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1.
Feasibility of a Lactobacillus casei Drink in the Intensive Care Unit for Prevention of Antibiotic Associated Diarrhea and Clostridium difficile.
Alberda, C, Marcushamer, S, Hewer, T, Journault, N, Kutsogiannis, D
Nutrients. 2018;(5)
Abstract
Background: Over 70% of patients are prescribed antibiotics during their intensive care (ICU) admission. The gut microbiome is dramatically altered early in an ICU stay, increasing the risk for antibiotic associated diarrhea (AAD) and Clostridium difficile infections (CDI). Evidence suggests that some probiotics are effective in the primary prevention of AAD and CDI. Aim: To demonstrate safety and feasibility of a probiotic drink in ICU patients. Methods: ICU patients initiated on antibiotics were recruited, and matched with contemporary controls. Study patients received two bottles daily of a drink containing 10 billion Lactobacillus casei which was bolused via feeding tube. Tolerance to probiotics and enteral nutrition, development of adverse events, and incidence of AAD was recorded. CDI rates were followed for 30 days post antibiotic treatment. Results: Thirty-two patients participated in the trial. There were no serious adverse events in the probiotic group, compared to three in the control group. AAD was documented in 12.5% of the probiotic group and 31.3% in the control group. One patient in the probiotic group developed CDI compared to three in the control group. Discussion: A probiotic containing drink can safely be delivered via feeding tube and should be considered as a preventative measure for AAD and CDI in ICU.
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2.
Efficacy of a quadruple therapy regimen for Helicobacter pylori eradication after partial gastrectomy.
Zhang, F, Bao, ZJ, Shi, DM, Xiang, P, Xiao, L, Huang, YQ, Zhang, GS, Yin, SM
Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas. 2016;(2):e5080
Abstract
We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients.
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3.
Periodontal treatment with topical antibiotics improves glycemic control in association with elevated serum adiponectin in patients with type 2 diabetes mellitus.
Bharti, P, Katagiri, S, Nitta, H, Nagasawa, T, Kobayashi, H, Takeuchi, Y, Izumiyama, H, Uchimura, I, Inoue, S, Izumi, Y
Obesity research & clinical practice. 2013;(2):e129-e138
Abstract
OBJECTIVES Chronic inflammation of periodontitis aggravates glycemic control in type 2 diabetic patients through aggravation of insulin resistance. Increased or decreased release of various inflammatory mediators, such as high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6 and adipokines, such as adiponectin, leptin, and resistin, are presumed to be responsible for developing and progressing insulin resistance. The purpose of this study was to examine the effects of periodontal treatment on glycemic control, serum inflammatory mediators and adipokines in type 2 diabetes patients with periodontitis. METHODS Twenty-one type 2 diabetic patients with periodontitis received periodontal treatment with topical antibiotics (intervention group) and 8 patients did not receive periodontal treatment (control group). Periodontal examination, including probing pocket depth (PPD) and bleeding on probing (BOP), and blood sampling were performed at baseline, 2 and 6 months after periodontal treatments. Glycated hemoglobin (HbA1c), hs-CRP, TNF-α, IL-6, adiponectin, leptin, and resistin were analyzed. RESULTS In the intervention group, improvements of PPD and BOP, decrease in HbA1c and elevation of serum adiponectin were observed, while in the control group, all parameters were not changed. Generalized linear model revealed that changes of serum adiponectin and TNF-α and change of BOP correlated significantly with the reduction of HbA1c at 6 months after periodontal treatments. CONCLUSION The results demonstrated that periodontal treatment improves periodontal status and glycemic control with elevation of serum adiponectin in type 2 diabetic patients. The results suggest that HbA1c is reduced by amelioration of insulin resistance due to elevated serum adiponectin after periodontal treatments.
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4.
[Using biocomplexes in therapeutic-and-prophylactic and palliative measures in chronic obstructive lung disease].
Lushchaev, AIu, Vishniakov, AA, Kozlov, BI, Frolov, NA
Advances in gerontology = Uspekhi gerontologii. 2009;(3):512-5
Abstract
The paper presents the results of a clinical study of the use of biocomplexes in therapy for chronic obstructive lung disease and shows possibility to use them in therapeutic-and-prophylactic and palliative measures.
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5.
Effects of periodontal therapy on glycemic control and inflammatory markers.
O'Connell, PA, Taba, M, Nomizo, A, Foss Freitas, MC, Suaid, FA, Uyemura, SA, Trevisan, GL, Novaes, AB, Souza, SL, Palioto, DB, et al
Journal of periodontology. 2008;(5):774-83
Abstract
BACKGROUND Periodontitis, a complication of diabetes mellitus (DM), can induce or perpetuate systemic conditions. This double-masked, placebo-controlled study evaluated the effects of periodontal therapy (scaling and root planing [SRP]) on the serum levels of glycated hemoglobin (HbA1c) and on inflammatory biomarkers. METHODS Thirty subjects with type 2 DM and periodontitis were treated with SRP + placebo (SRP; N = 15) or with SRP + doxycycline (SRP+Doxy; N = 15), 100 mg/day, for 14 days. Clinical and laboratory data were recorded at baseline and at 3 months after treatment. RESULTS After 3 months, the reduction in probing depth was 0.8 mm for the SRP group (P <0.01) and 1.1 mm for the SRP+Doxy group (P <0.01) followed by a 0.9% (SRP; P = 0.17) and 1.5% (SRP+Doxy; P <0.01) reduction in HbA1c levels. A significant reduction in interleukin (IL)-6; interferon-inducible protein 10; soluble fas ligand; granulocyte colony-stimulating factor; RANTES; and IL-12 p70 serum levels were also verified (N = 30). To our knowledge, this is the first report on the effects of periodontal therapy on multiple systemic inflammatory markers in DM. CONCLUSIONS Periodontal therapy may influence the systemic conditions of patients with type 2 DM, but no statistical difference was observed with the adjunctive systemic doxycycline therapy. Moreover, it is possible that the observed improvement in glycemic control and in the reduction of inflammatory markers could also be due to diet, which was not controlled in our study. Therefore, a confirmatory study with a larger sample size and controlled diet is necessary.
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6.
Biphosphonate-associated osteonecrosis can be controlled by nonsurgical management.
Montebugnoli, L, Felicetti, L, Gissi, DB, Pizzigallo, A, Pelliccioni, GA, Marchetti, C
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2007;(4):473-7
Abstract
Sixteen patients with jaw biphosphonate-osteonecrosis and with exposed bone areas were subdivided into 2 treatment groups. The first group (7 patients) underwent superficial or radical surgical therapy, while the second (9 patients) underwent antibiotic treatment. A slight reduction of the necrotic areas was observed in 5 of 7 patients in the first group, whereas no change was observed in the remaining 2 patients at 22- and 24-month follow-up. A slight reduction of the necrotic areas was observed in 7 of 9 patients in the second group, whereas no change was observed in the remaining 2 patients at 5- and 24-month follow-up. The statistical analysis showed that the treatment regimen did not significantly influence the dimensional change in the exposed bone. The preliminary results seem to suggest that biphosphonate-associated osteonecrosis can be well controlled by a nonsurgical protocol consisting in long-term administration of antibiotics.
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7.
No effect of pyridoxine on the incidence of myelosuppression during prolonged linezolid treatment.
Plachouras, D, Giannitsioti, E, Athanassia, S, Kontopidou, F, Papadopoulos, A, Kanellakopoulou, K, Giamarellou, H
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2006;(9):e89-91
Abstract
Complications of long-term linezolid administration include anemia and thrombocytopenia. A recent report has suggested that pyridoxine may prevent myelosuppression. Pyridoxine was administered to 24 patients with bone infections who were being treated with linezolid. Thrombocytopenia occurred in 11 patients (45.8%), and anemia occurred in 6 (25%). We concluded that treatment wtih pyridoxine is unlikely to benefit patients who have been receiving linezolid for >2 weeks.
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8.
Effect of local mupirocin application on exit-site infection and peritonitis in an Indian peritoneal dialysis population.
Mahajan, S, Tiwari, SC, Kalra, V, Bhowmik, DM, Agarwal, SK, Dash, SC, Kumar, P
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 2005;(5):473-7
Abstract
BACKGROUND Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India. METHODS This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application. RESULTS Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect. CONCLUSIONS Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.
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9.
Concomitant chronic sinusitis treatment in children with mild asthma: the effect on bronchial hyperresponsiveness.
Tsao, CH, Chen, LC, Yeh, KW, Huang, JL
Chest. 2003;(3):757-64
Abstract
STUDY OBJECTIVE Previous studies have suggested that aggressive treatment of sinusitis can decrease bronchial hyperresponsiveness (BHR). However, there is still too little evidence to draw this conclusion, and the concept remains controversial. DESIGN A prospective, open-label study. SETTING University children's hospital allergy and immunology center and radiologic department. PATIENTS Sixty-one children with mild asthma and allergic rhinitis participated in the study. Forty-one of these 61 children had sinusitis, and the remainder had no sinusitis. Ten matched, nonatopic, healthy children were used as a control group. INTERVENTION Children with chronic sinusitis were placed into two groups. One group was treated with amoxicillin-clavulanate for 6 weeks and then with nasal saline solution irrigation for 6 weeks. For the other group, the treatment order was reversed. Children without chronic sinusitis received nasal saline solution irrigation for 12 weeks. MEASUREMENTS Clinical symptoms and signs of sinusitis, FEV(1), and BHR were analyzed in the patients before and after treatment. RESULTS The clinical symptoms and signs of sinusitis, but not FEV(1), showed a significant improvement after antibiotic treatment. After aggressive treatment for sinusitis, it was found that the provocative concentration of methacholine causing a 20% fall in FEV(1) of children with mild asthma and sinusitis was significantly higher after treatment. CONCLUSION The results suggest that every asthmatic patient needs to carefully evaluate to determine whether the patient has concomitant sinusitis. Respiratory infections that meet criteria for sinusitis, even if they do not exacerbate asthma, should be treated. It is suggested that sinusitis should always be kept in mind as a possible inducible factor for BHR, and that aggressive treatment of chronic sinusitis is indicated when dealing with an asthmatic patient who shows an unpredictable response to appropriate treatment. Moreover, the findings of this study provide more evidence for an association between sinusitis and asthma with respect to BHR.
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10.
Community-acquired respiratory tract infections caused by resistant pneumococci: clinical and bacteriological efficacy of the ketolide telithromycin.
Fogarty, CM, Kohno, S, Buchanan, P, Aubier, M, Baz, M
The Journal of antimicrobial chemotherapy. 2003;(4):947-55
Abstract
The incidence of community-acquired respiratory tract infections caused by Streptococcus pneumoniae exhibiting antibacterial resistance has increased dramatically in recent years. Telithromycin is the first of a new class of antibacterials, the ketolides, which have been developed specifically to provide effective treatment for these infections. Data were analysed from 3935 patients who had participated in one Japanese Phase II study and 11 US/global Phase III studies in three indications: community-acquired pneumonia, acute exacerbations of chronic bronchitis or acute sinusitis. Patients received either telithromycin 800 mg once daily or a comparator antibacterial. S. pneumoniae isolates considered to be causative for infection were tested for susceptibility to penicillin G and erythromycin A. In per-protocol analyses, telithromycin showed a high level of clinical efficacy against S. pneumoniae, with clinical cure rates of 92.8% for all isolates, 91.7% for those with reduced susceptibility to penicillin G and 86.0% for those with reduced susceptibility to erythromycin A. Bacterial eradication rates were consistent with the clinical outcomes. High rates of clinical cure and bacterial eradication were also observed for infections caused by isolates demonstrating high-level resistance to erythro-mycin A [MICs ≥ 512 mg/L: 100% (13/13) clinical cure, 100% (13/13) bacterial eradication]. These results support the use of telithromycin as a first-line oral therapy for the treatment of community-acquired respiratory tract infections caused by S. pneumoniae with reduced susceptibility to penicillin G and erythromycin A.