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Eye. 2008 Jul 4;
Ramakrishnan R, Bharathi MJ, Shivkumar C, Mittal S, Meenakshi R, Khadeer MA, Avasthi A
PurposeTo identify the microbial aetiology of infectious endophthalmitis and to determine the in vitro antibacterial susceptibilities of bacterial isolates.MethodsA retrospective analysis was carried out of all patients presenting between January 1997 and December 2006 with clinically diagnosed infectious endophthalmitis who underwent microbiological evaluation. Intraocular specimens (aqueous and vitreous fluids) were collected from all cases of clinically suspected infectious endophthalmitis. In addition to intraocular aspirates, blood specimens from endogenous endophthalmitis, and corneal and scleral scrapes from relevant cases were also collected. The collected intraocular specimens, blood specimens, and corneal and scleral scrapes were subjected to microbiological evaluation.ResultsSamples from 955 patients with endophthalmitis underwent microbiological analysis, of which 424 (44.4%) were found to be culture positive. Of 424, 364 (85.8%) had bacterial growth and the remaining 60 (14.2%) had fungal growth. Among post-surgical endophthalmitis, Gram-negative bacilli (75%) were found to be the predominant cause for developing fulminant onset, Staphylococcus spp. (68.6%) for acute, and Streptococcus spp. (75%) for chronic onset of infections, whereas in post-traumatic endophthalmitis, Gram-negative bacilli (65.2%) were found to be the predominant cause for fulminant onset, Gram-positive bacillus (28.4%) for acute onset, and fungi (52.3%) for chronic onset of infections. Endophthalmitis associated with microbial keratitis was mainly caused by filamentous fungi (37.2%) and Gram-negative bacilli (37.2%). Overall, gatifloxacin (97.7%) showed highest activity against bacterial isolates followed by ciprofloxacin (95.9%) and ofloxacin (95.1%).ConclusionGram-negative bacilli cause predominantly fulminant onset, Staphylococci and Gram-positive bacilli acute, and Streptococci, Nocardia, and fungi chronic endophthalmitis. Gatifloxacin demonstrated greatest efficacy against these bacterial isolates.Eye advance online publication, 4 July 2008; doi:10.1038/eye.2008.197.
[Safety assessment of starters culture bacteria in fermented milk in China]
Wei Sheng Yan Jiu. 2008 Mar; 37(2): 193-5
Xu J, Yan W, Yang B, Li Z
In this study, we analysised the safety of 137 strains of starters culture bacteria in fermented milk between 2000 and 2006 in China. The study was designed to evaluate the acute oral toxicity of 137 strains to mice, and 31 of 137 strains for Minimum inhibitory concentrations (MIC) of 20 kinds of antibiotics by broth micro-dilution method. The result indicated that except a strain of Lactobacillus rhamnosus, other probiotics were non-pathogenic and safe for human consumption. 31 strains of probiotics were sensitive to Ampicillin, Penicillin, Imipenem, Gentamicine, Amoxicillin, Amoxicillin/clavulanic acid, Gatifloxacin, Erythromycin, Clindamycin, and were resistant to Nalidixic acid, Vancomycine, Fosfomycin.
Levofloxacin-induced delirium with psychotic features.
Gen Hosp Psychiatry. 2008 Jul-Aug; 30(4): 381-3
Kiangkitiwan B, Doppalapudi A, Fonder M, Solberg K, Bohner B
OBJECTIVE: To raise awareness of a rare but serious adverse effect of a commonly used medication. METHOD: Report of a case. RESULTS: A previously healthy 42-year-old woman presented with acute-onset delirium with psychotic features as a consequence of levofloxacin therapy. Withdrawal of the medication was associated with return of the patient's normal mental status. CONCLUSION: The new quinolone derivatives (levofloxacin, sparfloxacin, grepafloxacin, trovafloxacin, gatifloxacin and moxifloxacin), also called gyrase inhibitors, are known for their potential to cause central nervous system-related adverse effects, including headache, dizziness and insomnia. Risk factors for neurotoxicity include renal insufficiency, underlying central nervous system (CNS) disease and increased CNS penetration of drug. Acute delirium resulting from levofloxacin therapy is an exceedingly rare complication that has been thought to occur more commonly in elderly patients. Here, we describe levofloxacin-induced delirium with psychotic features in a relatively young, otherwise healthy female.
Incidence of metallo beta lactamase producing Pseudomonas aeruginosa in ICU patients.
Indian J Med Res. 2008 Apr; 127(4): 398-402
Varaiya A, Kulkarni N, Kulkarni M, Bhalekar P, Dogra J
BACKGROUND & OBJECTIVE: Metallo beta lactamase (MBL) producing Pseudomonas aeruginosa have been reported to be important cause of nosocomial infections. The appearance of MBL genes and their spread among bacterial pathogens is a matter of concern with regard to the future of antimicrobial therapy. The present study was undertaken to determine the incidence of MBL producing P. aeruginosa in patients with diabetes and cancer admitted to the intensive care unit of a tertiary care hospital in western India and to assess the clinical outcome after antimicrobial treatment. METHODS: A total of 240 isolates of P. aeruginosa from various specimens between January and December 2005 were subjected to susceptibility testing against various antibiotics by disc diffusion test as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Imipenem and meropenem resistant isolates were selected for the detection of MBL production by disc potentiation test. Enhancement of inhibition zone around imipenem and meropenem discs impregnated with EDTA as compared to those without EDTA confirmed MBL production. RESULTS: Of the 240 P. aeruginosa isolates, 60 (25%) were found to be carbapenem resistant and 50 (20.8%) were found to be MBL producers. Of the 50 MBL producing isolates, 38 (76%) were from diabetes patients and 12 (24%) from cancer patients. Overall, 36 per cent patients responded to gatifloxacin, 42 per cent responded to piperacillin/tazobactam while 14 per cent responded to combination of gatifloxacin and piperacillin/tazobactum. Due to this nosocomial pathogen, the average hospital stay was 32 days and was associated with 20 per cent mortality due to septicaemia. INTERPRETATION & CONCLUSION: Our findings showed that there is a need to do surveillance to detect MBL producers, judiciously use carbapenems to prevent their spread and use effective antibiotics, such as gatifloxacin and piperacillin-tazobactum, after sensitivity testing for treatment.
Quinolone-resistant Escherichia coli.
Braz J Infect Dis. 2008 Feb; 12(1): 5-9
Ito CA, Gales AC, Tognim MC, Munerato P, Dalla Costa LM
Quinolones (nalidixic acid - NAL, norfloxacin - NOR, ciprofloxacin - CIP and gatifloxacin - GAT) were tested against Escherichia coli isolated from urine (385 patient samples) by disk diffusion (DD) and agar dilution (AD) methods. Fifty-three samples (13.8%) were classified as resistant to at least one of the quinolones tested. CIP and NOR susceptibilities were the same (91.4%) and they were similar to GAT (92.7%). Susceptibility to NAL, detected by the disk diffusion method, was used to predict susceptibility to NOR, CIP and GAT by the agar dilution method. The sensitivity and specificity of NAL were 100% and 95%, respectively. Twelve samples were analyzed for mutations in the quinolone resistance-determining region (QRDR) of the gyrA and parC genes. Sequencing of these genes failed to find any mutations in the quinolone-sensitive isolates. However, three mutations were observed in the isolates resistant to all the quinolones tested - two in gyrA and one in parC. A single mutation in gyrA was found in the strains that were resistant to nalidixic acid but fluoroquinolone-sensitive. These findings support the suggestion that NAL could be used as a marker for susceptibility to fluoroquinolones in routine microbiology laboratories. The overall resistance rate to quinolones in the present study was 13.8%, which is higher than that observed in other studies carried out in developed countries. Our findings serve as a warning that resistance to this group of antimicrobial agents is increasing.
Arq Bras Oftalmol. 2008 Mar-Apr; 71(2): 191-6
Arantes TE, de Castro CM, Cavalcanti RF, Severo MS, Diniz Mde F, Urtiga RW
PURPOSE: To evaluate alterations of the conjunctival flora after the use of 0.3% ciprofloxacin and gatifloxacin in the prophylaxis of patients undergoing cataract surgery. METHODS: 40 patients undergoing cataract surgery were distributed into two groups according to the use of antibiotic eye drops: Group A: 0.3% ciprofloxacin and Group B: 0.3% gatifloxacin. Both groups used antibiotic eye drops 1 hour before surgery and 14 days after surgery. Conjunctival material was collected at 5 time points: 1 hour before surgery, without any topical medication (t0); immediately before the application of povidone-iodine (PVPI) (t1), before the beginning of surgery, after povidone-iodine (t2), 14 days (t3) and 28 days after surgery (t4). RESULTS: Preoperative antibiotics reduced the positivity of the cultures before the use of PVPI in both groups, although in Group A this reduction was not significant (Group A - p=0.07 and Group B - p=0.04). The number of positive cultures was reduced in all groups after the use of povidone-iodine and on the 14th postoperative day (p
Haemoptysis associated with gatifloxacin in a 27 year old male asthmatic--a case report.
Br J Clin Pharmacol. 2008 Jul; 66(1): 148-9
Gupta V, Rizvi W, Dar KA, Bhargava R, Kumar A
The effect of cyclosporine A (Restasis) on recovery of visual acuity following LASIK.
J Refract Surg. 2008 May; 24(5): 473-6
Ursea R, Purcell TL, Tan BU, Nalgirkar A, Lovaton ME, Ehrenhaus MR, Schanzlin DJ
PURPOSE: To compare the recovery of uncorrected visual acuity (UCVA) following LASIK in patients treated with topical cyclosporine A 0.05% and patients treated with a standard postoperative regimen. METHODS: In this single-center, open-label, retrospective study, a standard refractive workup was performed in 45 patients (85 eyes) who underwent LASIK and did not have preexisting dry eye. In 36 eyes, a standard postoperative eye drop regimen was followed, and in 49 eyes, cyclosporine A 0.05% was added to the standard regimen for 12 weeks. Uncorrected visual acuity was measured 1 week and 1 and 3 months postoperatively. RESULTS: One week postoperatively, 22 (44.9%) eyes in the cyclosporine A group and 8 (22.2%) eyes in the standard treatment group had UCVA of 20/15. Cumulatively, 36 (73.5%) eyes in the cyclosporine A group and 24 (66.7%) eyes in the standard treatment group had UCVA of 20/20 or better. One month postoperatively, 37 (75.5%) in the cyclosporine A group and 23 (63.9%) eyes in the standard treatment group had UCVA of 20/20 or better. Three months postoperatively, 40 (81.6%) eyes in the cyclosporine A group and 25 (69.4%) eyes in the standard treatment group had UCVA of 20/20 or better. Mean UCVA in the cyclosporine A group showed statistically significant improvements compared with the standard treatment group. CONCLUSIONS: Cyclosporine A 0.05%, in the form of Restasis, may be an effective treatment for reducing the time needed for visual recovery after LASIK. Use of cyclosporine A was associated with overall better and faster recovery of UCVA.
PLoS ONE. 2008; 3(5): e2188
Dolecek C, Tran TP, Nguyen NR, Le TP, Ha V, Phung QT, Doan CD, Nguyen TB, Duong TL, Luong BH, Nguyen TB, Nguyen TA, Pham ND, Mai NL, Phan VB, Vo AH, Nguyen VM, Tran TT, Tran TC, Schultsz C, Dunstan SJ, Stepniewska K, Campbell JI, To SD, Basnyat B, Nguyen VV, Nguyen VS, Nguyen TC, Tran TH, Farrar J
BACKGROUND: Drug resistant typhoid fever is a major clinical problem globally. Many of the first line antibiotics, including the older generation fluoroquinolones, ciprofloxacin and ofloxacin, are failing. OBJECTIVES: We performed a randomised controlled trial to compare the efficacy and safety of gatifloxacin (10 mg/kg/day) versus azithromycin (20 mg/kg/day) as a once daily oral dose for 7 days for the treatment of uncomplicated typhoid fever in children and adults in Vietnam. METHODS: An open-label multi-centre randomised trial with pre-specified per protocol analysis and intention to treat analysis was conducted. The primary outcome was fever clearance time, the secondary outcome was overall treatment failure (clinical or microbiological failure, development of typhoid fever-related complications, relapse or faecal carriage of S. typhi). PRINCIPAL FINDINGS: We enrolled 358 children and adults with suspected typhoid fever. There was no death in the study. 287 patients had blood culture confirmed typhoid fever, 145 patients received gatifloxacin and 142 patients received azithromycin. The median FCT was 106 hours in both treatment arms (95% Confidence Interval [CI]; 94-118 hours for gatifloxacin versus 88-112 hours for azithromycin), (logrank test p = 0.984, HR [95% CI] = 1.0 [0.80-1.26]). Overall treatment failure occurred in 13/145 (9%) patients in the gatifloxacin group and 13/140 (9.3%) patients in the azithromycin group, (logrank test p = 0.854, HR [95% CI] = 0.93 [0.43-2.0]). 96% (254/263) of the Salmonella enterica serovar Typhi isolates were resistant to nalidixic acid and 58% (153/263) were multidrug resistant. CONCLUSIONS: Both antibiotics showed an excellent efficacy and safety profile. Both gatifloxacin and azithromycin can be recommended for the treatment of typhoid fever particularly in regions with high rates of multidrug and nalidixic acid resistance. The cost of a 7-day treatment course of gatifloxacin is approximately one third of the cost of azithromycin in Vietnam. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN67946944.
Antimicrob Agents Chemother. 2008 May 19;
Hoshi S, Kikuchi K, Sasaki T, Sotozono C, Kinoshita S, Hiramatsu K
The bactericidal activities and postantibiotic effects (PAEs) of levofloxacin and gatifloxacin at concentrations corresponding to those in antibiotic eye drops were determined for methicillin-resistant Staphylococcus aureus strains. The simulated eye drop concentrations of levofloxacin and gatifloxacin showed lower bactericidal activities and shorter PAEs against fluoroquinolone-resistant strains than against fluoroquinolone-sensitive strains.