Antimicrobial therapy for acute cholangitis: Tokyo Guidelines

Antimicrobial agents should be administered to all patients with suspected acute cholangitis as a priority as soon as possible. Bile cultures should be performed at the earliest opportunity. The important factors which should be considered in selecting antimicrobial therapy include the agent’s activity against potentially infecting bacteria, the severity of the cholangitis, the presence or absence of renal and hepatic diseases, the patient’s recent history of antimicrobial therapy, and any recent culture results, if available. Biliary penetration of the microbial agents should also be considered in the selection of antimicrobials, but activity against the infecting isolates is of greatest importance. If the causative organisms are identified, empirically chosen antimicrobial drugs should be replaced by narrower-spectrum antimicrobial agents, the most appropriate for the species and the site of the infection

Predikce odolnosti vůči fuzáriím DNA markery se zřetelem na kvalitu zrna ječmene

β-lactamase inhibitors are clinically proven to revitalize old β-lactam antibiotics by neutralizing bacterial β-lactamases. We call these compounds antibiotic resistance breakers (ARB). Unfortunately, bacteria express more than 1000 β-lactamases, of which the metallo-beta-lactamases are proving difficult to neutralize. Here, we describe other antibiotic resistant breakers, which are not yet in the clinic, but which potentially revitalize other classes of antibiotics. These include aminoglycoside-modifying enzyme inhibitors, efflux pump inhibitors, and compounds that are associated with increased permeability of the bacterial cell membrane. If it were possible to develop new ARB for many different classes of antibiotics, this approach could be a viable alternative to the more expensive single novel compound route that has been pursued for pyogenic bacterial infections