Pharmaceutical probiotics for the treatment of anaerobic and other infections

Pharmaceutical probiotics have been used as alternative treatments or preventative therapies for a variety of clinical diseases. The overuse of antibiotics and emergence of multiple-antibiotic resistant pathogens has refocused clinical attention on the field of probiotics. Anaerobic infections which seem to respond well to probiotics are infections which involve the disruption of normal microbial flora. Gastrointestinal infections (travelers' diarrhea, antibiotic-associated diarrhea,Clostridium difficile disease, rotavirus diarrhea) have been studied using the following pharmaceutical probiotics:Saccharomyces boulardii, Lactobacillus casei GG, Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium bifidum, Streptococcus thermophilus and Enterococcus faecium. Vaginitis has been experimentally studied using L. acidophilus and L. casei GG. The efficacy, safety and mechanisms of action of these various probiotics are reviewed. Requirements for drug approval are similar for biologic probiotics and new drug entities and these requirements involve preclinical tolerability studies, pharmacokinetic studies and large, well-controlled blinded clinical trials.     

In vitro activity of Bulgarian propolis against 94 clinical isolates of anaerobic bacteria

The aim was to evaluate the effect of 30% ethanolic extract of Bulgarian propolis on 94 clinical anaerobic strains. The strains were tested by both agar-well diffusion (wells, 7 mm diameter) and disk-diffusion methods. Only 15% of Clostridium-, 3.3% of other Gram-positive- and 9.1% of Gram-negative anaerobic strains were not inhibited by 30 microL propolis extract per well. Propolis extract was more active than the ethanol (P < 0.001). By 30 microL extract per well, mean inhibitory diameters of the clostridia, other Gram-positive- and Gram-negative anaerobes were 11.5, 13.1, and 11.3 mm, and those by 90 microL were 16, 18.1 and 15.4 mm, respectively. Mean inhibitory diameters of all strains by 30 and 90 microL ethanol were only 8.4 and 9.5 mm. By 30 microL propolis extract per well, inhibitory diameters of 15 mm or more were more common in Gram-positive (32%) than in Gram-negative bacteria (13.6%, P < 0.05). Moist propolis disks inhibited more strains (89.4%) than dried disks (68.1%, P < 0.001). Most (81.8%) Bacteroides fragilis group strains and 75% of clostridial strains were inhibited by moist EEP disks. CONCLUSION: Bulgarian propolis was active against most anaerobic strains of different genera. In addition to oral pathogens, an activity of propolis against Clostridium, Bacteroides and Propionibacterium species was observed. The results could motivate a higher medical interest and further trials for evaluating the use of bee glue for prophylaxis or treatment of some anaerobic infections such as oral, skin and wound diseases.     

Evaluation of levofloxacin antitubercular activity in vitro and in lung tissue culture]

Levofloxacin in vitro demonstrated bactericidal effect against susceptible and multi-drug resistant Mycobacterium tuberculosis: range of MICs was 0.25-0.5 mcg/mL, MBC-0.5-1.0 mcg/mL. Postantibiotic effect after 24-hour exposition to bactericidal concentrations was 35-39 days. Levofloxacin possesed low toxicity when tested in mice lungs tissue culture--maximum safety concentration was 50 mcg/mL. Bactericidal effect of levofloxacin started three days after exposition and was maximal by 7 days of incubation: by this time mycobacterial microcolonies destruction started with detritus formation. It is emphasized that lung cells kept their viability completely. Combination of levofloxacin with isoniazide or pirazinamide resulted in strong synergistic effect obvious after 5 days of incubation, mycobacterial colonies destruction was registered by 7th day. Combination of levofloxacin with rifampicin resulted in antagonistic effect obvious by 7th day of the contact: the resulting effect was statistically significant and was manifested as microcolonies number and size enlargement when compared to data for single levofloxacin.     

In vitro method to assess the antimicrobial activity and potential efficacy of novel types of wound dressings

AIMS: To develop a simple, reproducible in vitro static diffusion method using cellulose disks and defined species to test antimicrobial efficacy of wound dressings. METHODS AND RESULTS: Cellulose disks were inoculated by immersion in cell suspensions of target species Staphylococcus epidermidis, Candida albicans and Fusobacterium nucleatum. Test and control wound dressings were cut into equal sized squares (25 x 25 mm) and applied to the surface of 10-mm thick tryptone yeast extract agar on test beds. Following a 2-h equilibration period, inoculated cellulose disks were inserted (one per dressing) at the interface between dressing and agar surface and a small weight applied over each square. At various sampling times, disks were removed and surviving cells enumerated by viable counts. Disk to disk variation for microbial loading was assessed using S. epidermidis for both initial (n = 16) and standard treatment (n = 16) conditions. The coefficient of variation was low (<5%) indicating good reproducibility for cell loading and treatment position on the test bed. Replicate assays (n = 6) using S. epidermidis and oxyzyme gels produced similar kill rates with low scatter (R2 > 0.9) indicating good reproducibility between assays. Significant differences (P < 0.05) in kill rates were observed for different target species, types of dressing and test bed conditions (+/-blood and nutrients). CONCLUSIONS: The method is reproducible and useful in tracking the death kinetics of test species, enabling the comparison of different types of dressing. SIGNIFICANCE AND IMPACT OF THE STUDY: The reported method has significant advantages over established test procedures; it can be applied equally across a wide range of target species (including anaerobes and yeasts), a wide range of conditions, and different types of surface dressings, including those relying upon oxygen diffusion.     

In vitro study of the proteolytic activity of rumen anaerobic fungi

Abstract To better define the antigenic structure of the outer cell membranes of Legionellae, a panel of 6 monoclonal antibodies was raised against partially purified outer membranes of Legionella pneumophila serogroup 1, Corby strain. This study describes the purification and characterization of one of these monoclonal antibodies reacting with a 135-kDa protein, which was shown to be common to all 14 serogroups of Legionella pneumophila . It shows no cross-reactivity with 20 other Legionella species, or 9 other Gram-negative species tested by SDS-PAGE and Western blotting procedures. The epitope would appear to be predominantly surface exposed and, from preliminary detergent extraction studies, not peptidoglycan-associated.     

壳聚糖治疗阴道感染的临床疗效及观察

目的分析壳聚糖治疗阴道感染的临床疗效及观察。方法对随机抽取的320例患者进行壳聚糖治疗前和治疗后的比较。结果在320例阴道感染中,治疗效果显效245例（占受检人数的76．56％）,治疗效果有效67例（占受检人数的20．94％）,治疗无效8例（占受检人数的2．5％）。结论分析壳聚糖对各种阴道感染都有较好的疗效,有利于阴道微感染的治疗,而且治疗过程中,无一例患者发生副反应,表明壳聚糖治疗阴道感染的安全性。     

Review of the clinical efficacy of flutrimazole gel in the treatment of dandruff and/or seborrheic dermatitis.

The purpose of this article is to review the phase II and phase III clinical trials with the new pharmaceutical gel form of flutrimazole. The aim of the phase II study was to determine the efficacy and tolerance of flutrimazole 1%, 2% and 4% gel when compared to placebo in the treatment of 80 patients with dandruff or seborrheic dermatitis at a dose of three applications per week during one month. Flutrimazole 1% gel had a similar efficacy compared to the other studied concentrations and a superior efficacy when compared to placebo (p < 0.05). All treatments studied had an excellent tolerance. In the phase III study, the efficacy and tolerance of flutrimazole 1% gel was compared to ketoconazole 2% gel in 192 patients with dandruff or seborrheic dermatitis. Flutrimazole gel had a similar efficacy to ketoconazole gel at a dose of three applications per week for 28 days. Both products were well tolerated and no adverse effects were recorded.     

In vitro activity of ramoplanin and comparator drugs against anaerobic intestinal bacteria from the perspective of potential utility in pathology involving bowel flora

Susceptibility of intestinal bacteria to various antimicrobial agents in vitro, together with levels of those agents achieved in the gut, provides information on the likely impact of the agents on the intestinal flora. Orally administered drugs that are poorly absorbed may be useful for treatment of intestinal infections and for certain other situations in which intestinal bacteria may play a role. The antimicrobial activity of ramoplanin (MDL 62,198) against 928 strains of intestinal anaerobic bacteria was determined using the NCCLS-approved Wadsworth brucella laked-blood agar dilution method. The activity of ramoplanin was compared with that of ampicillin, bacitracin, metronidazole, trimethoprim/sulfamethoxazole (TMP/SMX), and vancomycin. The organisms tested included Bacteroides fragilis group (n=89), other Bacteroides species (n=16), other anaerobic Gram-negative rods (n=56) anaerobic cocci (n=114), Clostridium species (n=426), and non-sporeforming anaerobic Gram-positive rods (n=227). The overall MIC(90)s of ramoplanin, ampicillin, bacitracin, metronidazole, and vancomycin were 256, 32, 128, 16, and 128 mcg/ml, respectively. Ramoplanin was almost always highly active vs. Gram-positive organisms and relatively poor in activity against Gram-negative organisms, particularly Bacteroides, Bilophila, Prevotella, and Veillonella. Vancomycin was quite similar to ramoplanin in its activity. Ampicillin was relatively poor in activity vs. organisms that often produce beta-lactamase, including most of the Gram-negative rods as well as Clostridium bolteae and C. clostridioforme. Bacitracin was relatively poor in activity against most anaerobic Gram-negative rods, but better vs. most Gram-positive organisms. Metronidazole was very active against all groups other than bifidobacteria and some strains of other types of non-sporeforming Gram-positive bacilli. TMP/SMX was very poorly active, with an MIC(90) of >2048 mcg/ml.     

Clinical efficacy and toxicity of netilmicin in the treatment of gram-negative infections.

Netilmicin, a new semisynthetic aminoglycoside antibiotic, was used to treat 41 infections in 38 patients. The outcome of four infections could not be evaluated: two patients received inadequate therapy and two did not have gram-negative infections. Clinical improvement occurred in 36 (97%) of the 37 gram-negative infections, and bacteriologic cure occurred in 30 (86%) of the 35 evaluable infections. Therapeutic serum concentrations of netilmicin were readily achieved by both intramuscular and intravenous routes. Reversible ototoxic effects occurred in 1 (3%) of 35 courses of therapy evaluated, reversible nephrotoxic effects occurred in 5 (14%) of 36 courses and mild reversible alterations in liver function occurred in 3 (19%) of 34 courses. Netilmicin appears to be effective and safe in the treatment of aerobic gram-negative infections.     

Determining specific biomass activity in anaerobic wastewater treatment processes

An experimental method for the measurement of specific gas production rate was developed and tested with biomass samples taken from anaerobic fluidized bed reactors, operating with a variety of carriers with molasses, condensate from cellulose production and brewery wastewater as feeds. The method is based on reactor sampling and offline gas volume measurement during a known time interval. Important factors are biomass and liquid sampling under oxygen-free conditions, using the liquid from the reactor as substrate, providing sufficient mixing and maintaining the physical integrity of the biomass. The method was developed in such a way that small samples (20 ml) were taken under anaerobic conditions (poising agent) for short-term (2–3 min.) gas rate measurements in a small fluidized bed (25 ml) batch reactor with U-tube. Biomass content was measured by an instrumental nitrogen method (Dumas), followed by weight determination of the carrier. The gas rates measured with the test system, and their dependence on substrate concentration, were in good agreement with those directly measured from the continuous fluidized bed reactor. Additions of molasses and acetate to the sample proved that the influence of concentration on the biomass activity can be obtained only by operating the continuous reactor at the concentration levels of interest. Comparison between the reactors showed large differences in the specific activity and the total reactor activity. It was found when comparing two reactors, that the values of the specific and the total activities permitted the calculation of the relative biomass quantities. In this way the influence of the carrier-type could be evaluated.     

In vitro fibrolytic potential of anaerobic rumen fungi from ruminants and non-ruminant herbivores

In the present study, anaerobic fungi were isolated from different ruminants and non-ruminants; i.e., cattle, buffalo, sheep, goats, wild bluebulls, elephants, deer, and zebras; and were identified as Anaeromyces, Orpinomyces, Caecomyces, Piromyces, and Neocallimastix sp., based on their morphological characteristics. These isolates possessed significant in vitro hydrolytic enzyme activities; however, an isolate of Caecomyces sp. from elephant was found to exhibit maximum activity, i.e., filter paper cellulase (Fpase; 21.4 mIU/ml), carboxymethyl cellulose (CMCase; 15.1 mIU/ml), cellobiase (37.4 mIU/ml), and xylanase (26.0 mIU/ml). Besides, this isolate also showed the significantly highest ability to digest plant cell-wall contents in vitro. The in vitro dry matter digestibility increased from 45.1 to 48.9% after 48 h of incubation, and the plant cell-wall contents, in terms of neutral detergent fiber and acid detergent fiber, decreased from 64.2 to 61.3% and from 31.3 to 29.6%, respectively. These results indicate that such fibrolytic ruminal fungal strains are prevalent in wild herbivores such as elephants, as well as in other ruminants and non-ruminants, and could be exploited as microbial feed additives for improved nutrition and productivity in domesticated ruminants.     

呼吸道感染临床实验室检查标本的评价

急性呼吸道感染(RTIs)是临床常见多发病,其病原体对抗生素耐药率的增加对诊断微生物学构成了严峻的挑战。临床微生物室对感染病原体的检出率较低,一般只有50%,且不同部位感染所采集的标本,其结果差异很大。本研究将评述呼吸道感染实验室检查标本采集的影响因素和常见病原体肺炎链球菌、流感嗜血杆菌、肺炎支原体、卡他莫拉菌、肺炎衣原体、嗜肺性军团病杆菌、呼吸道病毒、尿抗原试验的临床意义。     

Serum bactericidal activities of moxifloxacin and levofloxacin against aerobic and anaerobic intra-abdominal pathogens

We studied the serum bactericidal activity (SBA) of moxifloxacin and levofloxacin against common pathogens associated with complicated intra-abdominal infections. Ten healthy volunteers received a single dose of moxifloxacin (400 mg) and levofloxacin (750 mg) and serum samples were collected at 2, 4, 8, 12, and 24h after the dose of each drug. Bactericidal titers in serum over time were determined for aerobic gram-negative bacilli (Escherichia coli, Klebseilla pneumoniae, and Enterobacter cloacae) and anaerobic bacteria (Bacteroides fragilis, Bacteroides thetaiotaomicron, Prevotella bivia, and Finegoldia magna). Both fluoroquinolones provided rapid (2h) attainment and prolonged (24h) SBA (titers > or = 1:8) against each of the aerobic bacilli studied. SBA was observed for at least 12h against B. fragilis strains with MICs < or = 2 microg/ml to moxifloxacin and < or = 4 microg/ml to levofloxacin. Prolonged (12h) SBA (titers > or = 1:2) was also observed against isolates of B. thetaiotaomicron, P. bivia, and F. magna with moxifloxacin < or = MICs 2 microg/ml.