A review on antibiotics induced nephrotoxicity

One of the common causes of acute kidney injury (AKI) is drug nephrotoxicity. AKIs around 20-60% in hospitalised patients are caused by drug-induced nephrotoxicity, which is also linked to higher morbidity and death both in children and adults. Antibiotics are one of the most frequently prescribed drug classes worldwide and, also one of the leading contributors to nephrotoxicity. Nephrotoxicity has been related to a wide range of antimicrobial medications, although the characteristics of kidney damage vary depending on the agent, the site of toxicity and the mechanism of injury within the renal. Acute tubular necrosis, acute interstitial nephritis, crystal nephropathy, and proximal/distal tubulopathy with electrolyte problems are the most frequent mechanisms. Pre-existing chronic renal disease and concurrent use of medications with nephrotoxic potential are two general risk factors for antimicrobial-induced AKI. The various types of antimicrobial-induced nephrotoxicity especially antibiotics will be discussed in this review and offer guidance on how to prevent AKI and recognize it early in order to reduce it and prevent morbidity

REVIEW ON CLINICALLY DEVELOPING ANTIBIOTICS

The world is running out of antibiotics. Between 1940 and 1962, more than 20 new classes of antibiotics were marketed. Since then, only two new classes of antibiotics were marketed. Now, not enough analogues are reaching the market to stem the tide of antibiotic resistance, particularly among gram-negative bacteria which indicates the need of novel antibiotics for their effective action. This review describes those antibiotics in late-stage clinical development. Most of them belong to existing antibiotic classes and a few with a narrow spectrum of activity are novel compounds directed against novel targets. The reasons for some of the past failures to find new molecules and a path forward to help attract investments to fund the discovery of new antibiotics are described

EXPERIMENTAL DESIGN APPROACH TO FABRICATE AND OPTIMIZE FLOATING TABLETS OF LEVOFLOXACIN FOR HELICOBACTER PYLORI INFECTION

Objective: To improve the treatment of H. pylori infection, by achieving the required bactericidal concentrations of antibiotics in the stomach, by delivering the antibiotics to the mucus layer and release the drug at the site of infection for a prolonged period would be significantly more effective than conventional dosage forms. Methods: The experimental method of the research was designed to prepare Levofloxacin floating by using Hydroxypropyl Methylcellulose (HPMC K4M), Hydroxypropyl Methylcellulose (HPMC K100M) and Xanthan gum by Three-level Box–Behnken design optimization method. The prepared tablets were evaluated for Thickness, Hardness, Friability, Weight variation, Swelling index (SI), Floating lag time (FLT) and Time required to release 90% of the drug from the tablet (T90%). Results: It was found that the Thickness-3.12±0.11 mm to 3.28±0.10 mm, Hardness-4.52±0.36 kg/cm2 to 4.81±0.24 kg/cm2, Friability-0.81±0.02g to 0.86±0.12g, Weight variation-480±1.90 mg to 523±0.89 mg, Swelling index (SI)-61.9±0.624% to 99.95±0.226%, Floating lag time (FLT)-81.12±0.63 s to 119.7±0.567 s and Time required to release 90% of the drug from the tablet (T90%)-7.0±0.55 h to 10.33±0.289 h. HPMC K100M and Xanthan gum showed good swelling as compared to HPMC K4M. The study revealed that HPMC K100M grade had a significant effect on drug release. Conclusion: The developed gastro-floating tablets can extend levofloxacin duration in the stomach and produce a prolonged release effect. The prepared levofloxacin floating tablet oral drug delivery system appears to be a promising choice for the efficient eradication of H. pylor

A Review of Repercussions of Lithium Amalgamated with Antipsychotics for the Remedy of Bipolar Disorder

Bipolar disorder is a brain illness that causes mood, energy, and ability to function variations. Bipolar illness patients have extreme emotional states that often occur over a period of days to weeks, referred to as mood episodes. Manic/hypomanic (abnormally cheerful or angry mood) or depressed (sad mood) mood episodes are classified. People with bipolar disorder frequently have periods of neutral mood. People with bipolar disorder can live long and productive lives if they are treated. The management of BD may be summarized into 2 phases, acute treatment and long-term prevention. Lithium was observed to have a unique therapeutic profile, including mood-stabilizing effects, as well as anti-suicidal and neuroprotective properties.13 It is available in many different salt forms, namely lithium carbonate, lithium citrate, lithium chloride, and lithium sulfate. A meta-analysis discovered that a combination regimen of haloperidol, olanzapine, risperidone, and quetiapine was substantially more effective in treating BD manic episodes than monotherapy with a mood stabiliser, but the combination regimen was less well tolerated than monotherapy. Keywords: Bipolar Disorder, Lithium, Monotherapy, Combination therapy, Adverse effects

Antibiotic choice for respiratory infection in pediatric

Respiratory infection (RTI) is one of the leading factors of death in children in India. In most countries, RTI is a common cause of hospitalisation in children under five years old. There are different guidelines for management of various type of RTI. Most of these, emphasis on use of antibiotics in specific sub type of RTI. While literatures recommend avoiding antibiotic in viral infections, they mostly suggest beta lactams as first line drugs. Depends on patients, amoxicillin remains drug of choice for most of out-patients. In case of hypersensitivity to penicillin, cephalosporin commonly will be substituent. If specific and atypical organism found, need to switch to other type such as macrolides. In this research, we aimed to briefly review current guidelines and literatures regarding antibiotic selection in paediatrics suffering from different type of respiratory tract infection

Steroids Induced Hyperglycemia: Its Effects and Management

Steroids are medications that have been widely utilized for a number of ailments, both acute and chronic. The action of endogenous steroids, nuclear hormones that penetrate cell membranes to bind to certain glucocorticoid receptors in the cytoplasm of target cells to form glucocorticoid-receptor (GR) complexes, is mimicked by synthetic glucocorticoids. The translocated activated GR complex regulates DNA transcription in the cell nucleus. The main factor for drug-induced hyperglycemia is steroids. They not only worsen hyperglycemia in those who already have diabetes mellitus (DM), but they can also lead to DM in people who've not previously experienced it. Their incidence can reach up to 46% of patients, and their glucose levels can rise by up to 68% over baseline. Steroid effects are often narrow and reversible. Drug-induced diabetes is supposed to go away as steroid doses are decreased because their impact on endocrine metabolism returns to normal; however, this is often not the case. The synthesis of lipolysis, proteolysis, and hepatic glucose is increased by glucocorticoids (GCs) because they act as a substrate for oxidative stress metabolism. A wide range of medical conditions has been treated with GCs. Although steroid-induced hyperglycemia has been proven to be medically effective, it is still a widespread and potentially dangerous issue that must be taken into consideration when administering any GC dose. The most common scenario requires the use of insulin, particularly when the serum glucose level is greater than 200 mg/dL. Keywords: Steroids, Glucocorticoids, Hyperglycemia, Resistance, Insuli

The New Outlook of Monoclonal Antibodies in Neutralizing Target Cells in COVID-19

Background: The deadly arrival of novel coronavirus (COVID-19) in late December 2019, caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has emerged worldwide causing a pandemic. The World Health Organization (WHO) has proved ineffectiveness against existing medications this influenced the prompt identification of Monoclonal antibodies (mAbs) which plays a vital role as the prophylactic application that helps in developing new interventions. Objectives: To study the effect of mAbs in high-risk individuals in treating COVID-19. Methodology: The recent studies related to the aim of the review were undertaken through a literature search to analyze the importance of mAbs in combating SARS-CoV-2. Results:  In several countries even though vaccines have reached the Emergency Use Authorization (EUA) people still rely on traditional medications. Besides repurposed drugs, recently many mAbs targeting S-protein of SARS-CoV-2 have been signed up for clinical trials. Currently, no specific neutralizing mAbs have been reported for SARS-CoV-2 and it may take several years for such antibodies to be readily available. The development of mAbs for preventing the SARS-CoV 2 infection is challenged by the threat of antibody-dependent enhancement, antibody-resistant against SARS-CoV-2 variants, acute respiratory infections, clinical trials and risk assessment, and inexplicable. The clinical trial data proved that there is no life-threatening Adverse Drug Reactions (ADR) occurred during mAbs therapy for COVID-19 patients. Conclusion: Establishing monoclonal antibodies will continue to be the best prophylactic application as it minimizes the risk of hospitalization in the high-risk individuals affected by SARS-CoV-2 infection. Keywords: COVID-19, Monoclonal antibodies (mAbs), Emergency Use Authorization (EUA), Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2

Tapentadol: Use and Abuse

Tapentadol is a synthetic opioid analgesic that has been on the market in India since 2011. According to international studies, there is a low danger of abuse and diversion. Prescription opioid pain reliever abuse remains a major public health concern. Tapentadol, a prescription painkiller, differs from opioids such as oxycodone and morphine in that it has two modes of action: opioid receptor agonism and norepinephrine reuptake inhibition. Tapentadol has been on the market in India for eight and a half years. Our center was the topic of a single peer-reviewed research in 2017 that detailed two instances of abuse. Tapentadol is less likely to be diverted, abused, addicted, overdosed, or sold on the street than other prescribed opioids. This article reviews uses, pharmacological properties and abuse of tapentadol as it is the most serious issues like addiction, seeking behavior, withdrawal, and physical dependency .The main challenge with tapentadol use is controlling the ratio of MOR agonist to NRI. Finally, tapentadol provides both nociceptive and neuropathic pain relief, but there are concerns about abuse and reliance. Keywords: Tapentadol, Abuse, Opioid, Addiction

How does Heparan Sulfate and COVID-19 Work?: An Overview

Globally, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) had infected over 3 million individuals and claimed many lives producing a global epidemic that necessitates the rapid development of therapeutic solutions. The ideal technique for quickly deploying well-characterized medicines against novel infections is known as drug repurposing. Several repurposable medicines are currently being tested to see if they may be used to treat COVID-19. Heparin, which is commonly utilized to reduce thrombotic events associated with COVID-19-induced disease, is one such promising drug. Heparansulphate is prevalently expressed in mammalian tissues. CoV-2 requires the helping cofactor heparansulphate (HS) on the cell surface: knocking down genes related in HS formation or treating cells with an HS mimic both prevent spike-mediated viral entrance. Heparin/HS binds directly to spike and promotes viral entrance by facilitating the attachment of spike-bearing viral particles to the cell surface. As documented with cell surface-bound heparansulphate, heparin binding to the open conformation of the spike structurally supports the state and may enhance ACE2 binding. Thus, heparansulphate could potentially be utilised to prevent SARS-CoV-2 transmission, based on available datas also consumption of heparansulphate during SARS-CoV-2 cellular entrance may play a role in the thrombotic events associated with COVID-19 infection. Furthermore, this study provides the findings on the mechanism(s) by which heparansulphate could slow the progression of SARS-CoV-2 infection. Keywords: COVID-19, HeparanSulphate, Spike Protien

A Review on Gullian Barre Syndrome and its Association with COVID 19

Guillain-Barré syndrome (GBS) is an immune-mediated disease that affects peripheral nerves and can lead to life-threatening consequences. It affects around 10000 people per year worldwide. Since the outbreak of acute respiratory syndrome coronavirus-2 (sar-cov-2) the incidence of GBS has been increased with a fatality rate of 4-7%. The exact association between the Sar-cov-2 and GBS is still unknown. GBS commonly presents after viral infections such as influenza virus, campylobacter jejuni, and zika virus. Clinical recognition of SC2-GBS is required in order to administer appropriate treatment on time and enhance the overall output of the infection. In most of the conditions patient was treated with intravenous immunoglobulins and outcome was seen within eight weeks of treatment. less outcome was seen in older age in line with previous findings for both GBS and COVID-19. Studies should be conducted to compare patients associated with GBS to those with concurrent non-COVID-19 GBS to see if the incidence of GBS is higher in those with COVID-19. Keywords: Guillian-Barre syndrome, COVID-19, SAR-COV