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Introduction: Green tobacco sickness occurs from transdermal absorption of chemicals from freshly harvested, green tobacco leaves. Signs and symptoms include nausea, vomiting, headache, and abdominal cramps. Prevalence has shifted from the United States and Europe to China, India, and Brazil. Worldwide 8 million individuals are afflicted, including women and children. Areas covered: Mecamylamine (Inversine®, Vecamyl®), a nicotinic acetylcholine receptor (nAChR) antagonist, should be tested as a remedy for green tobacco sickness. Mecamylamine is approved as an oral tablet for the treatment of hypertension, is safe, and is off-patent. Mecamylamine attenuates many of the effects of nicotine and tobacco including seizures, thereby supporting its use as an effective pharmacotherapy for tobacco dependence. Varenicline (Chantix®) and cytisine (Tabex®) are low efficacy (i.e. intrinsic activity) nAChR agonists, are used as smoking cessation aids, and are viable options to test as remedies against green tobacco sickness. Nicotine immunization strategies may provide further options for future testing. Expert commentary: Efforts to demonstrate reversal and/or prevention of green tobacco sickness by mecamylamine will underscore the importance of nicotine in this illness and highlight a new medication for effective treatment of tobacco poisoning. [ABSTRACT FROM AUTHOR]

Abstract: In this study, daptomycin minimum inhibitory concentrations (MICs) for Staphylococcus aureus isolates were determined using Etest strips and were correlated with staphylococcal cassette chromosome mec (SCCmec) types and Panton–Valentine leukocidin (PVL) gene positivity. In total, 60 meticillin-resistant S. aureus (MRSA) and 60 meticillin-susceptible S. aureus (MSSA) isolates from clinical samples were subjected to antimicrobial susceptibility testing by disk diffusion according to Clinical and Laboratory Standards Institute guidelines, polymerase chain reaction (PCR) detection of PVL and mecA genes, and SCCmec typing. Daptomycin MICs were determined using Etest strips. The mecA gene was present in all MRSA isolates and was absent in 59 MSSA isolates. The PVL gene was present in 41 MRSA isolates and 25 MSSA isolates. Amongst the MRSA isolates, 10 were SCCmec type III, 27 were SCCmec IV and 23 were SCCmec V. Moreover, 26 SCCmec IV and 15 SCCmec V isolates were PVL-positive. All SCCmec III isolates were multidrug-resistant and PVL-negative. Daptomycin MICs ranged from 0.047μg/mL to 1μg/mL for MRSA and from 0.19μg/mL to 1μg/mL for MSSA. All MRSA and MSSA isolates were susceptible to daptomycin. Although SCCmec III MRSA and PVL-positive MSSA were resistant to more antimicrobial classes than SCCmec IV and V MRSA and PVL-negative MSSA, there does not appear to be a significant correlation between SCCmec types, PVL positivity and daptomycin MICs. MICs were not as low as expected for a newly introduced drug. [Copyright &y& Elsevier]