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Efficacy of N-acetyl-cysteine in combination with thiamphenicol in sequential (intramuscular/aerosol) therapy of upper respiratory tract infections even when sustained by bacterial biofilms.
Macchi, A, Ardito, F, Marchese, A, Schito, GC, Fadda, G
Journal of chemotherapy (Florence, Italy). 2006;(5):507-13
Abstract
A total of 102 patients with recurrent upper respiratory tract infections underwent microbiological exploration with appropriate sampling and direct biopsies of the infected sites. Therapy was then started and on day 1 each patient received two intramuscular injections of thiamphenicol glycinate acetylcysteinate (TGA). From day 2 to 10 sequential therapy with the same drug was continued employing TGA administered by aerosol. All putative etiologic agents recovered were susceptible to thiamphenicol and only 24 demonstrated the ability to produce in vitro biofilms. The organisms comprised 10 Staphylococcus aureus, 6 Streptococcus pyogenes, 4 Streptococcus pneumoniae and 3 Haemophilus influenzae. Of the 24 subjects in whom biofilms were demonstrated to be present in vivo by Scanning Electron Microscopy, clinical and bacteriological cure was obtained in 21 cases (87.5%) following sequential therapy with TGA. Failures were considered to be persistent signs and symptoms at day 15 after initiation of treatment and lack of eradication of 3 S. aureus strains, despite their in vitro susceptibility to thiamphenicol. Very few adverse events attributable to TGA were reported in this cohort of patients. In no case was discontinuation of treatment deemed necessary by the attending physician.
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Effects of cranberry juice on uropathogenic Escherichia coli in vitro biofilm formation.
Di Martino, P, Agniel, R, Gaillard, JL, Denys, P
Journal of chemotherapy (Florence, Italy). 2005;(5):563-5
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Substantivity of toothpaste slurries and their effect on reestablishment of the dental biofilm.
Arweiler, NB, Auschill, TM, Reich, E, Netuschil, L
Journal of clinical periodontology. 2002;(7):615-21
Abstract
OBJECTIVES Toothpastes are good vehicles for antibacterial substances to exert a prolonged effect. This effect depends on the substantivity and ability to interfere with plaque metabolism and/or vitality. It was the purpose of this clinical, randomized 2 x 4 cell crossover study to evaluate and to compare the antibacterial effects of two toothpastes (Colgate Total(R), COL and Parodontax(R), PAR) applied as slurries on established plaque over 24 h (Part I) and their effect on 4-day plaque regrowth (Part II). Chlorhexamed(R) (0.1%; CHX) and water served as positive and negative controls. MATERIAL AND METHODS After professional toothcleaning eight students were asked to refrain from all mechanical hygiene measures for the next 72 h. After 48 h plaque was sampled and vitality of the plaque flora examined (baseline, VF0%). The subjects then rinsed for 1 min with 15 mL of one of the test or control solutions. Every second hour up to 14 h and 24 h after rinsing, plaque sampling and staining was performed to assess plaque vitality (VF2-24, Part I). In Part II, the classical 4-day plaque regrowth design was used with two rinses (1 min) a day as the only oral hygiene measure. Vitality values were assessed on day 1 and day 4 (VF1, VF2). At day 4, teeth were stained to assess the whole mouth plaque index (PlI) and to evaluate the percentage of plaque area (PA) of the anterior teeth. RESULTS Compared to placebo, all active rinses reduced plaque vitality significantly over a period of 24 h (Part I). PAR, COL and CHX revealed reductions of 18-31%, 28-50% and 19-50%, respectively. In Part II, similar reductions of all parameters were found for all active rinses (PAR 12-30%, COL 34-51%, CHX 40-64%). CONCLUSIONS Colgate Total has shown a significant action on plaque regrowth and a high substantivity during 24 h, while Parodontax revealed a more moderate but still significant effect.
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Antibacterial effect of an enamel matrix protein derivative on in vivo dental biofilm vitality.
Arweiler, NB, Auschill, TM, Donos, N, Sculean, A
Clinical oral investigations. 2002;(4):205-9
Abstract
The purpose of this observer-blind, randomised, five-cell crossover study was to examine the antibacterial efficacy of an enamel matrix protein derivative (EMD) on established supragingival plaque in vivo. Saline (NaCl) served as a negative control solution and chlorhexidine (CHX) as a positive one. Additionally, the propylene glycol alginate (PGA) vehicle and the 24% ethylenediaminetetra-acetate (EDTA) gel were tested. After professional oral prophylaxis, 14 volunteers refrained from all mechanical oral hygiene measures for the following 48 h to build up plaque. In randomised order, the following procedures were applied: (a) 10 ml of CHX (0.2%) or (b) 10 ml of NaCl were used as a mouthrinse for 1 min each. In the cases of (c) EMD (Emdogain), (d) PGA, or (e) 24% EDTA (PrefGel), 1 ml of each were applied with a syringe on the teeth. Two hours after application, plaque samples were taken from one upper and one lower molar, and the vitality of the biofilm microbiota was examined using the vital fluorescence technique. Biofilm vitality (VF%) was lower for EMD, PGA, and CHX by 19% ( P<0.0001), 22% ( P=0.001), and 35% ( P<0.0001), respectively, than in negative controls. The EDTA showed similar vitality values to NaCl and was therefore not able to affect the biofilm flora significantly. The EMD and PGA displayed significantly reduced biofilm vitality compared to negative controls, which, however, could not reach the effect of the positive control (0.2% CHX). The present results demonstrate for the first time a direct influence of EMD on the vitality of supragingival dental plaque in vivo.
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Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution.
Krishnasami, Z, Carlton, D, Bimbo, L, Taylor, ME, Balkovetz, DF, Barker, J, Allon, M
Kidney international. 2002;(3):1136-42
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Abstract
BACKGROUND Tunneled dialysis catheters are complicated by frequent systemic infections. Standard therapy of catheter-associated bacteremia involves both systemic antibiotics and catheter replacement. Recent data suggest that biofilms in the catheter lumen are responsible for the bacteremia, and that instillation of an antibiotic lock (highly concentrated antibiotic solution) into the catheter lumen after dialysis sessions can eradicate the biofilm. METHODS We analyzed prospectively the efficacy of an antibiotic lock protocol, in conjunction with systemic antibiotics, for treatment of patients with dialysis catheter-associated bacteremia without catheter removal. Protocol success was defined as resolution of fever and negative surveillance cultures one week following completion of the protocol. Protocol failure was defined as persistence of fever or surveillance cultures positive for any pathogen. In addition, infection-free catheter survival was compared to that observed in institutional historical control patients treated with catheter replacement. RESULTS Blood cultures were positive in 98 of 129 of episodes (76%) in which patients dialyzing with a catheter had fever or chills. Protocol success occurred in 40 of 79 infected patients (51%) treated with the antibiotic lock. Protocol failure occurred in 39 cases (49%): 7 had persistent fever, 15 had positive surveillance cultures (9 for Candida and 6 for bacteria), and 17 required catheter removal due to malfunction. Each of the pathogens in the surveillance cultures was different from the original pathogen in that patient. Eight of the 9 secondary Candida infections and all 6 secondary bacterial infections resolved after catheter exchange and specific antimicrobial treatment. Overall catheter survival with the antibiotic lock protocol was similar to that observed among patients managed with catheter replacement (median survival, 64 vs. 54 days, P = 0.24). CONCLUSIONS Use of an antibiotic lock, in conjunction with systemic antibiotic therapy, can eradicate catheter-associated bacteremia while salvaging the catheter in about one half of cases. Moreover, this management approach offers clinical advantages over routine catheter exchange.