Effects of intervention measures on irrational antibiotics/antibacterial drug use in developing countries: A systematic review

Irrational antibiotics/antibacterial (AB) drug use is a global problem, especially in developing countries. This results in an increased emergence of resistance to most common bacteria, higher cost of treatment, prolonged hospitalization and adverse drug reactions. Interventions measures have been instituted to avert the problem but it still persists. A systematic review was conducted to determine the effect of different interventions (education, managerial, diagnostic tests, regulatory, economic and multifaceted) on misuse of AB drugs in developing countries. A total of 722 articles were retrieved and 55 were reviewed. About 10.9% of the studies were from Africa, 63.6% from Asia, 9.1% from Latin America, and 16.4% from Southeastern Europe. A total of 52.7% of the studies were from hospital settings, 5.5% from outpatient departments, 21.8% were from public health care facilities, 12.7% from private pharmacies/drug stores, and 7.3% from the communities. Education intervention had 27.3% studies, managerial had 20%, managerial/education had 3.6%, regulatory had 9.1%, education/regulation had 9.1% and diagnostic had 3.6% studies. Multifaceted intervention had 27.3% studies, with 63% improvement in appropriate AB doses prescribed, 2.6% mean number of AB encounter reduction, 23% AB prescription reduction, 18.3% generic AB prescription improvement, 32.1% reduction in AB use, 89% reduction in AB use in acute respiratory infection, 82% in surgery, 62.7% mean reduction in deliveries, 39% in STDs, 36.3% mean reduction in diarrhea, 14.6% mean reduction AB use in malaria, and 6%-11% in the cost of treating bacteria-resistant organisms. Also noted was 6.3% reductions in mean AB encounters after 1 month of intervention, and then increased to 7.7% after 3 months thus lacking sustainability. Multifaceted interventions were effective in reducing irrational AB drug use in the various health facilities and communities as well as reduction in the emergence of resistance to the commonest bacteria in the developing countries though there was lack of sustainability or continuity of rational drug use over the time.

Synergistic Effect of Metal Nanoparticles on the Antimicrobial Activities of Antibiotics against Biorecycling Microbes

Biorecycling microbes, which have critical functionalities in natural cycles, are essential to sustain eco-system of the earth. Any alterations in these cycles caused by the mutations of microbes could be a potential threat to life on earth. Antibiotics leached from pharmaceutical waste, animal food and agribusiness prod- ucts are accumulating in the environment. Metal nanoparticles are also accumulating in environment because of their extensive use as biocidal agent in domestic products. Interaction of antibiotics and metal nanoparticles with eco-ffiendly microorganisms has a potential to alter the ecosystem of the earth. In this article, we have studied the antibacterial activities of silver and copper nanoparticles and their for- mulations with antibiotics, tetracycline, and kanamycin against biorecycling microbes, Bacillus subtilis and Pseudomonas fluorescens. Strong synergistic effect of metal nanoparticles on the antimicrobial ac- tivities of commercial antibiotics has been observed. Antimicrobial activity of tetracycline improves by 286%-346% and 0%-28% when being tested in the presence of 250 ppm of silver and copper nanoparticles, respectively. For kanamycin, the improvement is 154%-289% for silver and 3%-20% for copper nanoparticles. Irrespective of the antibiotics and tested organisms, synergy is more prominent for silver nanoparticles even at their minimum active concentration （100 ppm）. This study demonstrates that the combination of metal nanoparticles with antibiotics could be more fatal to ecosystem than either the metal nanoparticles or the antibiotics alone.

Degradation of kanamycin from production wastewater with high-concentration organic matrices by hydrothermal treatment

It is known that many kinds of fermentative antibiotics can be removed by temperatureenhanced hydrolysis from production wastewater based on their easy-to-hydrolyze characteristics.However,a few aminoglycosides are hard to hydrolyze below 100℃ because of their stability expressed by high molecular energy gap(E).Herein,removal of hard-to-hydrolyze kanamycin residue from production wastewater by hydrothermal treatment at subcritical temperatures was investigated.The results showed the reaction temperature had a significant impact on kanamycin degradation.The degradation half-life(t1/2)was shortened by 87.17-fold when the hydrothermal treatment temperature was increased from 100℃ to 180℃.The t1/2 of kanamycin in the N2 process was extended by 1.08-1.34-fold compared to that of the corresponding air process at reaction temperatures of 140-180℃,indicating that the reactions during hydrothermal treatment process mainly include oxidation and hydrolysis.However,the contribution of hydrolysis was calculated as 75%-98%,which showed hydrolysis played a major role during the process,providing possibilities for the removal of kanamycin from production wastewaters with high-concentration organic matrices.Five transformation products with lower antibacterial activity than kanamycin were identified using UPLC-QTOF-MS analysis.More importantly,hydrothermal treatment could remove 97.9%of antibacterial activity(kanamycin EQ,1,109 mg/L)from actual production wastewater with CODCr around 100,000 mg/L.Furthermore,the methane production yield in anaerobic inhibition tests could be increased about 2.3 times by adopting the hydrothermal pretreatment.Therefore,it is concluded that hydrothermal treatment as a pretreatment technology is an efficient method for removing high-concentration hard-to-hydrolyze antibiotic residues from wastewater with high-concentration organic matrices.