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WHAT IS KNOWN AND OBJECTIVE Betalactam antibiotics are the most frequent cause of hypersensitivity reactions. Rapid drug desensitization (RDD) is a technique that induces temporary tolerance to a drug allowing a patient to receive the optimal agent. The increased use of RDD and the lack of standardization among available protocols in terms of formulation, starting dose, number of steps and dosing frequency make it essential to determine the safety and appropriate management of these protocols, especially regarding reconstitution, diluents, stability and drug administration in order to guarantee reproducibility. We reviewed betalactam desensitization protocols in a tertiary hospital, in accordance with currently published practices and evaluated its use on patients over a period of three years. METHODS (a) We performed a literature search in PubMed, MEDLINE and Google Scholar databases for case reports and/or systematic reviews describing desensitization protocols for betalactam antibiotics. Pharmacokinetic parameters and physicochemical stability were checked for each antibiotic. (b) We retrospectively reviewed inpatients undergoing our antibiotic desensitization protocols from February 2018 to January 2021. Data and outcomes of desensitization procedures were analysed. RESULTS We developed nine RDD protocols: meropenem, ceftriaxone, ceftazidime, ampicillin, ceftolozane/tazobactam, cloxacillin, piperacillin/tazobactam, amoxicillin/clavulanate and penicillin G sodium. Five antibiotics have RDD protocols for two different doses, adjusted to patients with impaired renal function. Detailed data (diluent, total dose, volume, concentrations, duration and stability) of the protocol of each antibiotic used are provided. 28 desensitizations were performed in 17 patients, three of them with confirmed allergies by skin test. 26 out of 28 (92.9%) of them were successfully completed, including those three with positive skin results. The pathogens most frequently involved were E. faecalis and P. aeruginosa; both frequently associated with bacterial resistance. Meropenem, ceftriaxone and ceftazidime were the antibiotics most desensitized. 25 out of 26 (96.1%) procedures were successful in resolving the infection. WHAT IS NEW AND CONCLUSIONS Detailed information about compounding, dilution and stability is crucial to ensure safe and successful desensitization processes, as well as good coordination between the Allergy and Pharmacy departments. The increase in bacterial resistance to many of the commercially available antibiotics limits the therapeutic options for treating multidrug-resistant infections; in those situations, antibiotic desensitization may be a key therapeutic option. Although there is a broad consensus in limiting the use of RDD to patients with confirmed allergy, in usual clinical practice its application in those strongly suspected of having type I hypersensitivity is still observed. Our betalactam desensitization protocols have shown themselves to be safe and effective, as evidenced by data from the 17 patients on whom they have been tested.

Introduction: Cloxacillin is the second most prescribed antibiotic for skin and soft tissue infection in Malaysia. A similar pattern was seen in Kuala Selangor, in which our district demonstrated that the Defined Daily Dose (DDD) of Cloxacillin is high (3.0-8.7) compared to the recommended value from World Health Organization (WHO). However, resistant patterns for Cloxacillin are alarming. This study focuses on appropriate use of Cloxacillin to prevent further antimicrobial resistance. Methodology: This is a retrospective cross-sectional audit, conducted in seven public health clinics in Kuala Selangor district from January 2020 to March 2020. All Cloxacillin prescriptions within this duration were selected. Audit format was adapted from the antimicrobial stewardship protocol (AMS). Appropriate Cloxacillin use is based on accuracy of diagnosis, indication of antibiotic, correct usage (pharmacological name, dose, frequency and duration). Results: A total of 259 prescriptions were collected. Majority were for age 40 years old, 48.6% (n=126) and male, 63.7% (n=165). Cloxacillin was prescribed most for infection of the skin and subcutaneous tissue 64.1% (n=166). Diagnosis was accurate in 63.7% (n=165). Those accurate diagnosis, had correct indication 79.4% (131/165); correct usage 51.5% (85/165); correct name 69.7% (115/165); correct frequency 55.2% (91/165); correct dose 55.8% (92/165), and correct duration 47.3% (78/165). Appropriate Cloxacillin use was 41.8% (69/165). Conclusion: Measures to improve appropriate Cloxacillin use and adherence to the National Antibiotic Guideline (NAG) and Antimicrobial Stewardship (AMS) protocol is crucial. Keywords: Cloxacillin, Skin and soft tissue infection, Malaysia, antimicrobial resistance

The distribution of six acid-type penicillins (penicillin G, penicillin V, oxacillin, cloxacillin, nafcillin, dicloxacillin) in the extraction systems of chloroform–aqueous solutions of ammonium sulfate was studied. The reported distribution coefficients values of penicillins demonstrated the effectiveness of using ammonium sulfate as a salting-out agent. Based on the data obtained, a procedure for milk sample preparation was developed for the quantification of the residual content of six acid-type penicillins.

Food quality and safety have been a concern of the world population, especially in relation to the chemical and microbiological hazards present in food. The presence of antimicrobial residues at levels above the maximum residue limit makes milk unsuitable for human consumption. In this context, the objective of this study was to analyze 184 raw milk samples from the dairy region of Pernambuco state, in order to evaluate the presence of 31 antimicrobial residues from six different groups (β-lactam, sulfonamide, tetracycline, quinolone, fluoroquinolone and pyrimidine). The samples were collected from producers who supply the dairys with and no inspection service and the analyses were performed by liquid chromatography coupled to mass spectrometry. In the qualitative analysis of multiresidues, no sample presented violation for the antimicrobials analyzed. In the quantitative analysis of β-lactams, only one sample of producers who supply milk to dairys with state inspection service presented a result above the maximum residue limit for cloxacillin (464 μg.L-1). It is concluded that raw milk produced in the dairy region of the state of Pernambuco has a low rate of violation of the values established by the current legislation for antimicrobial residues.

Introduction: Chronic suppurative otitis media is a chronic infection of the middle ear and mastoid cavity which if not treated leads to partial or total loss of hearing and even life-threatening complications like meningitis and Intracranial abscess. Hence it is important to treat the persistent ear discharge in CSOM according to the antimicrobial sensitivity of the organism isolated. Methods: This is a prospective cross-sectional study done in 135 clinically diagnosed patients of CSOM at GSL medical college and General Hospital, Rajamundry, Andhra Pradesh from May 2019 to October 2019. Sterile swabs were used to collect pus from discharging ear and were inoculated onto Blood and MacConkey agar for 24-48 hrs, and identification of organisms was done by using standard biochemical reactions and antibiotic sensitivity testing done by using modified Kirby- Bauer method as per CLSI guidelines. Results: A total of 156 strains were isolated from 135 patients in the present study of which Pseudomonas aeruginosa and Staphylococcus aureus were amongst the most isolated pathogens in culture. Imipenem showed the most sensitivity against Pseudomonas, subsequently levofloxacin and piperacillin. Linezolid was the most sensitive versus Staphylococcus ensued by ciprofloxacin and cloxacillin. Conclusions: In the present study of Chronic suppurative otitis media patients, Pseudomonas and Staphylococcus were highly prevalent and showed increased resistance to beta-lactams and commonly used antimicrobial drugs. Antimicrobials like imipenem, piperacillin, and quinolones are effective against most cases of chronic suppurative otitis media. Successful treatment and avoidance of antimicrobial resistance would be achieved by the appropriate use of antimicrobials with sufficient evidence.

The use of antibiotics in livestock production can potentially generate drug residues in animal products, leading to adverse health effects for consumers. This study was carried out to assess the presence and quantify the levels of antibiotic residues in milk sold in Juja and Githurai markets in Kenya. A total of 65 milk samples, comprising raw milk purchased from shops (32 samples), milk purchased from automated vending machines (23 samples) and packet milk (10 samples) were analyzed for the presence of amoxicillin, cloxacillin, tetracycline, sulfamethoxazole and trimethoprim residues. A single aqueous extraction was performed and the extracts were analyzed using liquid chromatography-tandem mass spectrometry. The prevalence of antibiotic residues in raw milk samples purchased from shops and milk dispensed from automated vending machines was 46.9% and 26.1%, respectively. No antibiotic residues were detected in packet milk samples. The prevalence of antibiotic residues was higher in milk from Githurai market compared to Juja market (52% vs. 25%, P value = 0.0137). Overall, 10.8% of samples tested positive for at least one antibiotic residue above the maximum residue limits established by the Codex Alimentarius Commission and the European Union, while 20% of samples had detectable antibiotic residues at concentrations below the maximum residue limits. The mean concentrations were 6.7 µg/L, 53.3 µg/L, 30.6 µg/L, 5.0 µg/L and 6.2 µg/L for amoxicillin, cloxacillin, tetracycline, sulfamethoxazole and trimethoprim, respectively. These results suggest frequent occurrence of antibiotic residues in some milk from the selected markets, which may be posing a public health risk to consumers.

The objective of this study is to control the quality by Thin Layer ChromatographyCloxacillin used in Niamey cityafter carrying out a prospective survey on antibiotics commonly used in health centers and at the same time purchased from street vendors. This quality control aimed to investigate on eleven samples distributed as following as: five samples are from pharmacies five samples are from street vendors and one sample is the specialty which is used as reference to check their active ingredient. The different reagents used in this research are: Hydrochloric acid (HCl) 37 %, acetone, distilled water, ethyl acetate and acetic acid. All samples migrated in proposed diluent. This shows that all samples contain the active ingredient substance of cloxacillin. The percentage of the active ingredient were calculated as per protocol of Clarkes analysis of drugs and poisons in chemistry guidelines. It varies from 96.87 to 97.91for the pharmacies and 97.91 to 104.17for the street vendors. According to the results of the different frontal reportspercentage, all of themmeet the standards required by the WHO which is 90 to 110 %. This technique can be used for practical work or tutorial and laboratories where drug quality control mechanism is not often checked.