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We report three cases of psittacosis in staff working in a veterinary surgery, which was related to exposure to a sick, wild psittacine bird. Chlamydial genus- and chlamydial species-specific DNA was detected in clinical specimens, including throat swabs, whole blood and urine. The organism load was quantified by real-time PCR (RT-PCR), which revealed 10(5)-fold more organisms in conjunctival swabs from the source bird than in the human samples. One clinic attendant was infected despite using personal protective equipment when handling the bird. This is the first report of PCR analyses of blood and urine samples being used to diagnose human psittacosis, and the first time that the organism load in humans has been compared to that of the infecting bird.
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Most of the isolates of S. pyogenes collected during 1995-99 were susceptible to midecamycin (93.8%), erythromycin (90.4%), clarithromycin (93.2%), roxithromycin (91.8%), azithromycin (88.4%), josamycin (94.5%), and clindamycin (94.5%). According to the CA-SFM criteria, 132 of the 146 isolates studied were susceptible to erythromycin (MICs < or = 1 mg/L), four were intermediate (MICs 2-4 mg/L), and 10 were resistant (MICs > 4 mg/L). Only nine isolates were midecamycin resistant (MICs > 4 mg/L), and the others were susceptible. The increased activity of midecamycin (MIC90 < or = 0.06 mg/L), as compared to erythromycin (MIC90 = 0.5 mg/L) and to other 14- or 15-membered macrolides, was related to the absence of the ermB determinant in seven isolates which displayed an efflux phenotype (five isolates) or an inducible resistance phenotype due to an ermTR determinant (two isolates).
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A liquid chromatographic method for the determination of the macrolide antibiotics, roxithromycin and clarithromycin, in plasma is described. The method is fully automated, employing on-line solid-phase extraction for sample clean-up, using the Prospekt unit. Plasma samples, mixed with internal standard, were injected onto exchangeable CN cartridges. After washing, the compounds were eluted and transferred to a C18 analytical column for separation and electrochemical detection. Clarithromycin was used as internal standard when assaying roxithromycin and vice versa. The recovery of the solid-phase extraction method was 90% and higher, and the relative standard deviation was about 3%. The limit of quantitation was 0.5 mumol/l when 25 microliters of plasma was injected. Comparison with a liquid-liquid extraction method for sample clean-up showed good agreement.
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All 47 patients who suffer chronic sinusitis at out-patient clinic from 2006. 10 to 2008. 03 were administered low dose Roxithromycin. Follow up all the patients and get polypi at 3-month and 6-month. AO/EB was employed to detect the apoptosis of endothelial cell.
Clarithromycin, azithromycin and dirithromycin have recently been introduced in France. We list the different drug-interactions with these three new drugs and with erythromycin, josamycin, roxithromycin, midecamycin and spiramycin.
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In this study, the occurrence and distribution of sixteen antibiotics belonging to four groups in surface water, sediment and groundwater samples from the Wangyang River (WYR), a typical river receiving sewage discharges were investigated. Laboratory analyses revealed that antibiotics were widely distributed in the studied area. The aqueous samples were unavoidably contaminated with antibiotics, and the target antibiotics present in high levels were oxytetracycline, tetracycline, chlortetracycline, ofloxacin, sulfamethoxazole, and trimethoprim, with maximum concentrations of the individual contaminant at 3.6×10(5), 9.7×10(3), 6.9×10(4), 1.2×10(4), 4.8×10(3), and 1.1×10(3) ng L(-1), respectively. Oxytetracycline, tetracycline, ciprofloxacin and roxithromycin were the most frequently detected compounds in sediment samples, with maximum concentrations of the individual contaminant at 1.6×10(5), 1.7×10(4), 2.1×10(3) and 2.5×10(3) ng g(-1), respectively. The results also revealed that the high intensity of aquaculture activities could contribute to the increasing levels of antibiotics in the area. According to the ratios of measured environmental concentration (MEC) to predicted no-effect concentration (PNEC), chlortetracycline, tetracycline, ofloxacin, ciprofloxacin, erythromycin-H2O and sulfamethoxazole may present possible environmental risk to Pseudokirchneriella subcapitata, Synechococcus leopoliensis and M. aeruginosa. Attention should be given to the long-term ecological effects caused by the continuous discharge of antibiotics in the WYR area.
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Sulfur mustard, a vesicant chemical warfare agent, causes airway injury due to massive release of destructive enzymes and mediators of inflammation. Nitric oxide plays an important yet controversial role in inflammation. An impressive number of reports suggest that excessive amount of nitric oxide may promote inflammation-induced cell injury and death. Overproduction of nitric oxide is catalysed by up-regulated expression of the inducible isoform of nitric oxide synthase (iNOS). In this study, we used quantum dot-mediated immunocytochemistry to analyse iNOS expression and flow cytometry to analyse the intracellular nitric oxide production in sulfur mustard-exposed normal human small airway epithelial cells and bronchial/tracheal epithelial cells and studied the effect of four US Food and Drug Administration-approved macrolide antibiotics, namely, azithromycin, clarithromycin, erythromycin and roxithromycin. Exposure to 100 microM sulfur mustard significantly up-regulated iNOS expression and resulted in overproduction of nitric oxide in these cells. Addition of macrolide antibiotics to 100 microM in the medium reduced both iNOS expression and nitric oxide production to near normal level. Thus, the current study provides in vitro evidence of the immunomodulatory effects of macrolide antibiotics in sulfur mustard-exposed airway epithelial cells. These results suggest that macrolide antibiotics may serve as potential vesicant respiratory therapeutics through mechanisms independent of their antibacterial activity.
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A 48-year-old female was seen at our hospital after having a severe fever of nearly 40 degrees C, for a period of 9 days. She complained of pain in the left side of her chest. An X-ray examination revealed a slight infiltration of the upper and middle lung fields. At this time, it was learned that the women's pet bird had recently died. This case was diagnosed as acute pneumonia due to psittacosis. Therefore the administration of Roxithromycin was started. After a few day her condition improved. During the course of treatment, serum was taken and a throat swab was done. A micro-immunofluorescence (MIF) test was performed to check the serum antibody levels against Chlamydia psittaci. The serum titer rose from 1:8 to 1:256 in 15 days after admission. The final diagnosis was made after positive isolation of C. psittaci by means of the cell culture method.
The causal agent of the disease was finally proved to be one species of bacteria that was identified as Shewanella putrefaciens. Experimental infection with S. putrefaciens resulted in the same gross signs as naturally infected fish and the same bacteria were recovered in a pure culture from freshly dead fish. The LD50 of S. putrefacien was calculated as 2.1 x 10(3) cfu/g. The result of drug sensitivity test showed that S. putrefaciens was sensitive to Pipemidic acid, Nalidixic acid, Fluperacid, Enoxacin, Florfenicol, Rifampicin, Minocycline, Fleroxacin, Enrofloxacin, Ceftriaxone, Cefalexin, Ceftazidine, Roxithromycin and Levofloxacin.
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To investigate the transplacental transfer of the macrolide antibiotics erythromycin, roxithromycin and azithromycin.
Azithromycin is effective and well tolerated for patients with diffuse panbronchiolitis.
A 25-year-old man was admitted to the hospital because of uncontrollable coughing and sputum production. He had been suffering from coughing and sputum production since he was 7 years old. He was given a diagnosis of bronchiectasis and persistent airway infection with Pseudomonas aeruginosa when he was 16 years old. One year of treatment with erythromycin and another year of treatment with roxithromycin were not effective. After he was referred to our hospital in 1993, he was given clarithromycin together with tosufloxacin for two years as an outpatient. The treatment was not very effective, but some prophylactic effect was seen with regard to prevention of acute exacerbations of Pseudomonas aeruginosa airway infection. Examination after admission revealed a high level of serum IgE (3703 U/ml), a strong skin reaction to aspergillus allergen, and marked central bronchiectasis in both upper lobes. He had no history of eosinophilia or of attacks of dyspnea. Our diagnosis was acute exacerbation of long-standing allergic bronchopulmonary aspergillosis and chronic airway infection. Treatment with oral prednisolone (30 mg per day) together with intravenous cefsulodin for three weeks resulted in marked relief symptoms and improvement in pulmonary function. The delay in correct diagnosis seems to have been caused by the lack of an obvious episode of asthma, and by the fact that the chronic productive coughing was thought to have been due to bronchiectasis, and to chronic bacterial infection. The characteristic bronchiectasis of this patient prompted us to examine the allergic reaction to aspergillus and let us to the correct diagnosis.
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The disposition of roxithromycin, an investigational macrolide antibiotic, was evaluated in 20 subjects, 10 with normal renal function (creatinine clearance [CLCR] of 116 +/- 17 ml/min [mean +/- standard deviation]) and 10 with severely impaired renal function (CLCR of 10.2 +/- 2.6 ml/min) after a single 300-mg oral dose. Plasma concentration-time data were analyzed in terms of a one- or two-compartment oral absorption model utilizing nonlinear regression analysis. The terminal elimination half-life was significantly prolonged in the group with severely impaired renal function (15.5 +/- 4.7 h) compared with that of the group with normal renal function (7.9 +/- 2.5 h). Apparent total body clearance was significantly reduced in the renally impaired (25.3 +/- 10.5 ml/min) in relation to the group with normal renal function (48.8 +/- 11.1 ml/min). The first-order absorption rate constants and apparent volumes of distribution did not differ between the two groups. These data indicate that the disposition of roxithromycin is significantly delayed in subjects with CLCRs of less than 15 ml/min and suggest that the roxithromycin dosing interval be doubled for these patients.
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Analysis of pharmacy dispensing data in June to October before (2000) and after (2001) the intervention, which commenced on 25 June 2001.
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In vitro post-antibiotic effect (PAE) induced by erythromycin, roxithromycin, josamycin and spiramycin has been compared on Staphylococcus aureus. Three MLSB sensitive and three MLSB inducible resistant S. aureus strains have been used. delta t was the time required for culture to increase by 1 log10 after drug removal in comparison with controls. For erythromycin and roxithromycin delta t ranged from 6 minutes at 1 x MIC to 48 minutes at 4 x MIC (average of the six strains at 4 x MIC: 33 minutes). For josamycin and spiramycin, delta t ranged from 36 at 1/2 x MIC to 138 minutes at 4 x MIC (average at 4 x MIC: 101 minutes). No difference was observed between MLSB sensitive and MLSB inducible resistant S. aureus strains. In our experimental conditions, PAEs observed with josamycin and spiramycin (16-membered-ring macrolides) were 2.5 to 3 times longer than those observed with erythromycin and roxithromycin (14-membered-ring macrolides). These results added to biological differences previously observed between 14-membered-ring and 16-membered-ring macrolides.
Eighty-four patients with small AAAs were randomized to either an annual 4 weeks' treatment with roxithromycin or placebo, and followed prospectively.
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150 patients were available for evaluation; H. pylori was successfully eradicated in 84.7% (127/ 150) as determined by urease quick test, 78.0% (117/150) by histology, 81.3% (109/134) by 13C-urea breath test; and in 75.3% (113/150), at least two tests were negative. Side-effects were reported in 34 patients (most commonly diarrhoea and changes in liver function tests), in two cases the study medication was interrupted. Prior to treatment, 23% of the H. pylori isolates were resistant against metronidazole and 3.4% against roxithromycin. After unsuccessful treatment, 84% of the isolates were resistant against metronidazole and 21% against roxithromycin. Primary resistance to metronidazole increased the chance of treatment failure approximately sevenfold (7% vs. 53%).
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In the Kalgoorlie Otitis Media Research Project nasopharyngeal aspirates were collected from children up to seven times between the age of 1 week and 2 years. A total of 261 M. catarrhalis strains from 50 Aboriginal and 50 non-Aboriginal children were tested against 14 antibiotics using the Clinical and Laboratory Standards Institute (CLSI) agar dilution method.
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Cytochrome P450 (CYP) 3A4 is the most prevalent metabolising enzyme in the human liver and is also a target for various drug interactions of significant clinical concern. Even though there are numerous reports regarding drug interactions involving CYP3A4, it is far from easy to estimate all potential interactions, since too many drugs are metabolised by CYP3A4. For this reason, a comprehensive framework for the prediction of CYP3A4-mediated drug interactions would be of considerable clinical importance.
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The binding to human polymorphonuclear leucocytes and the intracellular bioactivity of the macrolide antibiotics erythromycin and roxithromycin on Legionella micdadei, Listeria monocytogenes and Staphylococcus aureus were investigated in vitro by the combination of a fluorochrome microassay and a radioassay. Polymorphs with intact or absent membrane-associated oxidative metabolism were used to investigate the interactions which may occur between the intrinsic oxygen-dependent antimicrobial systems of human polymorphs and the test antibiotics, in the elimination of intracellular microbial pathogens. Elimination of O2-dependent antimicrobial systems with retention of phagocytic activity was achieved by using polymorphs from children with chronic granulomatous disease NaF-pulsed normal polymorphs. Both antimicrobial agents were actively concentrated by polymorphs. Erythromycin was concentrated ten-fold and roxithromycin approximately thirty-fold above extra cellular levels. Both agents possessed intracellular bacteriostatic activity for all three test microbial pathogens. Depletion of polymorph O2-dependent intrinsic antimicrobial systems interfered with the intracellular bioactivity of both antibiotics. This emphasizes the importance of interactions between cell-associated antibiotics and phagocyte antimicrobial systems in the elimination of intracellular microbial pathogens. Like erythromycin, roxithromycin is concentrated by human phagocytes and is bioactive intracellularly.