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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Serum levels of most antimicrobial agents are reduced during pregnancy, often by approximately 10–15 percent (Landers et al., 1983). For example, serum levels of ampicillin and gentamicin are lower during pregnancy compared to non-pregnant women given the same dose (Duff et al., 1983; Philipson, 1977, 1982; Zaske et al., 1980). Increased blood volume (i.e., increased volume of distribution) is usually the cause of lowered serum drug concentrations, but other pregnancy-associated physiologic changes (e.g., metabolism) also play important roles. For example, lower serum ampicillin concentrations are probably not caused by strong dissociation of ampicillin at physiological pH, which should theoretically interfere with placental transfer. Although ampicillin and methicillin are dissociated, maternal:fetal concentration ratios are 1:1, indicating free transfer across the placenta (Pacifici and Nottoli, 1995).
Cardiac Implantable Device Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Julian Anthony Rycroft, Simon Tiberi
In reflection, empirical antimicrobials should be anti-staphylococcal—vancomycin (or daptomycin) should be used until the sensitivities are known for any isolated organisms. For methicillin-sensitive strains, antibiotics can later be rationalized to anti-staphylococcal penicillin or cefazolin. Gram-negative cover should be included empirically until the organism is identified—piperacillin/tazobactam or an aminoglycoside.
Perioperative care of the pediatric and adolescent gynecology patient
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Geri D. Hewitt, Mary E. Fallat
Agents that are approved by the U.S. Food and Drug Administration (FDA) for use in surgical antimicrobial prophylaxis include cefazolin, cefuroxime, cefoxitin, cefotetan, ertapenem, and vancomycin. Alternatives are provided for patients who have β-lactam allergies. The most common gynecologic procedures that require antibiotic prophylaxis include hysterectomy and suction curettage. The American College of Obstetricians and Gynecologists (ACOG) does not recommend antibiotic prophylaxis for diagnostic laparoscopy or exploratory laparotomy.10 For gynecologic procedures requiring prophylaxis, the drug of choice is cefazolin at a dose of 25 mg/kg (maximum dose of 2 g). Vancomycin is an alternative agent in patients with a β-lactam allergy. For patients known to be colonized with methicillin-resistant Staphylococcus aureus, it is reasonable to add a single preoperative dose of vancomycin to the recommended agent(s). Pediatric patients weighing more than 40 kg should receive weight-based doses unless the dose or daily dose exceeds the recommended adult dose.11 In obese patients, serum and tissue concentrations of some drugs may differ from those in normal-weight patients because of pharmacokinetic alterations, and these changes may increase the dosing needed to achieve effective levels.
Recent updates in the development of molecular assays for the rapid identification and susceptibility testing of MRSA
Published in Expert Review of Molecular Diagnostics, 2023
Masako Mizusawa, Karen C Carroll
S. aureus was first described by Alexander Ogston in 1881 [11] and then isolated by Friedrich J. Rosenbach in 1884 [12]. Penicillin was discovered in 1928 by Alexander Fleming and penicillin resistance in S. aureus was first recognized in 1942 among the isolates obtained from patients with active S. aureus infections who had been on intravenous penicillin treatment [13]. Methicillin, the first semisynthetic anti-staphylococcal penicillin, was introduced in the U.K. in 1959 to circumvent penicillin resistance [14]. Methicillin blocks transcription of blaZ encoding β-lactamase that causes penicillin resistance in S. aureus [15]. Methicillin resistance was first reported from the U.K. in 1961 [16]. However, whole-genome sequencing of early MRSA isolates suggested that MRSA emerged in the mid-1940s and it has been hypothesized that methicillin resistance was driven by the extensive use of penicillin rather than introduction of methicillin [17].
Thermal susceptibility and antibiotic synergism of methicillin-resistant Staphylococcus aureus biofilms
Published in Biofouling, 2023
Haydar A. S. Aljaafari, Parham Parnian, Jaymes Van Dyne, Eric Nuxoll
This study investigated the combination of thermal shock on MRSA with three different classes of antibiotics which are not particularly effective against MRSA on their own. Ciprofloxacin (a fluoroquinolone) inhibits cell division and tobramycin (an aminoglycoside) inhibits mRNA translation. Both are more commonly used against gram-negative bacteria, such as Pseudomonas, but may also be effective against some gram-positive ones including S. aureus. Methicillin (a beta lactam) inhibits cell wall synthesis in gram-positive bacteria, though its efficacy against MRSA is of course compromised. While none of these antibiotics are particularly effective at clinically relevant concentrations, their efficacy does vary significantly, as seen in Figure 2 at higher concentrations, and their thermal stability is attractive for these studies.
Antibiotic susceptibility of Staphylococcus aureus isolated from skin lesions in children. A retrospective analysis from a tertiary care Italian pediatric hospital
Published in Journal of Chemotherapy, 2021
Marilea Lezzi, Roberto Bandettini, Elisabetta Ugolotti, Carolina Saffioti, Alessio Mesini, Carlotta Pastorino, Francesca Manunza, Marta Ferretti, Giacomo Brisca, Elio Castagnola
S. aureus identification was confirmed by MALDI-TOF technology (Vitek MS, BioMerieux, France), according to the manufacturer’s instructions. For each strain the susceptibility to the following antibiotics was recorded: ampicillin, methicillin, ciprofloxacin, clindamycin, cotrimoxazole, fusidic acid, mupirocin, gentamicin. The choice was made starting from the availability of results from automated tests (Vitek MS, BioMerieux, France) used routinely in our Insitute for pathogens isolated from skin lesions, and considering methicillin resistance as a standard, ampicillin as a surrogate for the presence of penicillinase and ciprofloxacin, clindamycin and cotrimoxazole as alternative drugs with an available oral formulation. Fusidic acid, mupirocin, gentamicin were also included since in Italy they have topical formulations and are frequently sold as out of the counter drugs. The interpretation of the results was based on The European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoint criteria.2