Medical Forum / Diseases and Disorders / Sinusitis / April 2008
antibiotic alternative
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Debbie - 17 Mar 2008 23:58 GMT so I know how horrible it is to be on antibiotics long term...but what are the alternatives? I was on antibiotics (amoxicillin) continuously from Oct. 2006 to January 2007, and since then its been a variety will 2-3 weeks off at a time before the infections return. Now its a nebulizer (vaporizor) with vancomycin so at least its not systemic antibiotics, but it will still contribute to antibiotic resistant bacteria wont it?
any thoughts, recommendations, suggestions?
Steven L. - 18 Mar 2008 00:48 GMT > so I know how horrible it is to be on antibiotics long term...but what > are the alternatives? I was on antibiotics (amoxicillin) continuously [quoted text clipped - 5 lines] > > any thoughts, recommendations, suggestions? Have you had surgery yet?
 Signature Steven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me.
Susan - 18 Mar 2008 01:27 GMT > so I know how horrible it is to be on antibiotics long term...but what > are the alternatives? I was on antibiotics (amoxicillin) continuously [quoted text clipped - 5 lines] > > any thoughts, recommendations, suggestions? Anything you breathe in is going directly into your bloodstream systemically, without passing Go.
If it doesn't kill the buggers, it certainly will contribute to resistance.
Susan
truehawk - 18 Mar 2008 03:23 GMT > x-no-archive: yes > [quoted text clipped - 14 lines] > > Susan Honey
Go to pubmed.gov and type in "biofilm sinusitis", and read what you find there. Then type in "staph and fibrin" and read what you find. Finally type in "biofilm antibiotic sensitivity" and you will see 300 odd enteries come up, include "Calgary" in your search and you will come up with studies at the University of Calgary on antibiotic sensitivities for bacteria in a biofilm, vs the same bacteria in it's "Planktonic" or free swimming state.
Like the one below, and you will see that the bug does not have to be resistant to exhibit functional resistance because it has formed Voltron with a couple of millions of it's friends.
To deal with the legal niceties, I am an engineer, not a doctor, and as such I can only comment in terms of what works for me, and post articals, you have to take responsibility for doing some research for yourself. If you read the threads down list you will find a pretty good sample of things that have antibiotic and antibiofilm action, including canada balsam, tannins, prilosec, licorice, splenda, xylitol, St John's Wart, Sage, mustard, bismuth (pepto bismol), pineapple, coconut oil etc, and some anecdotal discriptions of their use. You will find that a great many of the items on the spice shelf are antibiotic.
All of these things work better if you do not swallow them but rather let them diffuse into your sinuses by holding them in your mouth, or use them as a sinus wash. With the exception of Advil, which you can only take if you have no allergy to asprin, most of these compounds work topically rather than systemically, so swallowing them will not do a lot of good getting them where they need to go.
Pecan tannin from the center membrane between the nutmeats of the pecan is the most effective thing for me, along with prilosec OTC. Michael uses penta tea. Evidently 4 bags of black, one of green, 1/8th teaspoon of salt, and (maybe) several bags of splenda to a cup of water, and reports it to be effective in slowly regaining area from the 'film. There are also several reports of very fine emulsions (nanometer size droplets) of soybean or olive oil being able to disrupt bacterial cell walls and detach biofilms. Maybe one day these emulsions will be marketed.
Biofilm bacteria: formation and comparative susceptibility to antibiotics. Olson ME, Ceri H, Morck DW, Buret AG, Read RR.
Department of Biological Sciences, University of Calgary, Alberta. molson@ucalgary.ca
The Calgary Biofilm Device (CBD) was used to form bacterial biofilms of selected veterinary gram-negative and gram-positive pathogenic bacteria from cattle, sheep, pigs, chicken, and turkeys. The minimum inhibitory concentration (MIC) and minimum biofilm eradication concentration (MBEC) of ampicillin, ceftiofur, cloxacillin, oxytetracycline, penicillin G, streptomycin, tetracycline, enrofloxacin, erythromycin, gentamicin, tilmicosin, and trimethoprim- sulfadoxine for gram-positive and -negative bacteria were determined. Bacterial biofilms were readily formed on the CBD under selected conditions. The biofilms consisted of micro-colonies encased in extracellular polysaccharide material. Biofilms composed of Arcanobacterium (Actinomyces) pyogenes, Staphylococcus aureus, Staphylococcus hyicus, Streptococcus agalactiae, Corynebacterium renale, or Corynebacterium pseudotuberculosis were not killed by the antibiotics tested but as planktonic bacteria they were sensitive at low concentrations. Biofilm and planktonic Streptococcus dysgalactiae and Streptococcus suis were sensitive to penicillin, ceftiofur, cloxacillin, ampicillin, and oxytetracycline. Planktonic Escherichia coli were sensitive to enrofloxacin, gentamicin, oxytetracycline and trimethoprim/ sulfadoxine. Enrofloxacin and gentamicin were the most effective antibiotics against E. coli growing as a biofilm. Salmonella spp. and Pseudomonas aeruginosa isolates growing as planktonic populations were sensitive to enrofloxacin, gentamicin, ampicillin, oxytetracycline, and trimethoprim/sulfadoxine, but as a biofilm, these bacteria were only sensitive to enrofloxacin. Planktonic and biofilm Pasteurella multocida and Mannheimia haemolytica had similar antibiotic sensitivity profiles and were sensitive to most of the antibiotics tested. The CBD provides a valuable new technology that can be used to select antibiotics that are able to kill bacteria growing as biofilms.
PMID: 11989739 [PubMed - indexed for
truehawk - 18 Mar 2008 04:51 GMT > > x-no-archive: yes > [quoted text clipped - 98 lines] > > PMID: 11989739 [PubMed - indexed for http://www.nanoposts.com/htmldata/8/2007_04/89_1.html
Anti-biofilm nanoemulsions
Nano-Emulsion Technology 1. Microemulsion Microemulsions are spontaneously forming, fluid, oil and water dispersions stabilized by a surfactant and typically a cosurfactant. The size of the nanodroplets in a microemulsion is typically in the range 10-100nm. To date microemulsions have found application in drug delivery, particle engineering, food and beverages and chemical synthesis. They believe that microemulsions offer an exciting (but as yet untested) alternative to disinfectants and biocides (e.g. formaldehyde, phenols and sodium hypochlorite) as agents both to prevent the formation of bioflims and to facilitate the formation of an anti-bacterial film. However there are only a few studies exploring the potential of microemulsion as an effective anti-microbial agent for use as an anti-biofilm agent for industrial and environmental applications. For example microemulsions containing ethyl oleate, Tween® 80 and n- pentanol have been shown to decrease the viability of the two cultures of bacterial cells, Pseudomonas aeruginosa ATCC 9027 and Staphylococcus aureus ATCC 6538, from 106 cell/mL to zero in a minute or a 5 log reduction in bacterial titre within 45 mins. The viability of biofilm culture of Pseudomonas aeruginosa PAO1 was reduced to 3 log- cycle after incubation for 4 hours. The effect of microemulsions on the bacteria was cytoplasmic membrane dysfunction and cell death. Recently TiO2 films have been prepared on stainless steel by dip- coating in a microemulsion containing a TiO2 solution. 2. Nanoemulsion Nanoemulsions, in common with microemulsions, are stable systems that contain small droplets (typically 100-300nm) of one immiscible phase in another but, unlike microemulsions, are formed by the input of a high amount of energy. The group believe that nanoemulsions (a relatively new tool in nanotechnology), like microemulsions, offer potential as anti-biofilm agents. For example the sporicidal and anti- microbial activities of nanoemulsion have been reported. The water-in- oil nanoemulsions used were made from soybean oil, tri-n-butyl phosphate, Triton X-100 and water. The average size of the nanodroplets was about 200-800 nm. A 3-log reduction in the bacterial count of most Gram-positive bacteria, Bacillus subtilis, Bacillus cereus and Streptococcus pneumonia, and some Gram-nagative bacteria, Haemophilus influenzae, Neisseria gonorrhoeae, and Vibrio cholerae, was observed after incubation of bacteria with 1% nanoemulsions5. The resistance of most Gram-negative bacteria (e.g. Escherichia coli, Salmonella typhimurium) was thought to be due to the repulsive interaction of nanoemulsions and the bacterial cell wall. Electron microscopy studies showed a disruption of the spore coat and cortex with distortion and loss of core components of Bacillus cereus after exposure to nanoemulsions diluted 1:100 in the growth medium for 4 hours. The in vivo toxicity and sporicidal activity test of nanoemulsions were done in CD-1 mice. The injection of nanoemulsions diluted 1:10 in normal saline showed no signs of inflammatory reaction. After injection of Bacillus cereus premixed with nanoemulsions, the mice did not develop edema, necrotic lesion or inflammation and the size of necrotic lesion was smaller than that in nanoemulsion-untreated mice. The mechanism of sporicidal activity is unclear but is thought to be mediated by Triton-X-100 and tri-n-butyl phosphate. Nanoemulsions have also been reported to exhibit anti-viral activity against some viruses, namely, Herpes simplex, influenza A, vaccinia and Ebola (strain Zaire) viruses after 15-minute treatment with 1% nanoemulsions by destroying the viral envelope. Additionally, nanoemulsions have been reported to decrease the growth rate of Candida albicans and yeast.
Edited by: Andy
Murray Grossan - 18 Mar 2008 07:29 GMT On 3/17/08 7:23 PM, in article c10c4a9f-bfa2-439a-93b8-45d370539445@2g2000hsn.googlegroups.com, "truehawk"
>> x-no-archive: yes >> [quoted text clipped - 98 lines] > > PMID: 11989739 [PubMed - indexed for I agree with Susan that antibiotic via nebulizer is absorbed into the blood stream esp via the lungs.
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Fred - 18 Mar 2008 17:36 GMT > On 3/17/08 7:23 PM, in article > c10c4a9f-bfa2-439a-93b8-45d370539...@2g2000hsn.googlegroups.com, "truehawk" [quoted text clipped - 109 lines] > > - Show quoted text - I finally got more relief when I used a nebulizer with Alubuterol. This helped fix the chronic bronchial tickle that was driving me crazy. Things really got better when I was able to open the sinuses so that I could sleep better and not have the chronic apnea problems. Fred
Michael - 22 Mar 2008 08:04 GMT > > On 3/17/08 7:23 PM, in article > > c10c4a9f-bfa2-439a-93b8-45d370539...@2g2000hsn.googlegroups.com, "truehawk" [quoted text clipped - 116 lines] > problems. > Fred " ... any thoughts,... ?"
For what it is worth, note the sentence immediately before the conclusion in the abstract below on eradication of biofilms:- "Ciprofloxacin and vancomycin were largely ineffective in attaining MIB90 concentrations within safe dosage ranges. "
In vitro activity of mupirocin on clinical isolates of staphylococcus aureus and its potential implications in chronic rhinosinusitis. Ha KR, Psaltis AJ, Butcher AR, Wormald PJ, Tan LW. Department of Surgery-Otorhinolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia. Laryngoscope. 2008 Mar;118(3):535-40.
BACKGROUND: It has been postulated that bacterial biofilms are involved in the pathogenesis of chronic rhinosinusitis (CRS). Biofilms present on sinus mucosa are difficult to eradicate with conventional antibiotic therapy and are thought to provide a nidus for recurrent infection. Topical delivery of antibiotics via nasal irrigation may present a way of delivering high concentrations of antibiofilm agents with potentially low systemic absorption and side effects. This study investigates the effectiveness of mupirocin and two other antibiotics, ciprofloxacin and vancomycin, on established in vitro biofilms of Staphylococcus aureus isolated from patients with CRS. METHODS: S. aureus American Type Culture Collection 25923 and 12 clinical isolates were investigated for their ability to form biofilms in an in vitro setting using a 96 well microtiter crystal violet (CV) plate assay and confocal scanning laser microscopy (CSLM). Antimicrobial susceptibility tests to determine minimum inhibitory concentrations were performed on planktonic and biofilm forming strains. In addition, established biofilms were subjected to the antimicrobial agents at a twofold dilution series. A CV analysis of biofilm mass was performed after 1 and 24 hours of treatment, and minimum biofilm inhibition concentrations at 50% (MIB50) and 90% (MIB90) biofilm inhibition were recorded. RESULTS: With use of a 96-well microtiter plate CV assay, 8 of the 12 clinical isolates formed mature biofilms after 8 days of culture. These results correlated with findings from CSLM analysis of in vitro biofilms grown on Permanox chamber slides. Increased antimicrobial resistance was observed in the biofilm isolates when compared with planktonic counterparts. Mupirocin was capable of reducing biofilm mass by greater than 90% at concentrations of 125 mug/ mL or less in all S. aureus isolates. Ciprofloxacin and vancomycin were largely ineffective in attaining MIB90 concentrations within safe dosage ranges. CONCLUSIONS: The topical application of mupirocin via nasal irrigation may be useful in eliminating S. aureus biofilms present on the sinus mucosa of patients with CRS and may offer an additional treatment to patients with recalcitrant sinusitis. PMID: 18090864 [PubMed - in process]
truehawk - 22 Mar 2008 19:23 GMT > > > On 3/17/08 7:23 PM, in article > > > c10c4a9f-bfa2-439a-93b8-45d370539...@2g2000hsn.googlegroups.com, "truehawk" [quoted text clipped - 165 lines] > additional treatment to patients with recalcitrant sinusitis. > PMID: 18090864 [PubMed - in process] I like it. It works well in one of the little pump spray bottles, so it can be applied over time several times a day, rather than irrigating with it twice a day and watching most of it go down the drain. It seems to last just fine in the fridge. The mupricin irrigation solution is unnecessarily expensive because it is presently compounded to order each time it is prescribed now. It is a $35 co pay for me and about $135.00 per 8 ozs. for the uninsured. That I do not like, but it should get less expensive if it becomes the treatment of record and they make it up in bulk. The really bad thing about this disease is that even if the cultures are positive for staph, (and there is only a 30% chance they will be) current medical protocal requires $5000.00 worth of testing to eliminate the possibility of sudden growth of an obstructive bone spur, allergy, immune dysfunction, and sinful living with the partridge in the pear tree before they end their fishing expedition and really prescribe antibiotics.
Any recognition that MOST CS is not due to a case of nasal poison ivy is a good thing.
truehawk - 22 Mar 2008 19:48 GMT > > > > On 3/17/08 7:23 PM, in article > > > > c10c4a9f-bfa2-439a-93b8-45d370539...@2g2000hsn.googlegroups.com, "truehawk" [quoted text clipped - 174 lines] > > read more » Also it looks like Debbie's ENT prescribed an antibiotic that is incapable of doing the job when others that are capable exist. So often "antibiotics" are discussed as a category with little regard to distinctions like which bacteria a given bacteria is effective against and which that preticular antibiotic does not cover.
Cayzle - 09 Apr 2008 19:22 GMT > > > > On 3/17/08 7:23 PM, in article > > > > c10c4a9f-bfa2-439a-93b8-45d370539...@2g2000hsn.googlegroups.com, "truehawk" [quoted text clipped - 176 lines] > > - Show quoted text - Does the mupirocin come in an RX solution or did you have to mix it up yourself? I've done that in the past, but now I understand that using topical Bactroban is not the same.
truehawk - 10 Apr 2008 00:14 GMT > > > > > On 3/17/08 7:23 PM, in article > > > > > c10c4a9f-bfa2-439a-93b8-45d370539...@2g2000hsn.googlegroups.com, "truehawk" [quoted text clipped - 180 lines] > yourself? I've done that in the past, but now I understand that using > topical Bactroban is not the same. It is an RX, but I don't think that it is really any different from what you might mix for yourself.
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