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BACKRGOUND: Appendicitis is the condition in which the appendix, a finger-length appendage located in the right lower quadrant (RLQ) of the abdomen, becomes inflamed due to a bacterial infection. Every year, nearly 300,000 cases of appendicitis are diagnosed at hospitals and clinics throughout the United States. In the U.S., the current standard of care for appendicitis is an appendectomy; surgery that completely removes the appendix from the body. Numerous studies in Europe, however, have demonstrated that antibiotics can be an equally safe and effective treatment for treating appendicitis. This clinical research study hypothesizes that antibiotics for intra-abdominal infections like appendicitis can be an effective treatment. METHODS: Patients that met eligibility were randomized to either antibiotic treatment or appendectomy treatment. If patients decided not to randomize, they had the option to join the Electronic Medical Record (EMR) cohort in which they could choose the treatment that they received. Patients in both cohorts were followed along via EMRs for the span of two years after initial treatment. Individuals who consented to the randomization group also received follow-up phone calls at specified points in time. RESULTS: A total of 374 patients were approached between March 2016 – March 2018. 100 patients consented to the randomization group and 118 patients elected into the EMR group. In the randomization group, 49 patients were randomized to appendectomy and 51 were randomized to antibiotic treatment. 21 patients in the antibiotic treatment group (41.1%) returned back to the hospital within two years of their index visit for an appendectomy. From the EMR cohort, 109 patients chose to receive appendectomies, and 9 patients received antibiotics. CONCLUSION: Treatment with antibiotics can serve as an alternative to surgery. However, due to the recurrence rate of 41% after two years, antibiotics should only be used as a means to delay permanent treatment. If a patient’s current situation is not immediately life-threatening, they should be granted the option to decide whether they would prefer to take antibiotics or elect into surgery. / 2021-06-14T00:00:00Z

The evolution of antibiotic resistance presents an escalating problem in the treatment of various infectious diseases worldwide. Although the origin of antibiotic resistance genes is not generally clearly documented, it has been thought that they evolved from specific genetic elements which eventually managed to spread to other microorganism of different strains and species through mobile genetics elements, transposons and plasmids. Extensively studying all aspects of these genes and their impact on the development of new treatments and drugs is of extreme importance. This study focuses on evolving and understanding how novel antibiotic resistance develops. Error prone PCR (EP-PCR) was used to introduce random mutation in an arr gene which confers high level resistance to rifampicin in E. coli. The clones obtained from EP-PCR were screened on different antibiotics with varying concentration in an attempt to isolate a clone with an increased minimum inhibitory concentration (MIC) as compared to the wild type parent strain (pBstN49). Several clones showed decreased levels of resistance against rifampicin but however none showed any significant increase in any of the other antibiotic MICs tested.

Background The use of prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) is recommended by all major international gastroenterological societies, especially in the presence of an obstructed biliary system. Their use is intended to decrease or eliminate the incidence of complications following the procedure, namely cholangitis, cholecystitis, septicaemia, and pancreatitis. Objectives To assess the benefits and harms of antibiotics before elective ERCP in patients without evidence of acute or chronic cholecystitis, or acute or chronic cholangitis, or severe acute pancreatitis. Data collection and analysis We audited South African endoscopists who perform ERCPs in the form of a questionnaire. The review was conducted according to the recommendations of The Cochrane Collaboration as well as the Cochrane Hepato-Biliary Group. Review Manager 5 was used employing fixed-effect and random-effects model meta-analyses. Only randomised clinical trials were included in the analyses, irrespective of blinding, language, or publication status. Participants were patients that underwent elective ERCP that were not on antibiotics, without evidence of acute or chronic cholecystitis, cholangitis, or severe acute pancreatitis before the procedure. We compared patients that received prophylactic antibiotics before the procedure with patients that were given placebo or no intervention before the procedure. Results The audit revealed that no specific protocols were being implemented in South Africa, and there was a marked difference in the practice between surgical and medical gastroenterologists, with surgeons using antibiotics more often. There was also a wide spectrum of antibiotic types and combinations being used. Nine randomised clinical trials (1573 patients) were included into the review analyses. The majority of the trials had risks of bias. When all patients providing data for a certain outcome were included, the fixed-effect meta-analyses significantly favoured the use of prophylactic antibiotics in preventing cholangitis (relative risk (RR) 0.54, 95% CI 0.33 to 0.91), septicaemia (RR 0.35, 95% CI 0.11 to 1.11), bacteriaemia (RR 0.50, 95% CI 0.33 to 0.78), and pancreatitis (RR 0.54, 95% CI 0.29 to 1.00). In random-effects meta- analyses, only the effect on bacteriaemia remained significant. Overall mortality was not reduced (RR 1.33, 95% CI 0.32 to 5.44). If one selects patients in whom the ERCP resolved the biliary obstruction at the first procedure, there seem to be no significant benefit in using prophylactic antibiotics to prevent cholangitis (RR 0.98, 95% CI 0.35 to 2.69, only three trials). Conclusions Prophylactic antibiotics reduce bacteriaemia and seem to prevent cholangitis and septicaemia in patients undergoing elective ERCP. In the subgroup of patients with uncomplicated ERCP, the effect of antibiotics may be less evident. Further research is required to determine whether antibiotics can be given during or after an ERCP if it becomes apparent that biliary obstruction cannot be relieved during that procedure.