates dyspnea. Which of the following is least likely the diagnosis of idiopathic pulmonary arterial hypertension?

Fourth heart sound blowing murmur heard at the right upper sternal B. Irregular heart rate border C. Reversed splitting of the second heart sound murmur left lower sternal border E.

Third heart sound C. A year-old man is admitted to the intensive care D. He is harsh systolic murmur left upper sternal border addicted to heroin and cocaine and uses both drugs E. His vital signs show a blood pres- V Which of the following additional findings is most likely present on physical examination? Late diastolic murmur with opening snap B.

Pulsus parvus et tardus C. Slow y-descent of jugular venous pressure tracing D. A year-old man is admitted to the intensive care unit with decompensated heart failure. He has long-standing A year-old man seeks evaluation for leg pain with A. Atrial septal defect, coronary heart disease, aortic ambulation.

He describes the pain as an aching to crampy valve disease pain in the muscles of his thighs. The pain subsides within minutes of resting. On rare occasions, he has noted numb- B. He has a history of hypertension and cerebrovascular disease. Four years previously had C. Coronary heart disease, aortic valve disease, pulmo- a transient ischemic attack and underwent right carotid nary hypertension endarterectomy.

He currently takes aspirin, irbesartan, hydrochlorothiazide, and atenolol on a daily basis. Pulmonary embolism, cardiomyopathy, hypertensive examination, he is noted to have diminished dorsalis heart disease pedis and posterior tibial pulses bilaterally.

There is loss of hair in the distal E. Pulmonary hypertension, pulmonary embolism, extremities. Capillary refill is approximately 5 seconds in mitral stenosis the right foot and 3 seconds in the left foot. A year-old man with long-standing ischemic car- of the right foot? Ankle-brachial index less than 0. Ankle-brachial index greater than 1.

Lack of palpable dorsalis pedis pulse sium value of 2. The patient is referred to the E. Which of the following is likely to be found on ECG before V A year-old man is referred to cardiology after an administration of potassium?

He has no A. Diminution of P wave amplitude recollection of the event, but he was told that he col- B. Osborne waves lapsed while running. He awakened lying on the ground C. Prolongation of QT interval and suffered multiple contusions as a result of the fall. Prominent U waves He has always been an active individual but recently has E. Scooped ST segments developed some chest pain with exertion that has caused him to restrict his activity. His father died at age 44 while V A year-old woman from El Salvador is seen in the rock climbing.

On examination, the patient has tum, or fever. ECG shows a tall R in lead V1 and hypertrophy. Which of the be found on her echocardiography? Aortic regurgitation increase in the loudness of the murmur? Low left ventricular ejection fraction B.

A and B V A year-old woman is in the intensive care unit F. C and D with rhabdomyolysis due to compartment syndrome of the lower extremities after a car accident. Left bundle branch block is indicative of which of the course has been complicated by acute renal failure and following sets of conditions? She has undergone fasciotomies and is admit- ted to the intensive care unit. What is the most appropriate course of action at this point?

Intravenous fluids and a loop diuretic E. Acute hyperkalemia is associated with which of the A. A year-old female with acute-onset severe following electrocardiographic changes?

Prolongation of the ST segment C. Prominent U waves B. A year-old male with sudden-onset chest pain D. QRS widening while playing tennis E. A year-old female with a long history of smok- V The ECG shown below Figure V was most likely ing and 2 days of increasing shortness of breath and obtained from which of the following patients? A year-old female with end-stage renal insuffi- ciency who missed dialysis for the last 4 days E.

You are evaluating a new patient in your clinic who A. The ECG was performed on the patient 2 weeks C. Paroxysmal nocturnal dyspnea ago. What complaint do you expect to elicit from the D. Pleuritic chest pain patient?

All the following ECG findings are suggestive of left V R in aVL greater than 11 mm A. R in aVF greater than 20 mm B. R in aVR greater than 8 mm D. She undergoes a right heart catheteri- A. Determination of cardiac mass in a patient with an zation that shows the following results: Determination of left ventricular ejection fraction in Mean arterial pressure mmHg a patient with a history of myocardial infarction C.

Diagnosis of myocardial ischemia in a patient with Left-ventricular end-diastolic pressure 25 mmHg atypical chest pain Pulmonary artery PA systolic pressure 48 mmHg D. Diagnosis of pericardial effusion PA diastolic pressure 20 mmHg E.

Chronic thromboembolic disease not responded to medical therapy. He is inquiring about B. Diastolic heart failure the risks associated with the procedure. Which of the C. Obstructive sleep apnea following is the most common complication of cardiac D.

Systolic heart failure A. Acute renal failure B. Which of the following is a risk factor for the C. Tachyarrhythmias tachycardia-bradycardia variant of sick sinus syndrome?

Vascular access site bleeding A. Age greater than 50 years B. Which of the following patients is an appropriate C. Prothrombin mutation A.

A year-old woman with dyspnea of unclear E. A year-old man with an episode of sustained V A year-old man is evaluated for the recent onset of monomorphic ventricular tachycardia while at the feeling fatigued. He is a busy executive and active triathlete. After He competed a challenging course 1 week earlier without dif- arrival in the emergency department, the patient is ficulty but feels tired at other times.

Laboratory examination, hemodynamically stable. A year-old woman with a history of tobacco his wife reports occasional snoring, a sleep study is recom- abuse, hypercholesterolemia, and Type 2 diabetes mended. There are no notable apneas, but ECG monitoring mellitus with chest pain at rest, a normal ECG, and during the night shows sinus bradycardia.

His heart rate var- mild elevation in serum troponin value ies between 42 and 56 while sleeping. His resting heart rate D.

Carotid sinus massage of breath. An ECG shows a new C. No specific therapy ago. Referral for pacemaker placement E. A year-old man seen in the cardiology clinic for evaluation of severe aortic stenosis found on echocar- V All of the following are reversible causes of sinoatrial diography performed for evaluation of dyspnea node dysfunction EXCEPT: A year-old woman is undergoing evaluation of dys- B.

Hypothyroidism pnea on exertion. She has a history of hypertension since C. Increased intracranial pressure age 32 and is also obese with a body mass index BMI of D. Her pulmonary function tests show mild restric- E. Radiation therapy tive lung disease. A year-old man is admitted to the hospital after leg that looked like a target several days ago, but is other- experiencing 2 days of severe dyspnea. Three weeks ago he wise healthy. He reports excellent adherence to saturation is normal.

His examination is otherwise unre- his medical regimen that includes atorvastatin, lisinopril, markable except for a bulls-eye rash over the right upper metoprolol, and aspirin.

On examination, his heart rate thigh. ECG shows third-degree AV block. ANA eral leg edema. There are no gallops or new murmurs. HLA B27 testing shows sinus bradycardia and evidence of the recent infarct, C. Which of the following is the most D.

RPR appropriate next management step? Refer for pacemaker placement pathway is the block usually found? Refer for urgent coronary angiography A. First-degree AV block; intranodal B. Second-degree AV block type 1; intranodal V A year-old college student home for the summer is C. Second-degree AV block type 2; infranodal evaluated in the emergency department for dizziness that D. Second-degree AV block type 2; intranodal began within the last 3 days.

A year-old woman with a history of tobacco A. Atrial premature contractions are less common than abuse and ulcerative colitis is evaluated for intermit- ventricular premature contractions on extended tent palpitations.

She reports that for the last 6 months ECG monitoring. Echocardiography is indicated to determine if struc- She has not noted any precipitating factors and has not tural heart disease is present. Her physical examination is normal. A resting ECG C. Metoprolol should be initiated for symptom control. The patient should be reassured that this is not a checking serum electrolytes, which of the following is the most appropriate testing?

Abdominal CT with oral and IV contrast evaluation. The patient should undergo a stress test to determine C. Holter monitor if ischemia is present. Reassurance with no further testing needed V Referral for EP study ted to the intensive care unit with an exacerbation of his obstructive lung disease. Because of hypercarbic respira- V Despite aggressive sedation, his Which of the following statements regarding the dysrhyth- ventilator alarms several times that peak inspiratory pres- mia in this patient is true?

Cardiac examination shows a regular rhythm, but no other abnormality. Breath sounds are decreased on the right. ECG shows narrow complex tachycardia. Which of the following is V Adenosine mg IV push emergency department with palpitations for 3 days. Metoprolol 5-mg IV push ter.

An echocardiogram demonstrates moderate right and E. Sedation followed by cardioversion left atrial dilation, postoperative changes from her surgery, and normal left and right ventricular function.

All of the following are risk factors for stroke in a the following is true? If a transesophageal echocardiogram does not dem- B. History of congestive heart failure onstrate left atrial thrombus, she may be cardioverted C. History of stroke without anticoagulation. Intravenous heparin should be started immediately. Left atrial size greater than 4. She should be immediately cardioverted. Transthoracic echocardiogram is adequate to rule V Which of the following statements regarding restora- out the presence of left atrial thrombus.

Dofetilide may be safely started on an outpatient basis. A patient presents with palpitations and shortness of B. In patients who are treated with pharmacotherapy breath for 6 hours. In the emergency department waiting and are found to be in sinus rhythm, a prolonged room an ECG is performed shown in Figure V Patients who have pharmacologically maintained A.

Diffuse abdominal tenderness with guarding sinus rhythm after atrial fibrillation have improved B. Diffuse expiratory polyphonic wheezing with poor survival compared with patients who are treated with air movement and hyperinflation rate control and anticoagulation. Left ventricular heave and third heart sound D.

Recurrence of atrial fibrillation is uncommon when D. Supraclavicular lymphadenopathy pharmacotherapy is used to maintain sinus rhythm. A year-old woman is seen in the emergency depart- A. Adenosine ment after sudden onset of palpitations 30 minutes prior B. Carotid sinus massage to her visit. She was seated at her work computer when the C. DC cardioversion symptoms began. Aside from low back pain, she is oth- D.

In an ECG with wide complex tachycardia, which of in her neck and tachycardia, but is otherwise normal. ECG the following clues most strongly supports the diagnosis of shows a narrow complex tachycardia without identifiable ventricular tachycardia? Which of the following is the most appropriate A.

Atrial-ventricular dissociation first step to manage her tachycardia? Classic right bundle branch block pattern A. Irregularly irregular rhythm with changing QRS B. QRS duration greater than milliseconds D. Carotid sinus massage E. Slowing of rate with carotid sinus massage E.

DC cardioversion using J V A year-old male with diabetes and schizophrenia is V A year-old man who is healthy aside from a prior started on antibiotic therapy for chronic osteomyelitis in the knee surgery is evaluated in the emergency department hospital. His osteomyelitis has developed just under an ulcer for palpitations that developed suddenly while eating where he has been injecting heroin. His physical examination is normal aside is which of the following substances?

An ECG obtained A. Furosemide before his knee surgery shows delta waves in the early B. His current ECG shows wide complex C. Which of the following therapies is contrain- D. Metformin dicated for treatment of his tachyarrhythmia? Lidocaine electrocardiogram is notable for a prolonged QT C.

Besides stopping the offending drug, the most D. Metoprolol appropriate management for this rhythm disturbance E. Potassium should include intravenous administration of which of V You are caring for a patient with heart rate—related the following? With minor elevations in heart rate, the patient has anginal symptoms that impact his quality of life. The patient reports a regular exercise regimen of B. Early afterdepolarizations walking on the treadmill several times weekly and occa- C.

Increased automaticity sional exacerbations of his leg edema that he manages D. Reentry pathway with an extra dose of furosemide. He has never been hos- pitalized for heart failure. His current medical regimen V He is interested in A. Left atrial appendage stopping medications because of their expense. Mitral annulus of the following statements is true regarding his medical C. Pulmonary vein orifice regimen? ACE inhibition therapy has not been shown to E.

Sinus node improve heart failure symptoms. Beta blocker therapy in this patient may be exacer- V Symptoms of atrial fibrillation vary dramatically from bating his occasional need for extra furosemide and patient to patient. If digoxin is withdrawn, he will likely have worsening C. If he is intolerant to lisinopril because of cough, it E.

Postoperative after thoracotomy would be reasonable to switch him to an angiotensin- receptor blocker. A year-old postmenopausal woman is seen for onset of severe dyspnea over the last few weeks. She reports no pre- V A year-old slender woman is seen in the emergency ceding chest pain, cough, sputum, or fever, though she does department after several weeks of dyspnea on exertion that report leg swelling. Exophthalmos is present as well as bilateral inspiratory complains of leg swelling, orthopnea, and occasionally crackles occupying approximately one-third of the lower awakening at night with dyspnea.

Her past medical history chest; neck vein distention; normal cardiac rhythm, though is notable for long-standing systemic hypertension, uterine tachycardia is present; and a third heart sound with no mur- prolapse, and an anxiety disorder. Bilateral lower extremity edema and a fine hand tremor the presence of heart failure with a laterally displaced and are also present. She is admitted to the hospital and given diuret- A. Anemia with high-output state ics, and an echocardiogram is obtained.

Hemochromatosis with subsequent restrictive malities, and aortic and mitral valvular function is intact. Myocardial infarction with depressed left ventricular 45 mmHg. After resolution of her heart failure symptoms systolic function with diuresis, the patient is ready for discharge. Thyrotoxicosis with high-output state the following medications have been shown to improve mortality in patients with heart failure with preserved V Digoxin the diagnosis of left heart failure.

In the presence of renal failure, BNP levels are C. Plasma BNP levels may be falsely low in patients with E. None of the above obesity and heart failure. The concentration of the released antibiotic was decreasing gradually over time, following a similar pattern for both groups. The cleaning procedure A as well as the cleaning procedure B for bone allografts allowed the impregnation with gentamicin powder in the same concentrations in both groups.

The delivery of gentamicin was similar for both groups. Both cleaning procedures were easy to be carried out, making them suitable for routine use at the bone banks.

It works by killing bacteria. Antibiotics such as gentamicin injection will not work Novel antibiotic regimens against Enterococcus faecium resistant to ampicillin, vancomycin, and gentamicin. Enterococci have emerged as significant nosocomial pathogens. Enterococci with resistance to commonly used antibiotics are appearing more frequently. We encountered at our institution several infections caused by Enterococcus faecium with high-level resistance to ampicillin, vancomycin, and gentamicin.

The optimal antibiotic therapy for serious infections with unusually resistant enterococci has not been established. Using time-kill studies, we tested the effectiveness of various antibiotic combinations against 15 isolates of multidrug-resistant enterococci. No antibiotic was consistently effective when used alone.

The combination of ampicillin plus ciprofloxacin was bactericidal for the 12 isolates for which the ciprofloxacin MIC was antibiotic combinations may be important for the future treatment of serious infections caused by these resistant pathogens. Transferable resistance to gentamicin and other antibiotics in Enterobacteriaceae isolates from municipal wastewater.

In two sets of Enterobacteriaceae and Pseudomonas bacteria resistant to at least two antibiotics a distinctly upward trend was found in the incidence of strains resistant to gentamicin. The strains examined were either routine isolates from three municipal wastewater treatment facilities or from the Danube river samples collected near the outlet of municipal sewerage.

The resistance to gentamicin points to the representation of strains originating from hospitalized patients and its incidence among wastewater strains is recordable since the summer of Gentamicin resistance transfer could be demonstrated in a sewage sludge strain of Klebsiella pneumoniae resistant to seven antibiotics and in two multiresistant isolates from the river Danube.

Resistance transfers in the case of other antibiotics , especially those susceptible to beta-lactamase ampicillin, carbenicillin , were demonstrated in 10 out of the 24 di- and multiresistant strains tested.

These findings show that both municipal wastewater and water in streams may function as the reservoirs of strains bearing the determinants of transferable resistance. Such strains may play an important role not only in the ecology and epidemiology of R plasmids, but also in the accidental spread of the so-called DNA recombinants that might escape during gene manipulations.

We evaluate the effects the antibiotic Gentamicin on the development of Chrysomya putoria Wiedemann, The control consisted of distilled water. The relationships between mean body mass of mature larvae measured after diet abandonment, in batches of five individuals , duration of larval and pupal stages, and overall duration of development were analyzed.

The actual sex ratio was compared against the expected using the chi square. None of the parameters measured differed significantly among the four treatments, with one exception: All larvae from all treatments were considered normal. We conclude that the antibiotic did not significantly alter the development of C. The uptake of radiocalcium 45Ca into the isolated media-intimal layer of rabbit aortae was decreased in a maintained manner by each antibiotic. With gentamicin , the inhibitory effect on 45Ca uptake was shown to be dependent upon the concentration of gentamicin employed and to be more evident in a 0.

In addition, the rate of 45Ca efflux from the rabbit aortic media-intimal layer was increased in a sustained manner by gentamicin , streptomycin, and kanamycin. These in vitro findings may partially explain the occurrence of in vivo cardiovascular depression that has occasionally been observed after the administration of chemically related antimicrobial agents.

Relevance of Concomitant Systemic Antibiotic Therapy. Oral gentamicin , 80 mg four times daily, was administered to 50 consecutive patients with gut colonization by gentamicin -susceptible KPC-Kp in cases of planned surgery, major medical intervention, or need for patient transfer.

No difference in overall death rate between different groups was documented. Oral gentamicin was shown to be potentially useful for gut decontamination and prevention of infection due to KPC-Kp, especially in patients not receiving CSAT. The risk of emergence of gentamicin -resistant KPC-Kp should be considered.

Level 1 trauma center. Electronic medical record review revealed patients with type 3 open fractures, of which 72 were included in the final analysis. SSI, nonunion, death, and rehospitalization rates at 1 year. Surgical site infection at 1 year occurred in 12 of 37 patients Nonunion, death, and rehospitalization rates at 1 year were similar between the 2 groups.

Although there was no statistically significant difference in SSI at 30 days between groups, the rate was higher in the cefazolin plus gentamicin group See Instructions for Authors for a complete description of levels of evidence.

Controlled release of an antibiotic , gentamicin sulphate, from gravity spun polycaprolactone fibers. The antibiotic , gentamicin sulphate GS , was incorporated in gravity-spun polycaprolactone PCL fibers by spinning from particulate suspensions of the drug in PCL solution to produce a controlled delivery system.

The kinetics of drug release could be adjusted by varying the GS loading of the fibers and the suspension preparation conditions.

Studies of growth inhibition of Stapyhlococcus epidermidis in culture indicated that GS released after 2 weeks from PCL fibers retained antibacterial activity. This behavior recommends further investigation of PCL fibers for local delivery of antibiotics to combat infection associated with periodontal disease, musculoskeletal injuries, and implantation of fiber-based tissue substitutes such as vascular prostheses. J Biomed Mater Res, Biodegradation of gentamicin by bacterial consortia AMQD4 in synthetic medium and raw gentamicin sewage.

Gentamicin , a broad spectrum antibiotic of the aminoglycoside class, is widely used for disease prevention of human beings as well as animals. Nowadays the environmental issue caused by the disposal of wastes containing gentamicin attracts increasing attention. In this study, a gentamicin degrading bacterial consortia named AMQD4, including Providencia vermicola, Brevundimonas diminuta, Alcaligenes sp.

The component and structure of gentamicin have a great influence on its degradation and gentamicin C1a and gentamicin C2a were more prone to being degraded. AMQD4 could maintain relatively high gentamicin removal efficiency under a wide range of pH, especially in an alkaline condition.

In addition, AMQD4 could remove It was speculated that aac3iia was the gentamicin degradation gene and the main degradation product was 3'-acetylgentamicin. Our results suggest that AMQD4 and Brevundimonas diminuta BZC3 could be important candidates to the list of superior microbes for bioremediation of antibiotic pollution.

Biofilms that develop on indwelling devices are a major concern in clinical settings. While removal of colonized devices remains the most frequent strategy for avoiding device-related complications, antibiotic lock therapy constitutes an adjunct therapy for catheter-related infection. However, currently used antibiotic lock solutions are not fully effective against biofilms, thus warranting a search for new antibiotic locks.

To assess the ability of such chelators to eradicate mature biofilms, we used an in vivo model of a totally implantable venous access port inserted in rats and colonized by either Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, or Pseudomonas aeruginosa. Gentamicin -EDTA lock was able to eliminate biofilms with a single instillation, thus reducing length of treatment.

Moreover, we show that this combination was effective for immunosuppressed rats. Lastly, we demonstrate that a gentamicin -EDTA lock is able to eradicate the biofilm formed by a gentamicin -resistant strain of methicillin-resistant S. This in vivo study demonstrates the potential of EDTA as an efficient antibiotic adjuvant to eradicate catheter-associated biofilms of major bacterial pathogens and thus provides a promising new lock solution.

Borate bioactive glass-based composites have been attracting interest recently as an osteoconductive carrier material for local antibiotic delivery. In the present study, composites composed of borate bioactive glass particles bonded with a chitosan matrix were prepared and evaluated in vitro as a carrier for gentamicin sulfate. The cytocompatibility of the gentamicin sulfate-loaded composite carrier was evaluated using assays of cell proliferation and alkaline phosphatase activity of osteogenic MC3T3-E1 cells.

These results indicate that the gentamicin sulfate-loaded composite composed of chitosan-bonded borate bioactive glass particles could be useful clinically as an osteoconductive carrier material for treating bone infection.

An experimental design approach to the preparation of pegylated polylactide-co-glicolide gentamicin loaded microparticles for local antibiotic delivery. The present paper takes into account the DOE application to the preparation process of biodegradable microspheres for osteomyelitis local therapy. The results of in vitro gentamicin release study show prolonged gentamicin release up to three months from the microspheres prepared with salt addition in the dispersing phase; the behavior being consistent with their highly compact structure highlighted by scanning electron microscopy analysis.

The collected results confirm the feasibility of the scale up of microsphere manufacturing process and the high potential of the microparticulate drug delivery system to be used for the local antibiotic delivery to bone. Synergistic antibacterial effect of Bi2S3 nanospheres combined with ineffective antibiotic gentamicin against methicillin-resistant Staphylococcus aureus. In this paper, Bi2S3 nanospheres with size of nm were prepared by a simple hydrothermal process.

Raman spectroscopy and Z potential studies reveal that Bi2S3 could interact with GEN and the combination showed small electronegativity, which probably induced the increase of GEN content in cytoplasm of bacteria. Furthermore, the combination of Bi2S3 nanospheres and GEN can destroy the bacterial membrane function and induce more bactericidal reactive oxygen generation than that of Bi2S3 or GEN alone.

The cytotoxicity test indicates that the combination of Bi2S3 and GEN presented low toxicity to human normal hepatocyte L Gentamicin in the Clinical Setting. Gentamicin is an aminoglycoside antibiotic that has been a mainstay in pediatric care for decades. Although new antibiotics are constantly under development, gentamicin continues to play an important role in clinical medicine.

Although this may be surprising in the context of evidence of an association with hearing loss, both on a toxicity and a…. These lipospheres were characterized by evaluating on encapsulation efficiency, loading capacity, change in pH and the release profile. Antimicrobial activities were evaluated against Escherichia coli, Pseudomonas aeruginosa, Salmonella paratyphii and Staphylococcus aureus using the agar diffusion method.

Results Photomicrographs revealed spherical particles within a micrometer range with minimal growth after 1 month.

The encapsulation and loading capacity were all high, indicating the ability of the lipids to take up the drug. The antimicrobial activities were very high especially against Pseudomonas compare to other test organisms. This strongly suggested that the formulation retain its bioactive characteristics.

Conclusions This study strongly suggest that the issue of gentamicin stability and poor absorption in oral formulation could be adequately addressed by tactical engineering of lipid drug delivery systems such as lipospheres. Aged garlic extract, garlic powder extract, S-allylcysteine, diallyl sulfide and diallyl disulfide do not interfere with the antibiotic activity of gentamicin.

It was shown that aged garlic extract AGE , garlic powder and the following garlic-derived compounds: However, it was not established if the above mentioned extracts and compounds of garlic could interfere with the antibiotic action of GM. Effect of Taurine on the antimicrobial efficiency of Gentamicin. Gentamicin is mainly used in severe infections caused by gram-negatives.

However toxicity including nephrotoxicity and ototoxicity is one of the most important complications of its treatment. The production of free radicals seems to be involved in gentamicin toxicity mechanism. So potentially the co-therapy of taurine and gentamicin would reduce the adverse effects of the antibiotic.

In this study, we wished to know the effect of taurine on the antibiotic capacity of gentamicin. MICs were determined in the various concentrations of taurine for bacterial indicators. The MIC values of gentamicin for P. The bactericidal activity of gentamicin against S.

According to our study the antibacterial activity of gentamicin against the indicator microorganisms were not interfere with taurine at selected concentrations. Further in vivo studies are needed to establish if a combination of gentamicin and taurine would have the same effect.

Previous investigations have shown that liquid bacterial cultures grown in space flight were not killed as effectively by antibiotic treatments as were cultures grown on Earth. However, the cause for the decreased antibiotic effectiveness remains unknown. Possible explanations include modified cell proliferation and modified antibiotic transport in the culture medium. Escherichia coli cultures were grown in space flight STS and STS , with and without gentamicin , on a solid agar substrate thus eliminating fluid effects and reducing the unknowns associated with space-flight bacterial cultures in suspension.

This research showed that E. However, addition of gentamicin to the agar killed the bacteria such that both flight and ground control E. Therefore, while the reported existence of a decrease in antibiotic effectiveness in liquid cultures remains unexplained, these data suggest that gentamicin in space flight was at least as effective as, if not more effective than, on Earth, when E.

Comparative study of the effects of gentamicin , neomycin, streptomycin and ofloxacin antibiotics on sperm parameters and testis apoptosis in rats. The aim of this study was to investigate the comparative effects of aminoglycosides and fluoroquinolones on testis apoptosis and sperm parameters in rats. The experimental groups subdivided into four groups often. Each received 5 mg kg -1 IP gentamicin , 50 mg kg -1 IP neomycin, 40 mg kg -1 IP streptomycin and 72 mg kg -1 IP ofloxacin daily for 14 days, respectively; however, the control group just received vehicle IP.

In the fourteenth day, rats were killed and sperm analyzed for sperm parameters. There was a significant decrease in sperm count, viability and motility in all of experimental groups when compared with control group. Although in streptomycin group these parameters were less decreased than in the other experimental groups. The apoptotic cells were significantly increased in all experimental groups when compared with those seen in the controlled group.

Gentamicin , neomycin and streptomycin and ofloxacin have negative effects on sperm parameters and testis apoptosis in rats.

However, these side effects are less seen in the streptomycin group. Therefore, it is recommended that usage of this drug have fewer side effects on male fertility. A covalent method of gentamicin bonding to silica supports. Results of a novel method of covalent bonding of an antibiotic gentamicin to silica bead supports are shown. Gentamicin was immobilized to four types of matrix: Gentamicin was immobilized to the supports after opening its carbohydrate ring in the molecule.

This method of gentamicin activation before the immobilization process did not inhibit its antibiotic activity. The four gentamicin -containing immobilized preparations were stable, meaning that they did not release the antibiotic into the solution during the 30 days of incubation, not even during shaking experiments. Antibacterial efficacy of a new gentamicin -coating for cementless prostheses compared to gentamicin -loaded bone cement.

Cementless prostheses are increasingly popular but require alternative prophylactic measures than the use of antibiotic -loaded bone cements.

Here, we determine the h growth inhibition of gentamicin -releasing coatings from grit-blasted and porous-coated titanium alloys, and compare their antibacterial efficacies and gentamicin release-profiles to those of a commercially available gentamicin -loaded bone cement.

Antibacterial efficacy increased with increasing doses of gentamicin in the coating and loading with 1. The coating had a higher burst release than bone cement, and also inhibited growth of gentamicin -resistant strains. Antibacterial efficacy of the gentamicin coatings disappeared after 4 days, while gentamicin -loaded bone cement exhibited efficacy over at least 7 days. Shut-down after 4 days of gentamicin -release from coatings is advantageous over the low-dosage tail-release from bone cements, as it minimizing risk of inducing antibiotic -resistant strains.

Both gentamicin -loaded cement discs and gentamicin -coated titanium coupons were able to kill gentamicin -sensitive and -resistant bacteria in a simulated prothesis-related interfacial gap. In conclusion, the gentamicin coating provided similar antibacterial properties to those seen by gentamicin -loaded bone cement, implying protection of a prosthesis from being colonized by peri-operatively introduced bacteria in cementless total joint arthroplasty.

An In vitro Study. Elderly patients and those with comorbidities are at increased risk. On the basis of previous studies focusing on neonatal infections, penicillin plus gentamicin is recommended for infective endocarditis IE and periprosthetic joint infections PJI in adults. We used 5 GBS isolates, two clinical strains and three control strains, including one displaying high-level gentamicin resistance HLGR.

The results from the checkerboard and time-kill assays TKAs were compared. For TKAs, antibiotic concentrations for penicillin were 0. In the checkerboard assay, the median fractional inhibitory concentration indices FICIs of all isolates indicated indifference. TKAs for all isolates failed to demonstrate synergism with penicillin 0.

Rapid killing was seen with penicillin 0. TKAs with penicillin 0. Fast killing was seen with penicillin 0. Our in vitro results indicate that the addition of gentamicin to penicillin contributes to faster killing at low penicillin concentrations, but only within the first few hours. Twenty-four hours after antibiotic exposure, PEN alone was bactericidal and synergism was not seen. Once daily ceftriaxone and gentamicin for the treatment of febrile neutropenia. AIMS—To evaluate the pharmacokinetics of once daily OD gentamicin and its effectiveness as part of an OD regimen for the empirical treatment of febrile neutropenia in children with cancer.

The patients were assessed after 48hours. In 29 episodes, blood cultures identified a causative bacterial pathogen; for 17 of these, the first line antibiotic regimen was adequate; in four episodes, although the episode settled, ceftriaxone was replaced by a more appropriate antibiotic and OD gentamicin was continued; in the remaining eight episodes, a glycopeptide antibiotic was deemed necessary.

There was no failure of treatment in organisms sensitive to gentamicin , including Pseudomonas aeruginosa. Gentamicin concentrations were measured in episodes and they were all below the 24 hour line indicating that there was no need to change the dosing interval.

Although there was no vestibular toxicity, three of 30 children who underwent pure tone audiometry reported high frequency hearing loss in one ear. When used for a short period Surgical prophylaxis with gentamicin and acute kidney injury: There are limited data regarding nephrotoxicity related to gentamicin in these patients.

Methods We have conducted a systematic review and meta-analysis to evaluate the risk of acute kidney injury AKI in gentamicin -containing surgical prophylactic regimens, compared to regimens without gentamicin , in several types of surgery. Statistical analysis was then performed using a random-effect model; risk ratios RR , risk differences RD and heterogeneity I2 were calculated.

Funnel plot was used for assessment of publication bias. Results Eleven studies with fifteen cohorts with 18, patients were included in the analysis. Subgroup analysis was performed according to surgery type.

We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery RR 2. The results were inconclusive in other types of surgery. Funnel plot indicates potential publication bias. Conclusions Gentamicin -induced AKI is significant in patients undergoing orthopedic surgery. Physicians should consider risks and benefits of using this regimen in individual patients.

Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: WHO recommends hospital-based treatment for young infants aged days with clinical signs of possible serious bacterial infection, but most families in resource-poor settings cannot accept referral.

We aimed to assess whether use of simplified antibiotic regimens to treat young infants with clinical signs of severe infection was as efficacious as an injectable procaine benzylpenicillin- gentamicin combination for 7 days for situations in which hospital referral was not possible.

In a multisite open-label equivalence trial in DR Congo, Kenya, and Nigeria, community health workers visited all newborn babies at home, identifying and referring unwell young infants to a study nurse. We stratified young infants with clinical signs of severe infection whose parents did not accept referral to hospital by age days and days , and randomly assigned each individual within these strata to receive one of the four treatment regimens.

Randomisation was stratified by age group of infants. An age-stratified randomisation scheme with block size of eight was computer-generated off-site at WHO. The outcome assessor was masked. We randomly allocated infants to receive injectable procaine benzylpenicillin- gentamicin for 7 days group A, reference group ; injectable gentamicin and oral amoxicillin for 7 days group B ; injectable procaine benzylpenicillin- gentamicin for 2 days, then oral amoxicillin for 5 days group C ; or injectable gentamicin for 2 days and oral amoxicillin for 7 days group D.

Trained health professionals gave daily injections and the first dose of oral amoxicillin. Our primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event including death , no improvement by day 4, or not cured by day 8. Independent outcome assessors, who did not know the infant's treatment regimen, assessed study outcomes on days 4, 8, 11, and Primary analysis was per protocol. We used a prespecified. Effect of protamine on the accumulation of gentamicin in opossum kidney epithelial cells.

The purpose of this study was to examine whether or not protamine, an arginine-rich basic protein mixture, inhibits the accumulation of gentamicin , a nephrotoxic drug, in cultured opossum kidney OK epithelial cells.

The effect of protamine from salmon on accumulation and binding of [ 3 H] gentamicin was investigated in OK cells. Protamine inhibited the binding and accumulation of [ 3 H] gentamicin in a concentration-dependent manner. Our results indicate that protamine decreases the accumulation of gentamicin in OK cells.

These findings suggest that protamine or its derivatives might be useful in preventing the nephrotoxicity of aminoglycoside antibiotics including gentamicin. Additive effect of Lygodium venustum SW. The aim of this work was to evaluate the interactions between gentamicin and the ethanol extract of the fern Lygodium venustum SW EELV.

The ethanol extract of L. The antibiotic activity of gentamicin , when associated with the extract, was enhanced in an additive manner against both strains.

The results indicated that L. Assessment of nutrient supplement to reduce gentamicin -induced ototoxicity. Gentamicin is an aminoglycoside antibiotic used to treat gram-negative bacterial infections. Treatment with this antibiotic carries the potential for adverse side effects, including ototoxicity and nephrotoxicity. Ototoxic effects are at least in part a consequence of oxidative stress, and various antioxidants have been used to attenuate gentamicin -induced hair cell death and hearing loss.

Here, a combination of nutrients previously shown to reduce oxidative stress in the hair cells and attenuate hearing loss after other insults was evaluated for potential protection against gentamicin -induced ototoxicity. Three diets with iterative increases in nutrient levels were screened; the final diet selected for study use was one that produced statistically reliable increases in plasma levels of vitamins C and E and magnesium.

In two separate studies, significant decreases in gentamicin -induced hearing loss at frequencies including 12 kHz and below were observed, with less benefit at the higher frequencies. Consistent with the functional protection, robust protection of both the inner and outer hair cell populations was observed, with protection largely in the upper half of the cochlea. Protection was independently assessed in two different laboratories, using two different strains of guinea pigs.

Additional in vitro tests did not reveal any decrease in antimicrobial activity with nutrient additives. Currently, there are no FDA-approved treatments for the prevention of gentamicin -induced ototoxicity. The current data provide a rationale for continued investigations regarding translation to human patients. Use of topical antibiotics to improve perineal wound healing after abdominoperineal resection APR is controversial. The aim of this systematic review was to determine the impact of local application of gentamicin on perineal wound healing after APR.

Perineal wound outcome was categorized as infectious complications, non-infectious complications, and primary perineal wound healing. From a total of articles, eight studies published between and were included: There was substantial heterogeneity regarding underlying disease, definition of outcome parameters and timing of perineal wound evaluation among the included studies, which precluded meta-analysis with pooling. Regarding infectious complications, three of six evaluable studies demonstrated a positive effect of local application of gentamicin: Only two RCTs reported on non-infectious complications, showing no significant impact of gentamicin sponge.

All three comparative cohort studies demonstrated a significantly higher percentage of primary perineal wound healing after local application of gentamicin beads, but only one out of three evaluable RCTs did show a positive effect of gentamicin sponges.

Currently available evidence does not support perineal gentamicin application after APR. The formulation and characterization of gentamicin -loaded microspheres as a delivery system targeting enterotoxigenic Escherichia coli K88 E. The proposed target strategy was that exposed galactoses of MS-Lac could be specifically recognized by E. Lactosylated microspheres MS-Lac1, MS-Lac2 and MS-Lac3 were obtained using a water-in-oil emulsion, containing gentamicin , followed by crosslinking with different concentrations of glutaraldehyde.

In vitro release of gentamicin from MS-Lac was best fitted to a first order model, and the antibacterial activity of encapsulated and free gentamicin was comparable. MS-Lac treatments were recognized by plant galactose-specific lectins from Ricinus communis and Sophora japonica and by E.

Results indicate MS-Lac1, produced with 4. Synergy between penicillin and gentamicin against enterococci. The role of active uptake in aminoglycoside activity against penicillin-treated enterococci was studied by viable counts and ATP determinations. Penicillin and gentamicin gave synergistic bactericidal and post- antibiotic effects PAEs which were partially reduced by sodium azide, an electron transport inhibitor, and totally blocked in the presence of both sodium azide and EDTA, which chelates divalent cations.

This synergy was completely inhibited by sodium azide. The data indicate that the activity of gentamicin against enterococci that have been damaged by penicillin or EDTA is energy-dependent. This is consistent with present theories of gentamicin uptake via transportation drive by a protonmotive force. Urinary tract infections in hospital pediatrics: We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population.

We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals. Prior antibiotic exposure was documented from their health record. One hundred and ten patients 73 girls , 11 days to 12 years of age, were included in 10 months. The antibiotic resistance rate of E. Bacterial species and antibiotic resistance level in children are similar to those reported for adults. Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved previous antibiotic therapies and fecal-oral or mother-to-child transmission.

The antipseudomonal property of honey and gentamicin. Pseudomonas aeruginosa has a notorious characteristic of resistance to most antimicrobial compounds. This characteristic was subjected to verification in the present study, whereby 50 human isolates of the organism from different pathological sources were subjected to sensitivity tests against honey from three different sources by the agar-cup diffusion method. Gentamicin , an aminoglycoside antibiotic normally with activity against Gram-negative bacteria, was used alongside honey.

The 50 isolates of P. Honey is suggested as an effective natural product in overcoming the widespread antibiotic resistance of P. Automatic phylogenetic classification of bacterial beta-lactamase sequences including structural and antibiotic substrate preference information. Beta lactams comprise the largest and still most effective group of antibiotics , but bacteria can gain resistance through different beta lactamases that can degrade these antibiotics.

We developed a user friendly tree building web server that allows users to assign beta lactamase sequences to their respective molecular classes and subclasses.

Further clinically relevant information includes if the gene is typically chromosomal or transferable through plasmids as well as listing the antibiotics which the most closely related reference sequences are known to target and cause resistance against. This web server can automatically build three phylogenetic trees: We show that the latter is better suited to recover antibiotic substrate assignments through nearest neighbor annotation transfer.

The users can also choose to build a structural model for the query sequence and view the binding pocket residues of their query relative to other beta lactamases in the sequence alignment as well as in the 3D structure relative to bound antibiotics.

This web server is freely available at http: Gap junction channels GJCs and hemichannels HCs are composed of protein subunits termed connexins Cxs and are permeable to ions and small molecules. In most organs, GJCs communicate the cytoplasm of adjacent cells, while HCs communicate the intra and extracellular compartments. In this way, both channel types coordinate physiological responses of cell communities. However, the possible involvement of Cxs in the etiology of acquired hearing loss remains virtually unknown.

Factors that induce post-lingual hearing loss are diverse, exposure to gentamicin an aminoglycoside antibiotic , being the most common. In this work, the effect of gentamicin on the functional state of HCs was studied and its effect on GJCs was reevaluated in HeLa cells stably transfected with Cxs. We focused on Cx26 because it is the main Cx expressed in the cochlea of mammals where it participates in purinergic signaling pathways. We found that gentamicin applied extracellularly reduces the activity of HCs, while dye transfer across GJCs was not affected.

HCs were also blocked by streptomycin, another aminoglycoside antibiotic. Moreover, gentamicin drastically reduced the Cx26 HC-mediated membrane currents in Xenopus laevis oocytes. Therefore, the extracellular gentamicin -induced inhibition of Cx HCs may adversely affect autocrine and paracrine signaling, including the purinergic one, which might partially explain its ototoxic effects.

Exacerbation of iminodipropionitrile-induced behavioral toxicity, oxidative stress, and vestibular hair cell degeneration by gentamicin in rats. This study describes the effect of gentamicin , an aminoglycoside antibiotic on iminodipropionitrile IDPN -induced abnormal neurobehavioral syndrome in female Sprague-Dawley rats. The intensity of IDPN induced characteristic excitation with choreiform, and the circling movement ECC syndrome was examined using an observational test battery including dyskinetic head movements, circling, tail hanging, air righting reflex, and contact inhibition of the righting reflex on days 6, 8, 10, 12, 19, 26, and The animals for histopathological observation were sacrificed on day 10, whereas the remaining animals that were used for long-term behavioral studies were sacrificed on day 35 for biochemical observations.

The blood and brain samples were collected for the analysis of blood urea nitrogen BUN , serum creatinine, cerebral malondialdehyde MDA , conjugated dienes, and lipid hydroperoxides, whereas temporal bones were collected for inner ear histopathology.

Our results showed that gentamicin significantly and dose dependently exacerbated the incidence and the severity of the IDPN-induced behavioral syndrome. The histopathology of the inner ear demonstrated more severe loss of sensory hair cells in the crista ampullaris of the rats treated with IDPN plus gentamicin compared to the IDPN-alone treated animals.

Concomitant treatment with gentamicin also potentiated IDPN-induced increase in free radical indices, suggesting a possible role of oxidative stress in gentamicin -induced aggravation of IDPN toxicity. Further studies are warranted to determine the role of aminoglycosides in nitrile toxicity and drug-induced movement.

A gentamicin -releasing coating for cementless hip prostheses-Longitudinal evaluation of efficacy using in vitro bio-optical imaging and its wide-spectrum antibacterial efficacy. Cementless prostheses are increasingly popular in total hip arthroplasties.

Therewith, common prophylactic measures to reduce the risk of postoperative infection like the use of antibiotic -loaded bone cements, will no longer be available. Alternative prophylactic measures may include the use of antibiotic -releasing coatings. Previously, we developed a gentamicin -releasing coating for cementless titanium hip prostheses and derived an appropriate dosing of this coating by adjusting the amount of gentamicin in the coating to match the antibacterial efficacy of clinically employed gentamicin -loaded bone cement.

In this manuscript, we investigated two important issues regarding the prophylactic use of this 1 mg cm -2 bioactive gentamicin -releasing coating in cementless total hip arthroplasty: A geometrically relevant set-up was developed in which miniature titanium stems were surrounded by agar, contaminated with bioluminescent Staphylococcus aureus.

Novel, bio-optical imaging was performed allowing noninvasive, longitudinal monitoring of staphylococcal growth around miniature stems with and without the gentamicin -releasing coating. Furthermore, the antibacterial efficacy of the gentamicin -releasing coating was determined against a wide variety of clinical isolates, including bioluminescent Staphylococcus aureus strains, using traditional zone of inhibition measurements.

The gentamicin -releasing coating demonstrated a wide-spectrum of antibacterial efficacy and successfully prevented growth of bioluminescent staphylococci around a miniature stem mounted in bacterially contaminated agar for at least 60 h. This implies that the gentamicin -releasing coating has potential to contribute to the improvement of infection prophylaxis in cementless total hip arthroplasty. Synthesis and Molecular Modelling Studies. Antibiotic resistance has been the subject of interest in clinical practice due to high prevalence of antibiotic -resistant pathogenic organisms.

In view of the prevalence of lesser resistance in antibiotics belonging to aminoglycoside class of compounds viz. Food and Drug Administration-approved gentamicin for the treatment of Staphylococcus infections, which also has instances of resistance in the clinical isolates of Staphylococcus aureus, a series of novel glycoconjugates of 8-fluoro norfloxacin analogues with high regio-selectivity by employing copper I -catalyzed 1, 3-dipolar cycloaddition of 1-O-propargyl monosaccharides has been synthesized and evaluated for the antibacterial activity against gentamicin resistance Staphylococcus aureus.

The docking studies suggest DNA gyrase of Staphylococcus aureus as a probable target for the antibacterial action of compound 10g. Single-dose parenteral antibiotic prophylaxis in gastrointestinal surgery. In the course of two consecutive, double-blind and prospective studies, the authors evaluated the prophylactic effect of a single peroperative intravenous dose of gentamicin this study included patients or the combination gentamicin and clindamycin this study included patients , on the wound infection rate following interventions involving the incision of an abdominal hollow viscus.

Antibiotic prophylaxis lowered the post-operative wound sepsis rate, especially following clinically contaminated interventions, but this reduction did not reach statistical significance. It is concluded that a single peroperative parenteral dose of antibiotics does not constitute an entirely satisfactory means of wound infection prophylaxis in digestive surgery. Flavocoxid attenuates gentamicin -induced nephrotoxicity in rats. Gentamicin is a widely used antibiotic against serious and life-threatening infections; however, its usefulness is limited by the development of nephrotoxicity.

The present study was designed to determine whether flavocoxid has a protective effect against gentamicin -induced nephrotoxicity in rats. For this purpose, we quantitatively evaluated gentamicin -induced renal structural and functional alterations using histopathological and biochemical approaches.

Furthermore, the effect of flavocoxid on gentamicin induced hypersensitivity of urinary bladder rings to acetylcholine ACh was determined. At the end of the study, all rats were sacrificed and then blood, urine samples and kidneys were collected for further analysis.

Gentamicin administration caused a severe nephrotoxicity which was evidenced by an elevated renal somatic index RSI , serum creatinine, blood urea nitrogen, serum lactate dehydrogenase, and protein in urine with a concomitant reduction in serum albumin and normalized creatinine clearance value as compared with the controls.

Moreover, a significant increase in renal contents of malondialdehyde, myeloperoxidase, and tumor necrosis factor-alpha with a significant decrease in renal reduced glutathione and superoxide dismutase activities was detected upon gentamicin administration together with increasing the sensitivity of isolated urinary bladder rings to ACh.

Exposure to gentamicin induced necrosis of renal tubular epithelial cells. Flavocoxid protected kidney tissue against the oxidative damage and the nephrotoxic effect caused by gentamicin treatment. In addition, flavocoxid significantly reduced the responses of isolated bladder rings to ACh. The results from our study indicate that flavocoxid supplement attenuates gentamicin -induced renal injury via the amelioration of. The reasons why aminoglycosides are bactericidal have not been not fully elucidated, and evidence indicates that the cidal effects are at least partly dependent on iron.

We demonstrate that availability of iron markedly affects the susceptibility of the facultative intracellular bacterium Francisella tularensis strain SCHU S4 to the aminoglycoside gentamicin. Specifically, the intracellular depots of iron were inversely correlated to gentamicin susceptibility, whereas the extracellular iron concentrations were directly correlated to the susceptibility. Based on the aforementioned findings, it was hypothesized that gallium could potentiate the effect of gentamicin , since gallium is sequestered by iron uptake systems.

Moreover, treatment of F. Collectively, the data demonstrate that SCHU S4 is dependent on iron to minimize the effects of gentamicin and that gallium, by inhibiting the iron uptake, potentiates the bactericidal effect of gentamicin in vitro and in vivo. Antibiotics do not fight infections caused by viruses, such as Colds Flu Most coughs and bronchitis Sore throats, unless caused by strep If a virus is making you sick, taking antibiotics may do Vapour-phase activities of essential oils against antibiotic sensitive and resistant bacteria including MRSA.

To determine whether essential oil EO vapours could reduce surface and airborne levels of bacteria including methicillin-resistant Staphylococcus aureus MRSA. The antibacterial activity of geranium and lemongrass EO individually and blended were evaluated over a range of concentrations by direct contact and vapour diffusion. An EO blend containing lemongrass and geranium was used to formulate BioScent that was dispersed into the environment using the ST Pro machine.

The effects were variable depending on the methods used. EO vapours inhibited growth of antibiotic -sensitive and -resistant bacteria in vitro and reduced surface and airborne levels of bacteria. Results suggest that EO vapours, particularly Bioscent, could be used as a method of air disinfection. Background Drug regulatory agencies DRA support prescription of generic products of intravenous antibiotics assuming therapeutic equivalence from pharmaceutical equivalence.

Recent reports of deaths associated with generic heparin and metoprolol have raised concerns about the efficacy and safety of DRA-approved drugs. Although the design lacked power to detect differences in survival after thigh infection with P. Conclusion Pharmaceutical equivalence does not predict therapeutic equivalence of generic gentamicin.

Stricter criteria based on solid experimental evidence should be required before approval for human use. Gentamicin coating of metallic implants reduces implant-related osteomyelitis in rats. Antibiotic prophylaxis is a routine procedure in orthopedic surgery. Various local antibiotic delivery techniques are used to reduce bone- and soft tissue-related infection. The objective of this study was to evaluate the efficacy of a new biodegradable, gentamicin -loaded poly D,L-lactide PDLLA coating of orthopedic devices in preventing implant-related osteomyelitis.

The medullary cavities of tibiae in 30 Sprague Dawley rats were contaminated with Staphylococcus aureus 10 3 colony forming units. Ten animals that received phosphate-buffered saline and uncoated Kirschner wires served as controls group I. Follow-up was 6 weeks. In weekly intervals X-rays of the tibiae were performed, blood counts were taken, and body temperature and weight were determined.

After sacrifice infection was evaluated by histological and microbiological analysis. All animals of groups II and III developed microbiological, histological, and radiological signs of infection, including osseous destruction and soft tissue swelling. All animals of the control group remained sterile. Cultures of implants of group IV showed significantly reduced bacterial growth compared to cultures of groups II and III, and three implants of group IV remained sterile.

Further radiological and histological signs of infection were significantly reduced in the gentamicin -coated group compared to groups II and III. No significant differences in body weight, body temperature, and blood parameters between all groups were observed.

Combination therapy including serratiopeptidase improves outcomes of mechanical- antibiotic treatment of periimplantitis. This study was designed as a retrospective analysis of clinical outcomes of cases of periimplantitis treated by mechanical debridement and the administration of antibiotics combined or not with the administration of either the proteolytic enzyme serratiopeptidase SPEP or non-steroidal anti-inflammatory drugs NSAIDs.

Clinical charts of partially edentulous patients treated for periimplantitis between June and December were analyzed to obtain clinical data of the affected implants just before the beginning of treatment and 12 months later to evaluate the outcomes of combined mechanical antibiotic treatment alone or in combination with the co-administration of the anti-inflammatory SPEP or NSAIDs. The comparative analysis revealed that therapeutic outcomes were significantly different in the three groups.

Treatment including SPEP was associated with significantly better healing also when successful treatments alone were considered. The data reported in this paper strongly support the hypothesis that SPEP is a valid addition to protocols for the combined therapy of peri-implantitis.

In fact, it allows to enhance success rates significantly and also favors better tissue repair around successfully treated implants as compared to other regimens. Antibiotics disrupt the normal gut flora, sometimes causing antibiotic -associated diarrhoea AAD. Little is known either about the frequency or type of antibiotics prescribed in care homes or about the incidence and aetiology of AAD in this setting. PAAD stage 1 aimed to 1 prospectively describe antibiotic prescribing in care homes; 2 determine the incidence of C.

However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2. SETTING Recruited care homes had management and owner's agreement to participate and three or more staff willing to take responsibility for implementing the study.

Phage therapy of staphylococcal infections including MRSA may be less expensive than antibiotic treatment. The current drama of antibiotic resistance has revived interest in phage therapy.

In response to this challenge, a phage therapy center was established at our Institute in which accepts patients from Poland and abroad with antibiotic -resistant infections.

We now present data showing that efficient phage therapy of staphylococcal infections is no longer a treatment of last resort when all antibiotics fail , but allows for significant savings in the costs of healthcare.

Neonatal listeriosis is an exceptional disease in Northern Africa. Hence, protocols for maternal-fetal infection treatment include only a third generation cephalosporin and an aminoside. This protocol does not take into account the possibility of Listeria monocytogenes infection. We report a fatal case of neonatal listeriosis in Tunisia. The use of first antibiotics in maternal-foetal infection must be reconsidered when lacking sufficient bacteriological data and include systematically ampicillin in presumptive antibiotic protocols.

A biodegradable gentamicin -hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses.

Cheetahs

We conclude that the antibiotic did not significantly alter the development of C. The uptake of radiocalcium 45Ca into the isolated media-intimal layer of rabbit aortae was decreased in a maintained manner by each antibiotic. With gentamicin , the inhibitory effect on 45Ca uptake was shown to be dependent upon the concentration of gentamicin employed and to be more evident in a 0.

In addition, the rate of 45Ca efflux from the rabbit aortic media-intimal layer was increased in a sustained manner by gentamicin , streptomycin, and kanamycin. These in vitro findings may partially explain the occurrence of in vivo cardiovascular depression that has occasionally been observed after the administration of chemically related antimicrobial agents.

Relevance of Concomitant Systemic Antibiotic Therapy. Oral gentamicin , 80 mg four times daily, was administered to 50 consecutive patients with gut colonization by gentamicin -susceptible KPC-Kp in cases of planned surgery, major medical intervention, or need for patient transfer. No difference in overall death rate between different groups was documented.

Oral gentamicin was shown to be potentially useful for gut decontamination and prevention of infection due to KPC-Kp, especially in patients not receiving CSAT. The risk of emergence of gentamicin -resistant KPC-Kp should be considered.

Level 1 trauma center. Electronic medical record review revealed patients with type 3 open fractures, of which 72 were included in the final analysis. SSI, nonunion, death, and rehospitalization rates at 1 year. Surgical site infection at 1 year occurred in 12 of 37 patients Nonunion, death, and rehospitalization rates at 1 year were similar between the 2 groups.

Although there was no statistically significant difference in SSI at 30 days between groups, the rate was higher in the cefazolin plus gentamicin group See Instructions for Authors for a complete description of levels of evidence. Controlled release of an antibiotic , gentamicin sulphate, from gravity spun polycaprolactone fibers.

The antibiotic , gentamicin sulphate GS , was incorporated in gravity-spun polycaprolactone PCL fibers by spinning from particulate suspensions of the drug in PCL solution to produce a controlled delivery system. The kinetics of drug release could be adjusted by varying the GS loading of the fibers and the suspension preparation conditions. Studies of growth inhibition of Stapyhlococcus epidermidis in culture indicated that GS released after 2 weeks from PCL fibers retained antibacterial activity.

This behavior recommends further investigation of PCL fibers for local delivery of antibiotics to combat infection associated with periodontal disease, musculoskeletal injuries, and implantation of fiber-based tissue substitutes such as vascular prostheses.

J Biomed Mater Res, Biodegradation of gentamicin by bacterial consortia AMQD4 in synthetic medium and raw gentamicin sewage. Gentamicin , a broad spectrum antibiotic of the aminoglycoside class, is widely used for disease prevention of human beings as well as animals. Nowadays the environmental issue caused by the disposal of wastes containing gentamicin attracts increasing attention. In this study, a gentamicin degrading bacterial consortia named AMQD4, including Providencia vermicola, Brevundimonas diminuta, Alcaligenes sp.

The component and structure of gentamicin have a great influence on its degradation and gentamicin C1a and gentamicin C2a were more prone to being degraded. AMQD4 could maintain relatively high gentamicin removal efficiency under a wide range of pH, especially in an alkaline condition. In addition, AMQD4 could remove It was speculated that aac3iia was the gentamicin degradation gene and the main degradation product was 3'-acetylgentamicin.

Our results suggest that AMQD4 and Brevundimonas diminuta BZC3 could be important candidates to the list of superior microbes for bioremediation of antibiotic pollution. Biofilms that develop on indwelling devices are a major concern in clinical settings. While removal of colonized devices remains the most frequent strategy for avoiding device-related complications, antibiotic lock therapy constitutes an adjunct therapy for catheter-related infection.

However, currently used antibiotic lock solutions are not fully effective against biofilms, thus warranting a search for new antibiotic locks. To assess the ability of such chelators to eradicate mature biofilms, we used an in vivo model of a totally implantable venous access port inserted in rats and colonized by either Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, or Pseudomonas aeruginosa.

Gentamicin -EDTA lock was able to eliminate biofilms with a single instillation, thus reducing length of treatment. Moreover, we show that this combination was effective for immunosuppressed rats. Lastly, we demonstrate that a gentamicin -EDTA lock is able to eradicate the biofilm formed by a gentamicin -resistant strain of methicillin-resistant S. This in vivo study demonstrates the potential of EDTA as an efficient antibiotic adjuvant to eradicate catheter-associated biofilms of major bacterial pathogens and thus provides a promising new lock solution.

Borate bioactive glass-based composites have been attracting interest recently as an osteoconductive carrier material for local antibiotic delivery. In the present study, composites composed of borate bioactive glass particles bonded with a chitosan matrix were prepared and evaluated in vitro as a carrier for gentamicin sulfate. The cytocompatibility of the gentamicin sulfate-loaded composite carrier was evaluated using assays of cell proliferation and alkaline phosphatase activity of osteogenic MC3T3-E1 cells.

These results indicate that the gentamicin sulfate-loaded composite composed of chitosan-bonded borate bioactive glass particles could be useful clinically as an osteoconductive carrier material for treating bone infection. An experimental design approach to the preparation of pegylated polylactide-co-glicolide gentamicin loaded microparticles for local antibiotic delivery. The present paper takes into account the DOE application to the preparation process of biodegradable microspheres for osteomyelitis local therapy.

The results of in vitro gentamicin release study show prolonged gentamicin release up to three months from the microspheres prepared with salt addition in the dispersing phase; the behavior being consistent with their highly compact structure highlighted by scanning electron microscopy analysis.

The collected results confirm the feasibility of the scale up of microsphere manufacturing process and the high potential of the microparticulate drug delivery system to be used for the local antibiotic delivery to bone.

Synergistic antibacterial effect of Bi2S3 nanospheres combined with ineffective antibiotic gentamicin against methicillin-resistant Staphylococcus aureus. In this paper, Bi2S3 nanospheres with size of nm were prepared by a simple hydrothermal process.

Raman spectroscopy and Z potential studies reveal that Bi2S3 could interact with GEN and the combination showed small electronegativity, which probably induced the increase of GEN content in cytoplasm of bacteria. Furthermore, the combination of Bi2S3 nanospheres and GEN can destroy the bacterial membrane function and induce more bactericidal reactive oxygen generation than that of Bi2S3 or GEN alone.

The cytotoxicity test indicates that the combination of Bi2S3 and GEN presented low toxicity to human normal hepatocyte L Gentamicin in the Clinical Setting.

Gentamicin is an aminoglycoside antibiotic that has been a mainstay in pediatric care for decades. Although new antibiotics are constantly under development, gentamicin continues to play an important role in clinical medicine.

Although this may be surprising in the context of evidence of an association with hearing loss, both on a toxicity and a…. These lipospheres were characterized by evaluating on encapsulation efficiency, loading capacity, change in pH and the release profile. Antimicrobial activities were evaluated against Escherichia coli, Pseudomonas aeruginosa, Salmonella paratyphii and Staphylococcus aureus using the agar diffusion method. Results Photomicrographs revealed spherical particles within a micrometer range with minimal growth after 1 month.

The encapsulation and loading capacity were all high, indicating the ability of the lipids to take up the drug. The antimicrobial activities were very high especially against Pseudomonas compare to other test organisms. This strongly suggested that the formulation retain its bioactive characteristics. Conclusions This study strongly suggest that the issue of gentamicin stability and poor absorption in oral formulation could be adequately addressed by tactical engineering of lipid drug delivery systems such as lipospheres.

Aged garlic extract, garlic powder extract, S-allylcysteine, diallyl sulfide and diallyl disulfide do not interfere with the antibiotic activity of gentamicin. It was shown that aged garlic extract AGE , garlic powder and the following garlic-derived compounds: However, it was not established if the above mentioned extracts and compounds of garlic could interfere with the antibiotic action of GM. Effect of Taurine on the antimicrobial efficiency of Gentamicin. Gentamicin is mainly used in severe infections caused by gram-negatives.

However toxicity including nephrotoxicity and ototoxicity is one of the most important complications of its treatment. The production of free radicals seems to be involved in gentamicin toxicity mechanism. So potentially the co-therapy of taurine and gentamicin would reduce the adverse effects of the antibiotic. In this study, we wished to know the effect of taurine on the antibiotic capacity of gentamicin. MICs were determined in the various concentrations of taurine for bacterial indicators.

The MIC values of gentamicin for P. The bactericidal activity of gentamicin against S. According to our study the antibacterial activity of gentamicin against the indicator microorganisms were not interfere with taurine at selected concentrations. Further in vivo studies are needed to establish if a combination of gentamicin and taurine would have the same effect.

Previous investigations have shown that liquid bacterial cultures grown in space flight were not killed as effectively by antibiotic treatments as were cultures grown on Earth. However, the cause for the decreased antibiotic effectiveness remains unknown.

Possible explanations include modified cell proliferation and modified antibiotic transport in the culture medium. Escherichia coli cultures were grown in space flight STS and STS , with and without gentamicin , on a solid agar substrate thus eliminating fluid effects and reducing the unknowns associated with space-flight bacterial cultures in suspension.

This research showed that E. However, addition of gentamicin to the agar killed the bacteria such that both flight and ground control E. Therefore, while the reported existence of a decrease in antibiotic effectiveness in liquid cultures remains unexplained, these data suggest that gentamicin in space flight was at least as effective as, if not more effective than, on Earth, when E.

Comparative study of the effects of gentamicin , neomycin, streptomycin and ofloxacin antibiotics on sperm parameters and testis apoptosis in rats. The aim of this study was to investigate the comparative effects of aminoglycosides and fluoroquinolones on testis apoptosis and sperm parameters in rats. The experimental groups subdivided into four groups often. Each received 5 mg kg -1 IP gentamicin , 50 mg kg -1 IP neomycin, 40 mg kg -1 IP streptomycin and 72 mg kg -1 IP ofloxacin daily for 14 days, respectively; however, the control group just received vehicle IP.

In the fourteenth day, rats were killed and sperm analyzed for sperm parameters. There was a significant decrease in sperm count, viability and motility in all of experimental groups when compared with control group. Although in streptomycin group these parameters were less decreased than in the other experimental groups. The apoptotic cells were significantly increased in all experimental groups when compared with those seen in the controlled group.

Gentamicin , neomycin and streptomycin and ofloxacin have negative effects on sperm parameters and testis apoptosis in rats. However, these side effects are less seen in the streptomycin group. Therefore, it is recommended that usage of this drug have fewer side effects on male fertility.

A covalent method of gentamicin bonding to silica supports. Results of a novel method of covalent bonding of an antibiotic gentamicin to silica bead supports are shown. Gentamicin was immobilized to four types of matrix: Gentamicin was immobilized to the supports after opening its carbohydrate ring in the molecule.

This method of gentamicin activation before the immobilization process did not inhibit its antibiotic activity. The four gentamicin -containing immobilized preparations were stable, meaning that they did not release the antibiotic into the solution during the 30 days of incubation, not even during shaking experiments. Antibacterial efficacy of a new gentamicin -coating for cementless prostheses compared to gentamicin -loaded bone cement. Cementless prostheses are increasingly popular but require alternative prophylactic measures than the use of antibiotic -loaded bone cements.

Here, we determine the h growth inhibition of gentamicin -releasing coatings from grit-blasted and porous-coated titanium alloys, and compare their antibacterial efficacies and gentamicin release-profiles to those of a commercially available gentamicin -loaded bone cement. Antibacterial efficacy increased with increasing doses of gentamicin in the coating and loading with 1. The coating had a higher burst release than bone cement, and also inhibited growth of gentamicin -resistant strains.

Antibacterial efficacy of the gentamicin coatings disappeared after 4 days, while gentamicin -loaded bone cement exhibited efficacy over at least 7 days. Shut-down after 4 days of gentamicin -release from coatings is advantageous over the low-dosage tail-release from bone cements, as it minimizing risk of inducing antibiotic -resistant strains.

Both gentamicin -loaded cement discs and gentamicin -coated titanium coupons were able to kill gentamicin -sensitive and -resistant bacteria in a simulated prothesis-related interfacial gap.

In conclusion, the gentamicin coating provided similar antibacterial properties to those seen by gentamicin -loaded bone cement, implying protection of a prosthesis from being colonized by peri-operatively introduced bacteria in cementless total joint arthroplasty. An In vitro Study.

Elderly patients and those with comorbidities are at increased risk. On the basis of previous studies focusing on neonatal infections, penicillin plus gentamicin is recommended for infective endocarditis IE and periprosthetic joint infections PJI in adults.

We used 5 GBS isolates, two clinical strains and three control strains, including one displaying high-level gentamicin resistance HLGR. The results from the checkerboard and time-kill assays TKAs were compared. For TKAs, antibiotic concentrations for penicillin were 0.

In the checkerboard assay, the median fractional inhibitory concentration indices FICIs of all isolates indicated indifference. TKAs for all isolates failed to demonstrate synergism with penicillin 0. Rapid killing was seen with penicillin 0. TKAs with penicillin 0. Fast killing was seen with penicillin 0. Our in vitro results indicate that the addition of gentamicin to penicillin contributes to faster killing at low penicillin concentrations, but only within the first few hours.

Twenty-four hours after antibiotic exposure, PEN alone was bactericidal and synergism was not seen. Once daily ceftriaxone and gentamicin for the treatment of febrile neutropenia. AIMS—To evaluate the pharmacokinetics of once daily OD gentamicin and its effectiveness as part of an OD regimen for the empirical treatment of febrile neutropenia in children with cancer. The patients were assessed after 48hours. In 29 episodes, blood cultures identified a causative bacterial pathogen; for 17 of these, the first line antibiotic regimen was adequate; in four episodes, although the episode settled, ceftriaxone was replaced by a more appropriate antibiotic and OD gentamicin was continued; in the remaining eight episodes, a glycopeptide antibiotic was deemed necessary.

There was no failure of treatment in organisms sensitive to gentamicin , including Pseudomonas aeruginosa. Gentamicin concentrations were measured in episodes and they were all below the 24 hour line indicating that there was no need to change the dosing interval. Although there was no vestibular toxicity, three of 30 children who underwent pure tone audiometry reported high frequency hearing loss in one ear.

When used for a short period Surgical prophylaxis with gentamicin and acute kidney injury: There are limited data regarding nephrotoxicity related to gentamicin in these patients. Methods We have conducted a systematic review and meta-analysis to evaluate the risk of acute kidney injury AKI in gentamicin -containing surgical prophylactic regimens, compared to regimens without gentamicin , in several types of surgery. Statistical analysis was then performed using a random-effect model; risk ratios RR , risk differences RD and heterogeneity I2 were calculated.

Funnel plot was used for assessment of publication bias. Results Eleven studies with fifteen cohorts with 18, patients were included in the analysis. Subgroup analysis was performed according to surgery type. We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery RR 2. The results were inconclusive in other types of surgery.

Funnel plot indicates potential publication bias. Conclusions Gentamicin -induced AKI is significant in patients undergoing orthopedic surgery. Physicians should consider risks and benefits of using this regimen in individual patients.

Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: WHO recommends hospital-based treatment for young infants aged days with clinical signs of possible serious bacterial infection, but most families in resource-poor settings cannot accept referral. We aimed to assess whether use of simplified antibiotic regimens to treat young infants with clinical signs of severe infection was as efficacious as an injectable procaine benzylpenicillin- gentamicin combination for 7 days for situations in which hospital referral was not possible.

In a multisite open-label equivalence trial in DR Congo, Kenya, and Nigeria, community health workers visited all newborn babies at home, identifying and referring unwell young infants to a study nurse. We stratified young infants with clinical signs of severe infection whose parents did not accept referral to hospital by age days and days , and randomly assigned each individual within these strata to receive one of the four treatment regimens.

Randomisation was stratified by age group of infants. An age-stratified randomisation scheme with block size of eight was computer-generated off-site at WHO.

The outcome assessor was masked. We randomly allocated infants to receive injectable procaine benzylpenicillin- gentamicin for 7 days group A, reference group ; injectable gentamicin and oral amoxicillin for 7 days group B ; injectable procaine benzylpenicillin- gentamicin for 2 days, then oral amoxicillin for 5 days group C ; or injectable gentamicin for 2 days and oral amoxicillin for 7 days group D.

Trained health professionals gave daily injections and the first dose of oral amoxicillin. Our primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event including death , no improvement by day 4, or not cured by day 8.

Independent outcome assessors, who did not know the infant's treatment regimen, assessed study outcomes on days 4, 8, 11, and Primary analysis was per protocol. We used a prespecified. Effect of protamine on the accumulation of gentamicin in opossum kidney epithelial cells. The purpose of this study was to examine whether or not protamine, an arginine-rich basic protein mixture, inhibits the accumulation of gentamicin , a nephrotoxic drug, in cultured opossum kidney OK epithelial cells.

The effect of protamine from salmon on accumulation and binding of [ 3 H] gentamicin was investigated in OK cells. Protamine inhibited the binding and accumulation of [ 3 H] gentamicin in a concentration-dependent manner. Our results indicate that protamine decreases the accumulation of gentamicin in OK cells.

These findings suggest that protamine or its derivatives might be useful in preventing the nephrotoxicity of aminoglycoside antibiotics including gentamicin. Additive effect of Lygodium venustum SW. The aim of this work was to evaluate the interactions between gentamicin and the ethanol extract of the fern Lygodium venustum SW EELV. The ethanol extract of L. The antibiotic activity of gentamicin , when associated with the extract, was enhanced in an additive manner against both strains.

The results indicated that L. Assessment of nutrient supplement to reduce gentamicin -induced ototoxicity. Gentamicin is an aminoglycoside antibiotic used to treat gram-negative bacterial infections. Treatment with this antibiotic carries the potential for adverse side effects, including ototoxicity and nephrotoxicity. Ototoxic effects are at least in part a consequence of oxidative stress, and various antioxidants have been used to attenuate gentamicin -induced hair cell death and hearing loss.

Here, a combination of nutrients previously shown to reduce oxidative stress in the hair cells and attenuate hearing loss after other insults was evaluated for potential protection against gentamicin -induced ototoxicity. Three diets with iterative increases in nutrient levels were screened; the final diet selected for study use was one that produced statistically reliable increases in plasma levels of vitamins C and E and magnesium.

In two separate studies, significant decreases in gentamicin -induced hearing loss at frequencies including 12 kHz and below were observed, with less benefit at the higher frequencies. Consistent with the functional protection, robust protection of both the inner and outer hair cell populations was observed, with protection largely in the upper half of the cochlea. Protection was independently assessed in two different laboratories, using two different strains of guinea pigs.

Additional in vitro tests did not reveal any decrease in antimicrobial activity with nutrient additives. Currently, there are no FDA-approved treatments for the prevention of gentamicin -induced ototoxicity. The current data provide a rationale for continued investigations regarding translation to human patients. Use of topical antibiotics to improve perineal wound healing after abdominoperineal resection APR is controversial.

The aim of this systematic review was to determine the impact of local application of gentamicin on perineal wound healing after APR. Perineal wound outcome was categorized as infectious complications, non-infectious complications, and primary perineal wound healing. From a total of articles, eight studies published between and were included: There was substantial heterogeneity regarding underlying disease, definition of outcome parameters and timing of perineal wound evaluation among the included studies, which precluded meta-analysis with pooling.

Regarding infectious complications, three of six evaluable studies demonstrated a positive effect of local application of gentamicin: Only two RCTs reported on non-infectious complications, showing no significant impact of gentamicin sponge. All three comparative cohort studies demonstrated a significantly higher percentage of primary perineal wound healing after local application of gentamicin beads, but only one out of three evaluable RCTs did show a positive effect of gentamicin sponges.

Currently available evidence does not support perineal gentamicin application after APR. The formulation and characterization of gentamicin -loaded microspheres as a delivery system targeting enterotoxigenic Escherichia coli K88 E.

The proposed target strategy was that exposed galactoses of MS-Lac could be specifically recognized by E. Lactosylated microspheres MS-Lac1, MS-Lac2 and MS-Lac3 were obtained using a water-in-oil emulsion, containing gentamicin , followed by crosslinking with different concentrations of glutaraldehyde. In vitro release of gentamicin from MS-Lac was best fitted to a first order model, and the antibacterial activity of encapsulated and free gentamicin was comparable.

MS-Lac treatments were recognized by plant galactose-specific lectins from Ricinus communis and Sophora japonica and by E. Results indicate MS-Lac1, produced with 4. Synergy between penicillin and gentamicin against enterococci. The role of active uptake in aminoglycoside activity against penicillin-treated enterococci was studied by viable counts and ATP determinations. Penicillin and gentamicin gave synergistic bactericidal and post- antibiotic effects PAEs which were partially reduced by sodium azide, an electron transport inhibitor, and totally blocked in the presence of both sodium azide and EDTA, which chelates divalent cations.

This synergy was completely inhibited by sodium azide. The data indicate that the activity of gentamicin against enterococci that have been damaged by penicillin or EDTA is energy-dependent.

This is consistent with present theories of gentamicin uptake via transportation drive by a protonmotive force. Urinary tract infections in hospital pediatrics: We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population. We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals.

Prior antibiotic exposure was documented from their health record. One hundred and ten patients 73 girls , 11 days to 12 years of age, were included in 10 months. The antibiotic resistance rate of E.

Bacterial species and antibiotic resistance level in children are similar to those reported for adults. Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved previous antibiotic therapies and fecal-oral or mother-to-child transmission.

The antipseudomonal property of honey and gentamicin. Pseudomonas aeruginosa has a notorious characteristic of resistance to most antimicrobial compounds. This characteristic was subjected to verification in the present study, whereby 50 human isolates of the organism from different pathological sources were subjected to sensitivity tests against honey from three different sources by the agar-cup diffusion method. Gentamicin , an aminoglycoside antibiotic normally with activity against Gram-negative bacteria, was used alongside honey.

The 50 isolates of P. Honey is suggested as an effective natural product in overcoming the widespread antibiotic resistance of P. Automatic phylogenetic classification of bacterial beta-lactamase sequences including structural and antibiotic substrate preference information. Beta lactams comprise the largest and still most effective group of antibiotics , but bacteria can gain resistance through different beta lactamases that can degrade these antibiotics.

We developed a user friendly tree building web server that allows users to assign beta lactamase sequences to their respective molecular classes and subclasses. Further clinically relevant information includes if the gene is typically chromosomal or transferable through plasmids as well as listing the antibiotics which the most closely related reference sequences are known to target and cause resistance against.

This web server can automatically build three phylogenetic trees: We show that the latter is better suited to recover antibiotic substrate assignments through nearest neighbor annotation transfer. The users can also choose to build a structural model for the query sequence and view the binding pocket residues of their query relative to other beta lactamases in the sequence alignment as well as in the 3D structure relative to bound antibiotics.

This web server is freely available at http: Gap junction channels GJCs and hemichannels HCs are composed of protein subunits termed connexins Cxs and are permeable to ions and small molecules. In most organs, GJCs communicate the cytoplasm of adjacent cells, while HCs communicate the intra and extracellular compartments. In this way, both channel types coordinate physiological responses of cell communities.

However, the possible involvement of Cxs in the etiology of acquired hearing loss remains virtually unknown. Factors that induce post-lingual hearing loss are diverse, exposure to gentamicin an aminoglycoside antibiotic , being the most common.

In this work, the effect of gentamicin on the functional state of HCs was studied and its effect on GJCs was reevaluated in HeLa cells stably transfected with Cxs. We focused on Cx26 because it is the main Cx expressed in the cochlea of mammals where it participates in purinergic signaling pathways.

We found that gentamicin applied extracellularly reduces the activity of HCs, while dye transfer across GJCs was not affected. HCs were also blocked by streptomycin, another aminoglycoside antibiotic. Moreover, gentamicin drastically reduced the Cx26 HC-mediated membrane currents in Xenopus laevis oocytes.

Therefore, the extracellular gentamicin -induced inhibition of Cx HCs may adversely affect autocrine and paracrine signaling, including the purinergic one, which might partially explain its ototoxic effects.

Exacerbation of iminodipropionitrile-induced behavioral toxicity, oxidative stress, and vestibular hair cell degeneration by gentamicin in rats. This study describes the effect of gentamicin , an aminoglycoside antibiotic on iminodipropionitrile IDPN -induced abnormal neurobehavioral syndrome in female Sprague-Dawley rats.

The intensity of IDPN induced characteristic excitation with choreiform, and the circling movement ECC syndrome was examined using an observational test battery including dyskinetic head movements, circling, tail hanging, air righting reflex, and contact inhibition of the righting reflex on days 6, 8, 10, 12, 19, 26, and The animals for histopathological observation were sacrificed on day 10, whereas the remaining animals that were used for long-term behavioral studies were sacrificed on day 35 for biochemical observations.

The blood and brain samples were collected for the analysis of blood urea nitrogen BUN , serum creatinine, cerebral malondialdehyde MDA , conjugated dienes, and lipid hydroperoxides, whereas temporal bones were collected for inner ear histopathology.

Our results showed that gentamicin significantly and dose dependently exacerbated the incidence and the severity of the IDPN-induced behavioral syndrome. The histopathology of the inner ear demonstrated more severe loss of sensory hair cells in the crista ampullaris of the rats treated with IDPN plus gentamicin compared to the IDPN-alone treated animals.

Concomitant treatment with gentamicin also potentiated IDPN-induced increase in free radical indices, suggesting a possible role of oxidative stress in gentamicin -induced aggravation of IDPN toxicity. Further studies are warranted to determine the role of aminoglycosides in nitrile toxicity and drug-induced movement. A gentamicin -releasing coating for cementless hip prostheses-Longitudinal evaluation of efficacy using in vitro bio-optical imaging and its wide-spectrum antibacterial efficacy.

Cementless prostheses are increasingly popular in total hip arthroplasties. Therewith, common prophylactic measures to reduce the risk of postoperative infection like the use of antibiotic -loaded bone cements, will no longer be available. Alternative prophylactic measures may include the use of antibiotic -releasing coatings. Previously, we developed a gentamicin -releasing coating for cementless titanium hip prostheses and derived an appropriate dosing of this coating by adjusting the amount of gentamicin in the coating to match the antibacterial efficacy of clinically employed gentamicin -loaded bone cement.

In this manuscript, we investigated two important issues regarding the prophylactic use of this 1 mg cm -2 bioactive gentamicin -releasing coating in cementless total hip arthroplasty: A geometrically relevant set-up was developed in which miniature titanium stems were surrounded by agar, contaminated with bioluminescent Staphylococcus aureus.

Novel, bio-optical imaging was performed allowing noninvasive, longitudinal monitoring of staphylococcal growth around miniature stems with and without the gentamicin -releasing coating. Furthermore, the antibacterial efficacy of the gentamicin -releasing coating was determined against a wide variety of clinical isolates, including bioluminescent Staphylococcus aureus strains, using traditional zone of inhibition measurements.

The gentamicin -releasing coating demonstrated a wide-spectrum of antibacterial efficacy and successfully prevented growth of bioluminescent staphylococci around a miniature stem mounted in bacterially contaminated agar for at least 60 h. This implies that the gentamicin -releasing coating has potential to contribute to the improvement of infection prophylaxis in cementless total hip arthroplasty.

Synthesis and Molecular Modelling Studies. Antibiotic resistance has been the subject of interest in clinical practice due to high prevalence of antibiotic -resistant pathogenic organisms.

In view of the prevalence of lesser resistance in antibiotics belonging to aminoglycoside class of compounds viz. Food and Drug Administration-approved gentamicin for the treatment of Staphylococcus infections, which also has instances of resistance in the clinical isolates of Staphylococcus aureus, a series of novel glycoconjugates of 8-fluoro norfloxacin analogues with high regio-selectivity by employing copper I -catalyzed 1, 3-dipolar cycloaddition of 1-O-propargyl monosaccharides has been synthesized and evaluated for the antibacterial activity against gentamicin resistance Staphylococcus aureus.

The docking studies suggest DNA gyrase of Staphylococcus aureus as a probable target for the antibacterial action of compound 10g. Single-dose parenteral antibiotic prophylaxis in gastrointestinal surgery. In the course of two consecutive, double-blind and prospective studies, the authors evaluated the prophylactic effect of a single peroperative intravenous dose of gentamicin this study included patients or the combination gentamicin and clindamycin this study included patients , on the wound infection rate following interventions involving the incision of an abdominal hollow viscus.

Antibiotic prophylaxis lowered the post-operative wound sepsis rate, especially following clinically contaminated interventions, but this reduction did not reach statistical significance.

It is concluded that a single peroperative parenteral dose of antibiotics does not constitute an entirely satisfactory means of wound infection prophylaxis in digestive surgery.

Flavocoxid attenuates gentamicin -induced nephrotoxicity in rats. Gentamicin is a widely used antibiotic against serious and life-threatening infections; however, its usefulness is limited by the development of nephrotoxicity. The present study was designed to determine whether flavocoxid has a protective effect against gentamicin -induced nephrotoxicity in rats.

For this purpose, we quantitatively evaluated gentamicin -induced renal structural and functional alterations using histopathological and biochemical approaches. Furthermore, the effect of flavocoxid on gentamicin induced hypersensitivity of urinary bladder rings to acetylcholine ACh was determined. At the end of the study, all rats were sacrificed and then blood, urine samples and kidneys were collected for further analysis.

Gentamicin administration caused a severe nephrotoxicity which was evidenced by an elevated renal somatic index RSI , serum creatinine, blood urea nitrogen, serum lactate dehydrogenase, and protein in urine with a concomitant reduction in serum albumin and normalized creatinine clearance value as compared with the controls. Moreover, a significant increase in renal contents of malondialdehyde, myeloperoxidase, and tumor necrosis factor-alpha with a significant decrease in renal reduced glutathione and superoxide dismutase activities was detected upon gentamicin administration together with increasing the sensitivity of isolated urinary bladder rings to ACh.

Exposure to gentamicin induced necrosis of renal tubular epithelial cells. Flavocoxid protected kidney tissue against the oxidative damage and the nephrotoxic effect caused by gentamicin treatment.

In addition, flavocoxid significantly reduced the responses of isolated bladder rings to ACh. The results from our study indicate that flavocoxid supplement attenuates gentamicin -induced renal injury via the amelioration of.

The reasons why aminoglycosides are bactericidal have not been not fully elucidated, and evidence indicates that the cidal effects are at least partly dependent on iron. We demonstrate that availability of iron markedly affects the susceptibility of the facultative intracellular bacterium Francisella tularensis strain SCHU S4 to the aminoglycoside gentamicin. Specifically, the intracellular depots of iron were inversely correlated to gentamicin susceptibility, whereas the extracellular iron concentrations were directly correlated to the susceptibility.

Based on the aforementioned findings, it was hypothesized that gallium could potentiate the effect of gentamicin , since gallium is sequestered by iron uptake systems.

Moreover, treatment of F. Collectively, the data demonstrate that SCHU S4 is dependent on iron to minimize the effects of gentamicin and that gallium, by inhibiting the iron uptake, potentiates the bactericidal effect of gentamicin in vitro and in vivo. Antibiotics do not fight infections caused by viruses, such as Colds Flu Most coughs and bronchitis Sore throats, unless caused by strep If a virus is making you sick, taking antibiotics may do Vapour-phase activities of essential oils against antibiotic sensitive and resistant bacteria including MRSA.

To determine whether essential oil EO vapours could reduce surface and airborne levels of bacteria including methicillin-resistant Staphylococcus aureus MRSA.

The antibacterial activity of geranium and lemongrass EO individually and blended were evaluated over a range of concentrations by direct contact and vapour diffusion. An EO blend containing lemongrass and geranium was used to formulate BioScent that was dispersed into the environment using the ST Pro machine. The effects were variable depending on the methods used.

EO vapours inhibited growth of antibiotic -sensitive and -resistant bacteria in vitro and reduced surface and airborne levels of bacteria. Results suggest that EO vapours, particularly Bioscent, could be used as a method of air disinfection. Background Drug regulatory agencies DRA support prescription of generic products of intravenous antibiotics assuming therapeutic equivalence from pharmaceutical equivalence. Recent reports of deaths associated with generic heparin and metoprolol have raised concerns about the efficacy and safety of DRA-approved drugs.

Although the design lacked power to detect differences in survival after thigh infection with P. Conclusion Pharmaceutical equivalence does not predict therapeutic equivalence of generic gentamicin.

Stricter criteria based on solid experimental evidence should be required before approval for human use. Gentamicin coating of metallic implants reduces implant-related osteomyelitis in rats. Antibiotic prophylaxis is a routine procedure in orthopedic surgery. Various local antibiotic delivery techniques are used to reduce bone- and soft tissue-related infection. The objective of this study was to evaluate the efficacy of a new biodegradable, gentamicin -loaded poly D,L-lactide PDLLA coating of orthopedic devices in preventing implant-related osteomyelitis.

The medullary cavities of tibiae in 30 Sprague Dawley rats were contaminated with Staphylococcus aureus 10 3 colony forming units. Ten animals that received phosphate-buffered saline and uncoated Kirschner wires served as controls group I. Follow-up was 6 weeks. In weekly intervals X-rays of the tibiae were performed, blood counts were taken, and body temperature and weight were determined.

After sacrifice infection was evaluated by histological and microbiological analysis. All animals of groups II and III developed microbiological, histological, and radiological signs of infection, including osseous destruction and soft tissue swelling. All animals of the control group remained sterile.

Cultures of implants of group IV showed significantly reduced bacterial growth compared to cultures of groups II and III, and three implants of group IV remained sterile. Further radiological and histological signs of infection were significantly reduced in the gentamicin -coated group compared to groups II and III.

No significant differences in body weight, body temperature, and blood parameters between all groups were observed. Combination therapy including serratiopeptidase improves outcomes of mechanical- antibiotic treatment of periimplantitis. This study was designed as a retrospective analysis of clinical outcomes of cases of periimplantitis treated by mechanical debridement and the administration of antibiotics combined or not with the administration of either the proteolytic enzyme serratiopeptidase SPEP or non-steroidal anti-inflammatory drugs NSAIDs.

Clinical charts of partially edentulous patients treated for periimplantitis between June and December were analyzed to obtain clinical data of the affected implants just before the beginning of treatment and 12 months later to evaluate the outcomes of combined mechanical antibiotic treatment alone or in combination with the co-administration of the anti-inflammatory SPEP or NSAIDs.

The comparative analysis revealed that therapeutic outcomes were significantly different in the three groups. Treatment including SPEP was associated with significantly better healing also when successful treatments alone were considered. The data reported in this paper strongly support the hypothesis that SPEP is a valid addition to protocols for the combined therapy of peri-implantitis.

In fact, it allows to enhance success rates significantly and also favors better tissue repair around successfully treated implants as compared to other regimens. Antibiotics disrupt the normal gut flora, sometimes causing antibiotic -associated diarrhoea AAD. Little is known either about the frequency or type of antibiotics prescribed in care homes or about the incidence and aetiology of AAD in this setting. PAAD stage 1 aimed to 1 prospectively describe antibiotic prescribing in care homes; 2 determine the incidence of C.

However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2. SETTING Recruited care homes had management and owner's agreement to participate and three or more staff willing to take responsibility for implementing the study.

Phage therapy of staphylococcal infections including MRSA may be less expensive than antibiotic treatment. The current drama of antibiotic resistance has revived interest in phage therapy. In response to this challenge, a phage therapy center was established at our Institute in which accepts patients from Poland and abroad with antibiotic -resistant infections.

We now present data showing that efficient phage therapy of staphylococcal infections is no longer a treatment of last resort when all antibiotics fail , but allows for significant savings in the costs of healthcare. Neonatal listeriosis is an exceptional disease in Northern Africa. Hence, protocols for maternal-fetal infection treatment include only a third generation cephalosporin and an aminoside.

This protocol does not take into account the possibility of Listeria monocytogenes infection. We report a fatal case of neonatal listeriosis in Tunisia. The use of first antibiotics in maternal-foetal infection must be reconsidered when lacking sufficient bacteriological data and include systematically ampicillin in presumptive antibiotic protocols. A biodegradable gentamicin -hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses.

A degradable, poly lactic-co-glycolic acid PLGA , gentamicin -loaded prophylactic coating for hydroxyapatite HA -coated cementless hip prostheses is developed with similar antibacterial efficacy as offered by gentamicin -loaded cements for fixing traditional, cemented prostheses in bone.

We describe the development pathway, from in vitro investigation of antibiotic release and antibacterial properties of this PLGA- gentamicin -HA-coating in different in vitro models to an evaluation of its efficacy in preventing implant-related infection in rabbits. Bone in-growth in the absence and presence of the coating was investigated in a canine model.

The PLGA- gentamicin -HA-coating showed high-burst release, with antibacterial efficacy in agar-assays completely disappearing after 4 days, minimising risk of inducing antibiotic resistance. Gentamicin -sensitive and gentamicin -resistant staphylococci were killed by the antibiotic -loaded coating, in a simulated prosthesis-related interfacial gap. PLGA- gentamicin -HA-coatings prevented growth of bioluminescent staphylococci around a miniature-stem mounted in bacterially contaminated agar, as observed using bio-optical imaging.

PLGA- gentamicin -HA-coated pins inserted in bacterially contaminated medullary canals in rabbits caused a statistically significant reduction in infection rates compared to HA-coated pins without gentamicin. Bone ingrowth to PLGA- gentamicin -HA-coated pins, in condylar defects of Beagle dogs was not impaired by the presence of the degradable, gentamicin -loaded coating.

In conclusion, the PLGA- gentamicin -HA-coating constitutes an effective strategy for infection prophylaxis in cementless prostheses. Gentamicin B1 is a minor gentamicin component with major nonsense mutation suppression activity. They introduce a premature termination codon PTC and prevent the formation of full-length protein.

Pharmaceutical gentamicin , a mixture of several related aminoglycosides, is a frequently used antibiotic in humans that can induce PTC readthrough and suppress nonsense mutations at high concentrations. However, testing of gentamicin in clinical trials has shown that safe doses of this drug produce weak and variable readthrough activity that is insufficient for use as therapy. In this study we show that the major components of pharmaceutical gentamicin lack PTC readthrough activity but the minor component gentamicin B1 B1 is a potent readthrough inducer.

Molecular dynamics simulations reveal the importance of ring I of B1 in establishing a ribosome configuration that permits pairing of a near-cognate complex at a PTC. The B1 content of pharmaceutical gentamicin is highly variable and major gentamicins suppress the PTC readthrough activity of B1.

Purified B1 provides a consistent and effective source of PTC readthrough activity to study the potential of nonsense suppression for treatment of rare genetic disorders. Susceptibility genes for gentamicin -induced vestibular dysfunction. Buccal cell samples were obtained from all subjects and DNA was genotyped for 15 polymorphisms in 9 genes. Candidate genes were identified primarily for their roles in oxidative stress based on predicted mechanisms of gentamicin -induced ototoxicity.

Statistical analyses included the multi-dimensionality reduction MDR method for identifying gene x gene interactions across multiple candidate genes. GluAsp polymorphism as significantly associated with GM-induced vestibular dysfunction both p Gentamicin -loaded calcium carbonate materials: Synthetic aragonite-based porous materials were drug loaded with gentamicin sulphate, an antibiotic active on Staphylococcus aureus responsible for osteomyelitis.

Drug loading was accomplished by two different ways: We first investigated the influence of drug loading on compressive strength of materials. Results indicate that soaked materials presented the same compressive strength than unloaded materials with the same porosity. By contrast, the integration of gentamicin during processing increased significantly the compressive strength of materials. The materials drug content before elution was a least 10 times higher when gentamicin was integrated during processing comparatively to soaked materials.

Presentations cover the investigational antifungal isavuconazole, which is co-developed with Astellas Pharma Inc. In particular, data from the SECURE isavuconazole invasive aspergillosis phase 3 study with outcome analyses for subsets of patients with hematologic and other malignancies will be presented. Researchers will also present data from the VITAL phase 3 study on the activity of isavuconazole in patients with invasive fungal disease caused by a variety of emerging fungi that are associated with significant morbidity and mortality.

Basilea's isavuconazole Marketing Authorization Application for the treatment of invasive aspergillosis and mucormycosis zygomycosis is under regulatory review in Europe, and a New Drug Application has been filed with the U. In addition, post-hoc efficacy and tolerability analyses from two randomized phase 3 studies for certain Asian populations with ceftobiprole, Basilea's broad-spectrum anti-MRSA antibiotic, will be presented.

Further presentations will include data on the in-vitro activity of Basilea's investigational siderophore monosulfactam antibiotic BAL alone and in combination with carbapenem antibiotics against Gram-negative bacteria, and on the role of siderophore receptors for the susceptibility of Pseudomonas aeruginosa. BAL is currently in phase 1 clinical testing. Patterson; M; Saturday, September 6, Lepak; A; Saturday, September 6, 6: Townsend; A; Sunday, September 7, Hope; A; Sunday, September 7, Assessing Isavuconazole Induced Resistance in Aspergillus fumigatus.

Perlin; M; Sunday, September 7, Chowdhary; M; Sunday, September 7, Castanheira; M; Sunday, September 7, Resistance Mechanisms to Azoles in Moulds.

Ghannoum; M; Monday, September 8, Outcomes by Malignancy Status. Mujais; M; Monday, September 8, Maertens; M; Monday, September 8, Perfect; M; Monday, September 8, Hope; M; Monday, September 8, Vazquez; M; Monday, September 8, Kaufhold; L; Monday, September 8, Bonomo; C; Saturday, September 6, Santerre Henriksen; C; Monday, September 8, Naber; F; Monday, September 8,

well mops, microfibre

A year-old man seen in the cardiology clinic for evaluation of severe aortic stenosis found on echocar- V All of the following are reversible causes of sinoatrial diography performed for evaluation of dyspnea node dysfunction EXCEPT: A year-old woman is undergoing evaluation of dys- B. Hypothyroidism pnea on exertion. She has a history of hypertension since C. Increased intracranial pressure age 32 and is also obese with a body mass index BMI of D.

Her pulmonary function tests show mild restric- E. Radiation therapy tive lung disease. A year-old man is admitted to the hospital after leg that looked like a target several days ago, but is other- experiencing 2 days of severe dyspnea.

Three weeks ago he wise healthy. He reports excellent adherence to saturation is normal. His examination is otherwise unre- his medical regimen that includes atorvastatin, lisinopril, markable except for a bulls-eye rash over the right upper metoprolol, and aspirin. On examination, his heart rate thigh. ECG shows third-degree AV block. ANA eral leg edema. There are no gallops or new murmurs.

HLA B27 testing shows sinus bradycardia and evidence of the recent infarct, C. Which of the following is the most D. RPR appropriate next management step? Refer for pacemaker placement pathway is the block usually found? Refer for urgent coronary angiography A. First-degree AV block; intranodal B. Second-degree AV block type 1; intranodal V A year-old college student home for the summer is C.

Second-degree AV block type 2; infranodal evaluated in the emergency department for dizziness that D. Second-degree AV block type 2; intranodal began within the last 3 days. A year-old woman with a history of tobacco A. Atrial premature contractions are less common than abuse and ulcerative colitis is evaluated for intermit- ventricular premature contractions on extended tent palpitations.

She reports that for the last 6 months ECG monitoring. Echocardiography is indicated to determine if struc- She has not noted any precipitating factors and has not tural heart disease is present. Her physical examination is normal. A resting ECG C. Metoprolol should be initiated for symptom control. The patient should be reassured that this is not a checking serum electrolytes, which of the following is the most appropriate testing?

Abdominal CT with oral and IV contrast evaluation. The patient should undergo a stress test to determine C. Holter monitor if ischemia is present. Reassurance with no further testing needed V Referral for EP study ted to the intensive care unit with an exacerbation of his obstructive lung disease. Because of hypercarbic respira- V Despite aggressive sedation, his Which of the following statements regarding the dysrhyth- ventilator alarms several times that peak inspiratory pres- mia in this patient is true?

Cardiac examination shows a regular rhythm, but no other abnormality. Breath sounds are decreased on the right. ECG shows narrow complex tachycardia. Which of the following is V Adenosine mg IV push emergency department with palpitations for 3 days. Metoprolol 5-mg IV push ter. An echocardiogram demonstrates moderate right and E. Sedation followed by cardioversion left atrial dilation, postoperative changes from her surgery, and normal left and right ventricular function. All of the following are risk factors for stroke in a the following is true?

If a transesophageal echocardiogram does not dem- B. History of congestive heart failure onstrate left atrial thrombus, she may be cardioverted C. History of stroke without anticoagulation. Intravenous heparin should be started immediately. Left atrial size greater than 4.

She should be immediately cardioverted. Transthoracic echocardiogram is adequate to rule V Which of the following statements regarding restora- out the presence of left atrial thrombus. Dofetilide may be safely started on an outpatient basis. A patient presents with palpitations and shortness of B. In patients who are treated with pharmacotherapy breath for 6 hours. In the emergency department waiting and are found to be in sinus rhythm, a prolonged room an ECG is performed shown in Figure V Patients who have pharmacologically maintained A.

Diffuse abdominal tenderness with guarding sinus rhythm after atrial fibrillation have improved B. Diffuse expiratory polyphonic wheezing with poor survival compared with patients who are treated with air movement and hyperinflation rate control and anticoagulation.

Left ventricular heave and third heart sound D. Recurrence of atrial fibrillation is uncommon when D. Supraclavicular lymphadenopathy pharmacotherapy is used to maintain sinus rhythm. A year-old woman is seen in the emergency depart- A. Adenosine ment after sudden onset of palpitations 30 minutes prior B. Carotid sinus massage to her visit.

She was seated at her work computer when the C. DC cardioversion symptoms began. Aside from low back pain, she is oth- D. In an ECG with wide complex tachycardia, which of in her neck and tachycardia, but is otherwise normal. ECG the following clues most strongly supports the diagnosis of shows a narrow complex tachycardia without identifiable ventricular tachycardia?

Which of the following is the most appropriate A. Atrial-ventricular dissociation first step to manage her tachycardia? Classic right bundle branch block pattern A.

Irregularly irregular rhythm with changing QRS B. QRS duration greater than milliseconds D. Carotid sinus massage E. Slowing of rate with carotid sinus massage E. DC cardioversion using J V A year-old male with diabetes and schizophrenia is V A year-old man who is healthy aside from a prior started on antibiotic therapy for chronic osteomyelitis in the knee surgery is evaluated in the emergency department hospital.

His osteomyelitis has developed just under an ulcer for palpitations that developed suddenly while eating where he has been injecting heroin. His physical examination is normal aside is which of the following substances? An ECG obtained A. Furosemide before his knee surgery shows delta waves in the early B.

His current ECG shows wide complex C. Which of the following therapies is contrain- D. Metformin dicated for treatment of his tachyarrhythmia? Lidocaine electrocardiogram is notable for a prolonged QT C.

Besides stopping the offending drug, the most D. Metoprolol appropriate management for this rhythm disturbance E. Potassium should include intravenous administration of which of V You are caring for a patient with heart rate—related the following?

With minor elevations in heart rate, the patient has anginal symptoms that impact his quality of life. The patient reports a regular exercise regimen of B.

Early afterdepolarizations walking on the treadmill several times weekly and occa- C. Increased automaticity sional exacerbations of his leg edema that he manages D. Reentry pathway with an extra dose of furosemide. He has never been hos- pitalized for heart failure. His current medical regimen V He is interested in A. Left atrial appendage stopping medications because of their expense. Mitral annulus of the following statements is true regarding his medical C. Pulmonary vein orifice regimen?

ACE inhibition therapy has not been shown to E. Sinus node improve heart failure symptoms. Beta blocker therapy in this patient may be exacer- V Symptoms of atrial fibrillation vary dramatically from bating his occasional need for extra furosemide and patient to patient. If digoxin is withdrawn, he will likely have worsening C.

If he is intolerant to lisinopril because of cough, it E. Postoperative after thoracotomy would be reasonable to switch him to an angiotensin- receptor blocker. A year-old postmenopausal woman is seen for onset of severe dyspnea over the last few weeks. She reports no pre- V A year-old slender woman is seen in the emergency ceding chest pain, cough, sputum, or fever, though she does department after several weeks of dyspnea on exertion that report leg swelling. Exophthalmos is present as well as bilateral inspiratory complains of leg swelling, orthopnea, and occasionally crackles occupying approximately one-third of the lower awakening at night with dyspnea.

Her past medical history chest; neck vein distention; normal cardiac rhythm, though is notable for long-standing systemic hypertension, uterine tachycardia is present; and a third heart sound with no mur- prolapse, and an anxiety disorder. Bilateral lower extremity edema and a fine hand tremor the presence of heart failure with a laterally displaced and are also present. She is admitted to the hospital and given diuret- A.

Anemia with high-output state ics, and an echocardiogram is obtained. Hemochromatosis with subsequent restrictive malities, and aortic and mitral valvular function is intact. Myocardial infarction with depressed left ventricular 45 mmHg. After resolution of her heart failure symptoms systolic function with diuresis, the patient is ready for discharge. Thyrotoxicosis with high-output state the following medications have been shown to improve mortality in patients with heart failure with preserved V Digoxin the diagnosis of left heart failure.

In the presence of renal failure, BNP levels are C. Plasma BNP levels may be falsely low in patients with E. None of the above obesity and heart failure. All of the above are true. A year-old man with a history of myocardial inf- V Which of the following is a known complication arction and congestive heart failure is comfortable at rest.

He must rest for sev- A. Cerebrovascular accident eral minutes before these symptoms resolve. His New York B. Infection of insertion site Heart Association classification is which of the following?

Mechanical device failure A. All of the above C. Air embolism from a central venous catheter heart failure is concerned because his wife appears to stop B.

Arterial oxygen desaturation with exertion breathing for periods of time when she sleeps. He has noticed C. Pulmonary arterial hypertension then follows this with a similar period of hyperventilation. Unstable angina This does not wake her from sleep.

She does not snore. She feels well rested in the morning but is very dyspneic with V A year-old woman is seen by her primary care even mild activity. What is your next step in management? She also has a history of complex congenital heart B. Maximize heart failure management disease with a partially corrected VSD with predominantly C. Nasal continuous positive airway pressure CPAP right to left shunt across her patch. She is doing well and is during sleep able to work in janitorial services without severe dyspnea.

Obtain a sleep study She denies any heart failure or neurologic symptoms, but E. A year-old man undergoes cardiac transplantation the following is the most appropriate management of her for end-stage ischemic cardiomyopathy due to an underly- elevated hematocrit? His donor was A. Begin oxygen therapy a year-old motor vehicle accident victim. Check co-oximetry on arterial blood gas sample does well for the first 3 years after transplantation with only C.

He shows good compli- D. Expectant waiting ance with his immunosuppression regimen, which includes E. Refer to hematology for phlebotomy prednisone and sirolimus. He is evaluated at a routine fol- low-up visit and reports that he has developed dyspnea on V A year-old man recently was found to have an exertion. His pulmonary function tests are unchanged and asymptomatic atrial septal defect that was closed using a a chest radiograph is normal.

He undergoes right and left percutaneous patch 1 month ago without complication. He heart catheterization with biopsy of the transplanted heart. Which of the following statements is true shows no evidence of acute rejection. Which of the follow- regarding antibiotic prophylaxis in this patient? Because he had only simple congenital heart disease, found in this patient? No immunosuppressive regimen has been shown to B.

Because the lesion is corrected, no prophylaxis is have a lower incidence of coronary atherosclerosis indicated. He should avoid potentially bacteremic dental proce- B. The current coronary atherosclerosis after cardiac less than 6 months old. Routine antibiotic prophylaxis is indicated for bac- prior to transplantation.

A year-old man undergoes a physical examination E. Therapy with statins has not been associated with with chest radiograph for enrollment in the military. He has a reduced incidence of this complication of had a normal childhood without any major illness.

Chest radiograph shows dextrocardia. On admission to A. He is likely to have aortic stenosis. He is likely to have aspermia. He is likely to have an atrial septal defect. He is likely to have a ventriculoseptal defect. He is likely to otherwise be normal. Before transfer can be arranged to a tertiary center, V A year-old male seeks medical attention for the the patient reports extreme dyspnea.

He is found to be recent onset of headaches. Chest radiograph shows new lar AV nicking on funduscopic examination, normal alveolar infiltrates in the right lung greater than the left. Review of symptoms is positive A. Additional measure- ment of blood pressure reveals the following: Diffuse urticarial reaction, wheezing on pulmonary Which of the following diagnostic studies is most likely to examination demonstrate the cause of the headaches?

Mucosal edema, finger swelling, stridor A. MRI of the head B. MRI of the kidney V Which of the following is the most appropriate next C. MRI of the thorax step in therapy for the patient in question V? Initiation of norepinephrine infusion C. Intravenous infusion of nitroprusside V The patient described in question V is most D. Intravenous methylprednisolone likely to have which of the following associated cardiac E. Bicuspid aortic valve V A year-old healthy woman is seen for a pap smear B.

Mitral stenosis at a routine office visit. She feels well and has no complaints C. Preexcitation syndrome and no significant past medical history. Her internist per- D. Right bundle branch block forms a full physical examination and a midsystolic click is E. No murmur or gallop is present. She is concerned about this finding. Which of the following statements is V Mitral stenosis is frequently complicated by pulmo- true regarding her examination finding?

Which of the following is a cause of A. In most patients with this disorder, an underlying pulmonary hypertension in mitral stenosis? Interstitial edema in the walls of small pulmonary is found. Infective endocarditis prophylaxis is indicated B. Passive transmission of elevated left atrial pressure for dental procedures potentially associated with C. Pulmonary arteriolar constriction C. Most patients are asymptomatic from this lesion and E. All of the above will remain so their entire life.

She should begin therapy with aspirin mg po V A year-old man with a history of systemic hyper- daily. A year-old man is evaluated for the onset of dys- A. Bronchoscopy pnea on exertion.

He has a long history of tobacco abuse, B. Chest CT with contrast obesity, and diabetes mellitus. His current medications C. Echocardiogram include metformin, aspirin, and occasional ibuprofen. Right heart catheterization physical examination his peripheral pulses show a delayed E. Upper airway inspection by an otolaryngologist peak and he has a prominent left ventricular heave. In the patient described in question V, which of the is loudest at the base of the heart and radiates to the carotid following should be prescribed at her visit to alleviate her arteries.

A fourth heart sound is present. Which of the following most likely contributed to B. Digoxin the development of his cardiac lesion? Congenital bicuspid aortic valve D. Occult rheumatic heart disease D. Underlying connective tissue disease V None of the above evidence of significant mitral regurgitation has the best indication for surgery with the most favorable likelihood V A year-old man presents with new-onset exertional of a positive outcome?

A year-old man in sinus rhythm without symp- C. Which of the following physical examination findings dimension of 45 mm suggests severe aortic regurgitation? A year-old asymptomatic woman with newly dis- A. Pulsus alternans and end-systolic dimension of 35 mm C.

All of the following are potential causes of tricuspid E. Congenital heart disease V A year-old Somali woman is seen in clinic for onset B. Infective endocarditis of hemoptysis in the sixth month of her pregnancy. Inferior wall myocardial infarction her fourth pregnancy and the others were uncomplicated, D.

Pulmonary arterial hypertension though she was 35 years old at the birth of her last child. Rheumatic heart disease Prior to this, she had been healthy. She reports mild dyspnea E. All of the above will cause tricuspid regurgitation.

She began to A. Bioprosthetic valve replacement is preferred to cough small amounts of bloody sputum 5 days ago. She had mechanical valve replacement in younger patients neither fever nor purulent sputum and has not responded to because of the superior durability of the valve.

Bioprosthetic valves have a low incidence of throm- cal examination is notable for a normal temperature, heart boembolic complications. No source of bleed- replacement is higher in the mitral position than in ing is seen in her nares or oropharynx. Her lungs have dif- the aortic position. Mechanical valves are relatively contraindicated in elevated neck veins, a regular heart rhythm, a loud second patients who wish to become pregnant.

Double-disk tilting mechanical prosthetic valves at the apex. Which of the following is most single-disk tilting valves. Which of the following infectious agents have been asso- A. Use of tocolytics D. No significant coronary artery disease is found. Which of the following right heart catheterization numbers see Table V would support a diagnosis of beriberi heart disease?

A year-old basketball player is seen for evaluation shows an old left bundle branch block. Which clinical fea- prior to beginning another season of competitive sports. Which of the following maneuvers will enhance A. Elevated jugular venous pressure this murmur if hypertrophic cardiomyopathy is the under- B. Narrow pulse pressure A.

Leaning forward while sitting E. None of the above C. Lying left side down D. You are evaluating a new patient in the clinic. He has New York V A year-old woman presents to your office with Heart Association class II symptoms and denies angina. She has a history of mono- He presents for evaluation and management.

The patient clonal gammopathy of unclear significance MGUS and has been wheelchair bound for many years and has severe has been lost to follow-up for the past 5 years. She is able scoliosis. He has no family history of hyperlipidemia. She has developed orthopnea but crackles, an S3, and no cyanosis. Jugular venous pressure is with reduced ejection fraction. What is the most likely elevated, and the jugular venous wave does not fall with diagnosis?

An S3 and S4 are present, as well as a mitral A. Amyotrophic lateral sclerosis regurgitation murmur. The point of maximal impulse is B. Atrial septal defect not displaced. Abdominal examination is significant for C. Chronic thromboembolic disease ascites and a large, tender, pulsatile liver. A year-old woman with a history of tobacco abuse venous pressure is approximately 16 cm, and the neck presents to the emergency department because of severe veins do not collapse on inspiration.

Heart sounds are chest pain radiating to both arms. The pain began 8 hours distant. There is a third heart sound heard shortly after ago and is worse with inspiration. The sound is short and abrupt and lie down as this markedly exacerbates the pain, but she is heard best at the apex. The liver is enlarged and pulsa- feels better with sitting forward.

Examination is notable tile. Lungs are clear and nal wall. Which of the follow- abrupt cessation of ventricular filling in early diastole.

What is the best approach for A. Diffusely inverted T waves in the precordial leads treatment of this patient? Aggressive diuresis only C. Mitral valve replacement upward concavity and reciprocal depressions in aVR D. ST-segment elevation V1—V6 with convex curvature E. Pericardiocentesis and reciprocal depressions in aVR V A year-old previously healthy hockey player is V Which of the following statements is true regarding defending the goal when he is hit in the left chest with a pulsus paradoxus?

He immediately collapses to the ice. It consists of a greater than 15 mmHg increase in runs to his side and finds him unresponsive and without a systolic arterial pressure with inspiration. Which of the following is most likely responsible for B. It may be found in patients with severe obstructive this syndrome? It is the reversal of a normal phenomenon during B. It results from right ventricular distention during D.

Hypertrophic cardiomyopathy expiration resulting in compression of the left ven- E. Tension pneumothorax tricular volume and subsequent reduction in systolic pulse pressure. A year-old white man is seen in the clinic for a E.

He reports no complaints. The remainder of his cardiac tamponade? Which of the following is A. Hypotension, electrical alternans, prominent x-descent true regarding lifestyle modification? Brisk walking for as little as 10 minutes, 4 days per B. Hypotension, muffled heart sounds, jugular venous B. Dietary NaCl restriction of less than 6 g per day will distention reduce his blood pressure. Lifestyle modification will have no effect on his blood E.

Muffled heart sounds, hypotension, friction rub pressure. Reduction of alcohol consumption to three or fewer V A year-old woman is admitted to the hospital drinks per day will decrease his blood pressure. Weight loss of approximately 9 kg can be expected and edema.

The symptoms began about 3 months ago to bring his blood pressure to within the normal and gradually progressed. The patient reports an increase limit. The swelling in her legs has gotten increasingly worse such that she now V A year-old white female presents to your office feels her thighs are swollen as well.

She has dyspnea on with concerns about her diagnosis of hypertension exertion and two-pillow orthopnea. She was of developing complications of hypertension, includ- treated at that time with chemotherapy and mediastinal ing renal failure and stroke. There was a statistically significant decrease in distribution rate but not elimination rate of gentamicin.

For tylosin, there was a significant increase in elimination rate. These results indicate the kinetics of tylosin but not gentamicin are sufficiently altered as to support a need for increased frequency of administration with severe respiratory disease in calves.

Residual gentamicin -release from antibiotic -loaded polymethylmethacrylate beads after 5 years of implantation. In infected joint arthroplasty, high local levels of antibiotics are achieved through temporary implantation of non-biodegradable gentamicin -loaded polymethylmethacrylate beads.

Despite their antibiotic release, these beads act as a biomaterial surface to which bacteria preferentially adhere, grow and potentially develop antibiotic resistance. In routine clinical practice, these beads are removed after 14 days, but for a variety of reasons, we were confronted with a patient in which these beads were left in situ for 5 years. Retrieval of gentamicin -loaded beads from this patient constituted an exceptional case to study the effects of long-term implantation on potentially colonizing microflora and gentamicin release.

Gentamicin -release test revealed residual antibiotic release after being 5 years in situ and extensive microbiological sampling resulted in recovery of a gentamicin -resistant staphylococcal strain from the bead surface.

This case emphasizes the importance of developing biodegradable antibiotic -loaded beads as an antibiotic delivery system. Copyright Elsevier Science Ltd. Direct laser light enhancement of susceptibility of bacteria to gentamicin antibiotic. ObjectivesTo test the effect of pulsed Q-switched and continuous wave CW laser light at wavelength of nm on the viability of free-living stationary phase bacteria with and without gentamicin an antibiotic treatment.

MethodsFree living stationary phase gram negative bacteria Pseudomonas aeruginosa strain PAO1 was immersed in Luria Broth LB solution and exposed to Q-switched and CW lasers with and without the addition of the antibiotic gentamicin.

Cell viability was determined at different time points. ResultsLaser treatment alone did not reduce cell viability compared to untreated control and the gentamicin treatment alone only resulted in a 0. The combined laser and gentamicin treatment, however, resulted in a synergistic effect and viability was reduced by 8 logs for P.

ConclusionsCombination of laser light with gentamicin shows an improved efficacy against P. Understanding mechanisms of antibiotic resistance is important to the fields of biology and medicine. We find that glutathione contributes to antibiotic resistance in the cyanobacterium Synechocystis sp.

Our results also suggest that glutathione protects photosystem I from oxidative damage resulting from growth in the presence of gentamicin. Chitosan improves anti-biofilm efficacy of gentamicin through facilitating antibiotic penetration. Antibiotic overuse is one of the major drivers in the generation of antibiotic resistant "super bugs" that can potentially cause serious effects on health.

In this study, we reported that the polycationic polysaccharide, chitosan could improve the efficacy of a given antibiotic gentamicin to combat bacterial biofilms, the universal lifestyle of microbes in the world. Short- or long-term treatment with the mixture of chitosan and gentamicin resulted in the dispersal of Listeria monocytogenes L. Mechanistic insights indicated that chitosan facilitated the entry of gentamicin into the architecture of L.

Finally, we showed that this combination was also effective in the eradication of biofilms built by two other Listeria species, Listeria welshimeri and Listeria innocua. Thus, our findings pointed out that chitosan supplementation might overcome the resistance of Listeria biofilms to gentamicin , which might be helpful in prevention of gentamicin overuse in case of combating Listeria biofilms when this specific antibiotic was recommended.

The influence of ultrasound on the release of gentamicin from antibiotic -loaded acrylic beads and bone cements. Gentamicin -loaded acrylic beads are loosely placed in infected bone cavities, whereas gentamicin -loaded acrylic bone cement is used as a mechanical filler in bone to anchor prosthetic components.

Both drug delivery systems are used to decrease infection rates by gentamicin release. The objective of this study is to investigate the effects of pulsed ultrasound on gentamicin release from both materials. Gentamicin release from gentamicin -loaded beads Septopal and from three commercially-available brands of gentamicin -loaded bone cement CMW 1, Palacos R-G, and Palamed G was measured after 18 h of exposure in PBS to an ultrasonic field of Samples not exposed to ultrasound were used as controls.

Pulsed ultrasound significantly enhanced gentamicin release from gentamicin -loaded beads, whereas gentamicin release from the gentamicin -loaded bone cements was not significantly enhanced.

Mercury intrusion porosimetry revealed an increased distribution of pores between 0. Increased gentamicin release in beads due to ultrasound may be explained by micro-streaming in a porous structure, whereas the absence of changes in pore structure after gentamicin release in bone cement is concurrent with the lack of an enhanced release of the antibiotic by ultrasound. As an effective treatment of infections requires high local concentrations of antibiotic , increased gentamicin release due to ultrasound may be of clinical significance, especially since ultrasound has been demonstrated to increase bacterial killing by antibiotics.

Synergy effects of the antibiotics gentamicin and the essential oil of Croton zehntneri. The leaves of Croton zehntneri Pax et Hoffm Euphorbiaceae were subjected to hydrodistillation, and the essential oil extracted was examined with respect to antibacterial and antibiotic modifying activity by gaseous contact.

The gaseous component of the oil inhibited the bacterial growth of Staphylococcus aureus and Pseudomonas aeruginosa with a MID of 0. Thirteen independent isolates of Serratia marcescens associated with nosocomial urinary tract infections were obtained from the clinical microbiology laboratory at Hines Veterans Administration Hospital.

The isolates were resistant to at least ampicillin, carbenicillin, gentamicin , and tobramycin. They could be divided into two groups on the basis of their antibiotypes. Group I 9 strains showed resistance to 13 antibiotics , including 3 beta-lactams, 6 aminoglycosides, tetracycline, sulfonamide, trimethoprim, and polymyxin B. Group II 4 strains was resistant to 11 antibiotics , including 3 beta-lactams, 5 aminoglycosides, sulfonamide, trimethoprim, and polymyxin B.

Donors from both groups transferred resistance traits to Escherichia coli. Transconjugants from matings with group II donors all acquired resistance to nine antibiotics , including the three beta-lactams, five aminoglycosides, and sulfonamide. Transconjugants from matings with group I donors were of varied antibiotypes, inheriting resistance to up to 11 of the 13 antibiotics. Resistances to trimethoprim and polymyxin B were never observed to transfer. All group II S. The results suggest that these S.

Effect of two cleaning processes for bone allografts on gentamicin impregnation and in vitro antibiotic release. Bone allografts are a useful and sometimes indispensable tool for the surgeon to repair bone defects. Microbial contamination is a major reason for discarding allografts from bone banks.

To improve the number of safe allografts, we suggest chemical cleaning of the grafts followed by antibiotic impregnation. Comparison of two chemical cleaning processes for bone allografts aiming for antibiotic impregnation and consequently delivery rates in vitro. Bone chips of mm were prepared from human femoral heads.

Two cleaning methods cleaning A and cleaning B based on solutions containing hydrogen peroxide, paracetic acid, ethanol and biological detergent were carried out and compared. After the cleaning processes, the bone chips were impregnated with gentamicin. Bacillus subtilis bioassay was used to determine the gentamicin release after intervals of days. Differences were compared with non-parametric Mann-Whitney U tests.

The zones of inhibition obtained from the bone grafts cleaned with both cleaning processes were similar between the groups. The concentration of the released antibiotic was decreasing gradually over time, following a similar pattern for both groups. The cleaning procedure A as well as the cleaning procedure B for bone allografts allowed the impregnation with gentamicin powder in the same concentrations in both groups.

The delivery of gentamicin was similar for both groups. Both cleaning procedures were easy to be carried out, making them suitable for routine use at the bone banks. It works by killing bacteria. Antibiotics such as gentamicin injection will not work Novel antibiotic regimens against Enterococcus faecium resistant to ampicillin, vancomycin, and gentamicin. Enterococci have emerged as significant nosocomial pathogens. Enterococci with resistance to commonly used antibiotics are appearing more frequently.

We encountered at our institution several infections caused by Enterococcus faecium with high-level resistance to ampicillin, vancomycin, and gentamicin. The optimal antibiotic therapy for serious infections with unusually resistant enterococci has not been established.

Using time-kill studies, we tested the effectiveness of various antibiotic combinations against 15 isolates of multidrug-resistant enterococci.

No antibiotic was consistently effective when used alone. The combination of ampicillin plus ciprofloxacin was bactericidal for the 12 isolates for which the ciprofloxacin MIC was antibiotic combinations may be important for the future treatment of serious infections caused by these resistant pathogens.

Transferable resistance to gentamicin and other antibiotics in Enterobacteriaceae isolates from municipal wastewater. In two sets of Enterobacteriaceae and Pseudomonas bacteria resistant to at least two antibiotics a distinctly upward trend was found in the incidence of strains resistant to gentamicin. The strains examined were either routine isolates from three municipal wastewater treatment facilities or from the Danube river samples collected near the outlet of municipal sewerage.

The resistance to gentamicin points to the representation of strains originating from hospitalized patients and its incidence among wastewater strains is recordable since the summer of Gentamicin resistance transfer could be demonstrated in a sewage sludge strain of Klebsiella pneumoniae resistant to seven antibiotics and in two multiresistant isolates from the river Danube. Resistance transfers in the case of other antibiotics , especially those susceptible to beta-lactamase ampicillin, carbenicillin , were demonstrated in 10 out of the 24 di- and multiresistant strains tested.

These findings show that both municipal wastewater and water in streams may function as the reservoirs of strains bearing the determinants of transferable resistance. Such strains may play an important role not only in the ecology and epidemiology of R plasmids, but also in the accidental spread of the so-called DNA recombinants that might escape during gene manipulations.

We evaluate the effects the antibiotic Gentamicin on the development of Chrysomya putoria Wiedemann, The control consisted of distilled water.

The relationships between mean body mass of mature larvae measured after diet abandonment, in batches of five individuals , duration of larval and pupal stages, and overall duration of development were analyzed. The actual sex ratio was compared against the expected using the chi square.

None of the parameters measured differed significantly among the four treatments, with one exception: All larvae from all treatments were considered normal. We conclude that the antibiotic did not significantly alter the development of C. The uptake of radiocalcium 45Ca into the isolated media-intimal layer of rabbit aortae was decreased in a maintained manner by each antibiotic.

With gentamicin , the inhibitory effect on 45Ca uptake was shown to be dependent upon the concentration of gentamicin employed and to be more evident in a 0. In addition, the rate of 45Ca efflux from the rabbit aortic media-intimal layer was increased in a sustained manner by gentamicin , streptomycin, and kanamycin. These in vitro findings may partially explain the occurrence of in vivo cardiovascular depression that has occasionally been observed after the administration of chemically related antimicrobial agents.

Relevance of Concomitant Systemic Antibiotic Therapy. Oral gentamicin , 80 mg four times daily, was administered to 50 consecutive patients with gut colonization by gentamicin -susceptible KPC-Kp in cases of planned surgery, major medical intervention, or need for patient transfer. No difference in overall death rate between different groups was documented.

Oral gentamicin was shown to be potentially useful for gut decontamination and prevention of infection due to KPC-Kp, especially in patients not receiving CSAT. The risk of emergence of gentamicin -resistant KPC-Kp should be considered. Level 1 trauma center. Electronic medical record review revealed patients with type 3 open fractures, of which 72 were included in the final analysis.

SSI, nonunion, death, and rehospitalization rates at 1 year. Surgical site infection at 1 year occurred in 12 of 37 patients Nonunion, death, and rehospitalization rates at 1 year were similar between the 2 groups. Although there was no statistically significant difference in SSI at 30 days between groups, the rate was higher in the cefazolin plus gentamicin group See Instructions for Authors for a complete description of levels of evidence.

Controlled release of an antibiotic , gentamicin sulphate, from gravity spun polycaprolactone fibers. The antibiotic , gentamicin sulphate GS , was incorporated in gravity-spun polycaprolactone PCL fibers by spinning from particulate suspensions of the drug in PCL solution to produce a controlled delivery system.

The kinetics of drug release could be adjusted by varying the GS loading of the fibers and the suspension preparation conditions. Studies of growth inhibition of Stapyhlococcus epidermidis in culture indicated that GS released after 2 weeks from PCL fibers retained antibacterial activity. This behavior recommends further investigation of PCL fibers for local delivery of antibiotics to combat infection associated with periodontal disease, musculoskeletal injuries, and implantation of fiber-based tissue substitutes such as vascular prostheses.

J Biomed Mater Res, Biodegradation of gentamicin by bacterial consortia AMQD4 in synthetic medium and raw gentamicin sewage. Gentamicin , a broad spectrum antibiotic of the aminoglycoside class, is widely used for disease prevention of human beings as well as animals.

Nowadays the environmental issue caused by the disposal of wastes containing gentamicin attracts increasing attention. In this study, a gentamicin degrading bacterial consortia named AMQD4, including Providencia vermicola, Brevundimonas diminuta, Alcaligenes sp. The component and structure of gentamicin have a great influence on its degradation and gentamicin C1a and gentamicin C2a were more prone to being degraded.

AMQD4 could maintain relatively high gentamicin removal efficiency under a wide range of pH, especially in an alkaline condition. In addition, AMQD4 could remove It was speculated that aac3iia was the gentamicin degradation gene and the main degradation product was 3'-acetylgentamicin.

Our results suggest that AMQD4 and Brevundimonas diminuta BZC3 could be important candidates to the list of superior microbes for bioremediation of antibiotic pollution.

Biofilms that develop on indwelling devices are a major concern in clinical settings. While removal of colonized devices remains the most frequent strategy for avoiding device-related complications, antibiotic lock therapy constitutes an adjunct therapy for catheter-related infection. However, currently used antibiotic lock solutions are not fully effective against biofilms, thus warranting a search for new antibiotic locks.

To assess the ability of such chelators to eradicate mature biofilms, we used an in vivo model of a totally implantable venous access port inserted in rats and colonized by either Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, or Pseudomonas aeruginosa.

Gentamicin -EDTA lock was able to eliminate biofilms with a single instillation, thus reducing length of treatment. Moreover, we show that this combination was effective for immunosuppressed rats. Lastly, we demonstrate that a gentamicin -EDTA lock is able to eradicate the biofilm formed by a gentamicin -resistant strain of methicillin-resistant S.

This in vivo study demonstrates the potential of EDTA as an efficient antibiotic adjuvant to eradicate catheter-associated biofilms of major bacterial pathogens and thus provides a promising new lock solution. Borate bioactive glass-based composites have been attracting interest recently as an osteoconductive carrier material for local antibiotic delivery. In the present study, composites composed of borate bioactive glass particles bonded with a chitosan matrix were prepared and evaluated in vitro as a carrier for gentamicin sulfate.

The cytocompatibility of the gentamicin sulfate-loaded composite carrier was evaluated using assays of cell proliferation and alkaline phosphatase activity of osteogenic MC3T3-E1 cells. These results indicate that the gentamicin sulfate-loaded composite composed of chitosan-bonded borate bioactive glass particles could be useful clinically as an osteoconductive carrier material for treating bone infection. An experimental design approach to the preparation of pegylated polylactide-co-glicolide gentamicin loaded microparticles for local antibiotic delivery.

The present paper takes into account the DOE application to the preparation process of biodegradable microspheres for osteomyelitis local therapy. The results of in vitro gentamicin release study show prolonged gentamicin release up to three months from the microspheres prepared with salt addition in the dispersing phase; the behavior being consistent with their highly compact structure highlighted by scanning electron microscopy analysis.

The collected results confirm the feasibility of the scale up of microsphere manufacturing process and the high potential of the microparticulate drug delivery system to be used for the local antibiotic delivery to bone.

Synergistic antibacterial effect of Bi2S3 nanospheres combined with ineffective antibiotic gentamicin against methicillin-resistant Staphylococcus aureus. In this paper, Bi2S3 nanospheres with size of nm were prepared by a simple hydrothermal process. Raman spectroscopy and Z potential studies reveal that Bi2S3 could interact with GEN and the combination showed small electronegativity, which probably induced the increase of GEN content in cytoplasm of bacteria.

Furthermore, the combination of Bi2S3 nanospheres and GEN can destroy the bacterial membrane function and induce more bactericidal reactive oxygen generation than that of Bi2S3 or GEN alone.

The cytotoxicity test indicates that the combination of Bi2S3 and GEN presented low toxicity to human normal hepatocyte L Gentamicin in the Clinical Setting. Gentamicin is an aminoglycoside antibiotic that has been a mainstay in pediatric care for decades.

Although new antibiotics are constantly under development, gentamicin continues to play an important role in clinical medicine. Although this may be surprising in the context of evidence of an association with hearing loss, both on a toxicity and a….

These lipospheres were characterized by evaluating on encapsulation efficiency, loading capacity, change in pH and the release profile. Antimicrobial activities were evaluated against Escherichia coli, Pseudomonas aeruginosa, Salmonella paratyphii and Staphylococcus aureus using the agar diffusion method.

Results Photomicrographs revealed spherical particles within a micrometer range with minimal growth after 1 month. The encapsulation and loading capacity were all high, indicating the ability of the lipids to take up the drug. The antimicrobial activities were very high especially against Pseudomonas compare to other test organisms.

This strongly suggested that the formulation retain its bioactive characteristics. Conclusions This study strongly suggest that the issue of gentamicin stability and poor absorption in oral formulation could be adequately addressed by tactical engineering of lipid drug delivery systems such as lipospheres. Aged garlic extract, garlic powder extract, S-allylcysteine, diallyl sulfide and diallyl disulfide do not interfere with the antibiotic activity of gentamicin.

It was shown that aged garlic extract AGE , garlic powder and the following garlic-derived compounds: However, it was not established if the above mentioned extracts and compounds of garlic could interfere with the antibiotic action of GM. Effect of Taurine on the antimicrobial efficiency of Gentamicin. Gentamicin is mainly used in severe infections caused by gram-negatives. However toxicity including nephrotoxicity and ototoxicity is one of the most important complications of its treatment.

The production of free radicals seems to be involved in gentamicin toxicity mechanism. So potentially the co-therapy of taurine and gentamicin would reduce the adverse effects of the antibiotic.

In this study, we wished to know the effect of taurine on the antibiotic capacity of gentamicin. MICs were determined in the various concentrations of taurine for bacterial indicators. The MIC values of gentamicin for P. The bactericidal activity of gentamicin against S. According to our study the antibacterial activity of gentamicin against the indicator microorganisms were not interfere with taurine at selected concentrations.

Further in vivo studies are needed to establish if a combination of gentamicin and taurine would have the same effect. Previous investigations have shown that liquid bacterial cultures grown in space flight were not killed as effectively by antibiotic treatments as were cultures grown on Earth. However, the cause for the decreased antibiotic effectiveness remains unknown.

Possible explanations include modified cell proliferation and modified antibiotic transport in the culture medium. Escherichia coli cultures were grown in space flight STS and STS , with and without gentamicin , on a solid agar substrate thus eliminating fluid effects and reducing the unknowns associated with space-flight bacterial cultures in suspension. This research showed that E. However, addition of gentamicin to the agar killed the bacteria such that both flight and ground control E.

Therefore, while the reported existence of a decrease in antibiotic effectiveness in liquid cultures remains unexplained, these data suggest that gentamicin in space flight was at least as effective as, if not more effective than, on Earth, when E. Comparative study of the effects of gentamicin , neomycin, streptomycin and ofloxacin antibiotics on sperm parameters and testis apoptosis in rats.

The aim of this study was to investigate the comparative effects of aminoglycosides and fluoroquinolones on testis apoptosis and sperm parameters in rats. The experimental groups subdivided into four groups often. Each received 5 mg kg -1 IP gentamicin , 50 mg kg -1 IP neomycin, 40 mg kg -1 IP streptomycin and 72 mg kg -1 IP ofloxacin daily for 14 days, respectively; however, the control group just received vehicle IP. In the fourteenth day, rats were killed and sperm analyzed for sperm parameters.

There was a significant decrease in sperm count, viability and motility in all of experimental groups when compared with control group. Although in streptomycin group these parameters were less decreased than in the other experimental groups. The apoptotic cells were significantly increased in all experimental groups when compared with those seen in the controlled group.

Gentamicin , neomycin and streptomycin and ofloxacin have negative effects on sperm parameters and testis apoptosis in rats. However, these side effects are less seen in the streptomycin group. Therefore, it is recommended that usage of this drug have fewer side effects on male fertility. A covalent method of gentamicin bonding to silica supports. Results of a novel method of covalent bonding of an antibiotic gentamicin to silica bead supports are shown. Gentamicin was immobilized to four types of matrix: Gentamicin was immobilized to the supports after opening its carbohydrate ring in the molecule.

This method of gentamicin activation before the immobilization process did not inhibit its antibiotic activity. The four gentamicin -containing immobilized preparations were stable, meaning that they did not release the antibiotic into the solution during the 30 days of incubation, not even during shaking experiments. Antibacterial efficacy of a new gentamicin -coating for cementless prostheses compared to gentamicin -loaded bone cement.

Cementless prostheses are increasingly popular but require alternative prophylactic measures than the use of antibiotic -loaded bone cements. Here, we determine the h growth inhibition of gentamicin -releasing coatings from grit-blasted and porous-coated titanium alloys, and compare their antibacterial efficacies and gentamicin release-profiles to those of a commercially available gentamicin -loaded bone cement.

Antibacterial efficacy increased with increasing doses of gentamicin in the coating and loading with 1. The coating had a higher burst release than bone cement, and also inhibited growth of gentamicin -resistant strains. Antibacterial efficacy of the gentamicin coatings disappeared after 4 days, while gentamicin -loaded bone cement exhibited efficacy over at least 7 days.

Shut-down after 4 days of gentamicin -release from coatings is advantageous over the low-dosage tail-release from bone cements, as it minimizing risk of inducing antibiotic -resistant strains. Both gentamicin -loaded cement discs and gentamicin -coated titanium coupons were able to kill gentamicin -sensitive and -resistant bacteria in a simulated prothesis-related interfacial gap.

In conclusion, the gentamicin coating provided similar antibacterial properties to those seen by gentamicin -loaded bone cement, implying protection of a prosthesis from being colonized by peri-operatively introduced bacteria in cementless total joint arthroplasty. An In vitro Study. Elderly patients and those with comorbidities are at increased risk. On the basis of previous studies focusing on neonatal infections, penicillin plus gentamicin is recommended for infective endocarditis IE and periprosthetic joint infections PJI in adults.

We used 5 GBS isolates, two clinical strains and three control strains, including one displaying high-level gentamicin resistance HLGR. The results from the checkerboard and time-kill assays TKAs were compared. For TKAs, antibiotic concentrations for penicillin were 0.

In the checkerboard assay, the median fractional inhibitory concentration indices FICIs of all isolates indicated indifference.

TKAs for all isolates failed to demonstrate synergism with penicillin 0. Rapid killing was seen with penicillin 0. TKAs with penicillin 0. Fast killing was seen with penicillin 0. Our in vitro results indicate that the addition of gentamicin to penicillin contributes to faster killing at low penicillin concentrations, but only within the first few hours. Twenty-four hours after antibiotic exposure, PEN alone was bactericidal and synergism was not seen.

Once daily ceftriaxone and gentamicin for the treatment of febrile neutropenia. AIMS—To evaluate the pharmacokinetics of once daily OD gentamicin and its effectiveness as part of an OD regimen for the empirical treatment of febrile neutropenia in children with cancer. The patients were assessed after 48hours. In 29 episodes, blood cultures identified a causative bacterial pathogen; for 17 of these, the first line antibiotic regimen was adequate; in four episodes, although the episode settled, ceftriaxone was replaced by a more appropriate antibiotic and OD gentamicin was continued; in the remaining eight episodes, a glycopeptide antibiotic was deemed necessary.

There was no failure of treatment in organisms sensitive to gentamicin , including Pseudomonas aeruginosa. Gentamicin concentrations were measured in episodes and they were all below the 24 hour line indicating that there was no need to change the dosing interval.

Although there was no vestibular toxicity, three of 30 children who underwent pure tone audiometry reported high frequency hearing loss in one ear. When used for a short period Surgical prophylaxis with gentamicin and acute kidney injury: There are limited data regarding nephrotoxicity related to gentamicin in these patients. Methods We have conducted a systematic review and meta-analysis to evaluate the risk of acute kidney injury AKI in gentamicin -containing surgical prophylactic regimens, compared to regimens without gentamicin , in several types of surgery.

Statistical analysis was then performed using a random-effect model; risk ratios RR , risk differences RD and heterogeneity I2 were calculated. Funnel plot was used for assessment of publication bias. Results Eleven studies with fifteen cohorts with 18, patients were included in the analysis. Subgroup analysis was performed according to surgery type. We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery RR 2.

The results were inconclusive in other types of surgery. Funnel plot indicates potential publication bias. Conclusions Gentamicin -induced AKI is significant in patients undergoing orthopedic surgery. Physicians should consider risks and benefits of using this regimen in individual patients. Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: WHO recommends hospital-based treatment for young infants aged days with clinical signs of possible serious bacterial infection, but most families in resource-poor settings cannot accept referral.

We aimed to assess whether use of simplified antibiotic regimens to treat young infants with clinical signs of severe infection was as efficacious as an injectable procaine benzylpenicillin- gentamicin combination for 7 days for situations in which hospital referral was not possible. In a multisite open-label equivalence trial in DR Congo, Kenya, and Nigeria, community health workers visited all newborn babies at home, identifying and referring unwell young infants to a study nurse.

We stratified young infants with clinical signs of severe infection whose parents did not accept referral to hospital by age days and days , and randomly assigned each individual within these strata to receive one of the four treatment regimens.

Bonomo; C; Saturday, September 6, Santerre Henriksen; C; Monday, September 8, Naber; F; Monday, September 8, Isavuconazole demonstrated in-vitro and in-vivo coverage of a broad range of yeasts such as Candida species and molds such as Aspergillus species , including emerging and often fatal molds such as those that cause mucormycosis.

It has EU and U. In the phase 3 invasive aspergillosis SECURE study, isavuconazole demonstrated non-inferiority to voriconazole on the primary endpoint of all-cause mortality at day The treatment-emergent adverse events for isavuconazole were statistically fewer relative to voriconazole in the system organ classes of hepatobiliary, skin and eye disorders. In addition, isavuconazole showed statistically fewer study drug-related adverse events relative to voriconazole. In both treatment groups, the most common treatment-emergent adverse events were nausea, vomiting, pyrexia fever and diarrhea.

Isavuconazole for the treatment of candidiasis is currently being explored in the ongoing phase 3 study ACTIVE, which evaluates the safety and efficacy of intravenously i. Isavuconazole is being co-developed with Astellas Pharma Inc. Basilea holds full rights to isavuconazole in markets outside of the U. BAL is an investigational intravenous siderophore monosulfactam antibiotic with bactericidal activity against multidrug-resistant Gram-negative pathogens.

It is currently investigated in a phase 1 clinical study evaluating the safety, tolerability, and pharmacokinetics of multiple-ascending doses of intravenously administered BAL in combination with meropenem, an antibiotic of the carbapenem class. In-vitro data showed synergistic or additive activity of BAL with antibiotics from this class. Department of Health and Human Services. Through the integrated research, development and commercial operations of its Swiss subsidiary Basilea Pharmaceutica International Ltd.

This communication expressly or implicitly contains certain forward-looking statements concerning Basilea Pharmaceutica Ltd.

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The outcome assessor was masked. We randomly allocated infants to receive injectable procaine benzylpenicillin- gentamicin for 7 days group A, reference group ; injectable gentamicin and oral amoxicillin for 7 days group B ; injectable procaine benzylpenicillin- gentamicin for 2 days, then oral amoxicillin for 5 days group C ; or injectable gentamicin for 2 days and oral amoxicillin for 7 days group D.

Trained health professionals gave daily injections and the first dose of oral amoxicillin. Our primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event including death , no improvement by day 4, or not cured by day 8.

Independent outcome assessors, who did not know the infant's treatment regimen, assessed study outcomes on days 4, 8, 11, and Primary analysis was per protocol. We used a prespecified. Effect of protamine on the accumulation of gentamicin in opossum kidney epithelial cells.

The purpose of this study was to examine whether or not protamine, an arginine-rich basic protein mixture, inhibits the accumulation of gentamicin , a nephrotoxic drug, in cultured opossum kidney OK epithelial cells. The effect of protamine from salmon on accumulation and binding of [ 3 H] gentamicin was investigated in OK cells. Protamine inhibited the binding and accumulation of [ 3 H] gentamicin in a concentration-dependent manner. Our results indicate that protamine decreases the accumulation of gentamicin in OK cells.

These findings suggest that protamine or its derivatives might be useful in preventing the nephrotoxicity of aminoglycoside antibiotics including gentamicin. Additive effect of Lygodium venustum SW. The aim of this work was to evaluate the interactions between gentamicin and the ethanol extract of the fern Lygodium venustum SW EELV. The ethanol extract of L. The antibiotic activity of gentamicin , when associated with the extract, was enhanced in an additive manner against both strains.

The results indicated that L. Assessment of nutrient supplement to reduce gentamicin -induced ototoxicity. Gentamicin is an aminoglycoside antibiotic used to treat gram-negative bacterial infections. Treatment with this antibiotic carries the potential for adverse side effects, including ototoxicity and nephrotoxicity. Ototoxic effects are at least in part a consequence of oxidative stress, and various antioxidants have been used to attenuate gentamicin -induced hair cell death and hearing loss.

Here, a combination of nutrients previously shown to reduce oxidative stress in the hair cells and attenuate hearing loss after other insults was evaluated for potential protection against gentamicin -induced ototoxicity.

Three diets with iterative increases in nutrient levels were screened; the final diet selected for study use was one that produced statistically reliable increases in plasma levels of vitamins C and E and magnesium.

In two separate studies, significant decreases in gentamicin -induced hearing loss at frequencies including 12 kHz and below were observed, with less benefit at the higher frequencies. Consistent with the functional protection, robust protection of both the inner and outer hair cell populations was observed, with protection largely in the upper half of the cochlea. Protection was independently assessed in two different laboratories, using two different strains of guinea pigs.

Additional in vitro tests did not reveal any decrease in antimicrobial activity with nutrient additives. Currently, there are no FDA-approved treatments for the prevention of gentamicin -induced ototoxicity. The current data provide a rationale for continued investigations regarding translation to human patients. Use of topical antibiotics to improve perineal wound healing after abdominoperineal resection APR is controversial.

The aim of this systematic review was to determine the impact of local application of gentamicin on perineal wound healing after APR. Perineal wound outcome was categorized as infectious complications, non-infectious complications, and primary perineal wound healing. From a total of articles, eight studies published between and were included: There was substantial heterogeneity regarding underlying disease, definition of outcome parameters and timing of perineal wound evaluation among the included studies, which precluded meta-analysis with pooling.

Regarding infectious complications, three of six evaluable studies demonstrated a positive effect of local application of gentamicin: Only two RCTs reported on non-infectious complications, showing no significant impact of gentamicin sponge.

All three comparative cohort studies demonstrated a significantly higher percentage of primary perineal wound healing after local application of gentamicin beads, but only one out of three evaluable RCTs did show a positive effect of gentamicin sponges.

Currently available evidence does not support perineal gentamicin application after APR. The formulation and characterization of gentamicin -loaded microspheres as a delivery system targeting enterotoxigenic Escherichia coli K88 E.

The proposed target strategy was that exposed galactoses of MS-Lac could be specifically recognized by E. Lactosylated microspheres MS-Lac1, MS-Lac2 and MS-Lac3 were obtained using a water-in-oil emulsion, containing gentamicin , followed by crosslinking with different concentrations of glutaraldehyde. In vitro release of gentamicin from MS-Lac was best fitted to a first order model, and the antibacterial activity of encapsulated and free gentamicin was comparable.

MS-Lac treatments were recognized by plant galactose-specific lectins from Ricinus communis and Sophora japonica and by E. Results indicate MS-Lac1, produced with 4. Synergy between penicillin and gentamicin against enterococci. The role of active uptake in aminoglycoside activity against penicillin-treated enterococci was studied by viable counts and ATP determinations.

Penicillin and gentamicin gave synergistic bactericidal and post- antibiotic effects PAEs which were partially reduced by sodium azide, an electron transport inhibitor, and totally blocked in the presence of both sodium azide and EDTA, which chelates divalent cations.

This synergy was completely inhibited by sodium azide. The data indicate that the activity of gentamicin against enterococci that have been damaged by penicillin or EDTA is energy-dependent.

This is consistent with present theories of gentamicin uptake via transportation drive by a protonmotive force. Urinary tract infections in hospital pediatrics: We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population.

We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals. Prior antibiotic exposure was documented from their health record. One hundred and ten patients 73 girls , 11 days to 12 years of age, were included in 10 months.

The antibiotic resistance rate of E. Bacterial species and antibiotic resistance level in children are similar to those reported for adults.

Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved previous antibiotic therapies and fecal-oral or mother-to-child transmission. The antipseudomonal property of honey and gentamicin. Pseudomonas aeruginosa has a notorious characteristic of resistance to most antimicrobial compounds.

This characteristic was subjected to verification in the present study, whereby 50 human isolates of the organism from different pathological sources were subjected to sensitivity tests against honey from three different sources by the agar-cup diffusion method.

Gentamicin , an aminoglycoside antibiotic normally with activity against Gram-negative bacteria, was used alongside honey. The 50 isolates of P. Honey is suggested as an effective natural product in overcoming the widespread antibiotic resistance of P. Automatic phylogenetic classification of bacterial beta-lactamase sequences including structural and antibiotic substrate preference information. Beta lactams comprise the largest and still most effective group of antibiotics , but bacteria can gain resistance through different beta lactamases that can degrade these antibiotics.

We developed a user friendly tree building web server that allows users to assign beta lactamase sequences to their respective molecular classes and subclasses. Further clinically relevant information includes if the gene is typically chromosomal or transferable through plasmids as well as listing the antibiotics which the most closely related reference sequences are known to target and cause resistance against. This web server can automatically build three phylogenetic trees: We show that the latter is better suited to recover antibiotic substrate assignments through nearest neighbor annotation transfer.

The users can also choose to build a structural model for the query sequence and view the binding pocket residues of their query relative to other beta lactamases in the sequence alignment as well as in the 3D structure relative to bound antibiotics. This web server is freely available at http: Gap junction channels GJCs and hemichannels HCs are composed of protein subunits termed connexins Cxs and are permeable to ions and small molecules. In most organs, GJCs communicate the cytoplasm of adjacent cells, while HCs communicate the intra and extracellular compartments.

In this way, both channel types coordinate physiological responses of cell communities. However, the possible involvement of Cxs in the etiology of acquired hearing loss remains virtually unknown.

Factors that induce post-lingual hearing loss are diverse, exposure to gentamicin an aminoglycoside antibiotic , being the most common. In this work, the effect of gentamicin on the functional state of HCs was studied and its effect on GJCs was reevaluated in HeLa cells stably transfected with Cxs.

We focused on Cx26 because it is the main Cx expressed in the cochlea of mammals where it participates in purinergic signaling pathways. We found that gentamicin applied extracellularly reduces the activity of HCs, while dye transfer across GJCs was not affected.

HCs were also blocked by streptomycin, another aminoglycoside antibiotic. Moreover, gentamicin drastically reduced the Cx26 HC-mediated membrane currents in Xenopus laevis oocytes.

Therefore, the extracellular gentamicin -induced inhibition of Cx HCs may adversely affect autocrine and paracrine signaling, including the purinergic one, which might partially explain its ototoxic effects. Exacerbation of iminodipropionitrile-induced behavioral toxicity, oxidative stress, and vestibular hair cell degeneration by gentamicin in rats. This study describes the effect of gentamicin , an aminoglycoside antibiotic on iminodipropionitrile IDPN -induced abnormal neurobehavioral syndrome in female Sprague-Dawley rats.

The intensity of IDPN induced characteristic excitation with choreiform, and the circling movement ECC syndrome was examined using an observational test battery including dyskinetic head movements, circling, tail hanging, air righting reflex, and contact inhibition of the righting reflex on days 6, 8, 10, 12, 19, 26, and The animals for histopathological observation were sacrificed on day 10, whereas the remaining animals that were used for long-term behavioral studies were sacrificed on day 35 for biochemical observations.

The blood and brain samples were collected for the analysis of blood urea nitrogen BUN , serum creatinine, cerebral malondialdehyde MDA , conjugated dienes, and lipid hydroperoxides, whereas temporal bones were collected for inner ear histopathology.

Our results showed that gentamicin significantly and dose dependently exacerbated the incidence and the severity of the IDPN-induced behavioral syndrome. The histopathology of the inner ear demonstrated more severe loss of sensory hair cells in the crista ampullaris of the rats treated with IDPN plus gentamicin compared to the IDPN-alone treated animals.

Concomitant treatment with gentamicin also potentiated IDPN-induced increase in free radical indices, suggesting a possible role of oxidative stress in gentamicin -induced aggravation of IDPN toxicity. Further studies are warranted to determine the role of aminoglycosides in nitrile toxicity and drug-induced movement. A gentamicin -releasing coating for cementless hip prostheses-Longitudinal evaluation of efficacy using in vitro bio-optical imaging and its wide-spectrum antibacterial efficacy.

Cementless prostheses are increasingly popular in total hip arthroplasties. Therewith, common prophylactic measures to reduce the risk of postoperative infection like the use of antibiotic -loaded bone cements, will no longer be available. Alternative prophylactic measures may include the use of antibiotic -releasing coatings.

Previously, we developed a gentamicin -releasing coating for cementless titanium hip prostheses and derived an appropriate dosing of this coating by adjusting the amount of gentamicin in the coating to match the antibacterial efficacy of clinically employed gentamicin -loaded bone cement. In this manuscript, we investigated two important issues regarding the prophylactic use of this 1 mg cm -2 bioactive gentamicin -releasing coating in cementless total hip arthroplasty: A geometrically relevant set-up was developed in which miniature titanium stems were surrounded by agar, contaminated with bioluminescent Staphylococcus aureus.

Novel, bio-optical imaging was performed allowing noninvasive, longitudinal monitoring of staphylococcal growth around miniature stems with and without the gentamicin -releasing coating. Furthermore, the antibacterial efficacy of the gentamicin -releasing coating was determined against a wide variety of clinical isolates, including bioluminescent Staphylococcus aureus strains, using traditional zone of inhibition measurements.

The gentamicin -releasing coating demonstrated a wide-spectrum of antibacterial efficacy and successfully prevented growth of bioluminescent staphylococci around a miniature stem mounted in bacterially contaminated agar for at least 60 h. This implies that the gentamicin -releasing coating has potential to contribute to the improvement of infection prophylaxis in cementless total hip arthroplasty.

Synthesis and Molecular Modelling Studies. Antibiotic resistance has been the subject of interest in clinical practice due to high prevalence of antibiotic -resistant pathogenic organisms. In view of the prevalence of lesser resistance in antibiotics belonging to aminoglycoside class of compounds viz. Food and Drug Administration-approved gentamicin for the treatment of Staphylococcus infections, which also has instances of resistance in the clinical isolates of Staphylococcus aureus, a series of novel glycoconjugates of 8-fluoro norfloxacin analogues with high regio-selectivity by employing copper I -catalyzed 1, 3-dipolar cycloaddition of 1-O-propargyl monosaccharides has been synthesized and evaluated for the antibacterial activity against gentamicin resistance Staphylococcus aureus.

The docking studies suggest DNA gyrase of Staphylococcus aureus as a probable target for the antibacterial action of compound 10g. Single-dose parenteral antibiotic prophylaxis in gastrointestinal surgery. In the course of two consecutive, double-blind and prospective studies, the authors evaluated the prophylactic effect of a single peroperative intravenous dose of gentamicin this study included patients or the combination gentamicin and clindamycin this study included patients , on the wound infection rate following interventions involving the incision of an abdominal hollow viscus.

Antibiotic prophylaxis lowered the post-operative wound sepsis rate, especially following clinically contaminated interventions, but this reduction did not reach statistical significance. It is concluded that a single peroperative parenteral dose of antibiotics does not constitute an entirely satisfactory means of wound infection prophylaxis in digestive surgery. Flavocoxid attenuates gentamicin -induced nephrotoxicity in rats. Gentamicin is a widely used antibiotic against serious and life-threatening infections; however, its usefulness is limited by the development of nephrotoxicity.

The present study was designed to determine whether flavocoxid has a protective effect against gentamicin -induced nephrotoxicity in rats.

For this purpose, we quantitatively evaluated gentamicin -induced renal structural and functional alterations using histopathological and biochemical approaches. Furthermore, the effect of flavocoxid on gentamicin induced hypersensitivity of urinary bladder rings to acetylcholine ACh was determined.

At the end of the study, all rats were sacrificed and then blood, urine samples and kidneys were collected for further analysis. Gentamicin administration caused a severe nephrotoxicity which was evidenced by an elevated renal somatic index RSI , serum creatinine, blood urea nitrogen, serum lactate dehydrogenase, and protein in urine with a concomitant reduction in serum albumin and normalized creatinine clearance value as compared with the controls.

Moreover, a significant increase in renal contents of malondialdehyde, myeloperoxidase, and tumor necrosis factor-alpha with a significant decrease in renal reduced glutathione and superoxide dismutase activities was detected upon gentamicin administration together with increasing the sensitivity of isolated urinary bladder rings to ACh.

Exposure to gentamicin induced necrosis of renal tubular epithelial cells. Flavocoxid protected kidney tissue against the oxidative damage and the nephrotoxic effect caused by gentamicin treatment. In addition, flavocoxid significantly reduced the responses of isolated bladder rings to ACh.

The results from our study indicate that flavocoxid supplement attenuates gentamicin -induced renal injury via the amelioration of. The reasons why aminoglycosides are bactericidal have not been not fully elucidated, and evidence indicates that the cidal effects are at least partly dependent on iron.

We demonstrate that availability of iron markedly affects the susceptibility of the facultative intracellular bacterium Francisella tularensis strain SCHU S4 to the aminoglycoside gentamicin.

Specifically, the intracellular depots of iron were inversely correlated to gentamicin susceptibility, whereas the extracellular iron concentrations were directly correlated to the susceptibility. Based on the aforementioned findings, it was hypothesized that gallium could potentiate the effect of gentamicin , since gallium is sequestered by iron uptake systems. Moreover, treatment of F. Collectively, the data demonstrate that SCHU S4 is dependent on iron to minimize the effects of gentamicin and that gallium, by inhibiting the iron uptake, potentiates the bactericidal effect of gentamicin in vitro and in vivo.

Antibiotics do not fight infections caused by viruses, such as Colds Flu Most coughs and bronchitis Sore throats, unless caused by strep If a virus is making you sick, taking antibiotics may do Vapour-phase activities of essential oils against antibiotic sensitive and resistant bacteria including MRSA.

To determine whether essential oil EO vapours could reduce surface and airborne levels of bacteria including methicillin-resistant Staphylococcus aureus MRSA. The antibacterial activity of geranium and lemongrass EO individually and blended were evaluated over a range of concentrations by direct contact and vapour diffusion. An EO blend containing lemongrass and geranium was used to formulate BioScent that was dispersed into the environment using the ST Pro machine.

The effects were variable depending on the methods used. EO vapours inhibited growth of antibiotic -sensitive and -resistant bacteria in vitro and reduced surface and airborne levels of bacteria. Results suggest that EO vapours, particularly Bioscent, could be used as a method of air disinfection.

Background Drug regulatory agencies DRA support prescription of generic products of intravenous antibiotics assuming therapeutic equivalence from pharmaceutical equivalence. Recent reports of deaths associated with generic heparin and metoprolol have raised concerns about the efficacy and safety of DRA-approved drugs.

Although the design lacked power to detect differences in survival after thigh infection with P. Conclusion Pharmaceutical equivalence does not predict therapeutic equivalence of generic gentamicin.

Stricter criteria based on solid experimental evidence should be required before approval for human use. Gentamicin coating of metallic implants reduces implant-related osteomyelitis in rats. Antibiotic prophylaxis is a routine procedure in orthopedic surgery. Various local antibiotic delivery techniques are used to reduce bone- and soft tissue-related infection.

The objective of this study was to evaluate the efficacy of a new biodegradable, gentamicin -loaded poly D,L-lactide PDLLA coating of orthopedic devices in preventing implant-related osteomyelitis.

The medullary cavities of tibiae in 30 Sprague Dawley rats were contaminated with Staphylococcus aureus 10 3 colony forming units. Ten animals that received phosphate-buffered saline and uncoated Kirschner wires served as controls group I. Follow-up was 6 weeks. In weekly intervals X-rays of the tibiae were performed, blood counts were taken, and body temperature and weight were determined.

After sacrifice infection was evaluated by histological and microbiological analysis. All animals of groups II and III developed microbiological, histological, and radiological signs of infection, including osseous destruction and soft tissue swelling. All animals of the control group remained sterile. Cultures of implants of group IV showed significantly reduced bacterial growth compared to cultures of groups II and III, and three implants of group IV remained sterile. Further radiological and histological signs of infection were significantly reduced in the gentamicin -coated group compared to groups II and III.

No significant differences in body weight, body temperature, and blood parameters between all groups were observed. Combination therapy including serratiopeptidase improves outcomes of mechanical- antibiotic treatment of periimplantitis. This study was designed as a retrospective analysis of clinical outcomes of cases of periimplantitis treated by mechanical debridement and the administration of antibiotics combined or not with the administration of either the proteolytic enzyme serratiopeptidase SPEP or non-steroidal anti-inflammatory drugs NSAIDs.

Clinical charts of partially edentulous patients treated for periimplantitis between June and December were analyzed to obtain clinical data of the affected implants just before the beginning of treatment and 12 months later to evaluate the outcomes of combined mechanical antibiotic treatment alone or in combination with the co-administration of the anti-inflammatory SPEP or NSAIDs. The comparative analysis revealed that therapeutic outcomes were significantly different in the three groups.

Treatment including SPEP was associated with significantly better healing also when successful treatments alone were considered. The data reported in this paper strongly support the hypothesis that SPEP is a valid addition to protocols for the combined therapy of peri-implantitis. In fact, it allows to enhance success rates significantly and also favors better tissue repair around successfully treated implants as compared to other regimens.

Antibiotics disrupt the normal gut flora, sometimes causing antibiotic -associated diarrhoea AAD. Little is known either about the frequency or type of antibiotics prescribed in care homes or about the incidence and aetiology of AAD in this setting. PAAD stage 1 aimed to 1 prospectively describe antibiotic prescribing in care homes; 2 determine the incidence of C. However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2.

SETTING Recruited care homes had management and owner's agreement to participate and three or more staff willing to take responsibility for implementing the study. Phage therapy of staphylococcal infections including MRSA may be less expensive than antibiotic treatment. The current drama of antibiotic resistance has revived interest in phage therapy. In response to this challenge, a phage therapy center was established at our Institute in which accepts patients from Poland and abroad with antibiotic -resistant infections.

We now present data showing that efficient phage therapy of staphylococcal infections is no longer a treatment of last resort when all antibiotics fail , but allows for significant savings in the costs of healthcare. Neonatal listeriosis is an exceptional disease in Northern Africa. Hence, protocols for maternal-fetal infection treatment include only a third generation cephalosporin and an aminoside. This protocol does not take into account the possibility of Listeria monocytogenes infection.

We report a fatal case of neonatal listeriosis in Tunisia. The use of first antibiotics in maternal-foetal infection must be reconsidered when lacking sufficient bacteriological data and include systematically ampicillin in presumptive antibiotic protocols. A biodegradable gentamicin -hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses. A degradable, poly lactic-co-glycolic acid PLGA , gentamicin -loaded prophylactic coating for hydroxyapatite HA -coated cementless hip prostheses is developed with similar antibacterial efficacy as offered by gentamicin -loaded cements for fixing traditional, cemented prostheses in bone.

We describe the development pathway, from in vitro investigation of antibiotic release and antibacterial properties of this PLGA- gentamicin -HA-coating in different in vitro models to an evaluation of its efficacy in preventing implant-related infection in rabbits. Bone in-growth in the absence and presence of the coating was investigated in a canine model. The PLGA- gentamicin -HA-coating showed high-burst release, with antibacterial efficacy in agar-assays completely disappearing after 4 days, minimising risk of inducing antibiotic resistance.

Gentamicin -sensitive and gentamicin -resistant staphylococci were killed by the antibiotic -loaded coating, in a simulated prosthesis-related interfacial gap. PLGA- gentamicin -HA-coatings prevented growth of bioluminescent staphylococci around a miniature-stem mounted in bacterially contaminated agar, as observed using bio-optical imaging. PLGA- gentamicin -HA-coated pins inserted in bacterially contaminated medullary canals in rabbits caused a statistically significant reduction in infection rates compared to HA-coated pins without gentamicin.

Bone ingrowth to PLGA- gentamicin -HA-coated pins, in condylar defects of Beagle dogs was not impaired by the presence of the degradable, gentamicin -loaded coating. In conclusion, the PLGA- gentamicin -HA-coating constitutes an effective strategy for infection prophylaxis in cementless prostheses.

Gentamicin B1 is a minor gentamicin component with major nonsense mutation suppression activity. They introduce a premature termination codon PTC and prevent the formation of full-length protein.

Pharmaceutical gentamicin , a mixture of several related aminoglycosides, is a frequently used antibiotic in humans that can induce PTC readthrough and suppress nonsense mutations at high concentrations. However, testing of gentamicin in clinical trials has shown that safe doses of this drug produce weak and variable readthrough activity that is insufficient for use as therapy.

In this study we show that the major components of pharmaceutical gentamicin lack PTC readthrough activity but the minor component gentamicin B1 B1 is a potent readthrough inducer. Molecular dynamics simulations reveal the importance of ring I of B1 in establishing a ribosome configuration that permits pairing of a near-cognate complex at a PTC.

The B1 content of pharmaceutical gentamicin is highly variable and major gentamicins suppress the PTC readthrough activity of B1. Purified B1 provides a consistent and effective source of PTC readthrough activity to study the potential of nonsense suppression for treatment of rare genetic disorders. Susceptibility genes for gentamicin -induced vestibular dysfunction. Buccal cell samples were obtained from all subjects and DNA was genotyped for 15 polymorphisms in 9 genes.

Candidate genes were identified primarily for their roles in oxidative stress based on predicted mechanisms of gentamicin -induced ototoxicity. Statistical analyses included the multi-dimensionality reduction MDR method for identifying gene x gene interactions across multiple candidate genes.

GluAsp polymorphism as significantly associated with GM-induced vestibular dysfunction both p Gentamicin -loaded calcium carbonate materials: Synthetic aragonite-based porous materials were drug loaded with gentamicin sulphate, an antibiotic active on Staphylococcus aureus responsible for osteomyelitis. Drug loading was accomplished by two different ways: We first investigated the influence of drug loading on compressive strength of materials. Results indicate that soaked materials presented the same compressive strength than unloaded materials with the same porosity.

By contrast, the integration of gentamicin during processing increased significantly the compressive strength of materials.

The materials drug content before elution was a least 10 times higher when gentamicin was integrated during processing comparatively to soaked materials. The study of in vitro gentamicin release showed that for materials with gentamicin integrated during material processing, high concentrations of gentamicin were released up to 8 or 12 days, against 4 days for soaked materials.

The transport coefficients calculation, for the first step of release, indicated that the rate of release was higher for materials with integrated gentamicin because of the higher gentamicin content. The porosity rate influenced the rate of release for materials positively with gentamicin integrated during processing contrary to soaked materials for which a higher porosity rate allowed a deeper penetration of gentamicin during drug loading and then a slightly slower release. Results indicate that aragonite-based material with gentamicin integrated during material processing may be used either as resorbable device for release of high concentrations of gentamicin or as biomaterial for combined therapy: Introduction Osteitis is one of the most serious complications in orthopedic surgery.

In systemic administration, gentamicin has only a small therapeutic index and serious side effects; it is potentially nephrotoxic as well as ototoxic. It is not yet known if relevant gentamicin concentrations are released into the systemic circulation after implantation of gentamicin -coated nails.

Collection of blood samples occurred before the operation, at weeks 1—4, 3 and 6 months, and up to 1 year after the implantation. Measurement of gentamicin levels in serum samples was performed at the central laboratory of Heidelberg University Hospital. Additionally, laboratory parameters, C-reactive protein, leukocyte number, urea and creatinine concentrations were analyzed in routine controls before and after operating and assessed for systemic side effects.

Results Over the course of this prospective observational study, we were able to determine that gentamicin -coated nails do not release gentamicin into the systemic circulation above the lowest detectable level of 0. There were slight increases in the mean inflammation and renal retention markers, but no gentamicin -associated side effects could be linked to implantation.

Furthermore, no allergic reactions could be detected during our study. Conclusion Our findings suggest that there is no relevant release of gentamicin into the systemic circulation causing a systemic effect, and serious side effects due to gentamicin -coated tibia nails should not be feared. Effect of N, N'-dicyclohexylcarbodiimide and nigericin on Staphylococcus aureus susceptibility to gentamicin.

Each compound significantly increased both gentamicin uptake and killing. The use of agents which alter the plasma membrane energy state is a novel approach to enhance the activity of conventional antibiotics. It is considered to be difficult to detect tetracycline antibiotics in all-at-once simultaneous analysis with other drugs by liquid chromatography with tandem mass spectrometry, because tetracycline antibiotics chelate with bivalent metal ions such as calcium in samples.

Therefore, we studied simultaneous determination of tetracycline antibiotics after removal of calcium with disodium ethylenediaminotetraacetate EDTA-2Na. Tetracycline antibiotics could be assayed in all-at-once analysis by adding EDTA-2Na during the extraction procedure.

It was possible to determine 65 veterinary drugs in milk, 70 in yogurt, 59 in whipped cream, 67 in cheese and 60 in ice cream. Interaction of gentamicin polycation with model and cell membranes. The interaction of positively-charged antibiotic gentamicin with cell membranes was studied to determine if any changes in membrane organization were induced by the drug. Opossum kidney epithelia OK cells were used as models of eukaryotic cells.

Two methods were used: Both methods showed an altered membrane hydration and fluidity of gentamicin treated cells. Liposomes prepared from dimyristoyl-phosphatidylcholine DMPC mixed with cardiolipin, which mimics the heterogeneous charge composition of the natural cell membrane, were used to determine the effect of gentamicin on artificial bilayers.

The membrane lipid packing as revealed by generalized polarization GP and fluorescence anizotropy variation with increasing temperature was studied. It was found that the generalized polarization of liposomal membranes containing a negatively charged lipid cardiolipin is higher in the presence of gentamicin ; in the membrane of living cell OK , gentamicin induces, on the contrary, a decrease of general polarization.

Considering the role of membrane organization in the function of transmembrane channels and receptors, our findings suggest hypotheses that may explain the permeation of gentamicin through the living cell membrane by using these channels. Salicylic acid attenuates gentamicin -induced nephrotoxicity in rats. Gentamicin GM is a widely used antibiotic against serious and life-threatening infections, but its usefulness is limited by the development of nephrotoxicity.

The present study was designed to determine the protective effect of salicylic acid SA in gentamicin -induced nephrotoxicity in rats. Quantitative evaluation of gentamicin -induced structural alterations and degree of functional alterations in the kidneys were performed by histopathological and biochemical analyses in order to determine potential beneficial effects of SA coadministration with gentamicin.

Gentamicin was observed to cause a severe nephrotoxicity which was evidenced by an elevation of serum urea and creatinine levels. The significant increases in malondialdehyde MDA levels and protein carbonyl groups indicated that GM-induced tissue injury was mediated through oxidative reactions.

On the other hand, simultaneous SA administration protected kidney tissue against the oxidative damage and the nephrotoxic effect caused by GM treatment. Exposure to GM caused necrosis of tubular epithelial cells. Necrosis of tubules was found to be prevented by SA pretreatment.

The results from our study indicate that SA supplement attenuates oxidative-stress associated renal injury by reducing oxygen free radicals and lipid peroxidation in gentamicin -treated rats. Background Exposure to intense sound or high doses of aminoglycoside antibiotics can increase hearing thresholds, induce cochlear dysfunction, disrupt hair cell morphology and promote hair cell death, leading to permanent hearing loss.

When the two insults are combined, synergistic ototoxicity occurs, exacerbating cochlear vulnerability to sound exposure. The underlying mechanism of this synergism remains unknown. In this study, we tested the hypothesis that sound exposure enhances the intra-cochlear trafficking of aminoglycosides, such as gentamicin , leading to increased hair cell uptake of aminoglycosides and subsequent ototoxicity. Drug uptake was then examined in cochlear tissues by confocal microscopy.

Results Prolonged sound exposure that induced temporary threshold shifts increased gentamicin uptake by cochlear hair cells, and increased gentamicin permeation across the strial blood-labyrinth barrier. Enhanced intra-cochlear trafficking and hair cell uptake of gentamicin also occurred when prolonged sound, and subsequent aminoglycoside exposure were temporally separated, confirming previous observations.

Acute, concurrent sound exposure did not increase cochlear uptake of aminoglycosides. Conclusions Prolonged, moderate sound exposures enhanced intra-cochlear aminoglycoside trafficking into the stria vascularis and hair cells.

Gentamicin ointment versus petrolatum for management of auricular wounds. Surgeons frequently create defects on the ear in the treatment of cutaneous malignancies. Potentially significant complications of second-intention healing on the ear are suppurative and inflammatory chondritis. Consequently, many physicians advocate the use of oral or topical prophylactic antibiotics after auricular surgery.

The purpose of this study is to compare the efficacy of gentamicin ointment with that of petrolatum for the prevention of suppurative chondritis during second-intention healing of auricular wounds after Mohs surgery.

One hundred forty-two patients with a total of second-intention wounds were prospectively selected to receive either gentamicin ointment or petrolatum postoperatively. One hundred forty-four wounds were evaluated in a follow-up examination or by telephone interview.

Four wounds received gentamicin and four received petrolatum, for incidences of 4. There is no statistically significant difference between the use of gentamicin ointment and petrolatum in the prevention of postoperative auricular suppurative chondritis. The data also demonstrate a disproportionate number of cases of inflammatory chondritis in the gentamicin -treated group.

This study supports the cost-effective and potentially less irritating use of petrolatum for wound care in this difficult to manage area. In vitro susceptibility testing of Malassezia pachydermatis to gentamicin. Two studies have observed that growth media containing gentamicin can inhibit the growth of the yeast organism Malassezia pachydermatis. The minimum inhibitory concentration MIC of this bactericidal antibiotic for this organism has not been previously determined.

To evaluate the susceptibility of M. The MIC of gentamicin was determined using a modified version of the MA3 microdilution method following the guidelines of the Clinical and Laboratory Standards Institute. A modified Christensen's urea broth was used to enhance the growth of the M. Visual and spectrophotometric end-point readings were performed to detect the presence or absence of yeast growth.

The susceptibility of these isolates to gentamicin in vitro, by visual and spectrophotometric end-point reading, was: Prospective MICs for M. The clinical management of human brucellosis is still challenging and demands in vitro active antibiotics capable of targeting the pathogen-harboring intracellular compartments. A sustained release of the antibiotic at the site of infection would make it possible to reduce the number of required doses and thus the treatment-associated toxicity.

In this study, a hydrophobically modified gentamicin , gentamicin -AOT [AOT is bis 2-ethylhexyl sulfosuccinate sodium salt], was either microstructured or encapsulated in poly lactic-co-glycolic acid PLGA nanoparticles.

The efficacy of the formulations developed was studied both in vitro and in vivo. Moreover, in vivo studies demonstrated that gentamicin -AOT-loaded nanoparticles efficiently targeted the drug both to the liver and the spleen and maintained an antibiotic therapeutic concentration for up to 4 days in both organs. This resulted in an improved efficacy of the antibiotic in experimentally infected mice. Thus, while 14 doses of free gentamicin did not alter the course of the infection, only 4 doses of gentamicin -AOT-loaded nanoparticles reduced the splenic infection by 3.

These results strongly suggest that PLGA nanoparticles containing chemically modified hydrophobic gentamicin may be a promising alternative for the treatment of human brucellosis. Production by Actinomycetes, Including Streptomyces lactamdurans sp. A number of actinomycetes isolated from soil were found to produce one or more members of a new family of antibiotics , the cephamycins, which are structurally related to cephalosporin C.

The cephamycins were produced in submerged fermentation in a wide variety of media by one or more of eight different species of Streptomyces, including a newly described species, S. These antibiotics exhibit antibacterial activity against a broad spectrum of bacteria which includes many that are resistant to the cephalosporins and penicillins. Metabolomic approach to optimizing and evaluating antibiotic treatment in the axenic culture of cyanobacterium Nostoc flagelliforme.

The application of antibiotic treatment with assistance of metabolomic approach in axenic isolation of cyanobacterium Nostoc flagelliforme was investigated.

Seven antibiotics were tested at mg L -1 , and order of tolerance of N. Four antibiotics were selected based on differences in antibiotic sensitivity of N. The procedures of antibiotic treatment have been accordingly optimized as a consecutive treatment starting with spectinomycin, then gentamicin , ampicillin and lastly kanamycin, and proved to be highly effective in eliminating the bacteria as examined by agar plating method and light microscope examination.

Our work presented a strategy to obtain axenic culture of N. Antimicrobial activity of gentamicin palmitate against high concentrations of Staphylococcus aureus. The reduction of implant related infections plays a pivotal role in orthopaedic surgery as an increasing number of people require implants up to , per year in the United States source: The aim of the current study is to prevent and thus decrease the number of bacterial infections.

Both pre and post operative systemic antibiotic treatment and gentamicin containing bone cements polymethylmethacrylate, PMMA are commonly used strategies to overcome infections. In this study, the antimicrobial efficacy of gentamicin sulfate loaded bone cement was compared with titan discs coated with a new form of gentamicin , gentamicin palmitate. Adherence prevention, killing rates and killing kinetics were compared in an in vitro model, using Staphylococcus aureus S. In our experiments gentamicin , which was applied as gentamicin palmitate on the surface of the implants, showed a high efficacy in eliminating bacteria.

In contrast to gentamicin sulfate containing bone cements, gentamicin palmitate is released over a shorter period of time thus not inducing antibiotic resistance.

Another benefit for clinical application is that it achieves high local levels of active ingredient which fight early infections and minimize toxic side effects.

Furthermore, the short term hydrophobic effect of gentamicin palmitate can successfully impede biofilm formation. Thus, the use of self-adhesive antibiotic fatty acid complexes like gentamicin palmitate represents a new option for the anti-infective coating of cementless titan implants.

Action and interaction of penicillin and gentamicin on enterococci. The action and interaction of benzylpenicillin and gentamicin on Streptococcus faecalis was studied using mainly turbidimetric methods. The minimum antibacterial concentration MAC of each antibiotic lay considerably below the conventionally determined minimum inhibitory concentration, and levels of the two agents exceeding the MAC were necessary in order to obtain a synergic interaction.

Evidence was obtained that gentamicin interfered with bacterial lysis induced by penicillin, and this suggests that the aminoglycoside is responsible for the bactericidal activity of the combination, the role of the penicillin being solely to facilitate access of the aminoglycoside to its target site.

Our findings do not, however, fully support the generally held view that the increased permeability of enterococci to aminoglycosides is due to penicillin-induced cell wall damage. Multiplex characterization of human pathogens including species and antibiotic -resistance gene identification.

The efficient medical treatment of infections requires detailed information about the pathogens involved and potential antibiotic -resistance mechanisms. The dramatically increasing incidence of multidrug-resistant bacteria especially highlights the importance of sophisticated diagnostic tests enabling a fast patient-customized therapy.

However, the current molecular detection methods are limited to either the detection of species or only a few antibiotic -resistance genes. In this work, we present a human pathogen characterization assay using a rRNA gene microarray identifying 75 species comprising bacteria and fungi. A statistical classifier was developed to facilitate the automated species identification.

The specificity and sensitivity of the combined assay was determined using clinical isolates. The detection limit was 10 5 c. The total assay time was less than 7 hand the modular character of the antibiotic -resistance detection allows the easy integration of further genetic targets. In summary, we present a fast, highly specific and sensitive multiplex pathogen characterization assay. ABSTRACT Commonly used antimicrobials show poor cellular uptake and often have limited access to intracellular targets, resulting in low antimicrobial activity against intracellular pathogens.

An efficient delivery system to transport these drugs to the intracellular site of action is needed. Cell-penetrating peptides CPPs mediate the internalization of biologically active molecules into the cytoplasm. These CPPs, as well as Tat trans-activator of transcription from HIV-1, were used to deliver the antibiotic gentamicin to target intracellular bacteria. CPPs were covalently conjugated to gentamicin , and CPP- gentamicin conjugates were used to target infected cells to kill multiple intracellular Gram-negative pathogenic bacteria, including Escherichia coli K1, Salmonella enterica serovar Typhimurium, and Shigella flexneri.

Taken together, CPPs show great potential as delivery vehicles for antimicrobial agents and may contribute to the generation of new therapeutic tools to treat infectious diseases caused by intracellular pathogens. Commonly used antimicrobials show poor cellular uptake and often have limited access to intracellular targets, resulting in low antimicrobial activity against intracellular pathogens.

CPPs were covalently conjugated to gentamicin , and CPP- gentamicin conjugates were used to target infected cells to kill multiple intracellular Gram-negative pathogenic bacteria, including Escherichia coli K1, Salmonella enterica serovar Typhimurium, and Shigella flexneri Taken together, CPPs show great potential as delivery vehicles for antimicrobial agents and may contribute to the generation of new therapeutic tools to treat infectious diseases caused by intracellular pathogens.

Gentamicin resistance among Escherichia coli strains isolated in neonatal sepsis. Neonatal sepsis is a significant cause of morbidity and mortality among term and preterm infants. Ampicillin and gentamicin are standard empiric therapy for early onset sepsis.

Four cases of neonatal sepsis secondary to Escherichia coli E. To determine whether these cases could be tied to a single vector of transmission, and to more broadly evaluate the incidence of gentamicin resistant strains of E.

We also reviewed all positive E. Infants A and B had genetically indistinguishable strains which matched that of urine and placental cultures of Infant B's mother. Infant C had a genetically distinct organism. Infant D, the identical twin of Infant C, did not have typing performed. Review of all cultures positive for E. A review of other studies showed that rates of resistance vary considerably by institution. We conclude that gentamicin -resistant E.

Minimum inhibitory and bactericidal concentrations of four antibiotics and their combinations were determined for 38 strains of enterococci by a microtitration tube dilution technique.

The drugs were ampicillin, vancomycin, gentamicin , and streptomycin; the combinations were ampicillin- gentamicin , ampicillin-streptomycin, vancomycin- gentamicin , and vancomycin-streptomycin. Vancomycin alone showed striking inhibitory activity, but very poor bactericidal activity at achievable concentrations. Combination with one of the aminoglycosides increased the bactericidal activity substantially.

When combined with ampicillin, gentamicin was both more active and showed synergistic bactericidal activity significantly more often P Therapeutic monitoring of amikacin and gentamicin in critically and noncritically ill patients.

Therapeutic drug monitoring TDM enables individualization in the treatment to optimize clinical benefit and minimize drugs' side effects. Critically ill septic patients represent a challenge for antimicrobial treatment because of pathophysiological impact of sepsis on pharmacokinetics of drugs.

The aim of this study was to assess the appropriateness of gentamicin and amikacin dosing in critically and noncritically ill patients, as well as to estimate the need for its regular therapeutic monitoring. It was a prospective study which included 31 patients on gentamicin and 16 patients on amikacin from four different units who met the inclusion criteria.

Trough concentrations of drugs were measured in serum just before third or fourth dose of antibiotic , whereas peak concentrations were measured in serum 1 h after the completion of drug administration steady state. Relevant data on patients' clinical course of disease, comorbidities, and concomitant medication were collected from medical charts in order to identify their possible influence on drugs' concentrations. Peak concentrations of amikacin were in reference range in Peak concentrations of gentamicin were in reference range in Serum concentrations of aminoglycosides amikacin and gentamicin were in reference range in most of the patients in our study, suggesting that dosing of these drugs in the University Hospital Clinical Center, Banja Luka, was adequate.

In patients without kidney or liver disease, regular TDM of aminoglycosides is not necessary. Antibiotic -loaded bone cement and periprosthetic joint infection.

ALBC is commonly used in two-stage exchange arthroplasty with static and dynamic spacers, beads, rods, and other custom spacers. Hope; A; Sunday, September 7, Assessing Isavuconazole Induced Resistance in Aspergillus fumigatus. Perlin; M; Sunday, September 7, Chowdhary; M; Sunday, September 7, Castanheira; M; Sunday, September 7, Resistance Mechanisms to Azoles in Moulds.

Ghannoum; M; Monday, September 8, Outcomes by Malignancy Status. Mujais; M; Monday, September 8, Maertens; M; Monday, September 8, Perfect; M; Monday, September 8, Hope; M; Monday, September 8, Vazquez; M; Monday, September 8, Kaufhold; L; Monday, September 8, Bonomo; C; Saturday, September 6, Santerre Henriksen; C; Monday, September 8, Naber; F; Monday, September 8, Isavuconazole demonstrated in-vitro and in-vivo coverage of a broad range of yeasts such as Candida species and molds such as Aspergillus species , including emerging and often fatal molds such as those that cause mucormycosis.

It has EU and U. In the phase 3 invasive aspergillosis SECURE study, isavuconazole demonstrated non-inferiority to voriconazole on the primary endpoint of all-cause mortality at day The treatment-emergent adverse events for isavuconazole were statistically fewer relative to voriconazole in the system organ classes of hepatobiliary, skin and eye disorders. In addition, isavuconazole showed statistically fewer study drug-related adverse events relative to voriconazole. In both treatment groups, the most common treatment-emergent adverse events were nausea, vomiting, pyrexia fever and diarrhea.

Isavuconazole for the treatment of candidiasis is currently being explored in the ongoing phase 3 study ACTIVE, which evaluates the safety and efficacy of intravenously i. Isavuconazole is being co-developed with Astellas Pharma Inc. Basilea holds full rights to isavuconazole in markets outside of the U. BAL is an investigational intravenous siderophore monosulfactam antibiotic with bactericidal activity against multidrug-resistant Gram-negative pathogens.

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