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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Neomycin is by far most frequently used in topical pharmaceuticals. In the USA (but also in other countries), neomycin is often combined with other antibiotics, notably bacitracin and polymyxin B, to improve the antibacterial spectrum. It is also often combined with topical corticosteroids to suppress inflammation and sometimes with lidocaine to suppress pain. In the USA, neomycin preparations are widely available as over-the-counter products. This explains the high frequencies of sensitization there of 7-11% in consecutive patients suspected of contact dermatitis (table 3.235.2) and the very frequent co-reactivity to bacitracin (129,130,132,143 [Finland],157,158 [Thailand], 188 [Finland]). Co-reactivities from combined presence or concomitant or successive sensitization can also regularly be observed to corticosteroids (143-149,151,172) and – to a lesser extent – lidocaine (132) or vice versa. Indeed, in one study, of 131 patients allergic to corticosteroids, 41 (31%) co-reacted to neomycin, versus 8% in a control group of consecutive dermatitis patients (147). In a very large IVDK study, multiple patch test reactions to standard allergens (polysensitization) was a very strong risk factor for neomycin allergy, and an association with corticosteroid allergy was also evident (172).
Methylmalonic acidemia
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Propionic acid is synthesized by intestinal bacteria, and this may be an important source of propionate and methylmalonate in these patients [110]. Treatment with neomycin or metronidazole may reduce levels of propionic and MMAs in body fluids [108–110]. Doses of metronidazole have ranged from 10 to 20 mg/kg per day and have been divided into three doses. Neomycin has been used in a dose of 50 mg/kg. Other antibiotics, such as bacitracin, paromycin, clindamycin, or vancomycin, may be useful in acute situations. Lincomycin was not effective [110]. In our experience, intermittent antibacterial therapy has been useful, suggesting that clonal populations of propionate-forming bacteria may be intermittently present in some patients. An effect of antibiotic treatment on metabolite accumulation may be especially useful during a crisis of metabolic decompensation. A sudden increase in MMA excretion unaccompanied by dietary change or stimulus for catabolism may suggest a bacterial source and an argument for neomycin or metronidazole.
Anti-Infective Agents
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: Human pregnancy experience suggests Eighth cranial nerve damage following in utero exposure to Neomycin. It should only be used parenterally in serious infections caused by difficult gram-negative pathogens, and when first-choice antibiotics fail.
How effective are antibiotics for the treatment of irritable bowel syndrome?
Published in Expert Opinion on Pharmacotherapy, 2020
Christopher J. Black, Alexander C. Ford
One of the earliest randomized controlled trials (RCT) of antibiotics in IBS used a 10-day course of neomycin 500 mg twice-daily compared with placebo in 111 patients with either IBS-D or IBS-C [9]. Neomycin resulted in a significantly greater improvement in overall symptoms (35.0% vs. 11.4%, p< 0.05) 7 days post-treatment. Important limitations include the small sample size and the short duration of follow-up. However, the most widely studied antibiotic in IBS is rifaximin. The first published RCT compared a 10-day course of rifaximin 400 mg three times daily with placebo in 87 patients, demonstrating a significant improvement in IBS symptoms with rifaximin after 10 weeks of follow-up (36.4% vs. 21.0%, p= 0.020) [10]. A second RCT recruited 124 patients with abdominal bloating, of whom 70 met criteria for IBS, and compared 10 days of rifaximin 400 mg twice-daily with placebo [11]. Among those with IBS, there was a benefit of rifaximin over placebo after 10 days of follow-up (27.0% vs. 9.1%, p = 0.05). Each of these trials also included patients with either IBS-D or IBS-C.
A rare case of hemodialysis-related portosystemic encephalopathy and review of the literature.
Published in Acta Clinica Belgica, 2020
Barbara Geerinckx, Rachel Hellemans, Amaryllis H. Van Craenenbroeck, Sven Francque, Liesbeth De Waele, Jeroen Kerstens, Pieter-Jan Van Gaal, Bart Bracke, Peter Michielsen, Thomas Vanwolleghem
Treatment with lactulose syrup and lactulose enemas was started with prompt improvement of the encephalopathic state and decrease in serum ammonia. Afterwards, fluctuating symptoms remained despite optimal laxation with lactulose syrup and enemas. Four days later, a new hemodialysis session was initiated at a very low blood flow rate. However, after 30 minutes encephalopathic symptoms recurred and the hemodialysis session was immediately stopped. Neomycin needed to be associated to the medical treatment. We hypothesized that the tip of this catheter located in the superior vena cava created a negative pressure (suction) at the level of the hepatic veins, which might have increased the shunting of ammonia-rich blood over the TIPS. Therefore, we also decided to change the hemodialysis access and a new catheter was placed in the right femoral vein. The next hemodialysis session performed via the femoral catheter went uneventfully as went all subsequent sessions. Neomycin was stopped after seven days and the lactulose treatment could be tapered down. Four weeks later the patient underwent a living donor kidney transplant and dialysis could be discontinued. Up to now, 6 months after transplantation, he never experienced symptoms of PSE again. A time course of the aforementioned clinical and biochemical evolution as well as the associated treatment is displayed in Figure 2.
Diagnostics and management approaches for Acanthamoeba keratitis
Published in Expert Opinion on Orphan Drugs, 2020
Nóra Szentmáry, Lei Shi, Loay Daas, Berthold Seitz
It is a fact that there is a lack of standardized treatment for AK. In Table 1 we summarize chemicals with amoebicidal and cysticidal effect (in vitro), and their mode of action [32]. Nevertheless, only some of these compounds have been used in ophthalmology. In the literature, the following compounds have been described with an antiamoebic effect and are in ophthalmic use [33–35] (see also Table 2) [36]: The disinfectant/antiseptic diamidine (propamidine-isethionate (Brolene), hexamidin-diisoethionat (Hexacyl), and dibromopropamidine (Golden Eye) in 0.1% concentration).The disinfectant/antiseptic biguanide (polyhexamethilen-biguanide (polyhexanid) (Lavasept) and chlorhexidine (Curasept) are applied in 0.02% concentration, polyhexanid also in 0.08% concentration).The antibiotic neomycin.The disinfectant/antiseptic 1% povidon-iodine.The antileischmaniatic miltefosine.Antifungals such as miconazol, clotrimazole, voriconazol, natamycin.