Search Results (657)

Azelaic acid (AzA), a saturated dicarboxylic acid, is indicated for the treatment of acne vulgaris, rosacea, melasma, and post-inflammatory hyperpigmentation. Its antimicrobial, anti-inflammatory, and antimelanogenic properties support its use; however, its poor aqueous solubility and limited skin permeability constrain its optimal topical delivery. This review summarizes clinical evidence and advances in formulations—including conventional vehicles, polymeric/lipid nanocarriers, and deep eutectic solvent (DES) systems—to promote more effective and well-tolerated use. Across indications, 15–20% azelaic acid (AzA) formulations produced clinically meaningful improvements with mild, transient local irritation. For acne vulgaris, reductions in inflammatory and noninflammatory lesions were comparable to those of topical retinoids/adapalene, and tolerability was superior in some studies. For rosacea, the 15% gel formulation was comparable to metronidazole in reducing papules, pustules, and erythema while maintaining negligible systemic exposure. In melasma and other dyschromias, 20% cream demonstrated efficacy similar to hydroquinone, exhibiting a favorable safety profile. Advanced delivery systems, including liposomes, niosomes/ethosomes, nanostructured lipid carriers, microemulsions, nanosponges, and DES platforms, increased AzA solubilization, cutaneous deposition, and stability. This enabled dose-sparing strategies and improved adherence. Data on AzA cocrystals and ionic salts suggest additional control over release and irritation. AzA remains a versatile and well-tolerated dermatologic agent whose performance is strongly vehicle-dependent. Rational selection and engineering of carriers, particularly DES-integrated polymeric and lipid systems, can mitigate solubility and permeability limitations, enhance skin targeting, and reduce irritation in the treatment of acne and rosacea. Full article

Background/Objectives: Veillonella species are Gram-negative, non-motile, non-fermentative, obligate anaerobic cocci. They are typically considered commensals of the oral cavity, respiratory tract, genitourinary tract, and gastrointestinal tract. It may be a rare cause of dental infections and discitis/spondylodiscitis. Methods: We report the case of an 80-year-old patient diagnosed with discitis caused by Veillonella parvula, isolated from blood. In addition, we performed a comprehensive literature review summarizing all reported cases of discitis or spondylodiscitis caused by Veillonella species. Results: In our case, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method. Based on the results, the patient was treated with amoxicillin/clavulanate, which led to a favourable clinical outcome. A review of the literature revealed that, to date, only 14 cases of spondylodiscitis or discitis caused by Veillonella spp. have been reported. Potential risk factors for Veillonella spp. bacteremia were identified in only 9 cases. The most commonly affected site was the lumbar or lumbosacral spine. Magnetic resonance imaging was consistently regarded as the diagnostic gold standard. Most patients presented with localized pain. The overall therapeutic approach generally consisted of an initial course of intravenous antibiotics, typically ceftriaxone administered either as monotherapy or in combination with metronidazole, followed by an oral regimen with amoxicillin/clavulanate, given alone or alongside metronidazole. Conclusions: Spondylodiscitis due to V. parvula remains extremely rare. Although antimicrobial susceptibility patterns remain heterogeneous, beta-lactams, particularly amoxicillin/clavulanate, appear effective in most cases, and treatment regimens typically involve an initial intravenous phase followed by oral therapy. Full article

Background: Fusobacterium species are anaerobic Gram-negative bacilli that are part of the normal oropharyngeal and gastrointestinal flora. Although rare, they can cause infective endocarditis (IE), a severe condition with high morbidity. The clinical characteristics, treatment strategies, and outcomes of IE caused by Fusobacterium spp. remain incompletely defined. This systematic review aimed to synthesize available data on Fusobacterium IE and compare its features with IE caused by other pathogens. Methods: We conducted a systematic literature search in PubMed, Scopus, and the Cochrane Library up to 27 February 2025, using the terms “Fusobacterium” and “endocarditis.” Eligible studies included case reports or series describing adult or pediatric patients with Fusobacterium-associated IE. Data were extracted on demographics, risk factors, clinical features, microbiology, treatment, and outcomes. Results: A total of 21 studies (all case reports) involving 21 patients were included. The median age was 48 years, and 85.7% were male. Poor dental hygiene or recent dental work was the most common predisposing factor (47.6%). The mitral valve was most frequently affected (44.4%). Fever and sepsis were reported in nearly all cases, and embolic phenomena occurred in 81%. The most commonly isolated species were F. necrophorum (47.6%) and F. nucleatum (42.9%). Treatment commonly included metronidazole (61.9%), while surgical management was required in 23.8%. All-cause and infection-attributable mortality were both 9.5%. Conclusions: Fusobacterium IE predominantly affects younger males and is often linked to oral sources. This disease is associated with a high risk of systemic complications but seems to have a lower mortality compared to IE from other pathogens, including other anaerobic bacteria. Early diagnosis and appropriate antimicrobial treatment are of utmost importance for optimal outcomes. Further research is required to guide evidence-based management of this rare but serious infection. Full article

Preterm labour (PTL) affects about 11% of all deliveries world-wide. It is a major cause of perinatal morbidity and mortality. Although the precise cause is unknown in about 50% of cases, infections are thought to be a major contributing factor. These infections are more common in earlier preterm deliveries. While some women with these infections will manifest the classical features of fever, tachycardia (maternal and/or fetal), leucocytosis, raised biomarkers of infections, and uterine tenderness/irritation, others will be asymptomatic. Some of the women may develop a short/dilating cervix without any obvious contractions. Identifying such women is potentially challenging. Evidence has shown that a condensation of echogenic particles just above the cervix—amniotic fluid (AF) sludge, identified by ultrasound—is a marker for microbial invasion of the amniotic cavity (MIAC) and preterm birth (PTB) in both asymptomatic and symptomatic women (including those with a short or normal cervix). Those with a short cervix with AF sludge have a significantly greater risk of progression to PTB. Treatment with antibiotics has been shown in some but not all case series to result in a resolution of the sludge and either a delay or prevention of PTB. The widely varied results from treatment could be related to the antibiotics used and the route of administration. The use of the parenteral combination of clindamycin, a cephalosporin, and metronidazole has been shown to be more effective compared to azithromycin. Here we review the literature on the relationship between the sludge and PTB and conclude (1) that the AF sludge is an ultrasound marker of MIAC and PTL and (2) that following its diagnosis, appropriate counselling should be offered and the triple antibiotic combination offered. We suggest that randomised trials should be undertaken to determine the most efficacious antibiotic combination. Full article

Background and Clinical Significance: This case report highlights the rare but potentially sight-threatening presentation of corneal ulcers associated with methamphetamine abuse. Identifying the signs of illicit drug use is critical, as ocular complications may be overlooked without proper social history or lab confirmation. Case Presentation: A 48-year-old Hispanic male presented with progressive bilateral vision loss over four weeks, describing his condition as “blind vision.” Two weeks earlier, he had visited the emergency room after a fall caused by impaired vision and was prescribed insulin, metronidazole, and fluoroquinolone drops. At ophthalmology follow-up, visual acuity was 20/400 OD and 20/800 OS. Examination revealed bilateral stromal corneal ulcers with infiltrates. Notable systemic signs—pockmarks, poor dentition, thin body habitus, and jittery behavior—raised suspicion for methamphetamine use. He was treated with bandage contact lenses, dehydrated amniotic membranes, and a steroid-antibiotic combination drop. Conclusions: This case underscores the importance of recognizing physical signs of methamphetamine abuse, even in the absence of disclosed history. Emergency room laboratory testing confirmed methamphetamine use. Awareness of drug-induced ocular effects allows for appropriate patient education, timely intervention, and referral to addiction services. Patients should be warned that continued drug use may result in irreversible vision loss. Full article

Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the United States with increasing rates in younger patients and those in the community. CDI incidence may also be on the rise in peripartum women. Methods: We conducted a literature review to assess the incidence and outcomes of CDI in the peripartum population and review treatment options. Results: Peripartum patients have a high risk of complications and adverse events associated with CDI. Most patients have been treated with vancomycin or metronidazole; however, cases of patients recurring on standard treatment have been described, with patients having successful outcomes with fidaxomicin or fecal microbiota transplantation (FMT). Probiotics have been shown to be safe in peripartum women; however, the role in preventing primary and secondary CDI has not been studied. Conclusions: Peripartum women that develop CDI are at increased risk for complications. Treatment includes vancomycin, metronidazole, or fidaxomicin or FMT for recurrent cases. Full article

The search for a simple, scalable, and eco-friendly method for synthesizing micro-sized photocatalysts is an urgent task. Plasma technologies are highly effective and have wide possibilities for targeted synthesis of novel materials. The mass-average temperature of plasma treatment is higher than the stability temperature of anatase and brookite, the most photoactive polymorphs of titanium dioxide. In this work, by optimizing the plasma treatment conditions and selecting source materials, a method for synthesizing micro-sized photocatalyst based on heterocomposite TiO₂/ZnO particles with high anatase content is proposed. The synthesis method involves treating a powder mixture of titanium and zinc by low-temperature argon plasma under atmospheric conditions. The relationship between the structural-phase composition, morphology, and photocatalytic properties of the microparticles was investigated. A model for the synthesis of composite microparticles containing anatase, rutile, and heterostructural contact with zinc oxide is proposed. The photocatalytic degradation of methylene blue and metronidazole was studied to evaluate both sensitized and true photocatalytic processes. The metronidazole degradation confirmed the intrinsic photocatalytic activity of the synthesized composites. Additionally, the features of photocatalysis under UV and solar irradiation were studied, and a photocatalysis mechanism is proposed. The synthesized micro-sized heterocomposite photocatalyst based on TiO₂/ZnO contained anatase (36%), rutile (60), and brookite (4%) and showed a photocatalytic activity during the methylene blue degradation process under UV irradiation (high-pressure mercury lamp, 250 W): 99% in 30 min. Full article

Background/Objectives: Antibiotic prophylaxis is a key component of infection prevention strategies. This study aimed to evaluate whether the duration of antibiotic prophylaxis influences the incidence of HAIs in patients undergoing elective colorectal surgery. Methods: This prospective cohort study included 278 adult patients who underwent elective colorectal surgery at a single tertiary care center. Patients were categorized into two groups based on the duration of antibiotic prophylaxis: one day or more than one day. Data on demographics, clinical characteristics, perioperative variables, and infection outcomes were collected. Results: The overall incidence of HAIs was 16.9%, with no significant difference between patients receiving one-day versus extended antibiotic prophylaxis. However, traditional multivariate analysis showed that prophylaxis lasting more than one day was independently associated with a significantly lower risk of HAI (RR = 0.30, 95% CI: 0.12–0.75, p = 0.010) and surgical site infections (RR = 0.24, 95% CI: 0.08–0.72, p = 0.011). After adjusting for confounders using propensity score matching, this association was no longer statistically significant. No significant association was found between prophylaxis duration and urinary tract infections. Regarding antibiotic selection, first-generation cephalosporins were the most commonly used agents, accounting for 78.8% of prophylactic prescriptions. This was followed by fluoroquinolones (14.4%) and third-generation cephalosporins (5.0%). All patients received metronidazole, a nitroimidazole-class antimicrobial, in combination with the above agents. Conclusions: One day of prophylactic antibiotics may be sufficient in SSI prevention in patients undergoing elective colorectal surgery. The use of extended antibiotic prophylaxis beyond one day should be considered for high-risk patients at high risk of infection, particularly those requiring ICU care. Full article

Background/Objectives: Helicobacter pylori (H. pylori) is a common gastric pathogen linked to gastritis, gastroduodenal ulcers, and gastric cancer. Rising antimicrobial resistance (AMR) poses challenges for effective treatment and has prompted the WHO to classify H. pylori as a high-priority pathogen. This study aimed to detect the prevalence of AMR genes in H. pylori-positive gastric samples from patients in Algarve, Portugal, where regional data is scarce. Methods: Eighteen H. pylori-positive gastric biopsy samples from patients undergoing upper gastrointestinal endoscopy were analyzed. PCR and sequencing were used to identify genes associated with resistance to amoxicillin (Pbp1A), metronidazole (rdxA, frxA), tetracycline (16S rRNA mutation) and clarithromycin (23S rRNA). Sequence identity and homologies were verified using tBLASTx and the Comprehensive Antibiotic Resistance Database (CARD). Results: Out of the 18 H. pylori-positive samples, 16 (88.9%) contained at least one AMR gene. The most frequent genes were rdxA (83.3%) and frxA (66.7%) for metronidazole resistance, and the 16S rRNA mutation (66.7%) for tetracycline. Resistance to amoxicillin and clarithromycin was detected in 27.8% and 16.7% of cases, respectively. Most samples (72.2%) had multiple resistance genes. A significantly strong association was found between female sex and the presence of the rdxA gene (p = 0.043). Conclusions: The study reveals a high prevalence of H. pylori resistance genes in Algarve, particularly against metronidazole and tetracycline. These findings highlight the need for local surveillance and tailored treatment strategies. Further research with larger populations is warranted to assess regional resistance patterns and improve eradication efforts. Full article

Antibiotics may be used for gastrointestinal enteropathies but research has demonstrated significant microbiota dysmetabolism, fermentation pattern alterations, and prolonged dysbiosis following treatment. The objective of this study was to determine how dietary fiber or fecal microbial transplant (FMT) treatments impacted the fecal characteristics, metabolite concentrations, and microbiota populations of cats treated with metronidazole. Twenty-five healthy adult cats (6.75 ± 1.20 yr) were fed a commercial kibble diet for 2 wk, administered metronidazole (20 mg/kg BW BID) for 2 wk, then monitored for 4 wk. Cats were allotted to one of three interventions (diet, diet + beet pulp, diet + FMT) for 1 wk, interventions ceased, then recovery was monitored for 4 wk. Fresh fecal samples were collected at the end of each phase and at the mid-points of recovery. As anticipated, metronidazole increased fecal scores and moisture (p < 0.05), reduced fecal bacterial alpha diversity (p < 0.0001), and reduced fecal metabolite concentrations. Few treatment effects were detected, with antibiotic recovery contributing to many of the results observed. Dysbiosis was persistent throughout the study, with 4/25 cats still demonstrating mild dysbiosis after 9 wk. Overall, dietary or FMT treatments may aid in accelerated antibiotic recovery in cats but further research is needed to refine treatments for greater efficacy. Full article

Background: There has been a reduction in successful H. pylori eradication rates recently, which is largely attributed to increasing antibiotic resistance. In areas of high dual clarithromycin and metronidazole resistance such as ours, Maastricht VI/Florence guidelines recommend bismuth quadruple therapy (BQT) as first line of therapy; however, the availability of bismuth was poor in Ireland until recently. Similarly, tetracycline, a component of BQT, is restricted locally, with doxycycline (D) being approved and reimbursed for most indications. Aims: To assess the efficacy of BQT-D therapy for H. pylori eradication in an Irish cohort. Methods: All patients testing positive for H. pylori in three Irish referral centres by urea breath test, stool antigen, or histology were treated prospectively with BQT-D (bismuth subcitrate 120 mg QDS, metronidazole 400 mg TDS, doxycycline 100 mg BD and esomeprazole 40 mg BD) for 14 days. Eradication was evaluated with a urea breath test (UBT) >4 weeks after therapy cessation or by stool antigen testing, as available. Outcomes were recorded and analysed according to demographics and H. pylori treatment history of the patients. Results: 217 patients completed post-eradication testing. Of which, 124 (57%) were female, with a mean age 52 years. 180 patients (83%) were treatment-naïve. A total of 165/180 (92%) of the treatment-naïve patients had successful eradication. There was no association between eradication and gender or age in this cohort (p = 0.3091, p = 0.962 respectively). A total of 29 patients received this therapy as second-line therapy, of which 22 (76%) had successful eradication. Eight patients received the regimen as rescue therapy, with seven (88%) having successful eradication. No serious adverse events were reported. Eleven individuals (6.5%) commented on the complicated nature of the regimen, with 11 tablets being taken at five intervals daily. Conclusions: BQT-D as first-line therapy for H. pylori infection is highly effective in a high dual-resistance population, achieving >90% eradication. BQT-D as a second-line treatment performed less well. Our data support BQT-D as a first-line treatment. Full article

Helicobacter pylori, a spiral-shaped bacterium found in the stomach, is associated with various gastrointestinal and systemic health conditions. Effective suppression of H. pylori is therefore critical for managing gastrointestinal diseases. In a search for natural products with anti-H. pylori activity, the extract of Atractylodes macrocephala rhizoma showed significant inhibitory effects. Chromatographic purification of A. macrocephala extract yielded thirteen compounds, which were identified as ten sesquiterpenes and three polyacetylenes by spectroscopic analysis. The sesquiterpene compounds belong to the eudesmane or eudesmane lactone types and exhibited structure-dependent efficacy. The major eudesmane lactone sesquiterpene, atractylenolide I (1), showed strong inhibitory activity comparable to metronidazole, a positive control, and atractylenolide III (3) also showed good efficacy. However, structural modification such as hydroxylation, methylation, or acetylation of the sesquiterpenes led to reduced activity. In contrast, polyacetylene derivatives displayed only mild inhibitory effects. Further evaluation of the active compounds against three H. pylori strains such as 51, 43504, and 26695 showed that atractylenolide I (1) had potent inhibitory effects against all three strains, with MIC₅₀ values of ranging from 27.3 to 48.6 μM and MIC₉₀ values from 45.4 to 87.2 μM. Atractylenolide III (3) exhibited selective activity against strain 51 with MIC₅₀ value of 89.9 μM. Both compounds also exhibited anti-inflammatory activity with IC₉₀ values of 23.3 and 31.1 μM, respectively, although they showed little effect on urease. This is the first report on the anti-H. pylori efficacy of various constituents of A. macrocephala and comparative analysis of inhibitory effects against several strains, which will provide scientific evidence supporting its potential as therapeutic agent for H. pylori-related infection. Full article

Objective: Gut dysbiosis has been implicated in the pathology of inflammatory bowel disease (IBD). There is some evidence to suggest that the use of antibiotic treatment can incite an early clinical response or remission when used in conjunction with standard-of-care (SOC) therapy to treat IBD-related flares. Furthermore, antibiotics have been historically investigated for use as a bridge when initiating biologic therapy while waiting for peak biologic treatment effect to occur. This study investigated and compared the time to clinical response when treated with combination antibiotics, metronidazole monotherapy, or SOC therapy in pediatric patients with an active IBD flare. Methods: This study was a retrospective, Institution Review Board-approved, single-centered cohort study which included patients who were less than 18 years of age with a confirmed diagnosis of IBD who received conventional treatment alone or with either combination antibiotic therapy or metronidazole monotherapy to treat an active IBD flare between March 2013 and January 2024. Patients were excluded if they received antibiotic therapy to treat an active infection, had positive stool cultures or enteric pathogen polymerase chain reaction panel, or had colonic disease limited to the rectum. Results: Fifty-nine patients were included and divided into metronidazole monotherapy (n = 18), SOC therapy (n = 20), and combination antibiotics (n = 21). The primary outcome of days to clinical response was not significantly different across all groups; however, patients who received combination antibiotics achieved the fastest time to clinical response (median (IRQ))—4 days (1, 65), compared to 7.5 days (1, 119) for the SOC group and 9 days (2, 217) for the metronidazole group. Secondary outcomes of achievement of clinical response, remission, or failure were determined to be non-significant between all groups. Conclusions: There is no significant difference in time to clinical response, attaining clinical response or remission, or treatment failure rate for patients treated with combination antibiotics, metronidazole monotherapy, or SOC. However, results of this study suggest that the use of combination antibiotics plus SOC may lead to a faster time to clinical response and remission compared to SOC therapy alone. Further studies are warranted to elucidate the role of antimicrobial therapy in management of pediatric IBD. Full article

Antibiotic therapy is essential for managing bacterial infections, but rare yet serious hematological complications such as leukopenia and agranulocytosis may occur. These conditions, although uncommon, require timely diagnosis and intervention, particularly in vulnerable populations such as postpartum patients. This case report describes a 31-year-old puerperal woman who developed agranulocytosis after extended antibiotic treatment for a presumed multidrug-resistant infection. Initially treated with ceftriaxone and metronidazole, her therapy was later escalated to include ciprofloxacin, amoxicillin–clavulanic acid, and vancomycin. Enterococcus spp. and Staphylococcus aureus were isolated from multiple sites, although no systemic infection was confirmed. Bone marrow findings were consistent with agranulocytosis in the recovery phase. Despite improvements in infection markers, her leukocyte count progressively declined, reaching a nadir of 1.61 × 10⁹/L on the 19th day of therapy. Granulocyte-colony stimulating factor (G-CSF) therapy was initiated, resulting in hematological recovery. The patient was discharged with normal inflammatory markers and leukocyte counts. This case highlights the importance of diagnostic precision, rational antibiotic use, and timely hematologic assessment during prolonged antimicrobial treatment. Full article

Background: Metronidazole is the preferred anaerobic agent for empiric treatment of intra-abdominal infections (IAI). Although dosed every 8 h (q8hr), blood concentrations exceed the in vitro minimum inhibitory concentration (MIC) for anaerobic organisms at 12 h (q12hr). A drug shortage of intravenous (IV) metronidazole prompted the conversion to every 12 h dosing in qualifying patients treated for IAI. Objective: To determine efficacy outcomes of metronidazole dosed every 12 h versus every 8 h in patients treated for IAI. Methods: This was a multi-center, retrospective, cohort study of 201 patients from January to July 2021 (q8hr) and January to November 2023 (q12hr) at five hospitals through the greater Houston area. Included patients were adults with a diagnosis of IAI confirmed by radiographic evidence and a white blood count (WBC) > 12,000 cells/µL and/or temperature > 100.4 °F at the time of diagnosis. The primary outcome was clinical cure of IAI, defined as resolution of signs/symptoms of IAI and normalization of WBC or temperature. Results: A total of 201 patients were included, 103 patients in the q8hr group and 98 patients in the q12hr group. Clinical cure of IAI occurred in 72 patients (69.9%) in the q8hr group and 62 patients (63.2%) in the q12hr group (p = 0.318). The median duration of therapy days was similar for both groups (4.0 [4.0–6.0] vs. 4.0 [3.0–6.0] (p = 0.509)). The frequency of clinical failure was higher in the q12hr group (8.7% vs. 21.4%; p = 0.01). Seven patients in the q8hr group and fourteen patients in the q12hr group required escalation of antibiotics due to the need for broader-spectrum antimicrobial therapy by clinical failure definition. Conclusions: There was no difference in clinical cure of IAI with an extended dosing interval. Clinical failure and escalation in antibiotics was higher in the q12h group due to the need for broader-spectrum gram-negative coverage and not related to the need for anaerobic coverage. Findings suggest that every 12 h dosing has similar outcomes. Full article