Podcasts about Ciprofloxacin

What's the problem with antibiotics anyway? On this episode of Vitality Radio, Jared passionately answers this question. There is no antibiotic that doesn't cause harm. That's not to say they don't have their place, but as Jared explains, they are almost never necessary and almost always prescribed for common problems like UTI's and sinus infections. You'll learn why many infections don't need, and won't respond to antibiotics, the ramifications of even a single dose of antibiotics, and how antibiotic superbugs are a real problem. Jared delves into why antibiotics are overused, side effects of particularly dangerous forms, and the effects on mental health and the immune system. This show will be followed with one on antibiotic alternatives and ways to rebuild your microbiome after antibiotic exposure.Additional Information:#264: Emotional Vitality: Jen's Story Part 1 - From Addiction and Mental Illness to Vitality#266: Prescribing Poisons Part 2. Ibuprofen, PPI's, and Flouroquinalone AntibioticsVisit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

飛碟聯播網《飛碟早餐 唐湘龍時間》2024.09.17 週二醫療保健單元 潘懷宗的醫學新知時間《12種不與咖啡一起服用的藥物》 大多數歐美中年人（台灣也不少）早上起床後的例行公事，就是： 如廁盥洗→喝咖啡→早餐→吞藥（白開水）→上班。只要其中同時出現「吞藥」和「喝咖啡」這兩個項目，不論其先後順序，都是本篇文章討論的範圍。所謂「一起服用」的意思是說，在藥物治療的作用期間內，不要喝咖啡，而不是僅僅不使用咖啡吞藥丸而已。 舉例來說，葡萄柚（汁）中含有「呋喃香豆素」（Furanocoumarin），會抑制小腸及肝臟中的代謝酵素（Cytochrome P-450 3A4），由於許多藥物皆需要該酵素進行代謝，若大量食入（淺嚐1~2瓣OK，果汁不行），就會造成藥物血中濃度飆高，進而增加藥物不良反應的發生機率，而且，「呋喃香豆素」抑制酵素的作用時間，可以長達數小時，甚至2~3天，所以在服用降壓藥、降血脂藥、抗心律不整藥或免疫抑制劑等藥物的整個作用期間內，都不應該吃葡萄柚（汁）。 近日，英國《每日郵報》記者（Emily Joshu）特別邀請藥劑師（Jennifer Bourgeois）詳列了12類藥物，不應該和咖啡一起服用，提醒歐美人注意。以下為醫學院藥理教授，認為相當有通識教育意義，特別加註簡化並修改些小錯誤後，供大家參考。 1. 抗憂鬱藥 根據美國CDC估計，12歲以上的美國人中有1/10以上服用抗憂鬱藥，約3,700萬人。而抗憂鬱藥有許多種類，目前最常開出的第一線藥物SSRI（選擇性血清素回收抑制劑），像是Zoloft（樂復得）、Lexapro（立普能） 和 Fluoxetine（禧濱）等的藥物，並不會和咖啡因有交互作用。只有老一代的抗憂鬱藥（目前很少使用，但並非完全不用），如三環類藥物和單胺類氧化酶抑制劑 （MAOIs），才需要小心，它們會阻止身體正常代謝咖啡因，可能導致血壓升高，造成不良反應。一般情況下，咖啡因會以尿液形式經由腎臟排出，然而，這些藥物會中斷這個過程，使咖啡因在體內停留更久，這就會導致持續的高心跳和高血壓，這類藥物是：Fluvoxamine（氟伏沙明）、Phenelzine（苯乙肼）、Tranycypromine （反苯環丙胺） 等等。 2. 不需醫生處方的綜合感冒藥和鼻塞藥 有將近3/4的美國成年人使用非處方感冒藥和過敏藥來緩解症狀。其中許多含有興奮劑--「偽麻黃鹼」（Pseudoephedrine），它可以讓血管收縮，減少鼻黏膜的腫脹和充血，緩解鼻塞。然而，偽麻黃鹼同樣會刺激大腦中負責「戰鬥或逃跑」的警覺性神經細胞，如果與咖啡一起服用，會加劇這項效果，讓你覺得緊張和焦慮。市面上許多綜合感冒藥（含治鼻塞）或是專門治療鼻塞（Sudafed/速達菲）的藥物裡面，都含有偽麻黃鹼，大家應該詳細檢視成分，在服藥治療期間內，避免喝咖啡。若真的忍不住，服藥前4小時或服藥後2小時，才喝咖啡。 3. 糖尿病藥物 約2000萬的美國人有糖尿病，服用「庫魯化」（Metformin）藥物，甚至有200萬病患（1/10）使用胰島素，這都是想要維持血糖在標準範圍內。雖然糖尿病藥物並不會與咖啡因產生直接的交互作用，可是，當你喝咖啡時，就會增高血糖值，讓你的藥物療效降低，不利於病情，尤其是如果裡面又含有奶油和糖的話。根據美國糖尿病協會的研究，飲用任何含咖啡因的飲料都會增加血糖值。因此，量測您的血糖值，以確定您是否可以在服藥時喝咖啡。 4. 抗生素 抗生素用於治療細菌感染，根據美國CDC估計，每年約有2.3億次的感染事件，相當多。有些抗生素會抑制咖啡因的代謝，導致血中咖啡因的濃度增加。例如： 速博新（Ciprofloxacin），通常用於治療泌尿道感染、膀胱感染、感染性腹瀉和鼻竇感染，若與咖啡一起服用，就可能會導致心跳加速和感到緊張（feeling jittery）。 5. 抗凝血劑 約800萬的美國人需使用抗凝血劑來預防血栓，根據克利夫蘭診所統計，華法林（Warfarin）是歷史最久，最常開出的抗凝血劑，約占美國全部抗凝血劑處方中的1/4（也就是200萬人）。若與咖啡一起服用，可能會導致出血過多的事件，因為咖啡因會抑制華法林的分解，使藥物在體內的濃度升高，就算只是被紙割到等的輕傷，都可能會導致過度出血。不過，新一代的抗凝血劑「艾必克」（Eliuis），已經不會和咖啡因引起這些交互作用了，請認明你所吃的是哪一種抗凝血劑。若真的非喝不可，吞藥後至少要等6~8個小時。 6. 降壓藥 美國藥學院協會估計，每年有1.17億張降壓藥的處方籤，開給2,600萬的美國人，包括： 紓壓寧、康肯、達利全（β-Blockers）等藥物。這些藥物希望能降低血壓並阻止腎上腺素的作用，以便改善血液流動，並降低心跳，讓心臟不必那麼辛苦地工作。但當你喝咖啡或任何含咖啡因的飲料時，它就會加快你的心跳並升高血壓，這雖然不是直接的藥物交互作用，但更像是在對抗降壓藥的療效，相當不明智，不合邏輯，因此不應該和咖啡一起服用。若真的非喝不可，服藥前4小時或服藥後2小時，方可淺嚐一杯。 7. 甲狀腺功能低下藥物 治療甲狀腺功能低下會使用「左旋甲狀腺素」（Levothyroxine），甲狀腺功能減退症是美國處方最多的藥物之一，每年總共有2300萬張處方簽。然而，這類藥物若與任何食物或咖啡一起服用，會降低藥物吸收率達50% 之多，因此，服用左旋甲狀腺素的人應該是在飯前，空腹用白開水服藥，等30~60分鐘後，才可以進食或喝含咖啡因的飲料。 8. 阿茲海默症藥物 目前每10個65歲以上的美國成年人中就有一個被診斷出患有阿茲海默症，這是最常見的失智症。治療這種疾病症狀的藥物稱為「膽鹼酯酶抑制劑」，像是「愛憶欣」（Donepezil）和「憶思能」（Rivastigmine），可以防止乙醯膽鹼的分解，乙醯膽鹼是一種有助於記憶形成和思考的神經化學物質。若與咖啡一起服用時，咖啡因會收緊血腦屏障，使得藥物更難進入大腦，產生療效。非喝不可時，應該選在吞藥前四小時或吞藥後兩小時。 9. 骨質疏鬆症藥物 骨質疏鬆症是骨骼隨著時間的推移而變得脆弱或易斷的疾病，據美國CDC估計，有1000萬50歲以上的美國人患有此病，嚴重時，即使連咳嗽等輕微的壓力也會導致肋骨骨折，醫學界目前使用雙磷酸鹽類藥物，例如： 「安妥良」（Risedronate）和「骨維壯」（Ibandronate），來抑制蝕骨細胞，減緩骨質破壞，若與咖啡一起服用時，會導致它們無法被身體正常吸收，從而降低療效，建議吞藥後等待大約兩個小時才能喝咖啡。此類藥每月口服一次，服藥當日早上起床後，第一餐前空腹，保持上半身直立姿勢以一整杯冷開水（約 200 cc）整粒吞下（勿嚼碎或吸吮），服藥後半小時內不得躺下，不要進食。 10. 氣喘藥物 在美國，近2500萬人患有氣喘，支氣管擴張劑是用來放鬆和擴張氣道的處方藥。然而，若將「胺非林錠」（Aminophylline）和「喘克」（Theophylline）等支氣管擴張劑與咖啡一起服用，就會加劇藥物副作用，像是： 煩躁和不安，特別是剛剛開始使用這類藥物的病患，因為每個病人的反應不盡相同。您可以自行小心觀察，建議在服用這些藥物之前或之後四個小時，才喝咖啡。 11. 過動症藥物 根據CDC的數據，接近但不到1/10的17歲以下美國孩童被診斷出患有過動症，約4,100萬張處方簽被開出。過動症藥物像是： 阿德拉爾（Adderall）和利他能（Ritalin）等，可以強化腦中多巴胺和正腎上腺素等的神經傳導訊號，以改善注意力、專注力和控制衝動。然而，若與咖啡一起服用，會降低療效，產生過動，原因是咖啡因屬於中樞興奮劑，會興奮神經細胞，應該避免。 12. 抗思覺失調症狀的藥物 根據克利夫蘭診所數據，大約有400萬美國人正在服用抗思覺失調症狀的藥物，例如： 「可致律」（Clozapine）、「理思必妥」（Risperidone）和「金菩薩」（Olanzapine）等，這些藥物通常用於治療《思覺失調症》和《雙相情感障礙症》等疾病所特有的思覺失調症狀，期望透過調節多巴胺和血清素等神經傳導物質來減輕思想上和視覺上的兩項幻覺，由於咖啡因會增加藥物血中含量，所以應該遠離咖啡才是。 原文網址：https://www.chinatimes.com/opinion/20240905002864-262110?chdtv ▶ 《飛碟早餐》FB粉絲團 https://www.facebook.com/ufobreakfast/ ▶ 飛碟聯播網FB粉絲團 https://www.facebook.com/ufonetwork921/ ▶ 網路線上收聽 http://www.uforadio.com.tw ▶ 飛碟APP，讓你收聽零距離 IOS：https://reurl.cc/3jYQMV Android：https://reurl.cc/5GpNbR ▶ 飛碟Podcast SoundOn : https://bit.ly/30Ia8Ti Apple Podcasts : https://apple.co/3jFpP6x Spotify : https://spoti.fi/2CPzneD Google 播客：https://bit.ly/3gCTb3G KKBOX：https://reurl.cc/MZR0K4 -- Hosting provided by SoundOn

On episode #62 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 8/15/24 – 8/28/24. Host: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Clinician Specialty and HIV PrEP Prescription Reversals and abandonments (JAMA Network: JAMA Internal Medicine) The association between adherence to antiretroviral therapy and viral suppression under dolutegravir-based regimens (JIAS Journal of the International AIDS Society) Dexamethasone in adults with viral meningitis (CMI Clinical Microbiology and Infection) Oropouche Virus Disease Among U.S. Travelers — United States, 2024 (MMWR) Oropouche fever, the mysterious threat (LANCET: Infectious Diseases) Bacterial High rates of Non-susceptibility to common oral antibiotics in Streptococcus pneumoniae clinical isolates (OFID) New York State Department of Health Directs Providers to Discontinue Use of Ciprofloxacin to Prevent Meningococcal Disease Due to Increasing Antimicrobial Resistance (NY State: Department of Health) Tularemia Associated with Harbor Seal Necropsy — Kitsap County, Washington, October 2023 (MMWR) FDA Marketing Authorization Enables Increased Access to First Step of Syphilis Diagnosis (FDA) Clinical impact of pleural fluid Streptococcus pneumoniae PCR testing in children with complicated pneumonia (CID) The Role of the Gut, Urine and Vaginal Microbiome on the Pathogenesis of Urinary Tract Infection (OFID) Fungal The Last of US Season 2 (YouTube) Two dose levels of once-weekly fosravuconazole versus daily itraconazole in combination with surgery in patients with eumycetoma in Sudan (LANCET Infectious disease) Parasitic Usefulness of real-time PCR for urogenital schistosomiasis in preschool children in Angola (PLoS Neglected Tropical Diseases) Helminth infection driven gastrointestinal hypermotility alterations in smooth muscle instead of enteric neurons (PLoS Pathogens) Die-off reaction of Demodex mites after treating demodicosis with oral ivermectin (JAAD case reports) Miscellaneous Prevalence of carbapenem-resistant gram negative bacteria among neonates suspected for sepsis in Africa (BMC Infectious Diseases) New era of targeted clinical guidelines: IDSA (CID) Defining the landscape of educational experiences in transplant infectious diseases (OFID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

Join hosts Brooke and Elena as they discuss the little known (but extremely dangerous) side effects of ‘Cipro’, the drug very commonly prescribed to SCI patients for urinary tract infections. They expose Cipro’s black box FDA warning, and outline examples of how it could contribute to weight gain, mental health issues, skin/tissue degradation, negative cardiovascular […] Continue Reading The post WAGS of SCI: The Podcast – Ep. 147 – Ciprofloxacin: The Dangers You Probably Didn't Know About This Antibiotic first appeared on WAGS of SCI.

Gemeinsam mit der klinischen Pharmazeutin und gleichzeitig meiner Mutter Mag. Martina Anditsch spreche ich über Antibiotika gegen Harnwegsinfekte in Kombination mit anderen Medikamenten, über Wechselwirkungen und über die Reserveantibiotika Fluorchinolone (Ciprofloxacin, Levofloxacin, Ofloxacin,...) Mag. Martina Anditsch ist seit über 25 Jahren klinische Pharmazeutin und leitet seit 9 Jahren die Krankenhausapotheke des Universitätsklinikum AKH Wien. In dieser Zeit wurde im AKH die klinische Pharmazie an vielen Abteilungen erfolgreich etabliert. Eine Arzneimittelinteraktionsambulanz zur Überprüfung von Medikamentencocktails auch für Patienten aus dem niedergelassene Bereich eröffnet.

Metformin is a medication used in the management of diabetes. It can cause significant diarrhea, B12 deficiency, and in rare cases, lactic acidosis. Atorvastatin (Lipitor) is a statin medication used for cholesterol management. It lowers LDL and is associated with myopathy. Omeprazole is a PPI used for GERD and has drug interactions with citalopram and clopidogrel. Ciprofloxacin is a quinolone antibiotic used to treat gram-negative infections and UTIs. It carries numerous risks such as tendon rupture. Ondansetron is an antiemetic medication used in the management of nausea and vomiting. I discuss the prescribing cascade in relation to this medication.

Dr. Neil Paulvin can help you look and feel your best with peptides, nootropics, supplements, and biohacks such as red light therapy, methylene blue, and more. If you're looking to improve cognitive function as well as your skin, this episode is for you! This episode is brought to you by JOYLUX. Use code ASHLEY10 to save 10% 7:13: Peptides to make your hair grow 7:48: The 'Botox'-like peptide (most popular: BPC-157) 10:19: Psoriasis and eczema peptides 11:17: Peptides to heal the gut 12:43: Butyrate is superstar supplement (may help with weight loss) 13:35: Mast cell activation syndrome 14:50: Peptides for healing and recovery 17:49: HgH 21:50: Peptides to improve cognitive function 21:59: Cerebrolysin (best brain peptide) 22:37: Dihexa (brain peptide) 23:11: Prodome 24:29: Possible Neuropathy treatments: ARA290 peptide 25:57: MOTS-C helps boost energy, build bone, improve mitochondria function 30:00: Dr. Paulvin is one of the only doctor's treating relief from fluoroquinolone side effect reactions (Ciprofloxacin, Delafloxacin, Factive, Floxin, Gemifloxacin, Levaquin) 33:23: He used to get bad headaches, then treated himself with great success and his headaches stopped 40:16: The Vie Light (Code: DEELEY10) 40:30: Neuronic Red Light Therapy Helmet 40:52: Light Path LED 40:54: GembaRed 40:56: EMR-Tek Red Light Therapy (my favorite red light therapy device! Code: ASHLEY15) 43:23: Top recommended nootropics, including Centrifenoxine/Lucidril 43:34: Methylene blue (my fave brand, called Oxidal) (my other fave brand called TroScriptions) 46:01: Vagal neural stimulator Where to find Dr Paulvin: Website

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Ciprofloxacin Trade Name Cipro Indication Urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections Action Inhibits bacterial DNA synthesis Therapeutic Class Anti-infectives Pharmacologic Class Fluoroquinolone Nursing Considerations • Contraindicated in allergies • May cause QT prolongation, avoid use with other drugs that can cause QT prolongation • Can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson syndrome • May decrease effects of phenytoin • Monitor renal panel • Assess for infection, obtain cultures prior to therapy • Monitor liver function tests

Individualising drug dosing using model-informed precision dosing (MIPD) of beta-lactam antibiotics and ciprofloxacin has been proposed as an alternative to standard dosing to optimise antibiotic efficacy in critically ill patients. However, randomised clinical trials (RCT) on clinical outcomes have been lacking.In this podcast, Drs Ewoldt and Abdulla relate how they conducted a multicentre RCT in 8 Dutch hospitals. It included patients admitted to the intensive care unit (ICU) treated with antibiotics and randomised to MIPD with dose and interval adjustments based on monitoring serum drug levels (therapeutic drug monitoring) combined with pharmacometrics modelling of beta-lactam antibiotics and ciprofloxacin. Original paper: Model‑informed precision dosing of beta‑lactam antibiotics and ciprofloxacin in critically ill patients: a multicentre randomised clinical trialSpeakersTim M. J. EWOLDT. Department Hospital Pharmacy, Erasmus University Medical Center, Rotterdam (NL).Alan ABDULLA. Department Hospital Pharmacy, Erasmus University Medical Center, Rotterdam (NL).Ana-Maria IOAN. Intensive Care Medicine Unit, Fundación "Jiménez Díaz" University Hospital, Madrid (ES). NEXT Committe member, ESICM.

Utafiti mpya wa kisayansi uliofanyika kwa muda wa miaka sita umebaini kuna viwango vya juu vya usugu wa dawa dhidi ya vimelea au bakteria vinavyosababisha maambukizi kwenye mfumo wa damu yanayoweza kuhatarisha halikadhalika ongezeko la usugu wa tiba dhidi ya vimelea vinavyosababisha magonjwa yaliyozoeleka kwenye jamii. Shirika la Umoja wa Mataifa la Afya ulimwenguni WHO limesema hayo katika taarifa iliyotolewa leo jijini Geneva Uswisi.Ikipatiwa jina GLASS kifupi cha Global Antimicrobial Resistance and Use Surveillance System au Mfumo wa kimataifa wa ufuatiliaij wa matumizi na usugu wa viua vijiumbemaradhi, ripoi inatoa uchambuzi wa usugu wa viua vijiumbe maradhi au AMR tangu mwaka 2017 na takwimu za matumizi ya viua vijiumbe maradhi kwa binadamu katika nchi 27. Mkurugenzi Mkuu wa WHO Dkt. Tedros Adhanom Ghebreyesus amenukuliwa kwenye taarifa hiyo akisema ripoti hiyo iliyomulika nchi 127 zenye jumla ya asilimia 72 ya watu duniani imebaini kuna viwango vya juu zaidi ya asilimia 50 vya usugu wa dawa kwenye magonjwa ya maambukizi ya mifumo ya damu. Dkt. Tedros amebainisha kuwa baadhi ya bakteria wanaoonesha usugu husababisha mtu kupata magonjwa ya mfumo wa damu mara kwa mara na mengine kuongeza hatari ya kifo kutokana na kwamba yanashindwa kudhibitiwa. Akitoa ufafanuzi zaidi ametaja magonjwa ya zinaa kama vile kisonono kwa lugha ya kiingereza gonorrhoea umeonesha ukinzani kwa dawa ya kumeza ya Ciprofloxacin kwa asilimia 60.  Nayo magonjwa ya kuambukiza kwa njia ya kawaida ya mkojo yakionesha usugu kwenye dawa za Ampicillin na co-trimoxazole. Amesema “Usugu wa dawa dhidi ya viua vijiumbe maradhi unadhoofisha dawa za kisasa na kuweka mamilioni ya Maisha ya watu hatarini. Na ili kuelewa vyema ukubwa wa tishio hili kwa afya ya umma ulimwenguni na ili tupate majibu mazuri ya kukabiliana na usugu huu wa madawa ni lazima tuongeze huduma za upimaji na kutoa takwimu za maabara kwa nchi zote, si nchi tajiri pekee.” Mkuu huyo wa WHO ameyasema hayo kwa kuwa utafiti huo umeonesha nchi zenye kiwango kidogo cha kupima magonjwa hayo ni zile za kipato cha chini na cha kati ambazo pia ndio zimeonesha kuwa na idadi kubwa wa usugu wa madawa dhidi ya viuavijiumbe maradhi kwani hospitali nyingi katika nchi hizo mara nyingi zinatoa huduma kwa wagonjwa ambao tayari wanaweza kuwa wameshakunywa dawa za viuavijasumu au antibiotics. Hata hivyo WHO imekiri kuwa ni vigumu kutafsiri viwango vya usugu wa madawa kwa sababu ya uhaba wa huduma za upimaji na uwezo dhaifu wa maabara, hasa katika nchi za kipato cha chini na cha kati. Ili kuondokana na pengo hilo wameahidi kuendelea kufanya utafiti na kujengea uwezo nchi kufanya utafiti na kutoa takwimu bora zitakazo wezesha utungaji wa sera za kuongeza maabara katika ngazi zote za mfumo wa afya. Kusoma zaidi kuhusu ripoti hiyo soma hapa.

Mateo Rojas lives at the intersection of developmental disability with autism and physical disability as a person who uses a wheelchair and has vision loss. He was raised in Southern Massachusetts and is adopted, his biological family is Paraguayan. As a child, he hoped to travel to his birth country and to explore and learn more about South American and Central American cultures. When he had the opportunity to travel to Paraguay after graduating college, he contracted an illness from drinking the water. Upon return to the US, Mateo was prescribed Ciprofloxacin which had devastating side effects resulting in long-term disability.  From his lifelong experience with disability in multiple forms, Mateo eloquently shares reflections on his own experience and what it means to be disabled in our society.Guest info:Instagram: @cookiemonster31195Additional Resources:Mateo's Story: Disabled from Cipro Toxicity-FLOXED StoryContact us: Instagram: @unexpectedjourneypodcastEmail: tim@unexpectedjourneypod.com Hosted and produced by Tim BrownAudio engineer and sound design by Jesse LaFountaineEditing: Riss BickfordAudio editing: Jason DeWald Episode cover art by David McCaulley Cover art and logo design by Anne Holt

Celecoxib is a non-steroidal anti-inflammatory drug, or NSAID. Ciprofloxacin is an antibiotic that is used to treat a number of bacterial infections. The former has been trialed unsuccessfully in ALS. However, according to preclinical evidence and a phase 1 trial conducted by Neurosense, a biotech company based in Israel and Cambridge, MA, these two FDA-approved drugs may hold some promise for people with ALS when combined into one treatment. Neurosense's formulation of these two drugs is known as Prime C. The first participants were recently enrolled in a Phase 2b trial of the treatment, and it is also currently undergoing a pharmacokinetic trial in healthy volunteers. Recently, several members of Neurosense's team joined Endpoints to help us learn more about the company's mission, the science behind prime C, and what's next for the potential ALS Treatment. Episode Guide: 1:22 – NeuroSense's Company Story 5:58 – The Science Behind Prime C 15:13 –Details about Prime C in Clinical Trials Support the show: https://www.als.net/donate/ See omnystudio.com/listener for privacy information.

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/CiprofloxacinCiproNursingConsiderations    Generic Name Ciprofloxacin Trade Name Cipro Indication Urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections Action Inhibits bacterial DNA synthesis Therapeutic Class Anti-infectives Pharmacologic Class Fluoroquinolone Nursing Considerations • Contraindicated in allergies • May cause QT prolongation, avoid use with other drugs that can cause QT prolongation • Can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson syndrome • May decrease effects of phenytoin • Monitor renal panel • Assess for infection, obtain cultures prior to therapy • Monitor liver function tests

Fluorchinolone sind spezielle Antibiotika die eigentlich nur im absoluten Notfall eingesetzt werden dürfen. Der Grund dafür ist, dass sie fatale Nebenwirkungen für den Menschen haben können. Das bekannteste unter ihnen nennt sich Ciprofloxacin. Wenn es um die Nebenwirkung geht spricht man davon, gefloxt worden zu sein. Da diese Antibiotika weitläufig verschrieben werden und massiv viele Menschen weltweit unter den Folgen zu leiden haben, lohnt es sich in jedem Falle sich hier ausführlich zu informieren. Was sind Fluorchinolone? Was ist der Unterschied zu anderen Antibiotika? Welche Wirkung haben sie, warum werden sie eingesetzt? Topoisomerase 2 Hemmer, Gyrase  Hat der Mensch keine Topoisomerase 2 Wie groß ist die Selektivität? Welche Nebenwirkungen haben sie? Wie ist die Reaktion der Ärzte auf Folgeschäden? Werden die Patienten ernst genommen? Welche sozialen Folgen entstehen daraus? Wird das irgendwie von den Behörden anerkannt und unterstützt? Wie werden die FCs international gesehen? Wieso werden sie noch verschrieben? Wie häufig werden sie verordnet? Was können Betroffene tun?   Hole dir meine fantastische Mischung aus 15 heimischen Wildkräutern in feinster Rohkostqualität. Einfacher und leckerer kann man Wildkräuter nicht genießen.Mit dem Gutscheincode “bio360” bekommst du einen Rabatt auf deine erste Bestellung.   >>Hier geht's zu den Shownotes

Fluorchinolone sind spezielle Antibiotika die eigentlich nur im absoluten Notfall eingesetzt werden dürfen. Der Grund dafür ist, dass sie fatale Nebenwirkungen für den Menschen haben können. Das bekannteste unter ihnen nennt sich Ciprofloxacin. Wenn es um die Nebenwirkung geht spricht man davon, gefloxt worden zu sein. Da diese Antibiotika weitläufig verschrieben werden und massiv viele Menschen weltweit unter den Folgen zu leiden haben, lohnt es sich in jedem Falle sich hier ausführlich zu informieren.   Was sind Fluorchinolone? Was ist der Unterschied zu anderen Antibiotika? Welche Wirkung haben sie, warum werden sie eingesetzt? Topoisomerase 2 Hemmer, Gyrase  Hat der Mensch keine Topoisomerase 2 Wie groß ist die Selektivität? Welche Nebenwirkungen haben sie? Wie ist die Reaktion der Ärzte auf Folgeschäden? Werden die Patienten ernst genommen? Welche sozialen Folgen entstehen daraus? Wird das irgendwie von den Behörden anerkannt und unterstützt? Wie werden die FCs international gesehen? Wieso werden sie noch verschrieben? Wie häufig werden sie verordnet? Was können Betroffene tun?   Hol’ dir deine Energie zurück mit meinem Buch Zurück ins Leben und den vielen praktischen Übungen darin, die mich enorm weitergebracht haben. Jetzt anschauen!   >>Hier geht's zu den Shownotes

Fluorchinolone sind spezielle Antibiotika die eigentlich nur im absoluten Notfall eingesetzt werden dürfen. Der Grund dafür ist, dass sie fatale Nebenwirkungen für den Menschen haben können. Das bekannteste unter ihnen nennt sich Ciprofloxacin. Wenn es um die Nebenwirkung geht spricht man davon, gefloxt worden zu sein. Da diese Antibiotika weitläufig verschrieben werden und massiv viele Menschen weltweit unter den Folgen zu leiden haben, lohnt es sich in jedem Falle sich hier ausführlich zu informieren.   Was sind Fluorchinolone? Was ist der Unterschied zu anderen Antibiotika? Welche Wirkung haben sie, warum werden sie eingesetzt? Topoisomerase 2 Hemmer, Gyrase  Hat der Mensch keine Topoisomerase 2 Wie groß ist die Selektivität? Welche Nebenwirkungen haben sie? Wie ist die Reaktion der Ärzte auf Folgeschäden? Werden die Patienten ernst genommen? Welche sozialen Folgen entstehen daraus? Wird das irgendwie von den Behörden anerkannt und unterstützt? Wie werden die FCs international gesehen? Wieso werden sie noch verschrieben? Wie häufig werden sie verordnet? Was können Betroffene tun?   Warum die meisten Menschen bei ihrer Entgiftung scheitern und wie du alles richtig machen kannst erfährst du in dieser kostenlosen Videoserie, die ich für dich aufgenommen habe. >> Jetzt gleich anschauen Hier geht's zu den Shownotes

Fluorchinolone sind spezielle Antibiotika die eigentlich nur im absoluten Notfall eingesetzt werden dürfen. Der Grund dafür ist, dass sie fatale Nebenwirkungen für den Menschen haben können. Das bekannteste unter ihnen nennt sich Ciprofloxacin. Wenn es um die Nebenwirkung geht spricht man davon, gefloxt worden zu sein. Da diese Antibiotika weitläufig verschrieben werden und massiv viele Menschen weltweit unter den Folgen zu leiden haben, lohnt es sich in jedem Falle sich hier ausführlich zu informieren.   Was sind Fluorchinolone? Was ist der Unterschied zu anderen Antibiotika? Welche Wirkung haben sie, warum werden sie eingesetzt? Topoisomerase 2 Hemmer, Gyrase  Hat der Mensch keine Topoisomerase 2 Wie groß ist die Selektivität? Welche Nebenwirkungen haben sie? Wie ist die Reaktion der Ärzte auf Folgeschäden? Werden die Patienten ernst genommen? Welche sozialen Folgen entstehen daraus? Wird das irgendwie von den Behörden anerkannt und unterstützt? Wie werden die FCs international gesehen? Wieso werden sie noch verschrieben? Wie häufig werden sie verordnet? Was können Betroffene tun?   360 Energy ist die wohl innovativste Mitochondrienformel die es derzeit gibt.>> Hol dir jetzt die pure Energie! Hier geht's zu den Shownotes

The PJ Med Director and the PJ Medical Programs Manager discuss Ten key changes to the new handbook. The handbook is being formatted and then out for print with the Journal of Special Operations Medicine. DO NOT INSTITUTE THESE UNTIL THE HANDBOOK IS RELEASED OR YOUR FLIGHT DOC DIRECTS YOU TO. Updated MARCH assessment to align w/ JTS TCCC guidelines Moved pelvic binder to circulation, specified how/how not to assess pelvis Combat/Hemorrhagic Shock and blood protocol TXA – 2gm (1 minute slow IV push)-also used for suspected TBI cold stored type 'O' whole blood>fresh low titer-'O' whole blood >PRBCs and plasma>plasma alone>PRBCs alone>non-titered type ‘O’ fresh whole blood>non-titered type specific fresh whole blood added 10mL of 10% calcium gluconate “bougie assisted cric” method Added vent troubleshooting and adjustment guide General fluid guidance Omitted Hextend LR is primary crystalloid for non-hemorrhagic shock casualties (may still carry 100CC for med recon) Removing 3% Saline (see TBI protocol update) TBI Replaced 3% Saline with 30mL of 23.4% hypertonic saline (learn the technique first) Versed for active seizures, Keppra for prophylactic (depressed skull fx/penetrating head wounds) Procedural Sedation Replaced procedural analgesia w/ procedural sedation and provided protocol No longer promoting ketamine/fentanyl/versed rotation Dilauded f/ long term pain control in hemodynamically stable Ketamine for unstable Medications added to formulary to support ATP small unit care capability/modified TMEPS Famotidine (Pepcid) – Zantac replacement Amoxicillin Azithromycin 1% Hydrocortisone cream Metronidazole (Flagyl) Malarone/primaquine Ciprofloxacin 4% saline Medications removed Albumin Ranitidine (Zantac) CBRNE updates Added CRESS acronym (Consciousness, Respirations, Eyes, Secretions, Skin)-NATO method Added MARCH Squared Updated Cyanide Antidote Hydroxycobalimin, Sodium thiosulfate and activated charcoal Doc Dorsch then gives us an ATP update amongst other intel. THAT OTHERS MAY LIVE  

Tizanidine is primarily broken down by CYP1A2. Ciprofloxacin can inhibit CYP1A2 and cause higher tizanidine concentrations. Tizanidine has a similar classification as clonidine. Pay attention to adverse effects like hypotension and bradycardia. When patients taking routine tizanidine stop taking it, there is potential for a discontinuation syndrome that may lead to rebound hypertension. Dry mouth and CNS depression are common adverse effects of tizanidine.

Contributor: Don Stader, MD Educational Pearls: Yersinia Pestis is the bacteria that caused the black plague. It was first discovered to be the cause of the bubonic plague in 1800s in China during the 3rd bubonic plague where 10-20 million people died Causes 3 types of plague: Bubonic plague: characterized by severe swelling of lymph nodes called buboes, most commonly in the groin, also axillary and olecranon lymph nodes. Septicemic plague: characterized by severe sepsis, no lymphadenopathy. This strain famously causes disseminated intravascular coagulopathy (DIC) and can lead to limb necrosis and fingers turning black. Hence the name the Black Death. Pneumonic: most dangerous of the plagues and characterized by PNA on CXR with pronounced mediastinal lymphadenopathy  Fleas are the largest reservoir, although prairie dogs and squirrels have been known to carry the bacteria as well. Yersinia Pestis creates a microfilm inside the stomach of fleas and renders them incapable of digesting your blood when they try to eat it and they vomit the bacteria into your blood. Doxycycline and Ciprofloxacin are the mainstay of treatment. References Achtman M, Zurth K, Morelli G, Torrea G, Guiyoule A. Carniel E. Yersinia pestis, the cause of plague, is a recently emerged clone of Yersinia pseudotuberculosis. Proc Natl Acad Sci U S A. 1999. doi:10.1073/pnas.96.24.14043 Galimand M, Carniel E, Courvalin P. Resistance of Yersinia pestis to Antimicrobial Agents. Antimicrob Agents Chemother. 2006;50(10):3233 LP - 3236. doi:10.1128/AAC.00306-06 Sexton D, Stout J. Clinical Manifestations, Diagnosis, And Treatment Of Plague (Yersinia Pestis Infection). Waltham, MA: UpToDate; 2020.   Summarized by Mason Tuttle & Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD  

About John Cascone: Dr. Cascone, is a Board Certified Internal Medicine and Infectious Disease Physician. His internal medicine residency was done at the University of Kansas and infectious disease follow up at the University of Missouri, Columbia. He is the Medical Director of nursing homes in southwest Missouri. His medical practice includes the care of residents in long term care facilities, infectious disease consultations and telemedicine and infectious disease services to rural facilities. He has a special interest in the diagnosis and treatment of sepsis, C diff, colitis, staphylococcus aureus, antimicrobial stewardship, and pressure ulcers. He lives in Joplin, Missouri with his family. In this episode, Steve and John discuss:1. What is C. diff?C. diff refers to the organism that formerly was identified as Clostridium difficile, but has now been changed to Clostridioides difficile. So the organism and as we'll refer to it as C. diff, is essentially an organism that resides in our bowel and it is a spore forming organism, meaning within the gut exists as a bacteria that produces toxin that leads to the diarrhea that we'll talk about in a bit. Outside of the gut, it converts to a spore. That spore is very hardy, difficult to kill and difficult to get rid of, which leads to the significant risk of transmission that occurs.2. What is a spore? A spore is essentially a non replicating form of an organism, meaning it is a hibernation type of the existence. So, the organism is no longer replicating in the way antibiotics work in killing bacteria. Typically bacteria has to be dividing and increasing in number. So a spore is a vegetative state that is highly resistant and impermeable to antibiotics.3. Is it dangerous?It is dangerous and very contagious.4. What is a bacterial infection as opposed to a viral infection or another type of infection?An infection refers to the invasion of an organism in a normally sterile site that leads to inflammation and disease. In this case, we're talking about the bowel. So it doesn't necessarily have to be a sterile site, but it has an organism that has led to some degree of inflammation and subsequent infection, whether it be a bacterial etiology or a viral etiology. The end result is inflammation of tissues, disruption of tissues and symptoms.5. Is the affected organism the colon?No, the effective organ is the colon. I said originally a sterile site. That is not a sterile site, the colon, but the organism leads to inflammation within that site.6. So the spore or the seed is what causes the inflammation in the colon?The way that works is C. diff is outside of the bowel. It is a replicating organism, it's a bacteria. In the way C. diff causes colitis with diarrhea, it's not the bug itself it is the toxin that is produced from the C. difficile. It produces two toxins toxin A, toxin B and in certain cases can produce a third toxin called a binary toxin. Those toxins are poisonous to the lining of the gut  and they cause the gut to get inflamed, to leak water and leads to diarrhea and all types of other manifestations of the illness.7. Is diarrhea the main symptom of C. diff?Yes, so they have C. diff colitis and C. diff infection colitis. There has to be an infection of the colon to have had diarrhea. If there's no diarrhea, then you do not have C. diff infection. You may still have C. diff in the bowel and up to 20% of people who are hospitalized, in 50% of people who reside in long term care facilities if you check their stool, will have C. diff present. But unless the patient has diarrhea, there's no evidence of an infection. So you have to have the diarrhea to have the infection. A good rule of thumb for diarrhea is that the stool can no longer hold up a popsicle stick. So if it can't hold up the stick, then that is considered diarrhea by definition.8. If there's no diarrhea, but there is C. diff in the bowel then it's kind of laying dormant or it's there and can lead to infection?It's there, it can lead to transmission, but if there's no indication you don't treat that. You shouldn't be testing stool for C. diff in the first place. You should only perform C. diff studies or C. diff laboratory studies on stool in the presence of diarrhea.9. In your opinion what exactly is the cause of C. diff?The primary cause of C. diff is the use of antibiotics and antibiotics used to treat other infections in any antibiotic administration, even one dose can cause C. diff. That's an unfortunate event, but that’s when used inappropriately. If antibiotics are used to treat a urinary tract infection, and are used inappropriately, then it increases the risk of C. diff. That's what has caused this rise of C. difficile colitis or C. difficile infections in this country over the last 10 to 15 years. The appropriate use of antibiotics requires that a BB gun be used as opposed to a shotgun. So, the most specific antibiotic to kill that infection, say a urinary tract infection to treat that for an appropriate duration. For instance, a urinary tract infection should be treated for three days. So, if antibiotics are used, or they are too broad a spectrum and are used for a long period of time, longer than what is indicated, it increases one's risk of getting C. diff colitis.10. Isn't there a recognized protocol for how many days somebody should be taking antibiotics for urinary tract infection? Why would they be treated for more than the recommended protocol?There are recommended protocols. The whole shift of infectious disease has been less antibiotic or more specific antibiotic for a shorter duration, we're finding that, for instance, pneumonia, five days of treatment is adequate, no longer 10 to 14 days. There are medical guidelines, the Infectious Disease Society of America guidelines tell us how to treat infections, what antibiotics to use and for the duration. There's no indication and there's no reason to use anything longer than three to five days at the upper end of it for a simple urinary tract infection.11. The aging well article that I referred to earlier also mentions a weakened immune system, long institutional stays and GI surgery as other causes of C. diff. So if you don't have diarrhea, but you had a bad result from GI surgery, you stay in a nursing home and have been there a long time and your immune system is weakened, is that something that without diarrhea would not make the doctors even consider that it’s C. diff?No they wouldn't treat you for C. diff without diarrhea. They shouldn't really even be finding C. diff because there's no reason to do stool studies. Certainly, C. diff colitis is diarrhea but certainly those risk factors that you've mentioned, can lead to C. diff colitis. Not only the advanced age, but in antibiotic use, hospitalization, chemotherapy, inflammation and inflammatory bowel disease are all risk factors.12. Most people in those situations are on antibiotics so all of it together creates the perfect storm, Correct?Correct. That's why you want to be vigilant in using antibiotics judiciously, not over prescribing them and keeping patients out of harm's way when they don't need to be there.13. How dangerous is C. diff? What can be expected in a mild case of C. diff, as opposed to a severe case of C. diff?The mortality of C. diff has a lot to do with the underlying condition of the patient. As we get older, we typically have more comorbid illnesses and we're on other medications. We have other disease processes that are being treated, and then increases our risk for a bad outcome. C. diff can have a mortality of upwards 16 to 20% and, of course, if you're sick with other illnesses, that mortality can go up even higher. The way C. diff presents as we talked about, it's diarrhea but could also be worsening symptoms other than diarrhea, and that is abdominal distension, fever, nausea, vomiting, abdominal pain, or cramping. If C. diff colitis gets bad enough, it can actually shut the entire gut down, and patients no longer have bowel movements. So it can lead to constipation on the far end of the spectrum.14. What can happen if not adequately dealt with what can be the consequences from that point on?First and foremost, patients can become dehydrated from the diarrhea. In volume, salt water that's passed to the stool. So dehydration, sepsis can certainly occur as a result of the inflammation in the colon, then multi organ failure and as mentioned in 15 to 20% of patients death.15. Are seniors and the elderly the highest at risk part of the American population or world population? Why? They probably are the population that is at highest risk for acquiring C. diff, and they are the population that is at highest risk for bad outcome. That is because the older we get, we typically have multiple other medical problems. That impairs our ability to fight infection, we're typically on more medications that impair our ability to fight infection and our overall ability to overcome is reduced as we get older, we become more vulnerable. The health care provider needs to make sure that patients are appropriately diagnosed and treated and not over prescribed antibiotics to reduce the incidence of C. diff in our elderly patients.16. What is it about senior care facilities or nursing homes that increase the risk of C. diff?In senior care facilities, one increases the risk of contracting C. diff. Those facilities are where antibiotics are prescribed to other patients in the facility. So if there's antibiotics prescribed in the facility where you live it impacts the risk of other patients getting C. diff, and then you contract it from somebody else. That's the primary cause, just being close to others who are getting antibiotics and potentially could get C. diff and pass it to you.17. Do you see C. diff in little kids or schools or only in the senior and elderly population because of the weakened immune system and all the aging? It's the weakened immune system in the population more at risk for getting C. diff and for having a bad outcome. Interesting about kids. The reason you don't see C. diff in infants and nurseries, is because they don't have the receptors for the toxin to bind to and cause inflammation. So they still have C. d-ff in fact, some people think they're reservoirs of C. diff, but they don't get C. diff colitis because the toxin is ineffective in them.18. They're probably not being over prescribed antibiotics like our senior and elderly population are?Exactly.  If you look at a gut it is populated with millions and billions of organisms. Bacterias that, for the most part, help us have a nice healthy bowel and the bacteria also keep the bad bacteria at bay. C. diff still is one of those bad bacteria. When somebody is prescribed antibiotics for a urinary tract infection or pneumonia, that antibiotic not only kills the bacteria causing the urinary tract infection, pneumonia, but it also kills all the good bacteria in the gut. When the good bacteria are killed the bad bacteria, like C. diff, are allowed to start repopulating and then cause colitis and diarrhea.19. Would you advise our listeners to begin taking probiotics as a way to increase the good bacteria in the gut?The jury really is out on probiotics. I don't think there's anything wrong with doing it. I'm just not sure it's going to provide you with any benefit. Certainly, keeping the gut populated with good bacteria will be a benefit. The primary thing our elderly patient should do is when their doctor prescribes them an antibiotic, they should inquire and make sure that the physician is giving them the right antibiotic for the right duration. Shorter is better than longer when it comes to duration.20. When our listeners are getting the information about what antibiotic they were recommended or prescribed and how long it was prescribed for, how do they know whether it's over prescription or not?Starting the dialogue with your provider should force him to think about his decision and the antibiotic that he's using and for what duration. Some antibiotics that are really notorious are Levofloxacin, Levaquin, or Ciprofloxacin and these high powered antibiotics, really do a number if you will, on the gut and on the normal flora, the good bacteria in the gut, and cause  severe bouts of C. diff colitis. It's important to always be inquisitive, to always ask your providers and take nothing for granted when they prescribe antibiotics. I think they're probably the most overused, inappropriately used of all the drug classes out there.21. What are nursing homes and senior care facilities doing to address the problem of overuse of antibiotics?There's been a real push and rightly so, toward antimicrobial stewardship in long term care facilities and hospitals. Microbial stewardship essentially is somebody such as an infectious disease physician, overseeing the use of antibiotics in a facility and making sure the antibiotics are used for an appropriate diagnosis and that the antibiotic prescribed is a narrow spectrum as opposed to a broad spectrum antibiotic and it is prescribed for the appropriate duration. That push with regards to the use of antibiotics appropriately, really has done wonders to reduce the incidence of C. diff. The other things nursing homes do and should do is good hand hygiene. Because the alcohol based solution that you rub on your hands does not kill C. diff. You need to wash your hands with soap and water for two minutes and in fact, the soap and water does not kill the C. diff. What it does is some mechanical action that gets the spores off of the hands in patients who have it. If you're in a long term care facility, and your roommate has C. diff, you should be isolated from your roommate because there's a risk of them giving it to you.22. Wouldn't disinfection of hospital rooms on a consistent basis, and healthcare providers wearing gowns and gloves also be part of the protocol?Important preventive measures that are used in contact isolation when a patient has C. diff requires a gown, gloves, a throw away stethoscope so that the spores don't get on your stethoscope and you pass to another patient. In addition room disinfecting is an important measure. The spores as I mentioned are very hardy and even the best disinfection of a room is not always adequate. In fact, studies have shown that if a patient in the room before you had C. diff, you are more likely to acquire C. diff during your stay in that room.23. If somebody is demonstrating symptoms of C. diff, is there a standard test that they should be given or what is the test that is being utilized by the medical community to see if they have C diff? How reliable is it?We use a standard test that's called a PCR or a NAAT test, that looks for the toxin in the gut. It's very reliable and if it's present, you have it. If it's not present, you don't have it.24. Do they just take a stool sample and put it under the microscope?They take a stool sample that has to be a diarrheal stool sample. It has to be diarrhea, and then they run a chemical test on it, which looks for the production of toxin in the diarrheal stool.25. What would be the gold star treatment for somebody with C. diff?Antibiotics, and the antibiotics we use our oral antibiotics, vancomycin, or fidaxomicin is the first choice. It is orally given by mouth and what it does is it stays within the gut and it does not get absorbed into the systemic system. It stays within the gut and it is specific for killing the C. difficile bacteria within the bowel. That treatment is 10 to 14 days. Sometimes you can be prescribed vancomycin for a longer period of time, if you're on other antibiotics to treat another infection, sometimes they have to overlap. But typically it's 10 to 14 days.26. Are fecal transplants one of the additional types of treatments for individuals who have severe C. diff, and the antibiotics aren't working?Yes, fecal transplants are actually a very effective treatment for C. diff colitis. Fecal transplants provide stool from a donor and that stool is populated with all the good bacteria that normally resides in our bile. That sample is then put into the gut of the patient who has C. diff colitis and when you do that, you repopulate all the normal bacteria. The way vancomycin works is to kill the C. difficile. The way a fecal transplant works is to repopulate the good bacteria to suppress the production of the bad bacteria, which in this case is C. diff.27. Fecal transplants sound a little radical, but how effective are they?It's very effective and oftentimes can be life saving.28. What is the risk level for the general American population to develop C. diff?1% of patients that are hospitalized, will get C. diff colitis. It's important to note that there is such a thing as community, associated C. diff colitis. These are patients who have not been hospitalized have not been on antibiotics and develop C. diff colitis. What I don't want our listeners to think is just because I haven't been in the hospital, just because I haven't gotten any recent antibiotics. There's no way I can have C. diff. It’s uncommon, but it's still possible and your doctor should check you for it.29. What would you say to our listeners if they are in a nursing home, or they have a loved one in a nursing home, or a senior care facility and they're starting to show symptoms of C. diff? What action steps would need to be taken?If an elderly patient is in a nursing home and begins to develop diarrhea, abdominal pain, fevers, nausea, vomiting, whether they've recently gotten antibiotics or not, they should notify the provider, the nurse in charge immediately and then the patient should be checked with not only a stool sample to make sure C. diff isn't present, but also with laboratory to make sure that kidneys are not getting affected from the diarrhea in terms of dehydration, and check the white blood cell count to make sure it's not elevated due to the severe colitis. It's not something they should wait on, they should notify the providers immediately."Practice good hand hygiene because the alcohol based solution that you rub on your hands does not kill C. diff. You need to wash your hands with soap and water for two minutes and in fact, the soap and water does not kill the C. diff it’s the mechanical action that gets the spores off of the hands. " —  John CasconeTo find out more about the National Injured Senior Law Center or to set up a free consultation go to https://www.injuredseniorhotline.com/ or call 855-622-6530 Related Links:https://www.todaysgeriatricmedicine.com/archive/012312p18.shtmlConnect with John Cascone: Email: jcascone77@gmail.comCONNECT WITH STEVE H. HEISLER:Website: www.injuredseniorhotline.comFacebook: https://www.facebook.com/attorneysteveheisler/LinkedIn: https://www.linkedin.com/company/the-law-offices-of-steven-h.-heisler/about/ Email: info@injuredseniorhotline.com  Show notes by Podcastologist: Kristen Braun Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it. 

Antibiotika bekommst du leicht verschrieben. Anfangs harmlos, je öfter umso gefährlicher. Stichwort: Resistenzen! Meine Erfahrungen mit einem der stärksten Antibiotika überhaupt inklusive Tricks für die richtige Anwendung.  Quellen: Umweltbundesamt Wien, Packungsbeilage diverser Medikamente Instagram: dieblasefuerfortgeschrittene FB: Die Blase Für Fortgeschrittene      

In this episode, guest host Dr. David Poetker speaks with Dr. Brad Woodworth and Dr. Do-Yeon. They will discuss the article: In‐vitro evaluation of a ciprofloxacin‐ and ivacaftor‐coated sinus stent against Pseudomonas aeruginosa biofilms. Read the article in International Forum of Allergy and Rhinology Listen and subscribe for free on Apple Podcasts , Google Play […]

Side effects of Ciprofloxacin antibiotic taken for a urinary tract infection; Long-term drum playing changes brain structure -- more connection between the hemispheres; Gamma brain wave stimulation may be good for memory improvement and Alzheimers; More support for deep brain stimulation for more than tremors; Playing other musical instruments like piano probably also improve brain connections; Getting off PPI: Tagamet works since Zantac supplies are short because of recall; Strengthening muscles and stretches to counter neck muscle stiffness; Effectiveness and safety issues with laser hair removal treatments; Thyroid medication protocols are complicated by individual differences and age affecting hormone metabolism

Side effects of Ciprofloxacin antibiotic taken for a urinary tract infection; Long-term drum playing changes brain structure -- more connection between the hemispheres; Gamma brain wave stimulation may be good for memory improvement and Alzheimers; More support for deep brain stimulation for more than tremors; Playing other musical instruments like piano probably also improve brain connections; Getting off PPI: Tagamet works since Zantac supplies are short because of recall; Strengthening muscles and stretches to counter neck muscle stiffness; Effectiveness and safety issues with laser hair removal treatments; Thyroid medication protocols are complicated by individual differences and age affecting hormone metabolism

CC* is a Registered Nurse and has a lifetime of expertise and wisdom from both sides of the health care dynamic - as a patient harmed by medical care, and as a nurse. (* “CC” is a pseudonym to protect her identity.) It is CC’s experience having a permanently damaged body from multiple medical errors that have motivated her to share her story of neglectful and abusive encounters with inept and egotistical physicians so that others are aware and can take steps to protect themselves. The medical error damage to CC was compounded by a health care system designed to respond to medical errors with mafioso tactics: deny and defend and denigrate. Nurse CC pulls no punches in telling the tragic truth of the power dynamics, push for profit, and the wholesale of humanity by the Medical Mafia.   SHOW NOTES Childhood Spinal Infection NB - some of these show notes are based on CC's preparatory notes. Those portions are CC's voice and are italicized. 0:05:00 Born in 1957 just north of Philadelphia to a white, middle class family. Grew up suburban, one of 4 children with a very tough childhood due to family dysfunction. I was extremely ill at age 6 with a spinal infection that resulted in extended hospitalization, inability to attend first grade for 1/2 the school year and confinement in a body cast and body brace for years. Despite many obstacles I was smart, had tenacity and fight that would both make me the awesome person I am today despite much suffering and societal disapproval. 0:06:05 Fought my way to be the first on either side of my family to put myself through college. I entered a collegiate nursing program in a religious institution where I hardly fit in but I had the ability, even by that point, to become a chameleon instinctually knowing how to acclimate to any environment I found myself in throughout my life. Once there, a new world opened up to me and I was on fire. 0:07:00 Began working in a hospital technical job in high school paying well and allowing me to support myself and finance my tuition, books, transportation with a small student loan. Became a RN in 1979. It was hell but I had only known hell all my life so I loved it. It felt normal. Drama, life and death, front seat row to people’s most intimate moments. However, I had empathy even at that point for any human’s suffering and this became more and more of a curse as I aged. 0:08:00 Of course I married, I was pretty, had a supervisory role within 18 months of graduation and by society’s yardstick I was doing quite well. Eventually I reluctantly had children which was interesting because I didn’t ever like children but succumbed to my husband’s wishes and that in and of itself is a miracle that I could only attribute to God. Once my first baby was born, I truly knew love for the first time in life. I wanted to be a full time Mom but this was not even a remote possibility. 0:09:30 CC chose to become a school nurse to be closer to her kids, but away from the life and death drama of ICU - CC had a 2nd child with many birth defects and she had to advocate for him - he'd be dead if she wasn't a good advocate.     Flouroquinlolones   0:11:30 When CC worked in ICU, flouroquinolones were not in common use - I have extremely hard scientific evidence that I was given Levaquin in 2002 during a surgery but that memory would never occur to me till my records had been destroyed due to laws allowing health care providers to destroy after 7 years. 0:12:30 CC was an emotional wreck after that surgery, crying all the time - when she returned to work she had a mean streak - she asked her surgeon friend for an antidepressant prescription, and that helped control her behavior. 0:13:30 In 2011, CC had bronchitis so just went to an urgent care clinic and was given Ciprofloxacin. 0:14:30 Prior to Cipro, I had been superwoman. I worked at times 3 jobs, obtained a Master’s degree and even a real estate license. So, because I was a school nurse and could be off for the summer which I never did, I remained in bed all summer. As September approached I called my internist to report this resulting in a few blood tests and being told I was just getting older. I had never been this age so I accepted this was normal. 0:16:00 CC's symptoms were extreme tiredness and weakness: she couldn't get out of bed - I drug myself to work, had been on an AD (antidepressants) since the surgery in 2002 which I knew when going back for my first post op visit I told my surgeon colleague, I’m mean. I need a SSRI, which sent me to a psychiatrist since that time. Of course all was attributed to my journey in life of mammoth stress and I happily took this which did allow me to continue at superwoman warp speed but in retrospect I had agitation and anxiety apparent but did not interfere with my ability to function. 0:18:00 CC says people in her situation are doubly traumatized when they realize they've been brain washed by the health care system she worked in - so they carry a lot of guilt as a health care worker. 0:20:00 By early 2012 I told my psychiatrist that I could barely get out of bed and he gave me a type of stimulant, not an amphetamine, called Provigil used for sleep apnea and MS (multiple sclerosis) fatigue. This allowed me to get through the work day, going to bed for a few hours at a time but I was able to earn money. 0:21:15 But I became pathetically agitated and no longer could physically be Mother Theresa as everyone knew me to be. I had anxiety to such a degree that if things were going poorly at work, I’d pick up the phone, say I was sick and had to flee on a few occasions. I knew something was wrong but I never associated the word anxiety, panic attacks to my situation. I was confused because I was being abused in the educational system but just performed at superhuman levels and now was saying no. They didn’t like that and labeled me a troublemaker and suspected of having mental health problems.   "Lamb being lead to slaughter"   0:23:30 I can trace back to late 2012 seeing a foot doc because my feet hurt but was told this was a bony deformity. I attributed it to being on my feet so much as a nurse. I never put together this was progressing small fiber neuropathy and docs certainly would never have a clue till they totally disabled me. 0:25:00 In the spring of 2013, my left foot swelled and was painful. I had done nothing. I could never be athletic because of my childhood disease but did the treadmill daily prior for decades. I saw another foot doc, told him just what I’m telling you and he ordered an MRI. He told me the MRI showed I bruised myself so I had injured myself. I adamantly said I did not, he became angry, threw the report at me to inform me I was wrong. Well I now know they are all Incompetent. So it was June 2013 and I spent that summer in bed and the swelling subsided. 0:26:15 Fall of 2013 I returned to work and immediately my right foot swelled and became painful. I no longer could rest and figured the other got better, I would muddle through. So In October, as I walked down the hallway, I felt a snap and thought this might be a breakthrough but quickly realized things got worse. I didn’t know what to do but happened to run into an orthopeadic doc from my days in the hospital, showed him my foot and said I don’t even know what specialist I should see because I’ve seen them all. He recommended his associate, a foot and ankle surgeon. I made an appointment not knowing I was a lamb being led to slaughter. 0:29:00 November 2014, I was seen and work up done by his fellow who is already a podiatrist, now doing a fellowship in foot and ankle surgery. By now the pain In my feet was unmistakably burning of my soles. I told him everything but had no clue my demise started with Cipro, but even If I had, it would never had been recognized. He did say that my symptoms sounded like neuropathy and asked If I was diabetic which I was not. Subject dropped, never recorded on my medical records I recently discovered. Follow up MRI showed severely ruptured peroneal tendon and things were too bad for rehab. Surgery was my only option. I needed a fix. I had to work so I signed for surgery December 20, 2013 so I could finish my obligations before Christmas break to minimize my sick time. Mind you I could barely walk but I was always Superwoman and this was just how I functioned even as sick as I was. 0:31:00 I had been recruited to accompany the high school choir as a pianist because of political downsizing and building politics leaving the High School Music teacher without other options. He was the president of our union and powerful. But he paid a price just like me In his lifetime. I didn’t know him well and was actually afraid of him but he was desperate, he heard I was quite the pianist , listened to me play, and said “yep, you're good enough”. Now his standards of good enough, I found out as a did this for several years, was pretty high. He was one of the most talented musicians that I’ve ever been privileged to work with. I was again on fire as I worked with him and his Choir.     Nerve block   0:34:00 He protected me when people in management were abusing me and forcing me to go against my nursing license and this was a gift. On December 20, 2013, I went into surgery not knowing the life ending decision that I was embarking on. I was given a Popliteal Nerve Block for pain control post op and receiving general anesthesia. I left, felling no pain, got my narcotics and went home very ok. 0:36:10 The following day the nerve block wore off and I began screaming at the top of my lungs. Nurses in pain, like anyone, do not think rationally, because in retrospect, I had been nursing for 20 years in a hospital and the only patients I’ve ever heard scream like that were in a burn unit in the 80’s when pain control was barbaric. I’ve also endured a natural birth of a 10.5 pound baby and I didn’t scream like that. By evening, I broke down and called the surgeon who assured me I was almost over the hump. Ha. 0:38:25 My best friend and husband stood there paralyzed in fear as I demanded the bottle of narcotics fearing I would take them all. I screamed give me 3 fucking Vicodin. I knew that wouldn’t kill me but even in those days you knew that prescription was not going to last. I also screamed that my husband had to remove the bandages because they were giving more pain. He faints at the sight of blood but I was a crazy woman. 0:39:15 Finally, the surgeon after insisting I might have a blood clot first and I said absolutely not. There’s no redness swelling, tenderness. Then he said have you ever had back problems. I say no then remembering I pulled my back out the previous June but it healed. So he orders an MRI of my Lumbar spine. The MRI is done and my back is a mess Im told (every part of my spine is gone and so Is my jaw). 0:40:30 Flouroquinolone destroys every part of the body on a cellular level - CC has degeneration of her spine - she endures 3 epidurals in an effort to determine the source of the pain 0:43:30 CC under goes 3 epidural invasive, harmful, toxic spinal injections - she has been out of work for months and in tremendous pain - epidural is a steroid that is injected into the spine to decrease swelling, but if you read the data, it does not work, it is a bogus money making procedure - the doctor tells CC her only-from-the-knee-down pain is from her back, her sciatica nerve 0:45:00 CC then undergoes a very painful procedure - the doctor realizes CC has bad neuropathy, and tarsal tunnel syndrome - he tells her to see a neurologist, but CC has to find one - Feb 2014 CC sees a neurologist 0:46:30 Just prior to the MRI date, I am In agony and my husband has no tolerance for my pain thinking I’m a whiner. I drive myself to an ER at 4:30 in the morning in desperation. I tell them my story, which I recently read their documentation and all I can say Is; are they on drugs, does anyone even listen to the patient anymore, total incompetence. I think they’ll do the MRI sooner and I can get answers. Wrong. Narcotics (Tramadol-now classified by DEA (Drug Enforcement Agency) as a controlled substance Class 4 opiate and Valium-a muscle relaxant). Prior it was considered a safe opiate.   Misdiagnosis   0:47:45 CC saw the neurologist: That man I’m sure is on drugs even though I knew I was. He kept leaving the exam room, I’d have to go out and find him, he does no neurological exam and states I need to see a neurosurgeon. 0:49:00 CC says hospitals cover up medical errors causing harm and death - CC tells about a nurse serial killer who was caught and put in jail - some nurses knew this was happening - The Good Nurse by Charles Graeber is a book about it - a nurse went to the DA (District Attorney) and they exhumed a body, but the hospital didn't tell the examiner what drug to look for based on meds being diverted in the hospital 0:51:10 The pathologist tested 100 drugs, but not the one the whistleblower nurse had reported - and the serial killer nurse went on - worked at 9 institutions - they think he probably killed 300 to 400 people 0:52:00 CC is not glad she is alive, she wished the drug had of killed her - but she loves her kids and is plugging along - I See the neurosurgeon who emphatically shows me the MRI pointing out there in NO compression on those nerves. That pain Is not coming from your spine. I get a second opinion somewhere else and he says the same. He says you have to see a neurologist and I said I did, he sent me to you. He sets up an appointment the following day in that office. 0:53:15 Unfortunately I saw a nurse practitioner but it really wouldn’t have mattered. I ask her sobbing do you think I have MS. She so compassionately comes over and holds my hand and emphatically states there is no way you have MS. Wrong. Nurses are taught never to do such a thing but she felt so confident In her skills that she violated a sacred nursing ethic. But I feel relieved as I sat in the waiting room surrounded by patients horrendously deformed by neurodegenerative diseases. She put me on Gabapentin and orders another EMG of my arms , follow up in three months with a bonafide neurologist. 0:55:30 I return to my surgeon, he sees the horrendous EMG which although abnormal, unfactual and just documentation to support another surgery which was unneeded. I’ve now been out of work for over 3 months, in desperation. He sees the EMG report says I have Tarsal Tunnel Syndrome and offers to operate on that and maybe later do the other foot. I need to work, I think this might be the answer so I agree. I’m so stupid. Desperate people do desperate things. 0:57:00 I refuse the popliteal block because my gut tells me that this is not good. I come through that surgery and while convalescing decide I’ve got to see that neurologist before July. I see him in April. He’s not only incompetent, he’s a liar I now know. He raises his eyebrows that I had the TTS and says I do not recommend the other foot. I told him what the surgeon said and he just doesn’t comment. Conspiracy of Silence.      "I asked him what he found and he refused to tell me."   0:59:00 He orders the vitamin levels I demanded reluctantly even though this Is research based. He says he wants to repeat the EMG on my legs. I tell him I have the appt for the arms June He says good do arms and legs. Wrong. 1:00:00 I show up at the hospital June 5th for the EMG with his partner. He looks at the order and starts ranting that he’s not going to do 4 limbs in one day and he’s got a splitting headache and has had a horrendous day. I offer to reschedule and he rants No. I now have been scouring the internet trying to find help because I’m even weaker. He then begins a two hour session of electrical shocks as he mutters only to himself as my friend holds my hand trying to help me through the pain. But, I finally hear him say ok, this is starting to make sense. I know he found something. When we are done I ask him what he found and he refuses to tell me. I beg him to see me because he’s the only Board Certified Neuromuscular Neurologist in the area. He says no. 1:01:30 I furiously start calling for the results. The neurologist doesn’t call me back. Finally I call and tell the nurse he better call me because if Im dying, I need to know to make arrangements. Takes days to even connect but I have now discovered there are Peripheral Neuropathy Centers of Excellence and the closest is several states away. I get an appt in less than 2 weeks. The local 2nd neurologist finally calls me back and tells me the EMG didn’t show much in those exact words. I say I’m so weak I can barely get out of bed and he offers me physical therapy. I refuse and politely tell him that I need answers so I’m leaving the state. He becomes angry putting up barriers to getting my records which ultimately I don’t need. Good people don’t care what others wrote. But because I’m a nurse, and know the ropes, I do obtain the EMG report which report which is 8 pages long single spaced starting with the statement this is a highly abnormal and complex EMG. Idiocy. Lies. 1:04:45 I go to the out of state famous guy and to my unknown luck, I show up on a day Obama was In town- I’m the only one there. All the extensive testing is done that day only needing a specialized MRI machine that is not available most places . Skin punch biopsy, 17 tubes of blood, 4 limb EMG done In less than 30 minutes. No begging for any test and more I would never have known. But he does say, because he was the first person that actually listened to me, find out the precise location on your body where they injected you for that block. 1:06:00 Two weeks after seeing the famous neurologist I return for the results but now I’m one of the herd of patients there. He tells me you have small fiber neuropathy probably from Cipro since that’s when it started but of course was placed on other neurotoxic drugs as every body organ began to disintegrate. I also have B6 toxicity which is neurotoxic (seen by the local neurologist several months earlier but never told). He goes on to explain that I had very sick nerves that could not sustain the further injury of a neurotoxic nerve block and they should have never given that to you. He adds and if you think I’m going to court for you I’m not. He states there Is nothing he can do for me. I sob and ask how I will support myself and his response was I could go on disability. He tells me he’s busy and no longer has time for me. I plead that I’m so weak I can barely get out of bed and he scolds me saying you’re not that weak. He ushers me out hysterical.       Another misdiagnsois   1:07:30 I return home. Still feeling like I’m dying and I really wish I had. On Saturday night, I’m desperate to see anyone who will help me. My long term internist had left the practice before the tendon rupture but I work with her husband. I email him and beg for his wife to call me and she does. I ask her the name of her Internist as I’ve seen multiple ones with no help and she tells me. 1:08:30 I see that internist shortly and am too weak to even sit upright to speak. She, upon entering, demands I sit up to speak. I cry and tell her I’m too weak. She does listen o my story and has a fuller history to more accurately understand. After my story her response is let’s do a brain MRI because they’ve MRId everything but that. I get that done and she calls me the next night telling me it looks like I have MS. I need to see that kind of Neurologist. I tell her I will not see anyone local. She sets me up with the nearest big city prestigious university head of MS. 1:10:00 That guy was not only Incompetent, he abuses human beings. He demands further invasive testing which was done there and my civil rights were violated and I was treated like an animal. 2 weeks later he tells me there is no doubt I have MS and wants me on toxic drugs immediately. I’m scared but too abused to accept this so I travel 9 hours to a nationally renowned hospital, lying in the back seat of our compact car writhing in pain. He does listen to my story. His verdict is that’s a weird story, but I have seen weird stories. But, I would not take those meds, continue to monitor your brain MRIs and if you get more damage, then take them. Good enough for me. 1:11:45 I have to return to the first MS guy and he’s angry but does not refuse to continue seeing me which many do. I have a few years of monitoring with no further damage revealed but cannot take his verbal abuse. I tell him how he’s hurting people with the things he says, he’s outraged, tries to pawn it off on me and I stand my ground and say I had someone beside me who heard everything you said. I point out the repeated things he said to me, he starts to grovel and says he never intended to hurt me. I respond, I know you didn’t so that’s the point of this conversation. You're clueless about your verbal abuse. I never go back because of that and other things. 1:13:00 In 2016 I read a medical journal article that is titled 40 red flags this is not MS. The first red flag is small fibre neuropathy. I email the lead author from a Colorado. He emails me back within 5 minutes. I tell him why I think I’ve been misdiagnosed. He says go see his coauthor whose closer. I do. The verdict there was I do not meet the complex criteria that Is universally accepted to diagnose MS. The McDonald Criteria. But I should be monitored. A recent medical publication cites 1:5 are misdiagnosed as MS some being on toxic drugs for decades. There is no real test for MS. So why didn’t the head of MS at a city prestigious university not understand the McDonald criteria? Because his big ego and status made he think he knew best. Scary.     Black Box Warnings   1:14:00 CC says recent research shows 1 in 5 MS patients have been misdiagnosed, and they may have been on toxic medication for decades 1:16:00 Black Box warnings on medication come from reports of harm from patients, it is not doctors submitting reports of adverse reactions - there is 1 doctor who is an adverse drug reaction researcher and he is a good man - he is the reason many of the Black Box warnings are at the FDA - CC contacted him and told about her symptoms 1:17:30 Small Fibre Neuropathy (SFN) - basically damage to the nerve - there is also Large Fibre Neuropathy, diabetics get - in MS patients, they experience neuropathy because the damage in their brain manifests the pain, not the peripheral nerve 1:18:45 The pain after her surgery was so bad CC would not have survived without an opioid - she had been prescribed Tramadol, but it was not labeled as an opioid, but it is an opioid and more dangerous than others 1:20:00 1.5 years later I’m (was) still on Tramadol for self preservation and having been told by a Johns Hopkins peripheral nerve neurosurgeon that after 9 months that nerve was not going to heal. My only options were meds or a spinal stimulator implantation. Now I’m near total psychosis. I’m obsessed with death In that I cant stop reading about It. I get pleasure from this. I sob 24/7. I can’t leave the house because I’m a public spectacle. I never ever took more than was directed. One day I take it, start to sob more and realize this poison is making me worse. I abruptly stop them. I go into withdrawal and writhe in pain everywhere for weeks. But when it’s over, my horrendous anesthetic nerve injury pain is gone. My brain was recreating the pain to get the Opioids. Tramadol was labeled in August 2014 by the DEA a a controlled substance, so providers didn’t think it was addicting even though it was an Opioid. Now we know about the corruption between the FDA and Big Pharma and the Opioid Crisis is the tip of the iceberg. My psyche Improved but I will never be normal. 1:22:30 The last years have been spent looking for The Holy Grail, trying alternative medicine and therapies but I now know my life is over. I will never work again, my personality is different as is my perception of people. One by one you r abandoned by friends, coworkers, family, religious entities and finally God. I live in unbelievable pain 24/7 that cannot be relieved unless I risk further brain injury. I’m too weak to leave the house and spend much time in bed. Very little left. I see that my situation Is the result of global profit driven societies from the rich down to the poor. 1:23:30 CC goes for stem cell therapy in Mexico as did others poisoned by flouroquinolones - and CC did respond well, but every body else got worse - CC's quality of life improved enough she could connect with others globally for mutual support - they all have multi system damage - CC was treated better by Mexican health care workers than any American. --------------------------------------------------------------------------------- Be a podcast patron Support Medical Error Interviews on Patreon by becoming a Patron for $2 / month.  Or $5 / month to be a Premium Patron and watch the video versions of Medical Error Interviews. Be my Guest If you are a survivor, a victim’s surviving family member, a health care worker, advocate, or policy maker and have a medical error experience you would like to share, send me an email with a brief description of your experience:  RemediesPodcast@gmail.com  Scott Simpson:  Counsellor + Podcast Host + Patient Advocate I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard, train hard, rest hard. Like me, many of my clients at Remedies Counseling have experienced the often devastating effects of medical error. I have been living with HIV since 1998, and thanks to research and medications, it is not a problem in my life.  I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life. Need a Counsellor? If you need a counsellor for your experience with medical error, or living with a chronic illness(es), I offer online video counseling appointments. **For my health and life balance, I limit my number of counseling clients.**  Email me to find out if I have any counseling appointments open:  RemediesOnlineCounseling@gmail.com Remedies Counseling - Making Life Better Have you had traumatic experiences with the health care system? Are you living / struggling with a chronic illness?  Do you need a counsellor with proven expertise and experience to make life better? Book an appointment with Scott online at RemediesCounseling.com RemediesOnlineCounseling@gmail.com

You can practice pharmacy in numerous different settings- now, Pitt Pharmacy is gearing up for an interstellar environment: space. Antimicrobial resistance is a growing public health issue that has a global and even a universal effect. Our guest on this week's episode shares how pharmacy is now going beyond earth's atmosphere. Mohamed Kashkoush is a pharmacy student at the University of Pittsburgh and business development associate at Peptilogics, a biotechnology company combating the growing global epidemic of multi-drug resistant infections. As an undergraduate in Industrial Engineering, Mohamed was a researcher who explored anti-bacterial and anti-reflective surfaces at the Laboratory for Advanced Materials at Pittsburgh, as well as the impact of naloxone distribution on the opioid epidemic at the University of Pittsburgh School of Public Health. Most recently, he is a co-principle investigator of an experiment that is currently on board the International Space Station, making Pitt Pharmacy the first pharmacy school in the nation to send research to outer space. Above all else, Mohamed is passionate about innovations in the life sciences that make the world - and perhaps even the universe - a better place. With the concurrently increasing frequency, duration, and overall ambition of space exploration, it is important to approach the treatment of infections during spaceflight with confidence and precision. A closed, high-touch environment aboard the International Space Station and other space vessels, combined with increased bacterial virulence and human immunosuppression during spaceflight further highlight the importance of research into antimicrobial therapies under microgravity conditions. Specifically, this experiment will explore whether or not survival responses previously shown during spaceflight are antibiotic-specific or broadly attributable to other antibiotics. This will provide data towards constructing evidence-based guidelines for the treatment of infectious disease during spaceflight, as well as provide insight into mechanisms of antimicrobial resistance for drug development on Earth. In doing so, we can make space and Earth safer for all. Main Points From this Podcast: - Why pharmacy in space is a current reality - Explaining the experiment, Transcriptomic Analysis of Escherichia coli Response to Ciprofloxacin in Microgravity - Implications for interstellar travel - How antibiotic resistance can be addressed in space - The process of getting an experiment from a pharmacy school to a space ship ***Looking to prevent burnout, prioritize your own self-care, through a practical approach specific to pharmacy life? There is a phenomenal book written by a pharmacist guiding you through each step of the way, addressing the most common concerns and obstacles we face in pharmacy with SimpleSolutions for how YOU can nail your nutrition, master your mindset, and fit in fitness to life in pharmacy: "Rx: YOU! The Pharmacist's Guide to Managing Stress & Fitting in Fitness": amzn.to/2QDtqCP Like The Fit Pharmacist on Facebook: www.facebook.com/fitpharmfam Host: Adam Martin, PharmD, ACSM-CPT, NAMS-CNC -Website: www.thefitpharmacist.com -LinkedIn: www.linkedin.com/in/fitpharmfam -Instagram: www.instagram.com/thefitpharmacist -YouTube: bit.ly/2x2urwl Guest: Mohamed Kashkoush, PharmD(c) -Website covering the project: https://bit.ly/2L7r26h -Newspaper article: https://bit.ly/2MCm8kU -LinkedIn: https://bit.ly/30Bhreq-YouTube: bit.ly/2Oh1Drx

El episodio de esta semana lo dedicamos a comentar ciertas controversias y recomendaciones sobre el tratamiento de infecciones urinarias.    Referencias: Ainsley Moore y colaboradores. Canadian Task Force on Preventive Health Care Recommendations on screening for asymptomatic bacteriuria in pregnancy. CMAJ 2018 July 9;190:E823-30. doi: 10.1503/cmaj.171325. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Cai et al . Clin Infect Dis 2012: 55: 772-777.  .Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infection. Cai et al. Clin Infect Dis 2015; 61: 1655-1661. Krumpe PE, Cohn S, Garreltes J, et al. Intravenous and oral mono- or combination-therapy in the treatment of severe infections: ciprofloxacin versus standard antibiotic therapy. J Antimicrob Chemother. 1999;43(suppl A):117-128. Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012;380(9840):484-490. doi: 10.1016/S0140-6736(12)60608-4. Talan DA, Stamm WE, Hooton TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000;283(12):1583-1590. Kutob LF, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections. Int J Antimicrob Agents. 2016;48(5):498-503. doi: 10.1016/j.ijantimicag.2016.07.013. Mercuro NJ, Stogsdill P, Wungwattana M. Retrospective analysis comparing oral stepdown therapy for enterobacteriaceae bloodstream infections: fluoroquinolones versus beta-lactams. Int J Antimicrob Agents. 2018;51(5):687-692. doi: 10.1016/j.ijantimicag.2017.12.007.  Rieger KL, Bosso JA, MacVane SH, Temple Z, Wahlquist A, Bohm N. Intravenous-only or intravenous transitioned to oral antimicrobials for Enterobacteriaceae-associated bacteremic urinary tract infection. Pharmacotherapy. 2017;37(11):1479-1483. doi: 10.1002/phar.2024. Nelson AN, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections. Infection. 2017;45(5):613-620. doi: 10.1007/s15010-017-1020-5.     La Frase de la Semana: Esta semana la tomamos del escrito español Chufo Llorens. Y la frase dice: La distancia es al amor lo que el viento al fuego: apaga el pequeño, pero aviva el grande.  

The post Ciprofloxacin (Cipro) Nursing Pharmacology Considerations appeared first on NURSING.com.

Pseudomonas aeruginosa Eradication and Outcomes: Key Questions

Lisa Bloomquist joins Bulletproof Radio to discuss her devastating experience with Ciprofloxacin, the important role of mitochondria and how to choose a safer antibiotic. Enjoy the show!

Lisa Bloomquist joins Bulletproof Radio to discuss her devastating experience with Ciprofloxacin, the important role of mitochondria and how to choose a safer antibiotic. Enjoy the show!

  In this episode of the Survival Medicine Hour, Joe Alton, MD, and Amy Alton, ARNP, discuss the recent news about bird flu, all about lice infestations, and the antibiotic Cipro and its application in survival settings.

  In this episode of the Survival Medicine Hour, Joe Alton, MD, and Amy Alton, ARNP, discuss the recent news about bird flu, all about lice infestations, and the antibiotic Cipro and its application in survival settings.

Die gebräuchliche Therapie gegen Milzbrand besteht aus der Gabe von Antibiotika. Als Therapie der Wahl gilt hierbei das Fluorochinolon Ciprofloxacin. Resistenzen gegen dieses Antibiotikum wurden bei B. anthracis in vivo noch nicht, in vitro jedoch im Rahmen mehrerer Studien beschrieben. Es existieren herkömmliche Resistenztests, wie der Gradientendiffusions- oder der Mikrodilutionstest, welche bei einer Milzbranderkrankung genutzt werden können. Diese nehmen jedoch aufgrund der kulturellen Anzucht in einem Labor der Schutzstufe 3 vor der Durchführung des Tests ein bis zwei Tage Zeit in Anspruch. Um diese Zeitspanne zu verkürzen, wurden im Rahmen dieser Arbeit Schnelltests entwickelt. Diese basieren auf einer real-time-PCR Methode, mit welcher Ciprofloxacin-Resistenz verursachende Punktmutationen (= SNPs), nachgewiesen werden. Im ersten Abschnitt dieser Studie wurde der B. cereus Stamm ATCC10987 resistent gegen Ciprofloxacin generiert. Aufgrund der Dual-Use-Research-of-Concern-Problematik wurde dieser, wenig pathogene, aber genotypisch sehr nah mit B. anthracis verwandte, BSL-2-Organismus verwendet. Die Resistenzbildung erfolgte durch natürliche Selektion, indem der B. cereus Wildtyp mehrfach auf Ciprofloxacin-haltigen Agar-Platten, welche eine steigende Konzentration des Antibiotikums enthielten, angezüchtet wurde. Es folgte eine Sequenzierung der Quinolone Resistance Determinig Region (= QRDR), bestehend aus den Genen gyrA, gyrB, parC und parE, von neun B. cereus Mutanten, welche CIP-Resistenzen entwickelt hatten. Eine der Mutanten besaß einen SNP im Gen gyrA an Stelle 254 mit einer Mutation der Base Cytosin in ein Thymin. Solche SNPs stellen eine mögliche Ursache der Resistenz gegen Fluorochinolone dar. Acht der B. cereus Mutanten besaßen jedoch keine SNPs in der QRDR. Die Ursache für deren Resistenz wird in der erhöhten Funktion von Effluxpumpen vermutet. Im zweiten Teil der Studie wurden die Schnelltests entwickelt. Es wurden mehrere Protokolle für die beiden real-time-PCR Methoden TaqMan® und MeltMAMA (= Melt Analysis of Mismatch Amplification Mutation Assays) erstellt und getestet. Der Vergleich beider Methoden wertete den TaqMan® als die Methode der Wahl für die gesetzte Zielstellung. Daraufhin wurden für acht bekannte Ciprofloxacin-Resistenzen auslösende SNPs TaqMan®-Protokolle entwickelt. Im Abschluss wurden diese durch Versuche mit verschiedenen B. anthracis Stämmen, dem B. cereus ATCC10987 Wildtyp und seinen Mutanten, synthetisch hergestellten Templates, die als Mutationskontrollen genutzt wurden, sowie verschiedenen Bacillus Spezies hinsichtlich ihrer Sensitivität und Spezifität erprobt. Es wurden acht TaqMan® Protokolle erarbeitet, welche SNPs in der QRDR von B. anthracis nachweisen und somit eine schnelle Diagnose vieler Ciprofloxacin-resistenter Stämme gewährleisten. Der Einsatz dieser Schnelltests zusätzlich zu den herkömmlichen Empfindlichkeitstests gibt die Möglichkeit eine optimale Therapie von Milzbrandinfektionen in einem verkürzten Zeitraum zu gewährleisten.

ZUSAMMENFASSUNG Die Anwendung antimikrobieller Wirkstoffe in der Human- und Veterinärmedizin hat zu einer Selektion und Anreicherung antibakteriell resistenter Mikroorganismen geführt. Die Bedeutung tierischer Lebensmittel bei der Übertragung von Bakterien auf den Menschen wurde bereits des öfteren beschrieben. In Europa sind die meisten Y. enterocolitica-Stämme, die bei humanen Gastroenteritiden isoliert werden, vom Bioserotyp 4/O:3. Für menschliche Infektionen stellen symptomlos infizierte Schweine das wichtigste Erregerreservoir dar, dabei gilt Schweinefleisch als wichtigste Kontaminationsquelle. In der Literatur wurde bisher nur über eine Empfindlichkeitsbestimmung von Y. enterocolitica 4/O:3 in Deutschland berichtet. Aus diesem Grund befasste sich diese Studie mit dem Resistenzverhalten dieser Bakterien unter Anwendung zweier unterschiedlicher Methoden. Mittels Agardiffusionsverfahren wurden 200 Stämme (60 humane und 140 porcine) auf die antimikrobiellen Wirkstoffe Ampicillin, Amoxicillin/Clavulansäure, Cefotaxim, Aztreonam, Chloramphenicol, Colistin, Erythromycin, Gentamicin, Streptomycin, Nalidixinsäure, Ciprofloxacin, Tetracyclin, Sulphamethoxazol, Sulphamethoxazol/Trimethoprim und Trimethoprim getestet. Im Anschluss wurden 110 der gleichen Stämme (31 humane und 79 porcine) mittels Bouillon-Mikrodilutionsverfahren untersucht. Die im Handel erhältlichen Mikrotiterplatten wurden vom Nationalen Veterinärinstitut Schwedens bezogen und enthielten die antimikrobiellen Wirkstoffe Ampicillin, Cefotaxim, Ceftiofur, Chloramphenicol, Florfenicol, Gentamicin, Kanamycin, Streptomycin, Nalidixinsäure, Ciprofloxacin, Tetracyclin, Sulfamethoxazol und Trimethoprim. Mittels Agardiffusionstest wurden gegen fünf Wirkstoffe Resistenzen ermittelt. 98,0 % der untersuchten Yersinien waren gegen Ampicillin, 92,5 % gegen Erythromycin, 7,0 % gegen Streptomycin, 2,0 % gegen Sulphamethoxazol und nur 1 Stamm (0,5 %) war gegen den Kombinationswirkstoff Sulphamethoxazol/Trimethoprim resistent. Mittels Mikrodilutionsverfahren wurden bei drei von 13 getesteten Wirkstoffen Resistenzen ermittelt. So waren 97,2 % gegen Ampicillin, 15,5 % gegen Streptomycin sowie 1 Stamm (0,9 %), aus einer humanen Stuhlprobe, gegen Sulphamethoxazol resistent. Dieser Stamm war sowohl mittels Agardiffusions- als auch mittels Mikrodilutionsverfahren multiresistent. Es konnte kein wesentlicher Unterschied zwischen den Resistenzergebnissen humaner und porciner Stämme festgestellt werden. Von den 110 Yersinien waren die Ergebnisse von 82 Stämmen, mittels Agardiffusions- und Bouillon-Mikrodilutionsverfahren, übereinstimmend. Bei 28 Y. enterocolitica-Stämmen wurden unterschiedliche Resultate ermitelt. In 6 Fällen handelte es sich um größtmögliche Fehler, 4 mal sind große und 18 mal geringfügige Fehler aufgetreten. Dabei ist bei dem Vergleich der Ergebnisse der MHK-Wert als der verlässlichere anzusehen. Aus diesem zuletzt genannten Grund und da die Mikrodilution im Gegensatz zur Agardiffusion quantitative Ergebnisse liefert, was für eine effektive Therapie von Bedeutung ist, sollten Empfindlichkeitsbestimmungen mittels Mikrodilution durchgeführt werden. Insgesamt betrachtet, zeigen die Ergebnisse dieser Studie, dass Y. enterocolitica- Stämme 4/O:3 gegenüber den meisten antibakteriellen Wirkstoffen empfindlich sind und nur vereinzelt Resistenzen gegen antimikrobielle Wirkstoffe aufweisen. Des Weiteren ist zu sagen, dass bei Y. enterocolitica-Stämmen 4/O:3, die im süddeutschen Raum isoliert wurden, die Resistenzsituation zum derzeitigen Zeitpunkt nicht problematisch ist und mit den Ergebnissen anderer weltweit durchgeführten Untersuchungen übereinstimmt.

In der vorliegenden Arbeit wurde basierend auf der genotypischen Charakterisierung von Stämmen des Mycobacterium tuberculosis - Komplexes anhand des gyrA-Gens mit Hilfe einer auf dem LightCycler® System basierenden gyrA Real-time-PCR ein neuartiges Testverfahren zur Bestimmung von Chinolonresistenzen konzipiert und etabliert. Bei der Evaluierung des Testverfahrens mit 13 phänotypisch resistenten Stämmen mit einer MHK ≥ 4 µg/ml für Ciprofloxacin zeigten 9 Stämme bei der Schmelzpunktanalyse einen eine Mutation anzeigenden Shift des Tm’s, 2 weitere wiesen die typische Schmelzkurve einer Heteroresistenz auf. Die Sequenzierung ergab, dass 5 dieser Stämme eine Mutation des Codon 90 (Ala→Val, GCG→GTG) und 6 Stämme eine Mutation des Codons 94 (Asp→Gly, GAC→GGC) aufwiesen. Die beiden verbliebenen Stämme hatten den Schmelzpunkt des Wildtyps, der durch die Sequenzierung bestätigt werden konnte. Die molekularepidemiologische Unabhängigkeit der resistenten Stämme wurde durch das IS6110 Fingerprinting bestätigt. 44 phänotypisch sensible Stämme wiesen ebenfalls den Tm des Wildtyps auf. Damit besitzt das Testverfahren für den Nachweis von Chinolonresistenzen eine Sensitivität von 85% und eine Spezifität von 100%. Die Speziesspezifität wurde anhand von 7 typischen und 16 atypischen Mykobakterien sowie humanen DNA-Präparationen und Sputumproben überprüft, wobei sich eine Amplifikation nur bei Mitgliedern des M.tb. - Komplexes fand. Das Testverfahren ist somit hochspezifisch für den Mycobacterium tuberculosis - Komplex. Der Test wurde für die Bestimmung von der Primärkultur und für den Direktnachweis aus dem Sputum evaluiert. Der Nachweis von Mykobakterien direkt aus dem Sputum mit dem Testverfahren ist mit 103 KBE/ml eine Größenordnung sensitiver als die Mikroskopie. Das Testergebnis liegt in der Regel innerhalb eines Tages vor. Für die Testdurchführung und die Testauswertung wurden Standardprotokolle erstellt. Anhand einer kritischen Evaluation der Primärliteratur konnte gezeigt werden, dass eine hohe Konkordanz von über 90% zwischen höhergradigen Chinolonresistenzen (MHK ≥ 4 µg/ml) und Mutationen des gyrA-Gens besteht. Die Informationen aus der phänotypischen und der genotypischen Resistenztestung sollte genutzt werden, um die beiden Verfahren gegenseitig zu evaluieren. So sprechen die bisherigen molekularbiologischen Daten für den von der WHO vorgeschlagenen Grenzwert von >2µg/ml bei der phänotypischen Resistenzbestimmung. Anhand von klinischen Studien sollte die Grenzwertsetzung überprüft und vor allem der Nutzen der Techniken für den Patienten evaluiert werden. Chinolone haben eine stark zunehmende Bedeutung bei der Behandlung der Tuberkulose und werden bisher vor allem bei der Behandlung der MDR-Tuberkulose eingesetzt. In mehreren klinischen Studien wird derzeit auch der Einsatz von Gyrasehemmern der neusten Generation als Standardmedikament untersucht. Hiervon verspricht man sich insbesondere eine Verkürzung und eine bessere Verträglichkeit der Therapie. Sollten sich die Chinolone als First Line Medikament zur Behandlung der Tuberkulose durchsetzten, könnte die im Rahmen dieser Arbeit entwickelte auf dem LightCycler® System basierende gyrA Real-time-PCR aufgrund der schnellen Resistenzbestimmung innerhalb eines Tages dem Kliniker entscheidende Hinweise für die primäre Einleitung einer effektiven Therapie geben.

Ziel der Arbeit war es, das Vorkommen Antibiotika-resistenter Keime in Fleisch zu erfassen, um das Risiko des Übergangs resistenter Keime von Fleisch auf den Menschen besser einschätzen zu können. Gleichzeitig sollte geprüft werden, inwieweit die quantitative Erfassung von Resistenzgenen hierzu einen Beitrag leisten kann. Hierzu wurden in dem Zeitraum von November 2003 bis Februar 2005 aus 500 „Hähnchen-" und 500 „Schweinefleisch-Proben“ Bakterien der Gattungen Escherichia (E. coli, n=677), Salmonella (n=89), Campylobacter (n=421), Listeria (n=417), Enterococcus (n=782), Enterobacter (n=167), Citrobacter (n=83), Serratia (n=116) und Klebsiella (n=125) isoliert. Die untersuchten Fleischproben stammten jeweils zu gleichen Teilen vom Schlachthof und von der Verkaufstheke. Die Prüfung der Isolate hinsichtlich ihres Empfindlichkeitsverhaltens erfolgte gegenüber bis zu 31 ausgewählten, größtenteils human-relevanten Antibiotika im Mikrodilutionsverfahren. Weitere 100 „Hähnchen-" und 100 „Schweinefleisch-Proben“ wurden mittels real-time PCR nach Direkt-Extraktion der DNA auf das quantitative Vorkommen der Tetrazyklin-Resistenzgene tet (M) und tet (O) untersucht. Die Analyse der Prävalenzzahlen ergab zum einen, dass aus den „Schweinefleisch-Proben“ weit weniger Isolate (ausgenommen coliformer Keime) als aus den „Hähnchenfleisch-Proben“ gewonnen werden konnten. Zum anderen war das Vorkommen von Listeria spp., aber auch von coliformen Keimen und Salmonella spp. bei den „Verkaufstheke-Proben“ deutlich höher als bei den entsprechenden „Schlachthof-Proben“; gegensätzlich dazu verhielten sich die Campylobacter-Prävalenzraten. Im Rahmen der phänotypischen Empfindlichkeitsuntersuchungen wurde das Vorkommen resistenter und hochmehrfach-resistenter Keime in zum Verzehr geeignetem Fleisch nachgewiesen. Hinsichtlich der verschiedenen Bakterienspezies wurden sehr große Differenzen beobachtet. So mussten 69,0 % der E. coli, 61,8 % der Salmonella spp., 67,1 % der C. jejuni, 76,9 % der C. coli, 74,1 % der E. faecalis, hingegen nur 4,7 % der L. monocytogenes und nur 6,2 % der L. innocua als zumindest einfach-resistent eingestuft werden. Hierbei trugen die untersuchten E. coli-Stämme vor allem Resistenzen gegen Penicilline, die Aminoglykoside Streptomycin und Spectinomycin sowie gegen die Antibiotika Doxyzyklin, Sulfamethoxazol+Trimethoprim. Bei Campylobacter spp. wurden Resistenzraten von bis zu 30 % gegenüber Enrofloxacin, Ciprofloxacin, Ampicillin und Doxyzyklin ermittelt; zudem war bei den C. coli-Stämmen ein hohes Resistenzvorkommen gegenüber Sulfamethoxazol+ Trimethoprim zu beobachten. Bei dem Genus Enterococcus traten vor allem gegen Makrolide und die Wirkstoffe Doxyzyklin, Rifampicin und Fosfomycin Resistenzen auf. Die Auftrennung der Ergebnisse entsprechend der Fleischarten ergab ein weit häufigeres Vorkommen von resistenten Keimen in Hähnchenfleisch als in Schweinefleisch. Diese Tendenz war auch bezüglich mehrfach-resistenter Keime zu beobachten. So waren z. B. bei E. coli 46,1 % der aus Schweinefleisch und 61,1 % der aus Hähnchenfleisch isolierten Stämme als mehrfach-resistent einzustufen; bei den E. faecalis-Isolaten 20,3 % bzw. 47,8 %. Des Weiteren wiesen die Proben von der Verkaufstheke tendenziell häufiger Keime mit Resistenzen auf als solche vom Schlachthof. Vergleicht man die erhobenen Resistenzraten mit denen des GENARS-Projektes, so lagen in der überwiegenden Mehrzahl der Fälle die Resistenzraten der „aviären“ und „porcinen“ Isolate deutlich unter denen „humaner“ Isolate. Bei den molekularbiologischen Untersuchungen wurden relativ geringe Konzentrationen von tet (M) und tet (O) auf Fleischoberflächen gefunden. So ist ein Übergang von resistenten Keimen von Fleisch auf den Menschen durchaus möglich. Allerdings dürfte diesem Weg der Verbreitung Antibiotika-resistenter Keime eine geringere Bedeutung zukommen als mitunter angenommen.

Die vorliegende Arbeit befasst sich mit der Entwicklung enzymimmunologischer Verfahren zum Nachweis von in der EU-weit geltenden Verordnung (EWG) Nr. 2377/90 reglementierten Chinolonen. Zur Gewinnung gruppenspezifischer Antikörper wurde Ciprofloxacin-Ethylendiamin an Keyhole Limpet Haemocyanin (KLH) gekoppelt und drei Kaninchen intracutan immunisiert. Nach einer Restimulierung waren bei allen drei Kaninchen spezifische Antikörper nachweisbar. Die zur Erstellung eines direkten und indirekten kompetitiven enzymimmunologischen Nachweisverfahrens notwendigen markierten Antigene wurden durch Kopplung von Ciprofloxacin, Ciprofloxacin-Ethylendiamin, Clinafloxacin sowie Norfloxacin an Meerrettichperoxidase, Glucoseoxidase oder Ovalbumin hergestellt. Dabei kamen verschiedene Kopplungsmethoden (aktive Estermethode, Perjodatmethode und Carbodiimidmethode) zum Einsatz. Mit dem spezifischen Serum eines Tieres wurden verschiedene kompetitive Enzymimmun-testsysteme entwickelt. Von den direkten Enzymimmuntests wies das empfindlichste System eine Nachweisgrenze für Ciprofloxacin von 1,25 ng/ml auf, im indirekten Testsystem lag die untere Nachweisgrenze bei 1,5 ng/ml. Ciprofloxacin konnte somit weit unterhalb des geltenden MRL-Wertes von 100 µg/kg in Milch nachgewiesen werden. Das Antiserum zeigte nur bedingt Gruppenspezifität. Für fünf von 23 überprüften Chinolonen wurden Kreuzreaktionen von > 50 % ermittelt, von den mit einem MRL-Wert belegten Substanzen wurden Danofloxacin, Ciprofloxacin, Enrofloxacin und Oxolinsäure erfasst. Zur Überprüfung der Anwendbarkeit der entwickelten Testsysteme wurden künstlich kontaminierte und gewachsene Milch- und Garnelenproben untersucht, wobei das jeweilige Testsystem an die entsprechende Probenmatrix adaptiert wurde. Die mittlere Wiederfindungsrate lag bei 95,5 %, in keiner der Praxisproben konnten Chinolonrückstände nachgewiesen werden. Weiterhin wurde ein mikrobiologisches Verfahren unter Verwendung von E. coli als Testkeim zum Nachweis für Chinolone entwickelt. Dieser Agardiffusionstest zeichnete sich durch eine hohe Sensitivität und Gruppenspezifität aus. Ciprofloxacin konnte mit einer Nachweisgrenze von 2 ng/ml weit unterhalb des geltenden MRLs nachgewiesen werden, zehn weitere wichtige Chinolone wurden unterhalb von 100 ng/ml erfasst. Dieses System kann somit als nützlicher Kontrolltest verwendet werden.

Stenotrophomonas maltophilia, a micro-organism which colonises plastic material was isolated in only 10 known cases of postcataract surgery endophthalmitis (PE) world-wide. We present characteristics, treatment and outcome in 26 cases of PE caused by S. maltophilia contaminated rinsing solution used during cataract surgery. Methods: 21/26 patients (81%) required pars plana vitrectomy and were treated with intravitreal, topical, subconjunctival and systemic antibiotics covering to the most likely pathogens. 2 days after surgery identification of S. maltophilia allowed change of therapy to trimethoprim/sulfamethoxazol (TMP-SMX) 960mg bid i.v. and Ciprofloxacin 400mg -750mg bid p.o. for 10 days and TMP-SMX 960mg bid p.o. and Ciprofloxacin 250mg or 500mg bid p.o. for further 20 days, complemented with i.v. Fluorcortolone and topical treatment. Vision was examined before and during, 1 and 6 months after acute PE. Results: Before cataract surgery visual acuity was