[Show abstract][Hide abstract] ABSTRACT: Colonization by Helicobacter species is commonly noted in many mammals. These infections often remain unrecognized, but can cause severe health complications or more subtle host immune perturbations. The aim of this study was to isolate and characterize putative novel Helicobacter spp. from Bengal tigers in Thailand. Morphological investigation (Gram-staining and electron microscopy) and genetic studies (16SrRNA, 23SrRNA, flagellin, urease and prophage gene analyses, RAPD DNA fingerprinting and restriction fragment polymorphisms) as well as Western blotting were used to characterize the isolated Helicobacters. Electron microscopy revealed spiral-shaped bacteria, which varied in length (2.5–6 mm) and contained up to four monopolar sheathed flagella. The 16SrRNA, 23SrRNA, sequencing and protein expression analyses identified novel H. acinonychis isolates closely related to H. pylori. These Asian isolates are genetically very similar to H. acinonychis strains of other big cats (cheetahs, lions, lion-tiger hybrid and other tigers) from North America and Europe, which is remarkable in the context of the great genetic diversity among worldwide H. pylori strains. We also found by immunoblotting that the Bengal tiger isolates express UreaseA/B, flagellin, BabA adhesin, neutrophil-activating protein NapA, HtrA protease, c-glutamyl-transpeptidase GGT, Slt lytic transglycosylase and two DNA transfer relaxase orthologs that were known from H. pylori, but not the cag pathogenicity island, nor CagA, VacA, SabA, DupA or OipA proteins. These results give fresh insights into H. acinonychis genetics and the expression of potential pathogenicity-associated factors and their possible pathophysiological relevance in related gastric infections.
[Show abstract][Hide abstract] ABSTRACT: □ HintergrundAuch bei grampositiven Erregern wurden in den letzten Jahren vermehrt Antibiotikaresistenzen beobachtet. Für die Glykopeptidantibiotika
(zum Beispiel Vancomycin) ist die Resistenzsituation noch relativ günstig. Internationale Richtlinien empfehlen, den Einsatz
von Glykopeptiden auf das unbedingt notwendige Maß zu beschränken, um eine Resistenzentwicklung für diese Substanzgruppe zu
vermeiden. In Ländern, in denen Antibiotikarestriktionen verbreitet Anwendung finden, üben die Klinikapotheken in der Regel
diese Kontrollfunktion aus. An deutschen Krankenhäusern gestaltet sich eine entsprechende Überwachung der Antibiotikaverschreibungspraxis
jedoch schwieriger, da durch die dezentrale Medikamentenbevorratung auf den Stationen die Überprüfung der Indikation einer
individuellen Antibiotikaverordnung durch eine zentrale Stelle in der Regel nicht möglich ist.
□ MethodikUm eine Einschränkung des Vancomycin-Gebrauches zu erreichen, wurde in unserem Klinikum die Apotheke angewiesen, Vancomycin
nur noch auf Sonderanforderung durch Oberärzte an die Stationen zu liefern. Die Effizienz dieser Maßnahme wurde in Drei-Monats-Zeiträumen
vor und nach der Restriktion verglichen.
□ ErgebnisseKlinikumsweit führte die Vancomycin-Restriktion zu einer Senkung des intravenösen Vancomycin-Verbrauches von 53,8 g auf 43,0
g pro 1000 Patientenbehandlungstage(−20,1%) und des Verbrauches von Vancomycin-Kapseln von 2,1 auf 0,3 g pro 1000 Patientenbehandlungstage
(−85,7%). Ohne Berücksichtigung der onkologischen Stationen wurde ein Rückgang des intravenösen Vancomycin-Verbrauches von
41,6 auf 24,2 g pro 1000 Patientenbehandlungstage (−41,8%) erreicht. Die Zahl der mikrobiologischen Befunde, die eine Vancomycin-Therapie
indizierten, ging vom ersten auf den zweiten Beobachtungszeitraum leicht zurück (−8,3%, ohne Onkologie −10,9%). Unter Berücksichtigung
einer Therapiedauer von durchschnittlich sieben Tagen wurde geschätzt, daß außerhalb des Bereiches Onkologie vor der Restriktion
39,9% des Vancomycins empirisch verordnet wurden, nach Einführung der Restriktion jedoch lediglich 8,0%.
□ SchlußfolgerungDer gewählte Ansatz, die Entscheidung zur Therapie mit Vancomycin auf erfahrene (Ober-) Ärzte zu begrenzen, ist nach unseren
Erfahrungen eine wirksame Methode zur Einschränkung des nichtindizierten Einsatzes von Vancomycin.
□ BackgroundRecently, increasing antibiotic resistance has been observed among gram-positive bacteria. However, only few isolates were
found to be resistant against glycopeptides. Therefore, internationally accepted guidelines recommend a restricted use of
vancomycin and other glycopeptide antibiotics in order to prevent the development of resistance against these clinically important
antibiotics. In many countries, the hospital pharmacies play a key role in control and reinforcement of antibiotic formulary
restrictions. In Germany, however, the hospital pharmacies usually do not take over such control functions, and most wards
keep a stock of regularly used drugs including antibiotics, which makes reinforcement of restrictions difficult.
□ MethodsIn an attempt to achieve a restriction of vancomycin use, the pharmacy of our university hospital was advised to deliver vancomycin
to the wards only on request with a special order form signed by an attending, individually for every patient who should receive
vancomycin. The efficacy of this restriction measure was evaluated in 3-month periods before and after the restriction became
□ ResultsHospitalwide, this led to a 20.1% reduction of i. v. vancomycin and an 85.7% reduction of oral vancomycin use per 1000 patient
days. If the hematology/oncology units were not considered, the reduction of i. v. vancomycin use was 41.8%, and the total
use after the restriction 24.2 g per 1000 patient days. Microbiology results which justified the use of vancomycin decreased
by 8.3% (10.9% hematology/oncology units not considered) between the 2 observation periods. Assuming a 7-day mean course of
i. v. vancomycin therapy, the empirical use of i. v. vancomycin decreased from 39.9% to 8% after the restriction had been
□ ConclusionAllowing only experienced physicians (attendings) to decide on the use of vancomycin therapy, proved in our experience to
be an effective measure to reduce unnecessary vancomycin use.
[Show abstract][Hide abstract] ABSTRACT: Triple therapy with a proton pump inhibitor, moxifloxacin, and amoxicillin has been proven effective in first-line treatment of Helicobacter pylori infection.
To explore 1, the value of triple therapy with esomeprazole, moxifloxacin, and amoxicillin in second-line or rescue treatment of Caucasian patients and 2, the impact of treatment duration on eradication success.
H. pylori-infected patients with at least one previous treatment failure were randomized to oral esomeprazole 20 mg b.i.d., moxifloxacin 400 mg o.d., and amoxicillin 1000 mg b.i.d. for either 7 (EMA-7) or 14 days (EMA-14). Eradication was confirmed by 13C urea breath test. Antimicrobial susceptibility testing was performed in all patients at baseline and in patients who failed treatment.
Eighty patients were randomized, and 60% had ≥ 2 previous treatment failures. Pretreatment resistance against clarithromycin and metronidazole was found in 70.5 and 61.5% of cases, respectively. The intention-to-treat eradication rate was significantly higher after EMA-14 compared with EMA-7 (95.0 vs 78.9%, p = .036). No independent risk factor for treatment failure could be identified. There were no serious adverse events. Five of the EMA-14 patients (12.5%) compared with none of the EMA-7 patients discontinued prematurely because of adverse events (p = .031). Post-treatment resistance against moxifloxacin was found in one of seven patients with isolated organisms (14.3%).
Second-line/rescue H. pylori eradication therapy with esomeprazole, moxifloxacin, and amoxicillin is very effective and well tolerated. Fourteen days of treatment significantly increase the eradication rate but also the rate of adverse events.
[Show abstract][Hide abstract] ABSTRACT: Microbial contamination of whole human saliva is unwanted for certain in vitro applications, e.g., when utilizing it as a growth substratum for biofilm experiments. The aim of this investigation was to test gamma irradiation for its suitability to sterilize saliva and to investigate the treatment's influence on the composition and integrity of salivary proteins in comparison to filter sterilization. For inhibition of bacterial growth by gamma irradiation, a sterility assurance level of 10(-6) was determined to be reached at a dose of 3.5 kGy. At this dose, the integrity of proteins, as measured by fluorescence, circular dichroism, and gel electrophoretic banding pattern, and the enzymatic activities of salivary amylase and lysozyme were virtually unchanged. Filtration reduced the total protein concentration to about half of its original value and decreased lysozyme activity to about 10%. It can be concluded that irradiation is suitable for sterilizing whole saliva in its native form.
Applied and Environmental Microbiology 02/2011; 77(3):749-55. · 3.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: We previously demonstrated Moxifloxacin (MXF) + RIF to be equivalent to Vancomycin (VAN) + RIF for treatment of Sa IAO in a rat model. Efficacy of Flucloxacillin (F) and F + RIF were now assessed with the same model, and compared to placebo and (data previously reported) MXF + RIF, VAN + RIF, VAN and MXF. Methods: IAO of the hind leg femur was surgically induced in 68 male Wistar rats: 107 colony forming units (cfu) of methicillin-sensitive Sa strain ATCC 29213 were inoculated into the medullary cavity and a steel implant was inserted. After 7 days, rats were randomised to intraperitoneal administration of placebo, F 200 mg/kg t.i.d., RIF 20 mg/kg, F + RIF, MXF 10 mg/kg b.i.d., MXF + RIF, VAN 60 mg/kg b.i.d. or VAN + RIF. After 14 days of treatment, periprosthetic femur, capsular soft tissue of knee joint, muscle and implant were aseptically explanted and cultured quantitatively. Differences in remaining bacterial burden were analysed by Kruskal-Wallis and Wilcoxon post-hoc (with Holmes correction) test. Results: See table. Significant differences (p<0.05) to F + RIF (#) are shown. RIF-combination therapies performed equally.
Median remaining Sa
[interquartile range] Placebo
N = 12 F
N = 10 F+RIF
N = 9 MXF
N = 9 MXF+RIF
N = 10 VAN
N= 10 VAN+RIF
N = 8
(log10 cfu/g) 4.86#
[3.31-4.84] 0 $
[2.8-3.39] 0 $
[2.64-4.67] 0 $
(log10 cfu/g) 4.41#
[4.17-5.00] 0 $
[0-3.48] 0 $
(log10 cfu/g) 3.70#
[2.10-4.39] 0 $
(log10 cfu/ implant) 3.69#
[3.22-4.17] 0 $
[0-2.48] 0 $
[1.3-2.54] 0 $
[2.92-4.86] 0 $
$ Detection limit: 20 cfu/ml; n.d.: not done Conclusion: RIF-combination therapies with F, MXF or VAN were equivalent and more efficacious than either monotherapy. Those findings reemphasize the superiority of RIF over F, MXF and VAN in the treatment of Sa IAO. MXF might be an attractive combination partner due to excellent oral bioavailability.
Infectious Diseases Society of America 2008 Annual Meeting; 10/2008
[Show abstract][Hide abstract] ABSTRACT: The oral cavity has been suspected as an extra-gastroduodenal reservoir for Helicobacter pylori infection and transmission, but conflicting evidence exists regarding the occurrence of H. pylori in the mouth, independently of stomach colonization. Ninety-four gastric biopsy patients were analysed for the concurrent presence of H. pylori in the mouth and stomach. Samples were collected from different areas within the mouth and H. pylori DNA was amplified by the polymerase chain reaction (PCR) and verified by sequencing. Helicobacter pylori-specific serology was performed, and stomach colonization was determined by culture. In addition, relevant dental and periodontal parameters, as well as general health parameters, were recorded. Helicobacter pylori was found in the stomach of 29 patients and in the oral cavity of 16 patients. In only six patients was the bacterium detected simultaneously in the stomach and mouth. Notably, the 10 patients in whom the bacterium was found solely in the mouth did not have serum antibodies to H. pylori. The occurrence of H. pylori in the mouth was found to be correlated neither to any general or oral health parameters, nor to any particular site of collection. This study shows that H. pylori can occur in the oral cavity independently of stomach colonization.
European Journal Of Oral Sciences 08/2008; 116(4):297-304. · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate a 1-week once-daily triple therapy with esomeprazole, moxifloxacin, and rifabutin for rescue therapy of Helicobacter pylori infection.
Consecutive patients (n = 103) with at least one previous treatment failure and H. pylori infection resistant to both metronidazole and clarithromycin were treated with esomeprazole 40 mg, moxifloxacin 400 mg, and rifabutin 300 mg, given once daily for 7 days. Eradication was confirmed by histology and culture. CYP2C19 status was determined by polymerase chain reaction-restriction fragment length polymorphism.
Intention-to-treat and per-protocol eradication rates were 77.7% (68.4-85.3) and 83.3% (74.4-90.2). Five patients discontinued prematurely (4.8%). Eradication was achieved in 93.1% of poor/intermediate metabolizers and in 78.8% of homozygous extensive metabolizers (p = .14). Eradication rates in patients with one, two, three, and four or more previous failures were 78.3%, 89.6%, 68.6%, and 88.9%, respectively (p = .21). The regimen was effective in seven of nine patients who previously failed quadruple therapy. Post-treatment resistance to moxifloxacin and rifabutin was detected in two (12.5%) and five (31%) patients after treatment failure.
Once-daily triple therapy with esomeprazole, moxifloxacin, and rifabutin is a promising, safe, and convenient regimen for rescue therapy of H. pylori infection that may serve as a valuable alternative to quadruple therapy, particularly for patients with intolerance to amoxicillin.
[Show abstract][Hide abstract] ABSTRACT: Multi drug resistance of Mycobacterium tuberculosis (M. tuberculosis) remains a major threat to public health, reinforced by recent reports about the clinical course of patients infected with extensively drug resistant (XDR) strains in South Africa. There is little information about the clinical course of XDR tuberculosis patients in industrialised countries.
We evaluated all isolates of M. tuberculosis, in which drug susceptibility testing was performed at our institution since 1997, for multi and extensive drug resistance. Clinical courses of patients infected by strains fulfilling the recently revised criteria for XDR tuberculosis were analysed.
Four XDR M. tuberculosis isolates were identified. All patients had immigrated to Germany from Russia, Georgia, and former Yugoslavia and none were infected by the human immunodeficiency virus. All patients where treated for tuberculosis for 5.5 to 15 years and for XDR tuberculosis for 1.9 to 2.5 years. They received inhospital treatment in Germany for 11 months, 4.5 years and twice for 6 years. Non-compliance was an important factor in all four patients, three patients had to be treated in Germanys only locked facility for tuberculosis treatment. One patient with XDR tuberculosis died, one patient had still open pulmonary tuberculosis at last contact and 2 patients were cured.
Cases of XDR tuberculosis have been treated in our region for several years. Even in a high income setting, XDR tuberculosis has a tremendous impact on quality of live, outcome and the total cost. All reasonable efforts to prevent the spread of XDR tuberculosis must be made and maintained.
[Show abstract][Hide abstract] ABSTRACT: A one-step exchange of an endoprosthesis with periprosthetic infection requires effective antibiotics at high concentrations around the endoprosthesis. We evaluated the tissue distribution of vancomycin and Moxifloxacin in a standardized in vivo model of periprosthetic infection.
36 male rats with periprosthetic infection of the left hind leg, induced by a standardized procedure, received either antibiotic treatment with vancomycin or Moxifloxacin twice daily for 2 weeks, or a sham treatment. After the last administration, different tissues from each animal were evaluated for concentrations of antibiotic.
Compared to plasma, the tissue concentrations of Moxifloxacin were higher in all tissues investigated (lung, muscle, fat, bone) and the tissue-plasma ratio of Moxifloxacin was considerably higher than that of vancomycin. The concentrations of Moxifloxacin were equally high in the infected and the uninfected hind leg, whereas the vancomycin concentrations were significantly higher in the infected leg.
The standardized model of periprosthetic infection described here can be extrapolated to different bacterial and mycotic pathogens, and also to different antibiotics or therapeutic regimes. It provides a way of correlating tissue concentrations with clinical outcome in future studies.
[Show abstract][Hide abstract] ABSTRACT: We report the largest documented healthcare-associated outbreak of Panton-Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus (PVL(+) MRSA) in Europe. Six index patients from three long-term care facilities (LTCFs) were screened positive for PVL(+) MRSA in 2004 on admission to a community hospital in Germany. The purpose of this prospective study was to describe the prevalence of PVL(+) MRSA in the LTCFs before and after infection control interventions. Screening for MRSA with or without PVL was performed in all three LTCFs in 2004 [453 residents, 240 healthcare workers (HCWs)] and 2005 (440 residents, 192 HCWs). Swabs from anterior nares and wounds, if applicable, were collected. Colonised residents and staff were treated with mupirocin nasal ointment and topical antiseptics, and staff were provided with hygiene education. Total MRSA carrier rate of residents and HCWs in 2004 was 11.3% (PVL(+) MRSA 9.1%, PVL(-) MRSA 2.2%). There were comparable carrier rates between residents and HCWs in each LTCF. All PVL(+) MRSA isolates were of clonal origin (MLST 22) representing a novel spa sequence type t310. A decrease in total MRSA prevalence (from 11.3 to 5.5%) and PVL(+) MRSA (from 9.1 to 3.3%) was observed in 2005. The rate of PVL(-) MRSA remained unaffected. No symptomatic skin infections were noted among residents or HCWs. In this outbreak incomplete control of PVL(+) MRSA presumably resulted from difficult and delayed detection and decolonisation of carriers, incomplete compliance with control measures and lack of enforcement by public health authorities.
Journal of Hospital Infection 11/2007; 67(2):114-20. · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In order to assess the speed and accuracy of a real-time PCR assay targeting the lukS-PV gene of Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus, 700 S. aureus strains were tested and the results were compared to those achieved with block cycler PCR. Cross-reactivity was tested with 166 other bacterial species. Using this homogeneous real-time PCR assay format, the presence or absence of genetic information for PVL, which is also found in community-associated methicillin-resistant S. aureus, was correctly identified from pure culture and directly in various types of clinical specimens.
European Journal of Clinical Microbiology 03/2007; 26(2):131-5. · 3.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The antibacterial effect of piperacillin/sulbactam depends on the time of drug concentration above the minimal inhibitory concentration (MIC). Therefore, continuous infusion (CI) may be a more rational approach than standard intermittent short-term infusion (SI). The study investigated whether CI achieves effective drug concentrations comparable with SI.
Seven intensive care unit patients received either piperacillin/sulbactam as 4/1 g intravenous infusion over 15-20 min every 8 h or as 4/1 g intravenous loading dose (15-20 min) followed by 8/2 g intravenous CI per 24 h. After 2 days, regimes were crossed over.
Pharmacokinetic parameters (mean +/- SD) for SI piperacillin/sulbactam were: (1) peak serum concentration: piperacillin 231 +/- 66 mg/l, sulbactam 53.1 +/- 15.0 mg/l; (2) minimum serum concentration: piperacillin 11.5 +/- 14.8 mg/l, sulbactam 4.2 +/- 3.5 mg/l; (3) clearance: piperacillin 197 +/- 72 ml/min (CI 269 +/- 123 ml/min), sulbactam 167 +/- 61 ml/min (CI 212 +/- 109 ml/min); (4) half-life: piperacillin 2.4 +/- 1.2 h, sulbactam 3.1 +/- 1.6 h. Steady-state concentrations during CI were 25.5 +/- 14.5 mg/l for piperacillin and 8.0 +/- 3.7 mg/l for sulbactam. Average serum concentrations were comparable in both regimens.
A large German survey demonstrated that approximately 89% of Pseudomonas aerugionsa have an MIC < or =16 mg/l and approximately 82% have an MIC < or =8 mg/l. According to this threshold, appropriate anti-bacterial concentrations of piperacillin/sulbactam were achievable with CI. CI dosing has the additional advantage that less drug is necessary. Further prospective studies are warranted to compare the clinical efficacy of CI and SI regimens in bacterial infections.
[Show abstract][Hide abstract] ABSTRACT: The clinical management of Helicobacter pylori infected patients who failed standard eradication therapies remains a challenge.
To investigate the efficacy of rifabutin-based triple therapy and high-dose dual therapy for rescue treatment of H. pylori, and the correlation between cytochrome P450 2C19 (CYP2C19) polymorphisms and treatment outcome.
Patients infected with H. pylori resistant to both metronidazole and clarithromycin (n = 145) were randomized to either esomeprazole 20 mg, rifabutin 150 mg and amoxicillin 1 g, each given b.d. for 7 days (ERA), or to omeprazole 40 mg and amoxicillin 1000 mg, each given t.d.s. for 14 days (OA). Crossover therapy was offered in cases of persistent infection. CYP2C19 polymorphisms were determined by polymerase chain reaction restriction fragment length polymorphism.
Intention-to-treat and per-protocol eradication rates were: ERA 74% (62.4-83.6) and 78% (66.7-87.3); high-dose OA 70% (57.5-79.7) and 75% (62.5-84.5). Crossover therapy was successful in seven of 10 patients with ERA and in eight of 10 patients with OA. Premature discontinuation of treatment occurred in 2% and 5% of patients, respectively. There was only a non-significant trend to lower eradication rates in homozygous extensive metabolizers.
Triple therapy with esomeprazole, rifabutin and amoxicillin and high-dose omeprazole/amoxicillin are comparable and effective and safe for rescue therapy of H. pylori regardless of the patient's CYP2C19 genotype.
[Show abstract][Hide abstract] ABSTRACT: The efficacy of moxifloxacin in the treatment of an implant-associated infection by Staphylococcus aureus was compared with vancomycin in an animal study. The femoral medullary cavity of 36 Wistar rats was contaminated with S. aureus (ATCC 29213) and a metal device was implanted. After treatment for 14 days with moxifloxacin (2 x 10 mg/kg/day) or vancomycin (2 x 15 mg/kg/day), the bacterial counts (colony-forming units) in the periprosthetic bone, the soft tissue and the implant-associated biofilm were measured. Compared with the control group, moxifloxacin achieved a highly significant decrease in the microbial counts in the bone and soft tissue and in the biofilm (P<0.001). Moreover, the efficacy of moxifloxacin was significantly greater than that of vancomycin (P<0.01). Vancomycin did not reduce the microbial count significantly compared with the control group (P>0.05). The results justify further investigations of the treatment of implant-associated infections due to S. aureus with moxifloxacin.
International Journal of Antimicrobial Agents 06/2006; 27(5):444-8. · 4.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effect of Helicobacter-pylori status on survival after curative resection for gastric adenocarcinoma is unknown. We aimed to follow-up patients who were positive or negative for infection with H pylori who had curative (ie, R0) resection for gastric adenocarcinoma to assess differences in relapse-free survival and overall survival.
Before surgery, we assessed the H pylori status of 166 patients who had R0 resection for gastric adenocarcinoma between 1992 and 2002 with bacterial culture, histological analyses (ie, staining with haematoxylin and eosin and with Warthin-Starry), and serological analyses.
At a median follow-up of 53.0 months (range 1-146), relapse-free survival was 56.7 months (95% CI 4.7-108.7) and overall survival was 61.9 months (13.0-110.9) in patients positive for H pylori, compared with 19.2 months (12.7-25.6) and 19.2 months (7.1-31.3), respectively, in patients negative for H pylori (p=0.0009 for difference in relapse-free survival between groups, and p=0.0017 for difference in overall survival between groups). In multivariate analyses, H pylori was an independent prognostic factor for relapse-free survival (hazard ratio 2.16 [95% CI 1.33-3.49]) and overall survival (2.00 [1.22-3.27]). Depth of tumour invasion (2.60 [1.66-4.08]), lymph-node metastasis (2.11 [1.25-3.57]), and patient age 67.5 years or older (1.75 [1.11-2.75]) were also independent prognostic factors for overall survival.
Tumour-specific immune responses might be downregulated in patients who are negative for H pylori, and these patients should be followed up carefully because of a poor outlook.
The Lancet Oncology 04/2006; 7(3):211-22. · 25.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increasing resistance rates towards conventional antibiotics necessitate investigations of the efficacy of newly developed antibiotics. Thus, in a rat study, we compared the efficacy of moxifloxacin and vancomycin in the treatment of a local Staphylococcus aureus bone infection.
The femoral medullary cavities of 36 Wistar rats were contaminated with 100 muL of an oxacillin-sensitive Staphylococcus aureus strain (ATCC 29213) at 10(8) cfu/mL. On the seventh day, antibiotic treatment with moxifloxacin (10 mg/kg twice daily i.p.) or vancomycin (15 mg/kg twice daily i.p.) was commenced in 12 animals each. 12 control animals were left untreated. After 21 days, the infected femurs were explanted and the bacterial counts (cfu/g) were determined.
In the control group, a median of 3.42 x 10(6) cfu/g (LQ/UQ 1.09 x 10(6)/ 1.55 x 10(7)) was cultured, with a median of 2.53 x 10(6) cfu/g (LQ/UQ 1.95 x 10(6)/ 4.25 x 10(6)) in the vancomycin group and a median of 2.49 x 10(5) cfu/g (LQ/UQ 2.84 x 10(4)/ 3.75 x 10(5)) in the moxifloxacin group. The bacterial count was reduced by treatment with moxifloxacin both in comparison with the control group (p < 0.001), and in comparison with treatment with vancomycin (p < 0.001). There was no statistically significant difference between the vancomycin group and the control group (p = 0.53).
In contrast to vancomycin, moxifloxacin proved to be an effective antibiotic for the treatment of bone infections due to Staphylococcus aureus in our animal model.
[Show abstract][Hide abstract] ABSTRACT: Failed primary anti-Helicobacter pylori therapy results in a high rate of antimicrobial resistance. This necessitates a search for new regimens to cure H. pylori infection. The aim of this study was to evaluate the efficacy and tolerability of a new levofloxacin-containing 7-day triple therapy and to compare it with that of standard French triple therapy in patients with known H. pylori susceptibility to MET (metronidazole) and CLA (clarithromycin).
Sixty-one patients with documented antibiotic sensitivity (E-test) and an indication for anti-H. pylori treatment based on the Maastricht Consensus 2/2000 guidelines were randomized to receive either esomeprazole 2 x 40 mg, levofloxacin 2 x 500 mg, and amoxicillin 2 x 1 g for 7 days (ELA, n = 30), or esomeprazole 2 x 20 mg, clarithromycin 2 x 500 mg, and amoxicillin 2 x 1 g for 7 days (ECA, n = 31). A cure check was performed 4-6 weeks after conclusion of therapy.
Sixty-one patients were randomized to the two treatment groups. Twenty-eight of 30 patients of the ELA group were available for per-protocol (PP) analysis, of whom 26 (92.9% CI: 76-99%; intention-to-treat [ITT] analysis 86.7% CI: 68-96%) became H. pylori negative compared with 26 of the 31 patients of the ECA group (83.9%, CI: 66-93% both PP and ITT analyses). Five patients of the ELA group showed CLA resistance, three of whom also showed MET resistance, and all five were treated successfully. Two patients with levofloxacin-resistant strains, one in each group, were cured. Both regimens were generally well tolerated with minor adverse events being seen in 15 patients (51.7%) of the ELA group and in 13 (40.6%) of the ECA group. None of the patients discontinued treatment prematurely due to adverse events.
The data of this pilot study suggest a better than 80% efficacy of the new 7-day levofloxacin triple therapy, which is within the range of the French triple therapy in patients with MET- and CLA-susceptible strains. The data suggest that the new levofloxacin triple therapy may also be an option in patients with MET- and CLA-resistant H. pylori strains.