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Triderm® cream and ointment contain clotrimazole (CLO), betamethasone dipropionate (BET), and the poor UV absorbing gentamycin (GEN), in addition to the preservative benzyl alcohol (BEN) which exists only in a cream preparation. A green, selective colorimetric approach was elaborated to increase the sensitivity of GEN quantification in Triderm® preparations, which depends on the immediate formation of a pink ion-pair between GEN and erythrosine (ERY) reagent in an aqueous acidic medium. The ion pair was made soluble in water with the assistance of the surfactant agent poloxamer 188 which is presented in this manuscript as an efficient solubilizing agent for the hydrophobic ion-pair. This surfactant agent has the feature of not affecting the native color of ERY, additionally the ease of preparing its aqueous solution with no need for heating or long waiting. The resulting complex GEN-ERY was measured directly at 545nm. This colorimetric approach was coupled with the Unlimited Derivative Ratio (UDD), which is a new smart UV method employed for the concurrent quantification of BET and CLO in Triderm® preparations without any intervention from BEN, due to its capability to resolve an extremely overlapped ternary spectrum that has no extended part, iso-absorptive point or robust zero crossing point. The newly developed UDD method depends on filtrating and measuring the signal of BET and CLO through calculating the equality factor(F) for CLO and BET after dividing their spectrum by BEN spectrum, derivatizing the resulting ratio spectrum, then constructing a regression equation employing the F factor for each BET and CLO. The overlapping excipient BEN was quantified via the Double Divisor Ratio spectra derivative method (DDR) relying on using a divisor comprising of a mix of BET + CLO. The advanced spectrophotometric approach validity was checked by confirming the linearity, accuracy, precision, and specificity in accordance with the ICH directions. NO notable difference when statistically comparing the newly established approach to the reference approach.

Clinical chorioamnionitis, the most common infection-related diagnosis in labor and delivery units, is an antecedent of puerperal infection and neonatal sepsis. The condition is suspected when intrapartum fever is associated with two other maternal and fetal signs of local or systemic inflammation (eg, maternal tachycardia, uterine tenderness, maternal leukocytosis, malodorous vaginal discharge or amniotic fluid, and fetal tachycardia). Clinical chorioamnionitis is a syndrome caused by intraamniotic infection, sterile intraamniotic inflammation (inflammation without bacteria), or systemic maternal inflammation induced by epidural analgesia. In cases of uncertainty, a definitive diagnosis can be made by analyzing amniotic fluid with methods to detect bacteria (Gram stain, culture, or microbial nucleic acid) and inflammation (white blood cell count, glucose concentration, interleukin-6, interleukin-8, matrix metalloproteinase-8). The most common microorganisms are Ureaplasma species, and polymicrobial infections occur in 70% of cases. The fetal attack rate is low, and the rate of positive neonatal blood cultures ranges between 0.2% and 4%. Intrapartum antibiotic administration is the standard treatment to reduce neonatal sepsis. Treatment with ampicillin and gentamicin have been recommended by professional societies, although other antibiotic regimens, eg, cephalosporins, have been used. Given the importance of Ureaplasma species as a cause of intraamniotic infection, consideration needs to be given to the administration of antimicrobial agents effective against these microorganisms such as azithromycin or clarithromycin. We have used the combination of ceftriaxone, clarithromycin, and metronidazole, which has been shown to eradicate intraamniotic infection with microbiologic studies. Routine testing of neonates born to affected mothers for genital mycoplasmas could improve the detection of neonatal sepsis. Clinical chorioamnionitis is associated with decreased uterine activity, failure to progress in labor, and postpartum hemorrhage; however, clinical chorioamnionitis by itself is not an indication for cesarean delivery. Oxytocin is often administered for labor augmentation, and it is prudent to have uterotonic agents at hand to manage postpartum hemorrhage. Infants born to mothers with clinical chorioamnionitis near term are at risk for early-onset neonatal sepsis and for long-term disability such as cerebral palsy. A frontier is the noninvasive assessment of amniotic fluid to diagnose intraamniotic inflammation with a transcervical amniotic fluid collector and a rapid bedside test for IL-8 for patients with ruptured membranes. This approach promises to improve diagnostic accuracy and to provide a basis for antimicrobial administration., (Published by Elsevier Inc.)

At our institution, we observed an increase in the incidence of healthcare-associated infections (HAI) due to Gram-negative bacilli, including three cases of carbapenem-resistant Klebsiella pneumoniae, among patients who underwent renal transplantation. In addition to strengthening infection control measures, we chose to add gentamycin to the antibiotic prophylaxis regimen of patients undergoing renal transplantation. We assessed the number of HAI occurring within 30 days of renal transplantation during two time periods: (1) the preintervention period, between September 2009 and June 2010, and (2) the post-intervention period, between July 2010 and April 2011. The intervention consisted of the addition of gentamycin to the surgical antibiotic prophylaxis regimen. The percentage of patients with HAIs was 31% lower during the post-intervention period (p = 0.03), with the greatest reductions observed for urinary tract infections (p = 0.024). Carbapenem-resistant K. pneumoniae was not isolated during this period. The investigated patients did not exhibit worsening renal function. Further studies are needed to assess antibiotic prophylaxis in renal transplantation patients at institutions where there is a high prevalence of multidrug-resistant Gram-negative bacteria.

A number of clinical studies have highlighted the success of antibiotics formulated at concentrations between 0 and 6% w/w into bone cements to address localized infections. Separately, some commercial manufacturers have produced gentamycin-infused bone cement mixtures as a countermeasure to infection. The anecdotal evidence suggests that antibiotic infused cements can help eradicate or delay the onset of infections. Quantifying the functionality of that response is more challenging. We have surveyed the literature to identify studies in which controlled drug release or mechanical behavioral assessments have been conducted on drug-infused cements. The focus here is on vancomycin (VAN) in part due to its higher potency relative to gentamycin and its more common usage for staph infections. Takeaways from the limited pool of research studies indicate that large fractions (>99%) of the infused vancomycin remain sequestered in the cement and aren't bioavailable after solidification. Antibiotic fluence ranged from 1 to 283 μg/cm 2 hr. The initial strength of the various antibiotic loaded samples as produced were 52-96 MPa. Simulated exposures in a fluid environment by submersion reduced the antibiotic loaded strengths between 3 and 29%. Some strength measurements were noted below the ASTM F451 standard for acrylic bone cement although drug releasing spacers likely have different requirements. The glassy behavior of the cured cement led to both vancomycin and gentamicin having low permeability and a burst response. Smaller drug molecules and more gel-like immobilization matrices with lower glass transition temperatures offer higher potential for larger and more comprehensive drug bioavailability., (Copyright © 2021. Published by Elsevier B.V.)

Purpose: The treatment of small intestinal overgrowth (SIBO) varies according to the center. The present study aimed to evaluate the efficacy of COLIGENTA, an association of colimycin and gentamycin, on SIBO symptomatology and breath test normalization PATIENTS AND METHODS: In this prospective cross-sectional open study, 150 patients with functional bowel disorders and SIBO diagnosed by lactulose hydrogen breath test (LHBT) underwent COLIGENTA oral treatment. A new HLBT was performed 4 weeks after the first HLBT., Results: The patients were mainly female (74%), with a mean age of 47.4 ± 16.2 years and a body mass index of 26.2 ± 5.9 kg/m². After treatment, a decrease of expired hydrogen concentration (P<0.001) was found in the entire population. Improvement of gastrointestinal symptoms was found in 129 patients (86%), while the breath test's normalization was found in 62 patients (42%). Logistic regression showed that normalization of bowel symptoms was not associated with demographics, clinical, or hydrogen breath concentration. In contrast, normalization of LHBT was associated with an increase of breath hydrogen concentration at time 100 min during the first test (P = 0.003; OR=1.072; 95%CI= [1.023-1.123])., Conclusion: The present study shows that 10-days of COLIGENTA treatment has a high SIBO clinical improvement rate and can be used as the first or second treatment line., Competing Interests: Declaration of Competing Interest None to declare, (Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Drug-induced acute kidney injury is a serious problem in drug development and clinical treatment. Thus, highly efficient and non-invasive urinary biomarkers are required to control and prevent drug-induced acute kidney injury. Expanding on a previous study, we evaluated 9 novel urinary biomarkers in beagles, which were treated with gentamycin at a dose of 40 mg/kg for 12 consecutive days. N-acetyl-β-D-glucosaminidase was detected with high sensitivity and specificity at the early stage of renal injury (Area under the ROC cure (AUC) = 0.929, 95%CI: 0.722-0.995, P < 0.05 vs. serum creatinine and blood urea nitrogen). More importantly, the results indicated that albumin and trefoil factor-3 were significantly increased 6 days after gentamycin injection (compared with the control group, both P < 0.05). Receiver operator characteristics analysis showed that the diagnostic value of these two biomarkers were both high (both AUCs=1.000; both 95% CI: 0.832-1.000; albumin or trefoil factor-3 vs. serum creatinine or blood urea nitrogen, both P < 0.05). Moreover, albumin and trefoil factor-3 levels were highly correlated to the degree of kidney injury (both Pearson's r > 0.8, P < 0.05). Our data indicate that albumin and trefoil factor-3 may have value in the early diagnosis of kidney injury in non-rodent species and may thus inspire the preclinical use of urinary biomarkers in drug-induced acute kidney injury., (Copyright © 2018 Elsevier B.V. All rights reserved.)

To endow orthopaedic implants with satisfactory antibacterial properties, the design and development of antibiotic coating on the surface of implants is highly desired. In this work a novel and facile strategy was developed to form pH-responsive layer-by-layer (LbL) films implanted with polymeric micelles as nano-vehicles loaded with charge-weak antibiotic drugs, enabling high drug loading efficiency. Negatively charged tobramycin (Tob)-embeded heparin miscells (HET) and positively charged chitosan (CHT) were exploited as a pH-responsive LBL multilayer building block, respectively. The formation mechanism and pH-stimulated release behavior of the Tob-contained heparin micelles were studied. The characterization on the morphologies, chemical compositions and hydrophilicity of the modified surface confirmed the successuful deposition of the Tob-loaded CHT/HET multilayers coatings on the polydopamine-modified Ti surface. The drug release profiles displayed fast release at pH 7.4 and slow release after exposure to weakly acidic environments. Antibacterial tests indicated that the Tob-embed CHT/HET nanostructured multilayers not only strongly inhibited initial bacterial adhesion, but also disruptted biofilm formation. Particularly, this functional coatings showed "long-term antibacterial" pattern in acid condition. Meanwhile, MC3T3 cells showed acceptable adhesion, spread and proliferation on the multilayer coatings in cytocompatible studies. In a word, these multilayer coatings incorporated with a wide variety of antibiotics show promisiong applications in preventing postoperative infection and resolving unmet clinical need., (Copyright © 2018 Elsevier B.V. All rights reserved.)

At our institution, we observed an increase in the incidence of healthcare-associated infections (HAI) due to Gram-negative bacilli, including three cases of carbapenem-resistant Klebsiella pneumoniae, among patients who underwent renal transplantation. In addition to strengthening infection control measures, we chose to add gentamycin to the antibiotic prophylaxis regimen of patients undergoing renal transplantation. We assessed the number of HAI occurring within 30 days of renal transplantation during two time periods: (1) the preintervention period, between September 2009 and June 2010, and (2) the post-intervention period, between July 2010 and April 2011. The intervention consisted of the addition of gentamycin to the surgical antibiotic prophylaxis regimen. The percentage of patients with HAIs was 31% lower during the post-intervention period (p = 0.03), with the greatest reductions observed for urinary tract infections (p = 0.024). Carbapenem-resistant K. pneumoniae was not isolated during this period. The investigated patients did not exhibit worsening renal function. Further studies are needed to assess antibiotic prophylaxis in renal transplantation patients at institutions where there is a high prevalence of multidrug-resistant Gram-negative bacteria.

The Masquelet technique for the treatment of large bone defects consists of a 2-stage procedure. In the first stage, a polymethylmethacrylate (PMMA) cement spacer is inserted into the bony defect of a rat's femur and over a period of 2-4 weeks a membrane forms that encapsulates the defect/spacer. In a second operation the membrane is opened, the PMMA spacer is removed and the resulting cavity is filled with autologous bone. Different kinds of bone cements are available, with or without supplemental antibiotics. Both might influence the development and the characteristics of the induced membrane which might affect the bone healing response. Hence, this comparative study was performed to elucidate the effect of different bone cements with or without supplemental antibiotics on the development of an induced membrane in a critical size femur defect model in rats. A total of 72 male SD rats received a 10mm critical size defect of the femur which was stabilised by a plate osteosynthesis and filled with either Palacos+Gentamycin, Copal Gentamycin+Vancomycin, Copal+Gentamycin+Clindamycin or Copal Spacem. The induced membranes were analysed after two, four and six weeks (wks) after insertion of the cement spacers (n=6/group). Paraffin embedded histological sections of the membrane were microscopically analysed for membrane thickness, elastic fibres, vascularisation and proliferation by an independent observer blinded to the group setup. The thickness of the induced membrane increased significantly from 2 wks (553 μm) to 6 wks (774 μm) in group Palacos+Gentamycin whereas membrane thickness decreased significantly in groups Copal+Gentamycin+Clindamycin (682-329 μm) and Copal Spacem (916 μm to 371 μm). The comparison between the groups revealed significantly increased membrane thickness in group Palacos+Gentamycin and Copal Gentamycin+Vancomycin in comparison to group Copal+Gentamycin+Clindamycin six weeks after induction. However, the fraction of elastic fibres was significantly increased in groups Copal+Gentamycin+Clindamycin (71%, 80%) and Copal Spacem (82%, 81%) after 2 and 4 weeks in comparison to the groups Palacos+Gentamycin (56%, 57%) and Copal Gentamycin+Vancomycin (63%, 69%). Those differences however were partly diminished after 6 wks. The ratio of immature (vWF+) to more mature (CD31+) blood vessels increased significantly in groups Palacos+Gentamycin and Copal Gentamycin+Vancomycin whereas no significant alterations were noted in groups Copal+Gentamycin+Clindamycin and Copal Spacem. For the first time we demonstrated that thickness and proportion of elastic fibres in induced membranes were influenced by the type of cement and the kind of supplemental antibiotics being used. Whether these alterations of the induced membrane have an effect on bone healing remains to be proven in future studies., (Copyright © 2015 Elsevier Ltd. All rights reserved.)