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CONTEXT: The prevention of urinary tract infection recurrence (UTI) in children has been a abstract challenge yet to be solved. Current practice in children with recurrent UTI (RUTI) suggests that antibiotic prophylaxis may prevent further episodes of UTI and future complications. objective: To conduct a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis options for the prevention of UTI and kidney scarring in children with a history of RUTI. DATA SOURCES: We conducted a systematic literature search through major electronic databases (PubMed/Medline, Scopus and Cochrane Library) up to November 26th, 2023. Mean difference and SD were used for continuous outcomes and odds ratio for dichotomous outcomes. STUDY SELECTION: Our meta-analysis included 3335 participants from 23 studies. DATA EXTRACTION: The primary outcome was the effect of the different prophylaxis options on the incidence of symptomatic UTI in children with RUTI during prophylactic treatment. RESULTS: Cranberry products and nitrofurantoin lead to lower odds of symptomatic UTI episodes during prophylaxis compared with the control group and control, trimethoprim-sulfamethoxazole, or trimethoprim groups accordingly. Nitrofurantoin may be the best option for UTI incidence reduction compared with all available documented interventions. LIMITATIONS: No prophylaxis option has been shown to reduce kidney scarring. conclusions: Nitrofurantoin and cranberry products may decrease the incidence of symptomatic UTI episodes in pediatric patients with a history of RUTI. Future randomized control trials studying nonantibiotic prophylaxis options focusing on children with UTI recurrence and the risk for kidney scarring are needed to draw further conclusions. [ABSTRACT FROM AUTHOR]

The synthesis of a trinuclear Co(II)‐based coordination polymer (CP), [Co3(HL)2(H2O)6·2.2H2O]n(1), was achieved via a solvothermal method involving CoCl2·6H2O and 3‐(2,4‐dicarboxylphenyl)‐2,6‐dicarboxylpyridine (H3L). The photocatalytic efficiency of the complex was evaluated for the degradation of various antibiotics ornidazole (ODZ), nitrofurantoin (NFT), dinitroaniline (DNZ), and tinidazole (TDZ) in wastewater. Notably, NFT exhibited a remarkable 91.5% degradation within 20 min under optimal conditions. The catalytic performance was influenced by the amount of photocatalyst, NFT concentration, and solution pH, with optimal conditions identified at 6‐mg catalyst dose, 30 mg/L NFT concentration, and pH 7. Trapping experiments highlighted the roles of superoxide and hydroxyl radicals as primary active species in the photocatalytic process. Furthermore, the magnetic behavior is also discussed in detail. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe the intensity and patterns of antibiotic drug use among people with multiple sclerosis (pwMS) in the Netherlands. Methods: People with prevalent MS between 1 January 2018 and 31 December 2020 were identified using ambulatory hospital records from the PHARMO Database Network that contains routinely collected healthcare data from the Netherlands. Out‐patient pharmacy dispensing data were used to assess type of antibiotic, dosage, and amounts dispensed. Antibiotic intensity in defined daily doses (DDD)/1000 patient‐days (PD) was calculated together with frequency of dispensing of the same (prolongation) or different (switch) antibiotic up to 3 days after the end of the last antibiotic prescription; and stratified by sex, age, polypharmacy (use of > 4 out‐patient prescription drugs for > 29 days), type of disease‐modifying treatment, and Sars‐CoV‐2‐related lockdown. Results: A total of 1960 (37.8%) out of 5179 pwMS were dispensed ≥ 1 antibiotic. Of the 8762 dispensing events, 27.6%% were part of a prolongation, and 16.3% of a switch. Overall antibiotic use among pwMS was 18.8 DDD/1000 PD (95% confidence interval [95% CI]: 18.7–19.0) compared to 7.77–8.90 DDD/1000 PD in the general out‐patient population, as reported by the Dutch Working Party on Antibiotic Policy. Antibiotic use was higher among women, increased with age, and was higher in people with polypharmacy and lower during lockdown. Nitrofurantoin was the most commonly dispensed antibiotic (41.7%). Conclusions: The intensity of antibiotic use is considerably higher among pwMS than the general population. This reflects the burden of infection in this susceptible population. [ABSTRACT FROM AUTHOR]

This work is primarily focused on the utilization of an oxadiazole grafted 2D luminescent metal‐organic framework, {[Zn2(4‐tpom)2(oxdz)2]⋅4H2O}n (1), in the detection of trace amounts of nitrofuran‐based antibiotics such as nitrofurantoin (NFT) and nitrofurazone (NFZ) in aqueous medium. The π–electron rich moieties and the H‐bond accepting sites in the dual linkers (4‐tpom and oxdz2−) enable the framework to interact efficiently with NFT and NFZ exhibiting a turn‐off fluorescence response with the respective KSV (6.55×104 M−1 and 4×104 M−1) and LOD (89 ppb and 78 ppb) values. Furthermore, the efficiency of 1 in sensing commercially sold antibiotic tablet, Martifur‐100 (contains nitrofurantoin as an active ingredient), is demonstrated as an example with an LOD value of 277 ppb. Its multicycle reusability and the ultrafast response toward these antibiotics are also reported. The nature of quenching of 1 by NFT and NFZ has been investigated with experimental and theoretical considerations. [ABSTRACT FROM AUTHOR]

Objectives Patients with liver cirrhosis are prone to develop severe bacterial infections. Pharmacokinetics (PK) of antibiotics in cirrhosis are potentially affected by impaired biotransformation phases 0–3 and consequences of portal hypertension such as portovenous shunting, ascites formation and/or acute kidney injury (AKI). We aimed to elucidate to what extent PK of selected antibiotics and, therefore, dosage recommendations are affected in adults with cirrhosis. Methods We performed a systematic search in PubMed, Embase, Cochrane and CINAHL on effects of cirrhosis on PK profiles of ceftriaxone, fosfomycin, gentamicin, meropenem, nitrofurantoin, piperacillin/tazobactam and vancomycin in adults. Antibiotics were selected based on the lack of specific dosing recommendations for adults with cirrhosis. We included studies reporting on ≥1 of the following PK parameters: AUC, half-life (t ½), CL, volume of distribution (V d), peak (C max) or trough concentrations (C min). Results We identified 15 studies (ceftriaxone, n  = 5; gentamicin, n  = 3; meropenem n  = 5; vancomycin, n  = 2), including 379 patients with cirrhosis, of which two were of high quality. No eligible studies were identified for fosfomycin, nitrofurantoin or piperacillin/tazobactam. Ceftriaxone unbound concentration increased in cirrhosis, but was mitigated by increased renal CL. Gentamicin levels in ascitic fluid were comparable to those in plasma. Meropenem PK parameters were not altered in cirrhosis without AKI, but in the presence of AKI a decrease in CL was observed. In contrast, vancomycin CL decreased in advanced cirrhosis. Conclusions Available data in studies of mostly moderate quality suggest that PK of ceftriaxone, meropenem and vancomycin are altered in cirrhosis. More advanced PK studies are needed to provide specific dosing recommendations. [ABSTRACT FROM AUTHOR]

Background/Objectives: We aimed to assess the prevalence and risk factors for acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) in children admitted with urinary tract infection (UTI) at a tertiary university hospital in Saudi Arabia, as well as to investigate antibiotic resistance patterns. Methods: This retrospective cross-sectional study involved hospitalized children aged 0–14 years from January 2018 to December 2022 with urine cultures that grew E. coli or ESBL-producing E. coli. Data of the antimicrobial susceptibility for isolated bacteria were collected. Results: This study analyzed 242 urine samples obtained from 119 children with E. coli UTIs. Of these, 20.7% (n = 50) were ESBL producers. Previous antibiotic use (last 3 months), prophylactic antibiotic use, prior UTI (last 3 months), recurrent UTIs, and underlying co-morbidities (p = 0.011, <0.001, 0.025, <0.001, and 0.013, respectively) had a significant relationship with increased risk of ESBL E. coli UTIs. Generally, the highest resistance rates in the ESBL-producing isolates were for ampicillin and third-generation cephalosporin. Conversely, all ESBL-positive isolates were sensitive to meropenem, with variable resistance rates to other antibiotics as amikacin, nitrofurantoin, quinolones and trimethoprim/sulfamethoxazole (2%, 8%, 56% and 64%, respectively). Conclusions: There is a high prevalence of ESBL production among children hospitalized with E. coli UTIs. Addressing ESBL UTI risk factors helps to recognize high-risk cases and enhance proper antibiotic use. [ABSTRACT FROM AUTHOR]

The development of simple, accurate, responsive, and selective antimicrobial drug analysis platforms is extremely important for biomedical research. Developing a novel electrode material that possesses low detection limit, high sensitivity, and stability continues to be a difficult undertaking. Here, vanadium tungstate nanostones (VWNs) were synthesized by utilizing facile sonochemical method with the aid of urea and ethylene glycol for application in electrochemical sensing of antibiotic drug nitrofurantoin (NFT). Using a distinct analytical methods, the structural and morphological characteristics of the as‐prepared transducer material were described. Further, electrochemical behaviour of modified electrode were analysed using cyclic voltammetry and liner sweep voltammetry. Under the optimal conditions VWNs/GCE electrode exhibited superior electrocatalytic activity towards NFT with linear range (20–160 μM), limit of detection (0.019 μM) with better sensitivity (0.69 μM−1 cm−2). The modified electrode demonstrated remarkable repeatability, reproducibility, and excellent stability, indicating its potential as an electrocatalyst. Ultimately, the suggested electrode was used to measure FLT in real samples like tap water and NFT capsule. [ABSTRACT FROM AUTHOR]

Background: Warfarin and Direct Oral Anticoagulant (DOAC) users may have more frequent antibiotic prescriptions than non-users. The aim of this study was to estimate rates of common and resistant infections, and antibiotic prescribing amongst warfarin and DOAC users versus non-users. Methods: This matched retrospective cohort study used data from patients registered with General practices in England contributing to the Clinical Practice Research Datalink GOLD. We included 61,750 adults who initiated warfarin or a DOAC between 1st January 2011 and 31st December 2019, matched 1:1 to non-users. We estimated Incident Rate Ratios (IRR) and 95% Confidence Intervals for three common infections and all-cause antibiotic prescribing. We estimated hazard ratios (HRs) and 95% CIs for the risk of methicillin resistance Staphylococcus aureus (MRSA), other antibiotic-resistant organisms, or Clostridium difficile. We assessed the extent to which any of the effect of warfarin and DOAC use on antibiotic resistant infections or Clostridium difficile was mediated by antibiotic prescribing patterns. Results: 37,143 warfarin users and 24,607 DOAC users were matched 1:1 to non-users. Warfarin and DOAC users had greater relative consultation rates for respiratory, urinary, and skin infections. All-cause antibiotic prescribing was greater in warfarin and DOAC users (warfarin; adjusted IRR 1.47, 95% CI 1.45–1.50, DOAC; adjusted IRR 1.66, 95% CI 1.63–1.69). Largest effect sizes were observed for flucloxacillin (adjusted IRR 2.11, 95% CI 2.01–2.20), and erythromycin (adjusted IRR 2.32, 95% CI 2.00–2.70). Warfarin users had significantly higher risk of MRSA (adjusted HR 1.68, 95% CI 1.38–2.05) and hospital admission with antibiotic resistant infections (adjusted HR 1.91, 95% CI 1.11–3.30). DOAC users had significantly higher risk of MRSA (adjusted HR 1.57, 95% CI 1.20–2.06), hospital admission with antibiotic resistant infections (adjusted HR 2.13, 95% CI 1.61–2.82), and Clostridium difficile (adjusted HR 1.45, 95% CI 1.10–1.92). We found little evidence to suggest that the increased risks of studied outcomes were mediated by rates of antibiotic prescription. Conclusion: Warfarin and DOAC use was associated with greater rates of infection consultations, all-cause antibiotic prescribing, antibiotic resistant infections, and Clostridium difficile, but there was little evidence that antibiotic prescribing rates mediated risk of resistant infections or Clostridium difficile. [ABSTRACT FROM AUTHOR]

Introduction: Urinary tract infection (UTI) remains a prevalent bacterial infection among the pediatric age group, ranking as the third-most common bacterial infection in children in developing countries, following gastrointestinal and respiratory tract infections. It continues to pose a significant health challenge. Materials and Methods: The urine samples underwent gross examination, wet mount, and Gram stain. Semiquantitative cultures were conducted on conventional media (MacConkey agar, blood agar, and CLED agar) and UTI chromogenic media. Uropathogen identification employed standard microbiological techniques. Antibiotic susceptibility was determined using the Kirby–Bauer disk diffusion method, with interpretation based on CLSI guidelines. Plates were incubated overnight, and clear zone diameters around antibiotic discs were measured for sensitivity or resistance determination. Results: The study comprised 64.75% male children and 35.25% female children. Analyzing the age distribution, the majority of participants fell within the age range of 1–5 years (35%), followed by those <1 year (33.75%), and the age group of 5–12 years, accounting for 31.25% of the total 400 participants. The findings from our investigation revealed a UTI prevalence of 17.25%, with Escherichia coli and Klebsiella emerging as the predominant uropathogens. Notably, these pathogens exhibited a significant susceptibility to carbapenems, nitrofurantoin, and amikacin. Conclusion: Our study identified a male predominance and various age distributions among UTI patients. Antibiotic susceptibility patterns revealed E. coli and Klebsiella pneumoniae 's high sensitivity to key antibiotics, whereas Enterococcus spp. exhibited significant high-level aminoglycoside resistance. This study underscores the importance of tailored antibiotic strategies based on local resistance profiles to combat UTIs effectively. [ABSTRACT FROM AUTHOR]

Uncomplicated urinary tract infections (uUTI) are generally treated empirically with antibiotics. However, antibiotic allergies limit the available oral treatment options for some patients. We assessed the proportion of self-reported antibiotic allergies among US women with uUTI. We performed a cross-sectional survey of US women (≥18 years) with a self-reported uUTI in the previous 60 days and an oral antibiotic prescription. Participants completed an online questionnaire about their most recent uUTI episode. Descriptive self-reported allergy data were stratified into subgroups by whether the participant had recurrent UTI (≥2 uUTIs in the past 6 months or ≥3 uUTIs in past 12 months, including the index episode), the number of different antibiotics given for the index episode (1, 2, ≥3), and whether the treatment was clinically aligned according to Infectious Diseases Society of America uUTI guidelines. Overall, 375 participants completed the questionnaire. The most commonly prescribed antibiotics were trimethoprim-sulfamethoxazole (SXT; 38.7%), ciprofloxacin (22.7%), and nitrofurantoin (18.9%). Most participants (62.7%) received only 1 antibiotic for their uUTI, and most (56.5%) were classified as having a non-recurrent uUTI. No antibiotic allergies were reported for most participants (69.3%), with 24.0% reporting 1 antibiotic allergy and 6.7% reporting ≥2 antibiotic allergies. Allergies to ≥2 antibiotic types were more common among participants classified as having recurrent uUTI, or who used multiple antibiotics to treat their uUTI. The most common allergy was to SXT (15.7%), followed by amoxicillin-clavulanate (8.3%) and ciprofloxacin (5.3%). Similar allergy trends were seen across subgroups, except higher rates of ciprofloxacin allergy were seen in participants given multiple antibiotics. Antibiotic allergies were relatively frequent in this uUTI cohort and the most common allergy was to SXT, which was the most prescribed antibiotic. Allergies to antibiotics reduce the available treatment options for uUTI in some patients. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) are the second most common infection, affecting 150 million people each year worldwide. Enterobacteriaceae species expressing extended-spectrum β-lactamases (ESBLs) are on the rise across the globe and are becoming a severe problem in the therapeutic management of clinical cases of urinary tract infection. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to investigate the prevalence of Enterobacteriaceae isolates exhibiting ESBL and their selective oral antibiogram profile at the district general hospital, Polonnaruwa. Results: A total of 4386 urine specimens received to the Microbiology Laboratory during the study period. Among them, 1081 (24.6%) showed positive results for urine culture while 200/1081 specimens showed ESBL isolates. Out of the selected 200 specimen's majority (67.5%) of samples received from the In-Patient Department. There were 200 patients and reported that 115 (57.5%) were females and 85 (42.5%) were males. The majority (51%) of the patients belong to the age group of 55–74 years. Among the ESBLs positive specimens, the majority 74.5% (n = 149) identified organisms were E. coli followed by Klebsiella spp.17.5% (n = 35), Enterobacteriaceae 7% (n = 14) and only1% (n = 2) isolate of Proteus spp. Mecillinam (87.92%) and Nitrofurantoin (83.2%) showed higher effectiveness against E. coli. Nitrofurantoin showed the highest effectiveness against Klebsiella spp. (40%), other Enterobacteriaceae spp. (100%). Proteus spp. showed 100% effectiveness and resistance respectively against Ciprofloxacin, Cotrimoxazole and Nitrofurantoin. Conclusion: The most predominant ESBLs producing uro-pathogen was the E. coli in the study setting and E. coli had higher sensitivity rate against Mecillinam. Among currently used oral antibiotics Nitrofurantoin was the best choice for UTIs caused by ESBL producers. [ABSTRACT FROM AUTHOR]

Nitrofurantoin (NFR) is an antibiotic commonly used in the management of uncomplicated urinary tract infections. The study examined histoarchitectural and biochemical alterations in the liver and kidney of Wistar rats following exposure to nitrofurantoin. Fifteen (15) adult Wistar rats comprising five (5) animals per group were randomly assigned into three groups. Group A was the control group while Groups B and C received 30mg kg-1 and 60mg kg-1 body weight of NFR respectively for thirty (30) days. Data generated from liver and renal functional markers was analyzed on graph pad prism using descriptive statistics and outcomes implicated as standard error of the mean and mean. Mean value differences were evaluated using analysis of variance (ANOVA) considering p<0.05 as statistically significant value. Upshot display periportal hepatitis in the group given 30mg kg-1 of nitrofurantoin, the hepatocytes appeared polygonal and there was vascular congestion with inflammatory cell infiltration in rats given 60mg kg-1 NFR. These features were consistent with inflammatory responses. However, liver function tests showed a significant increase in Alanine transaminase (ALT), Aspartate aminotransferase (AST), and Alkaline phosphatase (ALP) levels across treated groups when rationalized to control group (p<0.05). Also observed is a statistically significant increase in mean serum level of total protein, direct and indirect Bilirubin across treatment groups compared to control. More so, there were features consistent with normal renal histoarchitecture with tubules comprising of multiple segments and corpuscle made up of the Glomerulus surrounded by the podocytes. Conversely, renal function parameters showed a decrease in the urea level across treatment groups. Nitrofurantoin displays no histoarchitectural outcome of the kidney but elucidated negative outcome on the liver histology, therefore caution should be considered when administered as a therapeutic agent. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) constitute one of the main complications in kidney recipients, increasing both morbidity and mortality. Due to the resurgence of antimicrobial resistance, new prophylactic approaches are being investigated. Nitrofurantoin is an antibiotic from the nitrofuran group that is effective against several Gram-negative and Gram-positive organisms; hence, there has been a resurgence in its prescription for treating MDR pathogens. Objectives: This study aims to assess the effectiveness of nitrofurantoin as an add-on to conventional therapy (amikacin + ceftriaxone or cefotaxime) for the treatment of urinary tract infections in kidney recipients. Methods: In a prospective cohort study, we included patients who received a kidney in a tertiary-care hospital. According to the intensive care specialist, group 1 patients were treated with the conventional prophylactic treatment plus nitrofurantoin as an add-on. Group 2 patients were treated only with the conventional prophylactic treatment. They were followed-up for 3 months, and the incidence of urinary tract infections was reported. Results: The UTI incidence for group 1 at 3 months was 20.6%, and for group 2, it was 20.0%; no statistical difference between treatments was observed (p = 0.9). The most commonly isolated pathogens were E. coli (28.5) and K. pneumonie (28.5%). The factor most associated with developing a UTI was female gender (aHR: 7.0; 95% IC 2.3–20.9, p < 0.001). Conclusions: In our cohort study, nitrofurantoin as an add-on in conventional therapy did not prove to be effective in preventing UTI development; therefore, other treatment options should be considered as a part of prophylactic treatment. [ABSTRACT FROM AUTHOR]

Safety and effectiveness are the two ends of the balance in drug development that needs to be evaluated. The biotransformation of drugs within a living organism could potentiate biochemical insults in the tissue and compromise the safety of drugs. Nitrofurantoin (NFT) is a cheap clinical antibiotic with a wide array of activities against gram-positive and gram-negative organisms. The NFT scaffold has been utilized to develop other derivates or analogues in the quest to repurpose drugs against other infectious diseases. Several techniques were developed over the years to study the mechanism of NFT metabolism and toxicity, such as voltammetry, chromatographic analysis, protein precipitation, liquid-liquid extraction, etc. Due to limitations in these methods, the mechanism of NFT biotransformation in the cell is poorly understood. Metabolomics has been adopted in drug metabolism to understand the mechanism of drug toxicity and could provide a solution to overcome the limitations of current techniques to determine mechanisms of toxicity. Unfortunately, little or no information regarding the metabolomics approach in NFT metabolism and toxicity is available. Hence, this review highlights the metabolomic techniques that can be adopted in NFT metabolism and toxicological studies to encourage the research community to widely adopt and utilize metabolomics in understanding NFT's metabolism and toxicity. [ABSTRACT FROM AUTHOR]

A new Cobalt(II)‐based metal–organic framework (MOF) with composition [Co2(μ2‐OH)(L)(bib)·H2O·2DMA]n(1) (H3L = 5‐[4′‐carboxylphenoxy] isophthalic acid, bib = 1, 4‐bis[1‐imidazolyl]benzene, DMA = dimethylacetamide) has been solvothermally synthesized and characterized. The MOF exhibits unprecedented topology with Schläfli symbol (43)2(4.66.1686) and display optical band gap of 3.68 eV and hence utilized as photocatalyst to photodegrade antibiotics such as metronidazole, tinidazole, nitrofurantoin, and dimetridazole. Among these antibiotics, it displays exceptional photocatalytic degradation of nitrofurantoin. Additional studies suggest that at pH 5 and 5 mg/L dosage of 1, 99.66% of nitrofurantoin decomposes at its 40 ppm concentration. Further, mechanistic pathway for light‐driven nitrofurantoin decomposition has been explored by utilizing experimental, namely, radical trapping experiments and computational techniques employing density of states and Hirshfeld surface analyses. [ABSTRACT FROM AUTHOR]

Aim: The most prevalent species in persistent and secondary infections linked to endodontic failure is Enterococcus faecalis. The objective of this in vitro investigation was to assess the antibacterial efficacy and penetration depth of calcium hydroxide, nitrofurantoin, levonadifloxacin, and a mixture of antibiotic and steroid paste (MAS paste) against E. faecalis. Materials and Methods: A total of 40 single-rooted tooth samples were decoronated apically and coronally to yield 10 mm root sections. All tooth samples were biomechanically prepared and were inoculated with E. faecalis bacteria for 21 days. The study involved four groups, each containing 10 teeth as follows: group 1--calcium hydroxide, group 2--MAS paste consisting of ciprofloxacin, metronidazole as antibiotics, and dexamethasone as corticosteroid, group 3--nitrofurantoin, and group 4--levonadifloxacin. For 7 days, the corresponding intracanal medications were injected into the canals. On the seventh day, dentinal debris was extracted from the blocked lumen to quantitatively evaluate the antibacterial activity of the experimental medications. The depth of penetration (DOP) of medicaments under study was assessed by viewing 1 mm thick horizontal sections under a confocal laser scanning microscope, one from each of the four subgroups. The sections were stained with florescent stain before being under the microscope. Results: Results showed that on day 7, the mean colony-forming units were lowest for levonadifloxacin, indicating the highest antimicrobial efficacy (P < 0.05). This was followed by nitrofurantoin, MAS paste, and calcium hydroxide. Additionally, levonadifloxacin achieved the greatest DOP, followed by nitrofurantoin, MAS paste, and calcium hydroxide. These results suggest a correlation between DOP and antimicrobial efficacy. Conclusion: Within the confines of this study, it can be concluded that levonadifloxacin exhibited the highest antimicrobial efficacy, even at a low concentration of 8 µg/mL. Therefore, it can serve as a viable intracanal medicament in endodontic therapy. [ABSTRACT FROM AUTHOR]

Background In clinical practice, challenges in identifying patients with uncomplicated urinary tract infections (uUTIs) at risk of antibiotic nonsusceptibility may lead to inappropriate prescribing and contribute to antibiotic resistance. We developed predictive models to quantify risk of nonsusceptibility to 4 commonly prescribed antibiotic classes for uUTI, identify predictors of nonsusceptibility to each class, and construct a corresponding risk categorization framework for nonsusceptibility. Methods Eligible females aged ≥12 years with Escherichia coli– caused uUTI were identified from Optum's de-identified Electronic Health Record dataset (1 October 2015–29 February 2020). Four predictive models were developed to predict nonsusceptibility to each antibiotic class and a risk categorization framework was developed to classify patients' isolates as low, moderate, and high risk of nonsusceptibility to each antibiotic class. Results Predictive models were developed among 87 487 patients. Key predictors of having a nonsusceptible isolate to ≥3 antibiotic classes included number of previous UTI episodes, prior β-lactam nonsusceptibility, prior fluoroquinolone treatment, Census Bureau region, and race. The risk categorization framework classified 8.1%, 14.4%, 17.4%, and 6.3% of patients as having isolates at high risk of nonsusceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, β-lactams, and fluoroquinolones, respectively. Across classes, the proportion of patients categorized as having high-risk isolates was 3- to 12-fold higher among patients with nonsusceptible isolates versus susceptible isolates. Conclusions Our predictive models highlight factors that increase risk of nonsusceptibility to antibiotics for uUTIs, while the risk categorization framework contextualizes risk of nonsusceptibility to these treatments. Our findings provide valuable insight to clinicians treating uUTIs and may help inform empiric prescribing in this population. [ABSTRACT FROM AUTHOR]

An ultra-performance liquid chromatography-tandem mass spectrometry method for estimating nitrofurantoin in K2EDTA human plasma has been developed using the liquid-liquid extraction technique. This method used electrospray ionization in negative mode for nitrofurantoin using triple quadruple mass spectrometry, with nitrofurantoin-13C3 employed as an internal standard. Nitrofurantoin was extracted via the liquid-liquid extraction method and separated on an analytical column Xbridge C18 (4.6 × 100 mm, 3.5 μm). Nitrofurantoin and nitrofurantoin-13C3 were performed using multiple-reaction monitoring acquisition modes with the transition of m/z from 237.06 to 152.05 (nitrofurantoin) and from 240.04 to 152.04 (nitrofurantoin-13C3). The linearity range for nitrofurantoin was optimized from 5 to 800 ng/mL, respectively. The average recovery of nitrofurantoin and nitrofurantoin-13C3 was 82.9 and 93.8%, respectively. The inter-precision ranged from 2.5 to 5.5%, and the inter-run accuracy range (deviation) ranged from –0.5 to 3.6% across quality control levels. The method was validated following USFDA guidelines and was determined to be straightforward, highly sensitive, precise, robust, and accurate. Therefore, it is suitable for routine quantification of nitrofurantoin in bulk drug and formulation. [ABSTRACT FROM AUTHOR]

Background: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive medication review (CMR) to all beneficiaries who qualify, and provides a platform to reduce PIM use. The objective of this study was to assess the impact of CMR on PIM discontinuation in Medicare beneficiaries and whether this differed by race or ethnicity. Methods: Retrospective cohort study of community‐dwelling Medicare Part D beneficiaries ≥66 years of age who were eligible for MTM from 2013 to 2019 based on 5% Medicare fee‐for‐service claims data linked to the 100% MTM data file. Among those using a PIM, MTM‐eligible CMR recipients were matched to non‐recipients via sequential stratification. The probability of PIM discontinuation was estimated using regression models that pooled yearly subcohorts accounting for within‐beneficiary correlations. The most common PIMs that were discontinued after CMR were reported. Results: We matched 24,368 CMR recipients to 24,368 CMR non‐recipients during the observation period. Median age was 74–75, 35% were males, most were White beneficiaries (86%–87%), and the median number of PIMs was 1. In adjusted analyses, CMR receipt was positively associated with PIM discontinuation (adjusted relative risk [aRR]: 1.26, 95% CI: 1.20–1.32). There was no evidence of differential impact of CMR by race or ethnicity. The PIMs most commonly discontinued after CMR were glimepiride, zolpidem, digoxin, amitriptyline, and nitrofurantoin. Conclusions: Among Medicare beneficiaries who are using a PIM, CMR receipt was associated with PIM discontinuation, suggesting that greater CMR use could facilitate PIM reduction for all racial and ethnic groups. [ABSTRACT FROM AUTHOR]

Objective: The objective is to evaluate and compare the antibacterial efficacy of nitrofurantoin, chitosan, and calcium hydroxide (Ca(OH)2) in combination with propylene glycol (PG) as an intracanal medicament against endodontic pathogens. Materials and Methods: Fifty-two extracted single-rooted maxillary and mandibular anterior teeth and premolars were selected. The root canals were enlarged using Protaper universal rotary files. Clinical isolates of microorganisms collected from retreatment cases were used. Bacterial isolates obtained from infected root canals were introduced into brain-heart infusion (BHI) broth. Incubation of samples for 14 days was carried out to facilitate the development of mature biofilms. Intracanal medicaments were divided into four groups: Group 1 - Nirofurantoin+20% PG, Group 2 - Chitosan+20% PG, Group 3 - Ca(OH)2 + 20% PG, and Group 4 - 20% PG. The prepared root samples were incubated for 7 days. After collecting dentin samples, they were placed in a phosphate-buffered saline solution. Serial dilutions were then performed, and each dilution was plated on BHI agar. The plates were incubated for 24 h at 37℃. The antibacterial efficacy was assessed by calculating the percentage of remaining colony-forming units. Results: Antibacterial efficacy of chitosan paste was significantly higher followed by nitrofurantoin as compared to other groups when used as an intracanal medicament. Conclusions: In the root-canal biofilm model, the combination of chitosan and PG demonstrated a significant reduction in the viability of endodontic pathogens when employed as intracanal medication for 7 days. This suggests its potential as an effective intracanal medicament for endodontic retreatment. [ABSTRACT FROM AUTHOR]

Background: The irrational use of antibiotics has led to the emergence of multidrug-resistant pathogens. The phenomenon of minimum inhibitory concentration (MIC) creeps occurs when organisms start showing raised MIC but within susceptible range giving an indication of the prevalence of rise in resistant pathogens in an area. Aims and Objectives: The aims and objectives of the study are to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps among the Escherichia coli isolates sensitive to nitrofurantoin. Materials and Methods: This retrospective study was done in a tertiary care hospital in Kolkata to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps. We took the data from all inpatient department and outpatient department patients sent for urine culture and sensitivity from October 1st, 2022, to September 30th, 2023. The antimicrobial susceptibility testing and MIC were conducted by VITEK Compact 2. The MIC of nitrofurantoin, one of the most widely used antibiotics for lower urinary tract infections, was calculated to investigate the phenomenon of MIC creep. All the statistical analyses were carried out using the Excel spreadsheet and OpenEpi version 3.01 platform. Results: In our study, a total of 631 urine samples were analyzed: 368 were positive with the most common isolate being E. coli (53%) followed by Klebsiella spp. (12%). Two percent of resistance was observed for fosfomycin and 8% for nitrofurantoin. Extended spectrum beta-lactamase (ESBL) producers E. coli was 127 (35%). Overall, 23/368 samples had a MIC ≥128 for nitrofurantoin. Among the ESBL producers, 13/127 had MIC ≥128 for nitrofurantoin. Conclusion: In the present study, it was observed that E. coli showed a reduced susceptibility for nitrofurantoin indicated by a creeping increase in MIC within normal range. Trends in rising MIC can be an alarming sign for using drugs such as nitrofurantoin judiciously. Antimicrobial stewardship practice should be strongly implemented in hospitals to curb rising resistance and for better prognosis of patients having infectious diseases.

Nitrofurantoin is the antibiotic of choice for treatment and prophylaxis of recurrent episodes of lower urinary tract infections. Although adverse effects such as anorexia, vomiting, and pulmonary hypersensitivity are commonly reported with nitrofurantoin use, studies have demonstrated that rarely nitrofurantoin can also induce diverse forms of liver injury, spanning from mild hepatitis to severe and potentially fatal fulminant liver failure. These occur especially in elderly females with preexisting liver or renal impairment. Here, we present a case of a 62-year-old female in good health who exhibited symptoms of fatigue, abdominal pain, and dark-colored urine. Through investigation, she was diagnosed with a case of drug-induced liver injury associated with the prolonged use of nitrofurantoin. [ABSTRACT FROM AUTHOR]

BACKGROUND In this study, we wanted to evaluate the prevalence of genitourinary tract infection in diabetic patients and to know the clinical presentation, bacteriological profile and antibiotic sensitivity pattern of organism causing Genitourinary tract infection. METHODS This was a hospital based study conducted among 344 patients who were screened for genitourinary tract infection by culture of urine and discharge, in the Department of Medicine with the assistance of Department of Microbiology at VIMSAR, Burla, over a period of two years from December 2015 to November 2017, after obtaining clearance from institutional ethics committee and written informed consent from the study participants. RESULTS Nephropathy was found to in maximum no. of cases (64%) followed by retinopathy and neuropathy. Most common urinary tract complications were found to be cystitis and pyelonephritis (31%). E. Coli was isolated in highest no. of cases (33%) followed by Klebsiella (25%). Amp-ampicillin, Nal-nalidixic acid, Nitro- nitrofurantoin, Cipciprofloxacin, Ctx-cotrimoxazole, Nor-norfloxacin, Gen-gentamicin, Cefocefotaxime, Ami-amikasin. Nitrofurantoin and Amikasin are found to be having highest sensitivity among the antibiotic tested and cefotaxime and cotrimoxazole having least sensitivity. CONCLUSION Abdominal imaging is recommended as a screening in a patient with diabetes mellitus presenting with systemic signs of diabetes. The fact that antibiotic sensitivity changes with time; therefore, knowledge of bacteria involved and their current sensitivity pattern will help us not only providing best initial empirical therapy but also preventing long term morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Acinetobacter baumannii is a multidrug-resistant bacterium commonly associated with hospital-acquired infections. The rapid spread of A. baumannii has raised concerns, as it has been linked to the emergence of clones in healthcare facilities worldwide. The challenges of treating and controlling infections caused by this bacterium in hospital settings are exacerbated by its resistance profile. The proliferation of clones worldwide highlights the need for careful infection control procedures and new tactics to fight illnesses caused by drug-resistant A. baumannii strains. Materials and Methods: Between January 2019 and December 2020, a total of 26,250 specimens were collected by personnel from the Department of Microbiology at King Fahad Specialist Hospital. Results: Our study highlights a significant surge in antimicrobial resistance, indicating a relative increase in multidrug-resistant A. baumannii isolates. Despite extensive resistance, azithromycin, cefoxitin, norfloxacin, penicillin, piperacillin, tetracycline, ceftriaxone, nitrofurantoin and aztreonam showed 91.2%-100% efficacy against these strains. Conclusions: This study emphasises the critical need for stringent infection control measures and judicious antibiotic strategies to curb multidrug-resistant A. baumannii outbreaks in healthcare settings. The identification of alternative therapies is imperative for improved management of infections caused by multidrug-resistant A. baumannii. [ABSTRACT FROM AUTHOR]

The antimicrobial agent nitrofurantoin is becoming increasingly important for treatment of urinary tract infections (UTIs) due to widespread occurrence of multidrug‐resistant Escherichia coli. Despite many years of use, little data on nitrofurantoin pharmacokinetics (PK) or ‐dynamics (PD) exist. The objective of this study was to (i) evaluate the pharmacokinetics of nitrofurantoin in a mouse model and (ii) use that data to design an in vivo dose fractionation study in an experimental model of UTI with E. coli for determination of the most predictive PK/PD index. Nitrofurantoin concentrations in urine were approximately 100‐fold larger than concentrations in plasma after oral administration of 5, 10, and 20 mg/kg nitrofurantoin. The area under the curve over the minimum inhibitory concentration (AUC/MIC) was weakly correlated to bacterial reduction in urine (r2 = 0.24), while no such correlation was found for the time that nitrofurantoin stayed above the MIC (T > MIC). Increasing size of single‐dose treatment was significantly correlated to eradication of bacteria in the urine, while this was not apparent when the same doses were divided in 2 or 3 doses 8 or 12 h apart. In conclusion, the results indicate that nitrofurantoin activity against E. coli in urine is driven by AUC/MIC. [ABSTRACT FROM AUTHOR]

In this paper, a new 0D Ag(I)‐based coordination polymer [Ag2(dib)(H2L)2](1) is proposed as a photocatalyst for the photocatalytic degradation of nitrofurantoin (NFT) under ultraviolet irradiation. The catalytic 1 was analyzed by various methods such as PXRD, SEM, FT‐IR, TGA, UV–vis, DRS, and electrochemical tests. The experimental result shows that 1 is an n‐type semiconductor, which can effectively catalyze the photodegradation of NFT under ultraviolet irradiation. Under the optimal reaction conditions, the photodegradation rate of NFT was 97.95% within 60 min when the concentration of NFT was 30 ppm. The experiment of free radical capture shows that O2˙− is the main active substance for photodecomposition, and the possible mechanism of 1 catalytic degradation of NFT is proposed. This research will lay the foundation for Ag(I)‐based coordination polymers in the field of antibiotic photocatalytic degradation. [ABSTRACT FROM AUTHOR]