The eradication rate was 0% in the RA group and 75% in the RAG group. The eradication rate in the RAG group was 100% in patients infected with GAT-susceptible bacteria and/or bacteria without gyrA mutations, but was only 33.3% in those infected with GAT-resistant bacteria or bacteria with gyrA mutations.
Drug metabolism and excretion is composed of four steps: Absorption, distribution, metabolism and excretion. The four steps are often abbreviated as ADME. Drug-drug interaction may occur at each step of ADME. Reported examples of drug-drug interaction occur mainly at the level of "drug metabolizing enzymes(DME)". The mechanisms of drug-drug interaction are: 1) Competitive inhibition of DME, 2) Destruction or irreversible inhibition of DME, 3) Induction of DME. Co-administration of 5-fluorouracil and sorivudine resulted in severe gastrointestinal and bone marrow toxicities. The toxicity is due to irreversible inhibition of dihydropyrimidine dehydrogenase by a sorivudine metabolite, which plays a role in detoxification of 5-fluorouracil. However, there is an example of beneficial drug-drug interaction, where proton pump inhibitor, omeprazole, antibiotics, amoxicillin and clarithromycin, are co-administered for eradication of Helicobacter pylori. Omeprazole is metabolized by CYP2C19 and CYP3A4. In poor metabolizers of omeprazole, a higher area under the drug concentration curve(AUC) and higher efficacy are achieved as compared to extensive metabolizers of omeprazole. In this regimen, co-administration of clarithromycin which is metabolized by CYP3A4 effectively raises the AUC of omeprazole. Thus, this drug combination results in a beneficial drug-drug interaction.
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Outpatient HIV specialty centers' clinics.
The susceptibility of Canadian isolates of three respiratory tract pathogens (Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae) to several antimicrobial agents were tested by two different methods. Beta-lactamase was produced by 68/211 (32.2%) of H. influenzae isolates and 64/75 (85.3%) of M. catarrhalis isolates. For S. pneumoniae, 19/156 (12.2%) isolates were resistant to penicillin (MIC > or = 0.12 mg/L) and two isolates had MICs of 1.5 mg/L. For some combinations of agents and organisms, different methods gave different values for the proportion of isolates susceptible. Regardless of methodology, for H. influenzae, the most active antimicrobials based on proportion of strains susceptible were ciprofloxacin (100%) and cefpodoxime (98.5-100%). For M. catarrhalis, the most active agents were azithromycin, cefaclor, cefixime, cefpodoxime, cefuroxime, ciprofloxacin, clarithromycin and loracarbef (100% each); the least active was ampicillin. Against penicillin-sensitive and -resistant pneumococci, the activity was not significantly different for azithromycin and clarithromycin (93.4-100%) and ciprofloxacin (MIC90 2.0 and 1.5 mg/L, respectively) but was different for cefuroxime (99.3% and 31.6%, respectively), cefaclor (MIC90 0.75 and > or = 256 mg/L, respectively), cefpodoxime (MIC90 0.047 and 1.5 mg/L, respectively) and loracarbef (MIC90 0.75 and > or = 256 mg/L, respectively). This study indicates the increasing incidence, in Canada, of beta-lactamase resistance in H. influenzae and M. catarrhalis and penicillin resistance in S. pneumoniae.
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The clinical features of tuberculosis vary according to its CD4 count. With CD4 count >350/microL pulmonary lesions are "typical" (upper lobe infiltrates +/- cavitation). With CD4 count< 50/microL extrapulmonary TB is more common, and chest X-rays show lower and middle lobe and miliary infiltrates, usually without cavitation. The treatment of tuberculosis in HIV-infected patients should follow the same principles for persons without HIV infection. Presence of active tuberculosis requires immediate initiation of anti-tbc therapy. The delay of antiretroviral therapy for 4-8 weeks after initiation of tuberculosis treatment is recommended. MAC is a relatively common cause of disseminated infection without pulmonary involvement in patients with AIDS. Preferred regimens contain clarithromycin and EB, and in case of high MAC load or absence of effective antiretroviral therapy rifabutin may be considered as a third drug. Start antiretroviral therapy simultaneously or within 1-2 weeks. In Japan, an increasing number of HIV infections are reported year after year. So HIV infection should be included in possible diagnosis for atypical Tbc or disseminated MAC infection.
We did a randomised, open-label, non-inferiority, phase 3 trial in 39 sites in Europe, comparing the efficacy and safety of 10 days of quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline (quadruple therapy) versus 7 days of omeprazole, amoxicillin, and clarithromycin (standard therapy) in adults with recorded H pylori infection. Patients were randomly assigned treatment according to a predetermined list independently generated by Quintiles Canada (Ville St-Laurent, QC, Canada). Our study was designed as a non-inferiority trial but was powered to detect superiority. Our primary outcome was H pylori eradication, established by two negative (13)C urea breath tests at a minimum of 28 and 56 days after the end of treatment. Our assessment for non-inferiority was in the per-protocol population, with subsequent assessment for superiority in the intention-to-treat population (ie, all participants randomly assigned treatment). This study is registered with ClinicalTrials.gov, number NCT00669955.
Outside the context of clinical trials, both regimens achieved acceptable eradication rates. However, 1-week low-dose therapy is preferable due to the lower incidence of severe side-effects.
Solubility tests indicated that lactobionic acid was the most effective to increase clarithromycin solubility and chremophor showed higher enhancing effect than myrj 52 on CLR solubility. The stability tests results also confirmed that shelf-lives of all formulations have been the equivalent to 24 months.
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We report what is believed to be the first case of pulmonary Actinomyces graevenitzii infection presenting as organizing pneumonia. Fever and night sweats developed in a 69-year-old male. The only abnormal laboratory data were an elevated erythrocyte sedimentation rate and C-reactive protein level. On chest images, multiple consolidations with air bronchograms were seen in the bilateral lungs. Histological examination from lung biopsy revealed a pattern of organizing pneumonia with microabscesses, but definitive diagnosis was not obtained because culture from lung specimen was negative. A. graevenitzii was eventually identified in the lung biopsy specimen by detection of an Actinomyces-specific PCR product followed by 16S rRNA gene sequencing. The patient was treated with high-dose ampicillin intravenously for 1 month, followed by oral amoxicillin and clarithromycin for 6 months, and recovered. We suggest that actinomycosis can present as organizing pneumonia, and identification of infection by PCR analysis and rRNA gene sequencing is a useful strategy in cases that are difficult to diagnose.
Forty-five consecutive patients, who underwent gastroscopy for symptoms and were found to be H. pylori-positive, were recruited. They received ranitidine bismuth citrate 400 mg b.i.d. plus clarithromycin 250 mg b.i.d. plus tinidazole 500 mg b.i.d., given for 6 days. The medications given in twice daily doses were taken after meals with an interval of 12 h. The H. pylori status was evaluated by means of histology and rapid urease test on admission, and by 13C-urea breath test alone 8 weeks after treatment.
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The defined daily dose (DDD) of antibiotics was analyzed using the Taiwan National Health Insurance (NHI) research database. H. pylori strains isolated from treatment naïve (N=1395) and failure from prior eradication therapies (N=360) from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method.