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Ciprofloxacin resistance


Ciprofloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic that fights bacteria in the body. It is used to treat different types of bacterial infections. Ciprofloxacin is also used to treat people who have been exposed to anthrax or certain types of plague.. Ciprofloxacin should be used only for infections that cannot be treated with a safer antibiotic. Mar 12,  · Whereas ciprofloxacin resistance is conferred by amino acid substitutions in the A subunits of DNA gyrase and parC, the A subunit of DNA topoisomerase IV, cephalosporin resistance, particularly ceftriaxone resistance, may require acquisition of an unusual penA mosaic allele and mutations in mtrR, penB, and ponA1 (22,23). Ciprofloxacin is the generic form of the brand-name antibiotic Cipro. Doctors prescribe ciprofloxacin to treat or prevent infections caused by various bacteria that are sensitive to ciprofloxacin.
Ciprofloxacin is an antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra abdominal infections, certain type of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others. For some infections it is used in addition to other genericcialistadalafil.onlinelism: Liver (incl. CYP1A2). Jul 15,  · Ciprofloxacin is a broad-spectrum antibiotic widely prescribed in clinical and hospital settings. The emergence of antimicrobial resistance against effective antibiotics is a global issue. The objective of study is the surveillance of ciprofloxacin against common pathogens. It is concluded that. The resistance of antimicrobial agents tested showed high resistance rates to amoxycillin, cotrimoxazole, and doxycycline while the lowest resistance was to amikacin and ceftazidime. The resistance rate of ciprofloxacin was % whereas, in a previous study () carried out in Gaza Strip, lower resistance to ciprofloxacin (%) was reported.


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It is a faintly yellowish to light yellow crystalline substance with a molecular weight of Close mobile search navigation Article navigation. Antimicrobial resistance in developing countries, google viagra pills for sale. The protocol for conducting this review has been registered and can be accessed on the International prospective register of systematic reviews PROSPERO available at http: Ciprofloxacin resistance Ciprofloxacin resistance is important in medicine as the bacteria that the drug can combat include several significant species that cause disease, such as Klebsiella, E. coli, and Salmonella. Bacteria are single-celled organisms. Each cell contains genetic material that act as an instruction booklet for the cell to read. Ciprofloxacin is an antibiotic used to treat a number of bacterial infections. This includes bone and joint infections, intra abdominal infections, certain type of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others. For some infections it is used in addition to other antibiotics. It can be taken by mouth, in eye drops, or intravenously. Pooled ciprofloxacin resistance proportions (with 95 % confidence intervals) in patients with E. coli UTI were separately calculated and compared between hospital and community settings using a random-effects meta-analysis model based on DerSimonian and Laird method [23, 24]. This method incorporates an estimate of the between-study variation into both the study weights and the standard error of the estimate of the common effect.

Urinary tract infections UTIs are the second most common infections in community practice. Worldwide, about million people are diagnosed with UTI each year costing the global economy in excess of 6 billion US dollars [ 1 ]. Antibiotics used in the therapy of UTI are usually able to reach high urinary concentrations, which are likely to be clinically effective. Fluoroquinolones are preferred as initial agents for empiric therapy of UTI in areas where resistance is likely to be of concern [ 3 , 4 ].

This is because they have a high bacteriologic and clinical cure rates, as well as low rates of resistance, among most common uropathogens [ 4 ].

Ciprofloxacin is the most frequently prescribed fluoroquinolone for UTIs because of its availability in oral and intravenous formulations. Ciprofloxacin has shown an excellent activity against pathogens commonly encountered in complicated UTIs. It is well absorbed from oral doses and is rapidly excreted from the body under normal conditions [ 3 , 5 , 6 ].

Resistance to fluoroquinolones has increased markedly since their introduction for UTI treatment. Many studies worldwide reported a clear increase in ciprofloxacin resistance. For instance, in China, from to the incidence of ciprofloxacin resistance increased steadily from In Spain, it was However, in previous studies in Gaza Strip, the resistance to ciprofloxacin among all isolates in was 4.

Evolving changes in drug resistance in various communities have forced the importance to a reassessment of local empiric choices for managing UTI [ 8 , 12 ]. The present study describes the most common organisms causing UTI in Gaza Strip and evaluates the antibacterial activity of ciprofloxacin against recently isolated UTI pathogens.

A total of clean voided midstream urine samples were collected from the main three Gaza Strip governmental hospitals Al Shefaa, Khan Younis, and the Gaza European hospital from UTI adult outpatients the physician suspected infection aged 18—60 years during January to June One sample per patient was collected consecutively from each of the UTI suspected cases female and male to avoid strain duplication.

The nature of the work followed in the present study was fully explained to all subjects, and the study was conducted with their informed consent. Significant growth was identified biochemically and serologically in a systematic way according to standard methods [ 14 ]. Staphylococci were identified by catalase, coagulase, novobiocin, DNase, and Staphylococcus latex tests.

The initial characterization of enterococci was based on catalase reaction, hemolysis, and colony morphology. Further identification of enterococci was accomplished by the use of bile esculin test. Antimicrobial susceptibility testing of the bacterial isolates was performed by the disk diffusion method [ 15 ] in accordance with the National Committee for Clinical Laboratory Standards NCCLS [ 16 ].

Of the urine samples processed, Gram-negative bacteria represented The yeast isolates were not included in this analysis because our study is concerned only with bacterial uropathogens and their antimicrobial susceptibility. The overall sex distribution of the subjects was The patients mean age was A summary of the different microorganisms isolated during the study period is shown in Table 1. It is clear that E coli was the predominant uropathogen Frequency of microorganisms isolated from outpatients positive urine cultures.

Figures reflect the number of the isolates. High rates of resistance were found to amoxycillin The resistance rate to ciprofloxacin was The isolated bacteria showed wide differences in their susceptibility to the tested antimicrobial drugs. A high resistance rate to ciprofloxacin was observed among the Acinetobacter haemolyticus The resistance to nitrofurantoin was only 2.

On the other hand, the resistance to nalidixic acid was The importance of this study lies in describing the most common bacteria causing UTI among outpatients in Gaza Strip and their resistance to 11 selected antimicrobial agents. The sex distribution of patients in the present study is consistent with that of other studies [ 17 , 18 ].

The significant differences in UTI rates between females and males are thought to be due to anatomical differences between the sexes. Among other factors, the length of the urethra, a drier environment surrounding the meatus, and antibacterial properties of prostatic fluid contribute to a lower rate of infection in males [ 19 ].

In this study, the predominance of E coli among Gram-negative bacteria followed by P mirabilis , K pneumonia , and, among Gram-positive bacteria, E faecalis Table 1 , was similar to many authors results all over the world [ 20 , 21 , 22 , 23 ]. The prevalence of E coli may be due to its existence as a normal flora in the large intestine and female vagina. Notably, comparison among different studies concerning resistance of uropathogens to different antimicrobial agents should take into account the different periods in which such studies were carried out as well as various socioeconomical, socioepidemiological, and clinical parameters of the target population.

Moreover, the comparison must consider the limitation of resistance to antimicrobials, which can vary from country to another. The resistance of antimicrobial agents tested showed high resistance rates to amoxycillin, cotrimoxazole, and doxycycline while the lowest resistance was to amikacin and ceftazidime. The resistance rate of ciprofloxacin was The widespread and more often the misuse of antimicrobial drugs in Gaza Strip have led to a general rise in the emergence of resistant bacteria, particularly to ciprofloxacin.

Higher resistance was reported in the USA to ampicillin and cotrimoxazole [ 24 ] whereas, for ciprofloxacin resistance, lower rates were found in other countries [ 25 , 26 ]. Among Gram-negative bacteria, E coli , K pneumonia , and Enterobacter cloacae were more susceptible to nitrofurantoin Table 2. These data suggest that nitrofurantoin may still be useful for the treatment of UTIs, especially for the mentioned organisms.

Antimicrobial resistance percentage of clinical bacterial strains isolated from urinary tract infections. When comparing the high resistance rates in this study to ciprofloxacin against Acinetobacter haemolyticus , S saprophyticus , P aeruginosa , E coli , and E faecalis with other authors, higher resistance rates were reported [ 7 , 8 ].

There are many reasons for this alarming phenomenon, including inappropriate prescribing of antibiotics and poor infection control strategies [ 27 ]. The situation in Gaza Strip, in terms of antimicrobial drug use, is not so different from that of many developing countries, where people usually take antimicrobial drugs without prescription or without performing the necessary culture testing.

The considerably high MIC values for ciprofloxacin reflects the extent of treatment problem for resistant isolates. Overall susceptibility testing of this study demonstrates increased resistance to many commonly used agents especially to ciprofloxacin and illustrates the need for a continuous evaluation for the common antibiotics used in the therapy of uropathogens.

The author wishes to express high appreciation and gratitude to the team members of Khan Younis Hospital Laboratory for their efforts and sustenance of the preparation of this study. National Center for Biotechnology Information , U. Seventeen cities met the inclusion criteria: For most cities in our analysis, the city-specific STD rates we obtained were derived from county data and may only approximate city jurisdictions.

Our dataset consisted of observations, and each observation included the annual prevalence of city-level gonococcal ciprofloxacin resistance prevalence in 17 cities each year over a year period. We calculated the median percentage of isolates resistant to ciprofloxacin in and labeled the 8 cities above the median as higher resistance cities and the 9 cities at or below the median as lower resistance cities. For each group, we calculated gonorrhea incidence rates during — The rate for each group of cities was calculated as the sum of reported gonorrhea cases in the cities divided by the sum of the populations of the cities and multiplied by , The percentage of isolates resistant to ciprofloxacin for each group of cities was calculated as the average across all cities in the group.

We performed regression analyses in which the dependent variable was the city gonorrhea incidence rate log and the independent variable of interest was the percentage of GISP isolates resistant to ciprofloxacin in GISP clinic s located in the given city. The regression also included sociodemographic variables percentage of persons who were black, percentage of persons 15—29 years of age, unemployment rate, per capita income, robbery rate and binary dummy variables for each city and year to control for city-specific factors and national trends in factors that influence city-level gonorrhea incidence rates Table 1.

We included percentage of persons who were black and percentage of persons 15—29 years of age as explanatory variables because reported STD rates are often disproportionately high among black persons and youth We included unemployment, income, and robbery rates as explanatory variables because STD rates also have been linked to social determinants of health 14 , Sociodemographic variables, such as these, have been shown to correlate with STD rates at the population level over time 16 , Gonorrhea and syphilis incidence rates, percentage of persons who were black, and percentage of persons 15—29 years of age were obtained from surveillance records and US Census Bureau data maintained by CDC Robbery rates, unemployment rates, and per capita income data were obtained online from various federal agencies Table 1.

Missing values for the variables were replaced with estimated values, and we assumed a linear trend from one year to the next. For example, if the unemployment rate for a given city in was missing, the average of the unemployment rate for the given city in and was assigned for A common problem with regression analysis of data consisting of multiple observations over time is serial correlation, in which the error term in a given year correlates with the error term in the previous year.

We used 2 approaches to address the issue of serial correlation. First, we calculated SEs that are robust to the serial correlation. Second, we corrected for the autocorrelated error terms when computing the regression Specifically, we used ordinary least squares OLS , included the lagged dependent variable as an exploratory variable, and used the Newey-West procedure to calculate heteroskedasticity- and autocorrelation-consistent SEs for the regression coefficients.

We also estimated a linear regression with correction for first-order autocorrelated errors AR1 by using the AR1 procedure. The equation we estimated with AR1 was the same as the previous equation except that the lagged value of the dependent variable G i,t — 1 was not included in the model. Thus, the differences between the 2 approaches we used to address serial correlation can be summarized as follows. The OLS regression includes the lagged value of gonorrhea incidence rates as an independent variable and calculates SEs that are robust to autocorrelation in the error terms.

The AR1 regression is corrected for first-order correlation in the error terms and does not include the lagged value of the gonorrhea incidence rate. We performed additional analyses to examine the robustness of our results. First, we repeated our regression analysis by substituting the log of the syphilis rate for the log of the gonorrhea incidence rate as the dependent variable, thereby testing to determine whether our model would suggest an implausible link between gonococcal ciprofloxacin resistance and changes in the incidence of syphilis.

In performing this procedure, we added 1 to the syphilis rate before taking the log so as not to exclude observations in which the syphilis rate was 0. Second, we examined temporal aspects of the association between ciprofloxacin resistance and gonorrhea incidence rates to determine whether gonorrhea incidence rates could be better predicted on the basis of past values of gonorrhea incidence rates and ciprofloxacin resistance rather than past values of gonorrhea incidence rates alone as in Granger causality tests 18 , To do so, we modified our model so that 3 lagged values of the resistance variable R i,t — 1 , R i,t —2 , and R i,t — 3 were included as explanatory variables rather than the current year value of the resistance variable R i,t.

We also included 3 lagged values of gonorrhea incidence specifically, the log of the gonorrhea incidence rate in years t — 3, t —2, and t —1 as explanatory variables rather than 1 lag. We examined the joint significance of the 3 lagged resistance variables R i,t — 1 , R i,t — 2 , and R i,t — 3 by using an F test to compare this model with a restricted model in which the coefficients of these 3 variables were set to 0.

The joint significance of the 3 lagged values of gonorrhea incidence was calculated in an analogous manner. We then reversed the model such that ciprofloxacin resistance was the dependent variable. Third, we tested the sensitivity of our results to functional form by using the gonorrhea incidence rate rather than the log of the gonorrhea incidence rate as the dependent variable.

Fourth, we tested for the effect of influential observations by using 2 approaches: The average fraction of GISP isolates resistant to ciprofloxacin across the 17 cities during the 16 years examined was 0. The average logged value of the gonorrhea incidence rate was 5.

The average city population was Ciprofloxacin resistance and gonorrhea incidence rates in 17 cities, United States, — A Gonorrhea incidence rates and B average percentage of isolates resistant to ciprofloxacin for 2 groups of In , a median percentage of 3.

We classified the 8 cities above the median in as higher resistance cities and the 9 cities at or below the median in as lower resistance cities. In our simple comparison of higher resistance and lower resistance cities, we found divergent trends in gonorrhea incidence rates in the s Figure. Although gonorrhea incidence rates were much lower overall in the higher resistance cities, gonorrhea incidence rates generally increased in the higher resistance cities and decreased in the lower resistance cities during — Figure, panel A.

The timing of the divergent trends in gonorrhea incidence rates coincided with the divergent trends in ciprofloxacin resistance Figure, panel B. Ciprofloxacin resistance in a given city in a given year was associated with higher gonorrhea incidence rates in that city in the given year.

This finding was consistent regardless of estimation procedure OLS in models 1 and 2 and AR1 in models 3 and 4 and regardless of the exclusion models 1 and 3 or inclusion models 2 and 4 of the additional sociodemographic variables.

We found no association between ciprofloxacin resistance and syphilis incidence. When we examined the temporal association between ciprofloxacin resistance and gonorrhea incidence, the coefficients of the lagged individual ciprofloxacin resistance variables were not all significant individually when the dependent variable was the log of the gonorrhea incidence rate Table 3.

When we reversed the model such that ciprofloxacin resistance was the dependent variable, lagged values of the gonorrhea incidence coefficients specifically the coefficients of the logs of the gonorrhea incidence rate in years t — 3, t — 2, and t — 1 were not jointly significant Table 3. Although past levels of ciprofloxacin resistance helped to predict current gonorrhea incidence rates, past gonorrhea incidence rates did not help to predict current ciprofloxacin resistance levels.

Our results were generally consistent across the range of additional analyses we conducted, including applying gonorrhea incidence rates in non-log form, omitting outliers, and omitting any given city from the analysis. We found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during — However, ecologic studies, such as ours, of the population-level association between ciprofloxacin resistance and gonorrhea incidence cannot establish that this association is causal.

Nonetheless, our study offers evidence consistent with that of a causal association between drug resistance and increased incidence. In focusing on the temporal order of the association between ciprofloxacin resistance and gonorrhea incidence rates, we found a strong association between ciprofloxacin resistance and subsequent gonorrhea incidence rates.

In contrast, we did not find a robust association between gonorrhea incidence rates and subsequent ciprofloxacin resistance. Nor did we did find an association between ciprofloxacin resistance and syphilis incidence.

If the association we observed between ciprofloxacin resistance and gonorrhea incidence rates were spurious, we might also expect to find an association between ciprofloxacin resistance and syphilis incidence rates, given a strong association between syphilis rates and gonorrhea incidence rates among the cities in our analysis for most years during — Although we found that ciprofloxacin resistance may have contributed to increases in gonorrhea incidence, reported gonorrhea incidence rates were generally lower in cities that had higher levels of ciprofloxacin resistance than in cities that had lower levels of ciprofloxacin resistance.

Thus, any effect that increased ciprofloxacin resistance might have had on gonorrhea incidence rates during the late s and early s would likely be relatively minor compared with all other factors that influence gonorrhea incidence at the population level.

Our results can help to quantify the possible effect of antimicrobial drug resistance on the incidence of gonorrhea at the population level. In model 2, the resistance coefficient was 0. At least 2 possible explanations exist for the observed association. First, treatment failures or delays in clearance of infections caused by ciprofloxacin resistance might have increased the duration of infectivity and facilitated transmission to partners.

Second, mutational changes in the organism that conferred resistance or co-occurred with resistance determinants might have supported gonococcal transmission. This possibility is suggested in the study reported by Kunz et al. Our assessment of the association between ciprofloxacin resistance and gonorrhea incidence offers evidence that emerging cephalosporin resistance could lead to higher gonorrhea incidence rates at the population level than would have been observed in the absence of cephalosporin resistance.

Whereas ciprofloxacin resistance is conferred by amino acid substitutions in the A subunits of DNA gyrase and parC, the A subunit of DNA topoisomerase IV 21 , cephalosporin resistance, particularly ceftriaxone resistance, may require acquisition of an unusual penA mosaic allele and mutations in mtrR , penB , and ponA1 22 , The ease with which N.

During the emergence of ciprofloxacin resistance, non-fluoroquinolone treatment options were readily available. However, few, if any, alternative options are available to treat ceftriaxone-resistant infections. In this scenario of limited treatment options, the population-level effect of ceftriaxone resistance could be more substantial. STD surveillance data are subject to limitations, such as incomplete reporting of cases and differences across jurisdictions in how data are collected Furthermore, for most cities in our analysis, the city-specific STD rates we obtained were derived from county data and might only approximate data for city jurisdictions.

However, our use of binary dummy variables for each city helps to guard against possible biases that arise because of constant differences across cities in STD reporting practices and the use of county-level data to approximate data for city jurisdictions.

The sociodemographic variables we included might likewise only approximate those for city jurisdictions because some of these variables were based on county data and some were based on metropolitan statistical area data. However, biases in the sociodemographic variables are unlikely to have influenced our findings substantially because the association we observed between ciprofloxacin resistance and gonorrhea incidence was consistent regardless of whether the sociodemographic variables were included in the model.

We assumed that the ciprofloxacin resistance in isolates collected from STD clinic s in a given city in a given year reasonably represent resistance for the entire city in the given year.

Although overall prevalence of gonorrhea in STD clinics is not representative of the overall population because STD clinic attendees are generally at higher risk, those infected with gonococcal infections with lower or greater antimicrobial drug susceptibility are unlikely to preferentially attend these clinics.

For instance, in China, from to the incidence of ciprofloxacin resistance increased steadily from Fluoroquinolones have been reported as present in a mother's milk and thus passed on to the nursing child, google viagra pills for sale. International Drug Price Indicator Guide. A review of the evidence". Ciprofloxacin resistance
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