A bibliographic search was conducted of English-language articles dealing with chronic hepatitis B virus (HBV) infection to evaluate the risk of chronicity following acute infection. Chronic HBV infection was defined as carriage of hepatitis B surface antigen (HBsAg) for at least 6 months. On the basis of incidence studies employing standard serological test methods, the highest risk (80%-90%) of chronic infection was found to be among infected neonates born to hepatitis B e antigen-positive carrier mothers. Of children infected before 6 years of age, chronic infection was reported to develop in approximately 30%. A relatively wide range of risks (< 1%-12%) was found among diverse populations of older children and adults. However, most of the 10 identified incidence studies of generally healthy adults indicated that the risk of chronicity is very low: < or = 5% in eight studies. In addition, the pooled incidence of chronicity was < 5% among two different adult population groups: initially uninfected subjects, who usually experienced asymptomatic infection, and patients presenting with acute hepatitis B. In addition to the primary influence of age, the studies revealed a higher risk of chronic HBV infection among males and among patients with impaired immunity due to various causes.

Risks of Chronicity Following Acute Hepatitis B Virus Infection: A Review

Amoxicillin/clavulanate (Augmentin ® ) is a broad-spectrum antibacterial that has been available for clinical use in a wide range of indications for over 20 years and is now used primarily in the treatment of community- acquired respiratory tract infections. Amoxicillin/clavulanate was developed to provide a potent broad spec- trum of antibacterial activity, coverage of β-lactamase-producing pathogens and a favourable pharmaco- kinetic/pharmacodynamic (PK/PD) profile. These factors have contributed to the high bacteriological and clinical efficacy of amoxicillin/clavulanate in respiratory tract infection over more than 20 years. This is against a background of increasing prevalence of antimicrobial resistance, notably the continued spread of β-lactamase-mediated resistance in Haemophilus influenzae and Moraxella catarrhalis, and penicillin, macrolide and quinolone resistance in Streptococcus pneumoniae. The low propensity of amoxicillin/ clavulanate to select resistance mutations as well as a favourable PK/PD profile predictive of high bacterio- logical efficacy may account for the longevity of this combination in clinical use. However, in certain defined geographical areas, the emergence of S. pneumoniae strains with elevated penicillin MICs has been observed. In order to meet the need to treat drug-resistant S. pneumoniae, two new high-dose amoxicillin/ clavulanate formulations have been developed. A pharmacokinetically enhanced tablet dosage form of amoxicillin/clavulanate 2000/125 mg twice daily (available as Augmentin XR ® in the USA), has been devel- oped for use in adult respiratory tract infection due to drug-resistant pathogens, such as S. pneumoniae with reduced susceptibility to penicillin, as well as β-lactamase-producing H. influenzae and M. catarrhalis. Amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses (Augmentin ES-600 ® ) is for paediatric use in persistent or recurrent acute otitis media where there are risk factors for the involvement of β-lactamase- producing strains or S. pneumoniae with reduced penicillin susceptibility. In addition to high efficacy, amoxicillin/clavulanate has a well known safety and tolerance profile based on its use in over 819 million patient courses worldwide. Reassuringly, the safety profiles of the two new high-dose formulations are not significantly different from those of conventional formulations. Amoxicillin/clavulanate is included in guide- lines and recommendations for the treatment of bacterial sinusitis, acute otitis media, community-acquired pneumonia and acute exacerbations of chronic bronchitis. Amoxicillin/clavulanate continues to be an important agent in the treatment of community-acquired respiratory tract infections, both now and in the future.

/pdf/augmentin-amoxicillin-clavulanate-in-the-treatment-of-1pyicqam2b.pdf

Augmentin ® (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent

https://www.amjmed.com/article/0002-9343(85)90196-2/pdf

Aztreonam: the first monobactam.

Background The efficacy of new antimicrobial regimens against Neisseria gonorrhoeae infection of sites other than the urethra and cervix is rarely adequately assessed. Goal of this study To learn whether modern antigonococcal agents eradicate infections at some mucosal sites less reliably than at others. Study design This was a systematic review of published therapeutic trials of various antimicrobial regimens for the biological cure of uncomplicated mucosal Neisseria gonorrhoeae infections. Data were aggregated by treatment regimen and the cure rates were calculated by site of infection. Results Of 16,737 infections, 96.4% were cured--female urethra, 98.4%; male urethra, 96.4%; cervix, 98.0%; female pharynx, 83.7%; male pharynx, 79.2%; female rectum, 97.9%; and male rectum, 95.3%. The differences between the cure rates at the pharynx and at all other sites were statistically significant in the crude analysis and after stratifying by treatment regimen. Conclusion Modern antigonococcal regimens highly effective against infection of the urethra are highly effective at the cervix and rectum as well, but pharyngeal infections are more difficult to cure.

Treating uncomplicated Neisseria gonorrhoeae infections: is the anatomic site of infection important?

Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are increasingly prevalent and have become a major worldwide threat to human health. Carbapenem resistance is driven primarily by the acquisition of β-lactamase enzymes, which are able to degrade carbapenem antibiotics (hence termed carbapenemases) and result in high levels of resistance and treatment failure. Clinically relevant carbapenemases include both serine β-lactamases (SBLs; e.g., KPC-2 and OXA-48) and metallo-β-lactamases (MBLs), such as NDM-1. MBL-producing strains are endemic within the community in many Asian countries, have successfully spread worldwide, and account for many significant CRE outbreaks. Recently approved combinations of β-lactam antibiotics with β-lactamase inhibitors are active only against SBL-producing pathogens. Therefore, new drugs that specifically target MBLs and which restore carbapenem efficacy against MBL-producing CRE pathogens are urgently needed. Here we report the discovery of a novel MBL inhibitor, ANT431, that can potentiate the activity of meropenem (MEM) against a broad range of MBL-producing CRE and restore its efficacy against an Escherichia coli NDM-1-producing strain in a murine thigh infection model. This is a strong starting point for a chemistry lead optimization program that could deliver a first-in-class MBL inhibitor-carbapenem combination. This would complement the existing weaponry against CRE and address an important and growing unmet medical need.

Discovery of a Novel Metallo-β-Lactamase Inhibitor That Potentiates Meropenem Activity against Carbapenem-Resistant Enterobacteriaceae.

In a pilot study by field-screening in two different sauna baths, a day-sauna and a night-sauna, 318 homosexual men were investigated for syphilis and hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs). Of the 134 visitors to the day-sauna 35.1% were seroreactive for syphilis, four (3%) carried HBsAg, and 95 (70.9%) anti-HBs. Of the 184 visitors to the night-sauna 33.2% were seroreactive for syphilis, 16 (8.7%), carried HBsAg, and 97 (52.7%) anti-HBs. The correlation between seroreactivity for syphilis and the presence of HBsAg amd anti-HBs was statistically significant.

https://sti.bmj.com/content/sextrans/57/3/196.full.pdf

Prevalence of syphilis and hepatitis B among homosexual men in two saunas in Amsterdam.

The combination of clavulanic acid and amoxycillin (Augmentin) in the treatment of patients infected with penicillinase producing gonococci.

In January 1981 the incidence of penicillinase producing Neisseria gonorrhoeae (PPNG) strains in Amsterdam had increased to 18% of all new cases of gonorrhoea. Auxanographic typing in combination with plasmid determination of 729 PPNG strains showed that in 1981 the predominant and endemic types were those with the Africa plasmid and transfer factor which were non-requiring and inhibited by phenylalanine. In 1982 proline requiring strains with the Asia plasmid and transfer factor increased after being imported and spread by prostitution. Four different plasmid patterns and 12 auxotypes were distinguishable. Unusual auxotypes of both African and Asian plasmid types are frequently imported, some disappearing soon after their introduction into Holland but others providing an opportunity to trace sources and contacts. Prostitution and the biological properties of PPNG strains seem to play an important role in their spread. Only 2.6% of them were isolated from homosexual men. In areas where PPNG strains are prevalent, auxotyping is an important tool in their surveillance.

https://sti.bmj.com/content/sextrans/60/1/23.full.pdf

Epidemiology of PPNG infections in Amsterdam: analysis by auxanographic typing and plasmid characterisation.

One hundred and two patients with an uncomplicated infection due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) were treated with a single 1 g dose of cefotaxime. At follow-up within 15 days all genital and rectal infections were cured. Pharyngeal infections also seemed to respond to this treatment. A relatively high proportion (30.9%) of patients, however, developed post-gonococcal urethritis.

https://sti.bmj.com/content/sextrans/59/2/100.full.pdf

D Tio

Papers

Prevalence of syphilis and hepatitis B among homosexual men in two saunas in Amsterdam.

The combination of clavulanic acid and amoxycillin (Augmentin) in the treatment of patients infected with penicillinase producing gonococci.

Epidemiology of PPNG infections in Amsterdam: analysis by auxanographic typing and plasmid characterisation.

Single 1 g dose of cefotaxime in the treatment of infections due to penicillinase-producing strains of Neisseria gonorrhoeae.

[The spread of penicillinase-forming gonococci in Amsterdam].