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      Synergistic antimicrobial effects of Cefabronchin ®

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          Abstract

          Antibiotic resistance of Streptococcus pneumoniae has risen to worrying levels in the past few decades worldwide, and subsequently, effective treatment of respiratory tract infections has become even more challenging. While the need to develop new strategies to combat bacterial infections is urgent, novel antibiotic compounds are no longer a priority of the pharmaceutical industry. However, resistance-modifying agents can alleviate the spread of antibiotic resistance and render existing antibiotics effective again. In the present study, we aimed to determine the combinatory antimicrobial effects of the commercial herbal product Cefabronchin ® and antibiotic compounds, such as amoxicillin and clarithromycin, on 6 clinical isolates of S. pneumoniae. Therefore, the minimal inhibitory concentration (MIC) of each agent before and after adding Cefabronchin ® at different concentrations was determined by applying the checkerboard method. Sub-inhibitory concentrations of the added Cefabronchin ® were found to reduce the MIC down to between 3.4% and 29.2% of the amoxicillin MIC and down to between 10.4% and 45.8% of the clarithromycin MIC in all 6 strains. In conclusion, this study provides evidence for the improved antimicrobial effects of commonly used antibiotics in combination with Cefabronchin ® in order to combat infections with antibiotic-resistant S. pneumoniae strains.

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          Most cited references34

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          Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

          It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.
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            Clinical and economic burden of community-acquired pneumonia among adults in Europe.

            It is difficult to determine the impact of community-acquired pneumonia (CAP) in Europe, because precise data are scarce. Mortality attributable to CAP varies widely between European countries and with the site of patient management. This review analysed the clinical and economic burden, aetiology and resistance patterns of CAP in European adults. All primary articles reporting studies in Europe published from January 1990 to December 2007 addressing the clinical and economic burden of CAP in adults were included. A total of 2606 records were used to identify primary studies. CAP incidence varied by country, age and gender, and was higher in individuals aged ≥65 years and in men. Streptococcus pneumoniae was the most common agent isolated. Mortality varied from <1% to 48% and was associated with advanced age, co-morbid conditions and CAP severity. Antibiotic resistance was seen in all pathogens associated with CAP. There was an increase in antibiotic-resistant strains, but resistance was not related to mortality. CAP was associated with high rates of hospitalisation and length of hospital stay. The review showed that the clinical and economic burden of CAP in Europe is high. CAP has considerable long-term effects on quality of life, and long-term prognosis is worse in patients with pneumococcal pneumonia.
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              Mechanisms of antibacterial action of three monoterpenes.

              In the present paper, we report the antimicrobial efficacy of three monoterpenes [linalyl acetate, (+)menthol, and thymol] against the gram-positive bacterium Staphylococcus aureus and the gram-negative bacterium Escherichia coli. For a better understanding of their mechanisms of action, the capability of these three monoterpenes to damage biomembranes was evaluated by monitoring the release, following exposure to the compounds under study, of the water-soluble fluorescent marker carboxyfluorescein from unilamellar vesicles with different lipidic compositions (phosphatidylcholine, phosphatidylcholine/phosphatidylserine [9:1], phosphatidylcholine/stearylamine [9:1], and phosphatidylglycerol/cardiolipin [9:1]). Furthermore, the interaction of the terpenes tested with dimyristoylphosphatidylcholine multilamellar vesicles as model membranes was monitored by means of differential scanning calorimetry. Finally, the results were related to the relative lipophilicity and water solubility of the compounds examined. Taken together, our findings lead us to speculate that the antimicrobial effect of (+)menthol, thymol, and linalyl acetate may result, at least partially, from a perturbation of the lipid fraction of microorganism plasma membrane, resulting in alterations of membrane permeability and in leakage of intracellular materials. Besides being related to physicochemical characteristics of the drugs (such as lipophilicity and water solubility), this effect seems to be dependent on lipid composition and net surface charge of microbial membranes. Furthermore, the drugs might cross the cell membranes, penetrating into the interior of the cell and interacting with intracellular sites critical for antibacterial activity.
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                Author and article information

                Journal
                1886
                European Journal of Microbiology and Immunology
                EuJMI
                Akadémiai Kiadó
                2062-8633
                September 2019
                : 9
                : 3
                : 100-104
                Affiliations
                [1 ]Institute of Pharmacy, Freie Universität Berlin , Berlin, Germany
                [2 ]Institute of Microbiology, Infectious Diseases and Immunology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin , and Berlin Institute of Health, Berlin, Germany
                Author notes
                [*]

                Author for correspondence: Charité - University Medicine Berlin, CC5, Department of Microbiology, Infectious Diseases and Immunology, Campus Benjamin Franklin, FEM, Garystr. 5, D-14195 Berlin, Germany; Phone: +49-30-450524318; E-mail: markus.heimesaat@ 123456charite.de .

                [†]

                These authors contributed equally.

                Article
                10.1556/1886.2019.00009
                bf39f30b-b4fc-49f6-a65b-821fc0b306f8
                © 2019 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes - if any - are indicated.

                History
                : 2 May 2019
                : 29 May 2019
                : 27 June 2019
                Page count
                Pages: 5
                Categories
                Original Research Paper

                Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                macrolide resistance, Streptococcus pneumoniae ,antibiotic resistance modifiers,natural products,β-lactam resistance

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