Natural alpha-Galactosyl (Gal) antibodies play an important role in the rejection of pig xenografts by humans and Old World monkeys. In this study we investigate the efficacy of two different strategies to reduce the serum level of natural anti-Gal antibodies. On the one hand, removal of aerobic gram-negative bacteria from the intestinal flora, because anti-Gal antibodies appear to be produced as a result of the continuous sensitization by these microorganisms. On the other hand, we studied the effect on these antibodies of an immunosuppressive regimen of cyclophosphamide and steroids. Ten baboons were treated for three months with norfloxacin (Nor Group; n=6) or cyclophosphamide and steroids (CyP Group; n=4). A further four baboons did not receive any treatment (Control Group). Aerobic gram-negative bacteria became negative in stools of the Nor Group after two weeks of treatment, and remained undetectable until week 7. Thereafter, a gradual increase on the fecal concentration of aerobic gram-negative bacteria was observed despite the norfloxacin treatment. The mean anti-Gal IgG in the Nor Group gradually declined from week 4 to 9 to a mean of 62.7 +/- 18% of the baseline level, and during this period were significantly lower than in the CyP (P<0.02) and the Control (P<0.05) groups. No differences were observed between the three groups during the 16 weeks of follow-up in serum levels of anti-Gal IgM, hemolytic anti-pig antibodies, total IgG, IgM and IgA. In conclusion, removal of normal aerobic gram-negative bacteria from the intestinal flora is more effective than immunosuppression with CyP and steroids in reducing the level of natural anti-Gal antibodies, although there is no discernible effect on IgM antibodies.
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We identified 11 studies enrolling 7535 women. There were no significant differences in clinical or microbiological efficacy between quinolones. Photosensitivity reactions were more frequently observed for sparfloxacin when compared to ofloxacin. Any adverse event, adverse events causing withdrawal, skin adverse events, photosensitivity reactions were more common for lomefloxacin when compared to norfloxacin. Any adverse event, adverse drug reactions, CNS adverse events were more common for ofloxacin when compared to ciprofloxacin. CNS adverse events and insomnia were more often reported for rufloxacin when compared to pefloxacin. Adverse drug reactions occurred frequently for ofloxacin than levofloxacin. Insomnia was reported more frequently for enoxacin than ciprofloxacin.
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The study was conducted at Chughtais Lahore Lab, Lahore, Pakistan, from December 2013 to May 2014, and comprised urine specimens from suspected patients. Antimicrobial profiling of isolated strains of Enterococcus faecalis was determined by Kirby-Bauer disc-diffusion method.
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A 200 mg oral dose of ciprofloxacin, norfloxacin or ofloxacin was administered to six healthy male volunteers in a three way cross-over study in order to examine the kinetics in humans in relation to the bactericidal activity in serum and urine. Serum concentrations for ciprofloxacin were similar to norfloxacin and lower than ofloxacin. Despite this fact, ciprofloxacin showed the highest serum bactericidal titers compared to norfloxacin and ofloxacin when serum-resistant Escherichia coli C14 was used as a test organism. These results correlate with observations from timekill curve studies in human whole blood, where ciprofloxacin showed superior bactericidal activity compared to norfloxacin or ofloxacin. The amounts of unchanged drug excreted in urine (48 h period) were found to be 35%, 24% and 77% for ciprofloxacin, norfloxacin and ofloxacin respectively, indicating different excretion kinetics. The volumes of urine excreted in the different collection periods were comparable for the three drugs tested. Mean urine concentrations for ciprofloxacin were higher during the 0 to 4 h collection periods, whereas ofloxacin was excreted into the urine over a longer time period. Measurements of urine bactericidal activity showed that ciprofloxacin had the highest titers during the early collection periods, whereas the prolonged excretion of ofloxacin did not result in higher urine bactericidal titers, compared to ciprofloxacin.
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In the present study, the sublethal effects of norfloxacin alone and in combination with sulfamethoxazole in goldfish (Carassius auratus) were investigated, the biomarkers including acetylcholinesterase (AChE) in brain, 7-ethoxyresorufin O-deethylase (EROD), glutathione S-transferase (GST), and superoxides dismutase (SOD) activities in liver, vitellogenin (Vtg) in serum and DNA damage in gonad were determined after 1, 2, 4 and 7 days of exposure. Brain AChE activity was significantly inhibited by norfloxacin (≥0.4 mg/L) after 4 and 7 days and the mixtures with sulfamethoxazole (≥0.24 mg/L) after 4 days of exposure, and significant concentration-response relationships were obtained. Liver EROD, GST and SOD activities were significantly increased by the individual and mixed pharmaceuticals in most cases and exhibited analogously bell-shaped concentration-response curves. Serum Vtg was increased by the highest concentration of norfloxacin and two higher concentrations of the mixtures. Higher concentrations of the test antibiotics induced significant DNA damage in a concentration- and time-dependent manner. The results indicated that selected antibiotics possesses cytotoxic and genotoxic potential against the non-target organism C. auratus.
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The in-vitro activity of enoxacin, ofloxacin, norfloxacin and nalidixic acid was determined against 1499 Gram-negative and 279 Gram-positive isolates from different clinical institutions in the Federal Republic of Germany. 90% of all Enterobacteriaceae were inhibited by 0.5 mg/l. Glucose non-fermenting Gram-negative rods and staphylococci were less sensitive to all 4-quinolones. All Gram-negative strains selected for resistance to nalidixic acid were significantly less sensitive to the new generation of 4-quinolones tested.
The susceptibility rates for penicillin and tetracycline in N. gonorrhoeae strains were 35.9 and 24.3%, respectively. All gonococcal strains were susceptible to ceftriaxone, with very low MICs (MIC90 0.008 microg/ml). Telithromycin was highly active against N. gonorrhoeae and U. urealyticum strains (MIC90 0.25 microg/ml for both). Ciprofloxacin was the most active quinolone against N. gonorrhoeae (MIC90 0.008 microg/ml) while quinolone resistance was detected in a single strain (1.3%).
Fluoroquinolone-induced hypoglycemia is not a common adverse drug reaction. However, it has been reported with most of the available agents and appears to be more common in elderly patients with a history of type 2 diabetes who are receiving oral sulfonylureas. The exact mechanism of this effect is unknown but is postulated to be a result of blockage of Adenosine 5'-Triphosphate (ATP)-sensitive potassium channels in pancreatic β-cell membranes. This report highlights hypoglycemia with urticaria as an adverse drug reaction of norfloxacin in a middle aged non-diabetic patient. Clinicians should be alert about the possibility of its potential adverse effect in patients who are receiving norfloxacin therapy.
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We examined the distribution of multidrug-resistant Salmonella enterica serotype Typhimurium definitive phage type 104 (DT104) among Japanese livestock from 1973 to 1998. The 144 S. Typhimurium field isolates were tested for susceptibility to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, tetracycline, kanamycin, trimethoprim, nalidixic acid, and norfloxacin. Thirty-six of 68 strains which exhibited resistance to five or more antimicrobials (ACSSuT+) were identified as DT104. Results of plasmid profiling showed that all DT104 strains retain a 90-kb virulence plasmid, while 20 of 36 strains possessed a few additional small plasmids ranging from 2 to 4 kb. These results showed that DT104 strains have existed in Japanese livestock since 1990, and that this phage type may be an important pathogen for cattle in Japan.
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The occurrence of eight pharmaceuticals (beta-blockers: acebutolol, atenolol, metoprolol and sotalol; antiepileptic: carbamazepine; fluoroquinolone antibiotics: ciprofloxacin, norfloxacin, ofloxacin) were assessed in the raw and treated sewage of 12 sewage treatment plants (STPs) in Finland. The average concentrations in the raw and treated sewage ranged from 100 to 1060 ng L(-1) and from <24 to 755 ng L(-1), respectively. The average daily loads ranged from 36 to 405 mg/1000 inh and from 2 to 302 mg/1000 inh, respectively. In the treatment plants, fluoroquinolones were eliminated by >80%. Carbamazepine was not eliminated during the treatment and in fact even higher concentrations were frequently found in the treated than in the raw sewages. The increase in concentration was shown to be most likely due to enzymatic cleavage of the glucuronic conjugate of carbamazepine and release of the parent compound in the treatment plant. The beta-blockers were eliminated in average by less than 65% and the elimination varied greatly between the treatment plants. Especially the dilution of raw sewage by rainwater and a consequent decrease in the hydraulic retention time of a treatment plant was found to deteriorate the elimination of the beta-blockers. The work shows that especially carbamazepine and the beta-blockers may reach the recipient waters and there is a need to enhance their elimination in the sewage treatment plants. In this attempt, a denitrifying biofilter as a tertiary treatment could be of minor importance since in this study it did not result in further elimination of the target compounds.
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To investigate antibiotic consumption in a sample of physicians from Osijek-Baranja county in Eastern Croatia and to determine the volume of prescribed antimicrobials and assess the appropriateness of prescribing practices.
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Cytopenias are frequently observed in patients with cirrhosis and are associated with increased morbidity. In particular, thrombocytopenia can impact routine care of patients with cirrhosis by potentially postponing or interfering with diagnostic and therapeutic procedures including liver biopsy and medically indicated or elective surgery. The pathogenesis of cytopenias in cirrhosis remains largely unknown. Historically, the concept of hypersplenism has long been associated with the cirrhosis-related hematological disorders but was never proven. On the other hand, intestinal bacterial overgrowth and altered gut permeability in cirrhotic patients lead to increased translocation of bacteria and endotoxin into the portal circulation. The impaired phagocytic function of the reticuloendothelial system together with the portosystemic shunting allow endotoxin to reach the systemic circulation and high concentrations of circulating endotoxin are found in cirrhotic patients even with no clinical evidence of infection and correlate with the severity of liver disease. Endotoxin activates monocytes and promotes the release of proinflammatory cytokines. Indeed, serum levels of interleukin-1, interleukin-6, tumor necrosis factor-α, and interferon-γ are elevated in patients with cirrhosis in proportion to the severity of liver disease. Endotoxaemia stimulates the vascular production of nitric oxide (NO) directly or indirectly via the cytokine cascade, and correlates with serum NO metabolite levels in cirrhosis. Several lines of evidence strongly suggest that endotoxaemia may reduce peripheral blood counts either directly or through the release of cytokines and NO. Previous studies in experimental models of cirrhosis and cirrhotic patients have demonstrated that long-term administration of oral antibiotics such as trimethoprim-sulfamethoxazole, norfloxacin, and rifaximin can reduce bacterial translocation and circulating levels of endotoxin, TNF-α, IL-6, and NO. We hypothesize that endotoxaemia plays a pivotal role in the pathogenesis of cytopenias in cirrhosis and that intestinal decontamination could raise peripheral blood counts by the suppression of endotoxaemia and the inhibition of cytokine and NO production.
The occurrence, removal efficiency and seasonal variation of 22 antibiotics, including eight fluoroquinolones, nine sulfonamides and five macrolides, were investigated in eight sewage treatment plants (STPs) in Beijing, China. A total of 14 antibiotics were detected in wastewater samples, with the maximum concentration being 3.1 μg L(-1) in the influent samples and 1.2 μg L(-1) in the effluent samples. The most frequently detected antibiotics were ofloxacin, norfloxacin, sulfadiazine, sulfamethoxazole, erythromycin and roxithromycin; of these, the concentration of ofloxacin was the highest in most of the influent and effluent samples. Eighteen antibiotics were detected in the sludge samples, with concentrations ranging from 1.0×10(-1) to 2.1×10(4) μg kg(-1). The dominant antibiotics found in the sludge samples were the fluoroquinolones, with ofloxacin having the highest concentration in all the sludge samples. The antibiotics could not be removed completely by the STPs, and the mean removal efficiency ranged from -34 to 72%. Of all the antibiotics, the fluoroquinolones were removed comparatively more efficiently, probably due to their adsorption to sludge. Seasonal variation of the antibiotics in the sludge samples was also studied. The concentrations of antibiotics in winter were higher than in spring and autumn. Since the total levels of the fluoroquinolones detected in the influent samples were lower than the predicted no-effect concentration (PNEC) of 8.0 μg L(-1), the residues of these antibiotics would be unlikely to have adverse effects on microorganisms involved in sewage treatment processes.
The new fluorinated 4-quinolones appear to represent orally effective alternatives to parenteral and oral agents currently in use. A number of new fluorinated 4-quinolones were compared in acute systemic mouse-infection models with various Gram-positive cocci (streptococci and staphylococci), Enterobacteriaceae and Pseudomonas aeruginosa. Also included were standard oral and parenteral antimicrobial agents. CI-934 was the most potent quinolone in infections induced by Streptococcus pyogenes and Str. pneumoniae. CI-934, ciprofloxacin, enoxacin, norfloxacin, ofloxacin and pefloxacin were as effective as or superior to standard oral agents currently utilized in infections induced by the Enterobacteriaceae and staphylococci. They were active against antibiotic-susceptible strains and strains resistant to beta-lactams and gentamicin. Most were also quite potent against systemic P. aeruginosa mouse infections. These studies indicate good chemotherapeutic potential for the new generation fluorinated 4-quinolones in infections induced by the staphylococci, streptococci, Enterobacteriaceae and P. aeruginosa, including strains resistant to standard antimicrobial agents.
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The 4 strains were all resistant to sulphamethoxazole/trimethoprim, erythromycin, streptomycin. High drug susceptibility of the samples was found to 6 kinds of antibiotics such as amikacin, norfloxacin, ciprofloxacin, gentamicin, chloramphenicol, ampicillin. The isolates expressed phenotypic traits of both serogroup O1 ogawa and El Tor and carried 9 kinds of virulence genes, ctxA, ace, zot, toxR, tcpI, ompU, rtxC, tcpA, and hlyA gene. They were also identified as harboring the classical ctxB genotype based on amino acid residue substitutions. The PFGE profiles of NotI showed a single banding pattern, while SfiI's was 2 banding patterns.
All the prescriptions for medicines to combat infection filled outside the hospital (940,662 units) in the province of Zaragoza. These following subgroups: J01 Systemic antibiotics, J03 Systemic chemotherapy drugs, J04A Tuberculosis, G04A Antiseptic and urinary infection drugs and R05C1 Mucolytic and anti-infection expectorants.
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In an international effort to reduce antibiotic resistance, in part suggested to be the effect of inappropriate antibiotic use, several quality indicators for outpatient antibiotic use have been proposed. In this study, geographical and educational differences in fluoroquinolone prescription in the treatment of urinary tract infection in women are presented.
Urinary tract infections caused by urea-splitting bacteria are severe clinical conditions and very difficult to treat due to their association with calculi, and because such bacteria form ammonium hydroxide raising the urinary pH and thereby creating an unfavourable condition for the action of most antimicrobials. We tested ofloxacin, norfloxacin, nalidixic acid, amoxicillin, amoxicillin-clavulanic acid, gentamicin, co-trimoxazole and nitrofurantoin against 143 gram-negative and 99 gram-positive bacteria, all urea-splitting, isolated from patients with urinary tract infections. All drugs were tested using media at two different pHs (pH 7.4 and PH 8.5) and two inoculum sizes (10(4) and 10(6) cfu). Although ofloxacin and norfloxacin had a similar spectrum of activity, ofloxacin had somewhat greater intrinsic activity against gram-positive organisms. MICs of ofloxacin for 90% of Proteus mirabilis, indole-positive Proteus spp., Klebsiella pneumoniae, Staphylococcus aureus, coagulase-negative staphylococci and the Corynebacterium group D2 were greater than or equal to 4 mg/l. The activity of the other drugs varied, but there were many strains resistant to these antimicrobials. The pH and inoculum size did not significantly affect the activity of ofloxacin so that this drug should be useful for the treatment of urinary tract infections caused by the commonest urea-splitting bacteria involved in such infections.
A 99-yr-old Chinese woman with cutaneous malakoplakia and concomitant urinary tract infection was reported. The patient presented with an ulcerated right lower quadrant mass and computerized tomography showed that it was limited to the skin and subcutaneous tissue with no extension to the pelvic or abdominal structures. The patient also suffered from urinary tract infection and was treated with oral norfloxacin. The ulcerated subcutaneous mass disappeared on follow-up visit 6 months after presentation. The cytologic (fine-needle aspiration), histologic (trucut biopsy) and ultrastructural features of cutaneous malakoplakia were described. The possible usefulness of fine-needle aspiration in the diagnosis of this condition was discussed.
One month after renal transplantation, a 60-year-old man developed acute allograft dysfunction associated with gross hematuria and dysuria. Urinary cytological examination showed viral inclusion-bearing epithelial cells. A renal transplant biopsy specimen showed granulomatous interstitial nephritis, tubular necrosis, and ground glass-like intranuclear viral inclusion bodies in tubular cells caused by an adenovirus (ADV) infection. A reduction in baseline immunosuppressive therapy resulted in rapid normalization of allograft function and ultimately viral clearance. We report this case not only to illustrate an exceptional manifestation of an ADV infection in a renal allograft, but also to highlight the beneficial effect of reduction in immunosuppressive therapy on viral replication and clinical outcome.
The purpose of this study was to determine the effectiveness and tolerability of norfloxacin, cinoxacin and oxolinic acid in the treatment of urinary tract infections (UTI) in comparison to nalidixic acid. 125 patients were given the drugs in the appropriate doses for 10-14 days and 30 patients were treated for six weeks. Clinical, bacteriological, hematological and chemical checks were made on all patients before and after treatment. It was found that norfloxacin, cinoxacin and oxolinic acid are safe and effective against Escherichia coli, Klebsiella and Proteus, the commonly encountered organisms in urinary tract infections. The cure rate for norfloxacin was 93%, for cinoxacin 83%, for oxolinic acid 80% and for nalidixic acid 70% in the short course. However, these differences were not statistically significant. Oxolinic acid, cinoxacin and norfloxacin have the advantage over nalidixic acid of being administered only twice daily.
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To review relevant studies for both primary and secondary antibiotic prophylaxis of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis without gastrointestinal bleeding.