As micobactérias de crescimento rápido causam infecções pulmonares, infecções relacionadas a traumas cutâneos e aos cuidados com a saúde. Ha um número reduzido de opções terapêuticas para o tratamento dessas infecções e os dados nacionais sobre os determinantes genéticos dessa resistência são escassos. Duas classes de antimicrobianos importantes no tratamento são as fluorquinolonas e os macrolídeos. Enquanto a maioria dos isolados do Grupo M. chelonae-abscessus apresenta resistência intrínseca às fluorquinolonas, e são sensíveis aos macrolídeos, a maioria dos isolados do Grupo M. fortuitum é sensível às fluorquinolonas e expressa RNA-metilases que impedem a ação dos macrolídeos. Os determinantes da resistência às fluorquinolonas conhecidos em micobactérias são mutações no gene gyrA e para os macrolídeos é a expressão de genes erm, que codificam RNA-metilases. Nos dois casos os determinantes tem localização cromossômica. Outros determinantes de resistência podem ter localização plasmidial, a exemplo do gene aacA4\'-8, presente em plasmídio do grupo de incompatibilidade IncP, detectado em M. abscessus, que codifica resistência à kanamicina e tobramicina. Neste estudo foram avaliados: a correlação entre à susceptibilidade ao ciprofloxacino e moxifloxacino e presença de mutações nos genes gyrA e gyrB; a susceptibilidade à claritromicina e presença de genes que codificam RNA-metilases; a presença de plasmídios do grupo de incompatibilidade IncP em diferentes espécies de micobactérias; a estabilidade e a transferência por conjugação do plasmídio pBRA-100; a relação clonal entre isolados que albergam plasmídios IncP e o perfil de susceptibilidade antimicrobiana de uma coleção de isolados da espécie M. abscessus. Cento e vinte e dois isolados dos Grupos M. abscessus e M. fortuitum foram analisados quanto às concentrações inibitórias mínimas, por microdiluição, utilizando-se o painel RAPMYCO®. As sequências parciais dos genes gyrA e gyrB e a presença de genes que codificam RNA-metilases foram determinadas em 69 e 59 desses isolados, respectivamente. A presença de plasmídios do grupo IncP foi determinada por PCR e os produtos de amplificação tiveram suas sequencias caracterizadas. A estabilidade do plasmídio pBRA-100 em Escherichia coli TOP10® foi avaliada realizando-se repiques sucessivos por 57 dias e semeadura em agar LB contendo kanamicina. A transferência horizontal foi avaliada por ensaio de conjugação com E. coli J53 resistente à azida sódica. Em M. abscessus não houve diferença entre as sequencias da região QRDR de GyrA e GyrB entre isolados sensíveis e resistentes ao ciprofloxacino. Em M. abscessus subsp. abscessus e M. abscessus subsp. bolletii todos os isolados testados apresentaram genes erm; entretanto não foi observada correlação entre a presença dos genes e resistência indutiva a claritromicina. O gene erm(45), descrito neste trabalho, foi detectado apenas em M. abscessus subsp. bolletii. Os ensaios de microdiluição evidenciaram que os antimicrobianos mais ativos contra M. abscessus subsp. abscessus foram amicacina (89%), tigeciclina (96%) e claritromicina (86%). Apenas nos dois isolados da espécie M. fortuitum resistentes ao ciprofloxacino foi detectada a substituição S83W na proteína GyrA. Trata-se de substituição ainda não descrita em micobactérias. Nao foi observada correlação entre substituições em GyrB e resistência ao ciprofloxacino ou moxifloxacino. O gene erm(46), descrito neste estudo, foi detectado em 65% dos isolados. Nos demais isolados foram detectados três outros genes: erm(47), erm(48) e erm(49), ainda nao descritos. Os plasmídios IncP foram detectados apenas em \"M. massiliense\" pertencentes a três grupos clonais distintos com índice de similaridade maior que 92%, quando analisados por ERIC-PCR. Houve sucesso na conjugação entre E. coli TOP-Myco e E. coli J53. Os ensaios de estabilidade evidenciaram que o plasmídio pBRA-100 é estável em E. coli com aproximadamente 100% da população bacteriana albergando o plasmídio após 57 subcultivos. / The rapidly growing mycobacteria cause lung infections, skin infections related to trauma and health care associated infections. There are a limited number of therapeutic options for treating these infections and national data on the genetic determinants of this resistance are scarce. Two major classes of antimicrobials used in treatment of these infections are macrolides and fluoroquinolones. While the majority of the isolates from M. chelonae-abscessus Group have intrinsic resistance to fluoroquinolones, and are sensitive to macrolides, most isolates from M. fortuitum Group are sensitive to fluoroquinolones and express RNA methylases that prevent the action of macrolides. The known fluoroquinolones resistance determinants in to mycobacteria are mutations in thegyrA gene and for macrolides the main determinant is the expression of erm genes which encode RNA methylases. In both cases the determinants are located at the chromosome. Other resistance determinants may have a plasmidial location, such as aacA4\'-8 gene, present in the pBRA100 plasmid detected in M. abscessus, which encodes resistance to kanamycin and tobramycin. This study evaluated the correlation between the susceptibility to ciprofloxacin and moxifloxacin and mutations in genes gyrA and gyrB; susceptibility to clarithromycin and the presence of RNA-methylases encodinggenes , the presence of plasmids of the incompatibility group IncP in different species mycobacteria; stability and conjugal transfer of plasmid pBRA-100; the clonal relationship between isolates harboring plasmids IncP and antimicrobial susceptibility profile of a collection of isolates of M. abscessus. One hundred and twenty-two isolates of M. chenolae-abscessus and M. fortuitum Groups were analyzed for their minimal inhibitory concentrations by microdilution, using the RAPMYCO® Panel. The partial sequences of the genes gyrA and gyrB and the presence of genes encoding RNA methylases were determined in 69 and 59 isolates, respectively. The presence of IncP group plasmids was determined by PCR and the sequence of PCR products were characterized. The stability of the pBRA-100 plasmid in Escherichia coli TOP10® was evaluated by performing successive subcultures for 57 days, and plating on LB agar containing kanamycin. The horizontal transfer was evaluated by conjugation with E. coli J53 a sodium azide resistant strain. In M. abscessus no differences between the sequences of the QRDR region of gyrA or gyrB among isolates susceptible and resistant to ciprofloxacin were observed. In M. abscessus subsp. abscessus and M. abscessus subsp. bolletii all isolates tested had erm genes; however there was no correlation between the presence of these genes and inducible resistance to clarithromycin. The erm(45), gene described in this paper, was only detected in M. abscessus subsp. bolletii. Microdilution tests showed that the most active antibiotics against M. abscessus subsp. abscessus were amikacin (89%), tigecycline (96%) and clarithromycin (86%). In only in two M. fortuitum isolates resistant to ciprofloxacin the amino acid substitution S83W was detected in GyrA. This substitution had not been described mycobacteria. No correlation was observed between substitutions in GyrB and resistance to ciprofloxacin or moxifloxacin. The erm(46) gene described in this study, was detected in 65% of the isolates. In the remaining isolates other three not yet described genes were detected: erm(47), erm(48) and erm(49). IncP plasmids were detected only in \"M. massiliense\" belonging to three clonal groups with at similarity index greater than 92% when analyzed by ERIC-PCR.We succeeded in conjugating E. coli TOP-Myco and E. coli J53. The stability tests showed that the plasmid pBRA-100 is stable in E. coli since approximately 100% of the bacterial population harbored the plasmid after 57 subcultures.

Maintenance of a topological homeostasis by introduction and removal of the supercoils to relieve excessive strain on the DNA is a hallmark of topoisomerase function in the cell. The requirement of the topoisomerases during DNA transaction processes marks a ubiquitous presence of the enzymes in all the life forms. Different reactions carried out by the enzymes include relaxation of positive and negative supercoils required majorly during DNA replication and transcription, decatenation at the end of DNA replication to separate the daughter chromosomes and removal of lethal knots generated in the circular chromosome. In eubacteria, the enzymes introduce negative supercoils to facilitate easier strand separation for DNA transaction processes. However, in thermophiles, a different enzyme maintains the genome in a positively supercoiled form to protect from denaturation by excessive heat. These varied functions are carried out by different topoisomerases. Therefore, each organism maintains a minimum required set of the enzymes and the absence of a certain enzyme may be compensated for by topoisomerases with dual functions. For example, Mycobacterium tuberculosis and many other slow growing mycobacteria do not possess topoisomerase IV or its homologs. In these organisms, the DNA gyrase is suggested to carry out both negative supercoiling and decatenation reactions. Therefore, the mycobacterial DNA gyrase must be able to manage between both the functions in vivo. In contrast, Mycobacterium smegmatis and few other mycobacteria contain an additional type II topoisomerase which does not resemble any known type II enzyme but could catalyze relaxation and decatenation reactions. Importantly, the enzyme displays a unique ability to introduce limited positive supercoils and may have certain functions inside the cell which remains to be studied. Owing to the indispensability for bacterial survival topoisomerases present themselves as important drug targets. A large number of inhibitors have been found to inhibit the enzyme and thereby killing the bacterial. Among these, quinolones are successfully being used as broad spectrum antibacterial drugs. Although the commonly used quinolones inhibit many bacterial pathogens, a reduced susceptibility is exhibited by some of the pathogens e.g. Mycobacterium tuberculosis. To circumvent the lower efficacy of existing drugs, new and modified quinolones have been developed which are highly effective against mycobacteria. The difference in the susceptibility may be conferred by a difference in the chemical property of the drug and the interacting residues present in the enzyme. In the present thesis efforts have been made to understand the mechanism of the type II topoisomerases from mycobacteria and drug action on these enzymes. The thesis is divided into four chapters. In Chapter I of the thesis an introduction is provided on the topoisomerases, their classification and different reactions catalyzed by these enzymes. As the work in present thesis has been carried out with type II topoisomerases, introduction of type II enzymes, their structure and mechanisms is elaborated. DNA gyrase, its mechanism of reaction and in vitro and in vivo functions are explained in great detail. DNA gyrase and topoisomerase IV are targeted by a range of different inhibitors. These different classes of inhibitors and their mechanism of action are described. Finally, the mechanism of mycobacterial DNA gyrase with structural information and the current understanding of quinolone action on the enzyme are explained. The chapter ends with the objective of the study in the present thesis. In chapter II, the studies are aimed at understanding the molecular basis for decatenation carried out by mycobacterial DNA gyrase. Previous work from the laboratory showed that the enzyme can carry out decatenation more efficiently than its homolog from E. coli. It was shown that the mycobacterial enzyme binds two DNA molecules in trans in a length dependent manner. The ability to bind the second DNA is conferred upon the holoenzyme by ATPase subunit (GyrB) subunit which alone can bind DNA. Similar studies using topo IV from E. coli, the strongest known decatenase showed binding of two DNA molecules and the second DNA binding by ATPase (ParE) subunit. However, GyrB subunit from E. coli DNA gyrase, a weaker decatenase, does not bind second DNA molecule efficiently. The results provide a general mechanism for decatenation by type II enzymes in which efficient binding of second DNA is important. In Chapter III, studies have been carried out using topo NM, an atypical type II topoisomerase from Mycobacterium smegmatis. The enzyme has been characterized previously in the laboratory. In addition to efficient decatenation and relaxation, the enzyme exhibits a unique ability to introduce positive supercoils into the DNA. As demonstrated for the mycobacterial DNA gyrase and topo IV in the Chapter II, the ATPase subunit (Topo N) of topo NM, binds second DNA efficiently. The binding of both gate and transport segments increases with the length of the DNA. Binding of two DNA molecules by the holoenzyme appears to be a cumulative effect of DNA binding to individual subunits. In the absence of any inhibitor, the enzyme accumulates cleaved DNA products with shorter DNA but not with larger DNA. The cleavage of the shorter DNA is supported only in the presence of Mg2+ and Mn2+. Another important property of the enzyme is to introduce positive supercoils which appears to be due to its efficient utilization of ATP and a high rate of reaction. Chapter IV deals with the interaction of mycobacterial gyrase with fluoroquinolones (FQs). Although DNA gyrase is the sole target of the FQs in M. tuberculosis, the lower susceptibility to commonly used FQs have led to the studies to find out more effective quinolones. Previous studies from the laboratory showed a lower susceptibility of the mycobacterial gyrase to ciprofloxacin, but moxifloxacin could inhibit the enzyme efficiently. The better inhibition by moxifloxacin appears to be due to efficient trapping of the enzyme-DNA covalent complex. Both ciprofloxacin and moxifloxacin bind the DNA gyrase from mycobacteria, E. coli and E. coli topo IV, independent of DNA. The extent of binding also correlates with the inhibition potential of the drug against a given enzyme. A general model of quinolone enzyme interaction is provided wherein the quinolones are shown to interact with GyrA subunit or holoenzyme or the enzyme- DNA complex which would finally result in the trapping of the covalent complex.

The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study. A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season. A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin. In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study. A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season. A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin. In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015

I performed two randomised controlled trials (RCTs) to determine the best treatments for enteric fever in Kathmandu, Nepal, an area with a high proportion of nalidixic acid resistant S. Typhi and S. Paratyphi A isolates. I recruited 844 patients with suspected enteric fever to compare chloramphenicol versus gatifloxacin. 352 patients were culture confirmed. 14/175 patients treated with chloramphenicol and 12/177 patients treated with gatifloxacin experienced treatment failure (HR=0.86 (95% CI 0.40 to 1.86), p=0.70). The median times to fever clearance were 3.95 and 3.90 days, respectively (HR=1.06 [CI 0.86 to 1.32], p=0.59). The second RCT compared ofloxacin versus gatifloxacin and recruited 627 patients. Of the 170 patients infected with nalidixic acid resistant strains, the number of patients with treatment failure was 6/83 in the ofloxacin group and 5/87 in the gatifloxacin group (Hazard Ratio, HR=0.81, 95% CI 0.25 to 2.65; p=0.73); the median times to fever clearance were 4.7 and 3.3 days respectively (HR=1.59 [CI 1.16 to 2.18], p=0.004). I compared conventional blood culture against an electricity free culture approach. 66 of 304 patients with suspected enteric fever were positive for S. Typhi or S. Paratyphi A, 55 (85%) isolates were identified by the conventional blood culture and 60 (92%) isolates were identified by the experimental method. The percentages of positive and negative agreement for diagnosis of enteric fever were 90.9% and 96.0%, respectively. This electricity free blood culture system may have utility in resource-limited settings or potentially in disaster relief and refugee camps. I performed a literature review of RCTs of enteric fever which showed that trial design varied greatly. I was interested in the perspective of patients and what they regarded as cure. 1,481 patients were interviewed at the start of treatment, 860 (58%) reported that the resolution of fever would mean cure to them. At the completion of treatment, 877/1,448 (60.6%) reported that they felt cured when fever was completely gone. We suggest that fever clearance time is the best surrogate for clinical cure in patients with enteric fever and should be used as the primary outcome in future RCTs for the treatment of enteric fever.

Os tratamentos convencionais de efluentes em geral não são eficientes para a degradação de compostos persistentes como os fármacos. Neste trabalho, estuda-se o tratamento de soluções aquosas contendo o antibiótico ciprofloxacina (CIP) por meio de processo oxidativo avançado baseado em ozônio. Para tanto, foram realizados experimentos em semi-batelada com recirculação de líquido em um reator (coluna de bolhas) com escoamento gás-líquido em contracorrente. Amostras de líquido foram retiradas e analisadas para medida das concentrações de CIP e de carbono orgânico total (COT); a concentração de ozônio no gás foi medida por espectrofotometria UV-vis. Estudaram-se os efeitos das seguintes variáveis quanto à degradação de CIP, por meio de um planejamento Doehlert: concentração de ozônio à entrada do reator (8-25 mgO3 L-1), pH (3,5-10,5) e concentração inicial de CIP (5-26 mg L-1). Avaliaram-se as seguintes variáveis dependentes por meio da análise de superfícies de resposta: variação de concentração de CIP em 2 minutos; taxa inicial de degradação de CIP e variação de concentração de COT em 30 minutos. Os resultados indicaram total degradação de ciprofloxacina em menos de 15 minutos, tanto por via direta, com ataque por ozônio molecular em meio ácido, como por via indireta, com ataque por radicais hidroxila em meio básico. Os compostos resultantes da degradação da CIP mostraram-se recalcitrantes, obtendo-se maiores remoções de COT após 30 minutos apenas em meio básico ou neutro (máximo de 72,8% para pH=7, [O3]=24,9 mgO3 L-1 e [CIP]0=15,8 mg L-1). Apesar da persistência dos compostos orgânicos remanescentes, os ensaios respirométricos sugeriram que os produtos de degradação são menos tóxicos que o composto de partida, com menor inibição da atividade microbiana. No conjunto, os resultados do trabalho indicam que o processo de ozonização pode ser aplicado para pré-tratamento de efluentes aquosos contendo ciprofloxacina em baixas concentrações, podendo ser associado a processos de tratamento biológico em ETEs antes do descarte. / Conventional wastewater treatment processes are not generally efficient for the degradation of persistent substances like pharmaceutical compounds. In this work, the treatment of aqueous solutions containing the antibiotic ciprofloxacin (CIP) by means of the ozone-based advanced oxidation process is studied. With this aim, experiments were carried out in semi-batch mode with liquid circulation in a bubble column reactor with gas-liquid counter flow. Liquid samples were analyzed for CIP and total organic carbon (TOC) concentrations; ozone concentration in the gas was measured by UVvisible spectrophotometry. The effects of the following variables on CIP degradation were studied according to a Doehlert experimental design: inlet ozone concentration (8 to 25 mgO3 L-1), pH (3.5 to 10.5), initial CIP concentration (5 to 26 mg L-1). The following dependent variables were investigated by response surface analysis: variation in CIP concentration after 2 minutes; CIP initial degradation rate and variation in TOC concentration after 30 minutes. The results showed total degradation of ciprofloxacin in less than 15 minutes either by direct reaction with molecular ozone in acidic medium, or by indirect attack of hydroxyl radicals in alkaline medium. Compounds resulting from CIP degradation showed to be recalcitrant, yielding larger TOC removals after 30 minutes only in alkaline or neutral medium (maximum of 72.8% for pH=7, [O3]=24.9 mgO3 L-1, and [CIP]0=15.8 mg L-1). Despite the persistence of remaining organic compounds, respirometric assays suggested that degradation products are less toxic than the parent compound, exhibiting lower inhibition of microbial activity. Overall, the results indicate that the ozonation process can be used in the pre-treatment of aqueous effluents containing ciprofloxacin in low concentrations, and could be associated with biological treatment processes in wastewater treatment plants prior to final disposal.

Os tratamentos convencionais de efluentes em geral não são eficientes para a degradação de compostos persistentes como os fármacos. Neste trabalho, estuda-se o tratamento de soluções aquosas contendo o antibiótico ciprofloxacina (CIP) por meio de processo oxidativo avançado baseado em ozônio. Para tanto, foram realizados experimentos em semi-batelada com recirculação de líquido em um reator (coluna de bolhas) com escoamento gás-líquido em contracorrente. Amostras de líquido foram retiradas e analisadas para medida das concentrações de CIP e de carbono orgânico total (COT); a concentração de ozônio no gás foi medida por espectrofotometria UV-vis. Estudaram-se os efeitos das seguintes variáveis quanto à degradação de CIP, por meio de um planejamento Doehlert: concentração de ozônio à entrada do reator (8-25 mgO3 L-1), pH (3,5-10,5) e concentração inicial de CIP (5-26 mg L-1). Avaliaram-se as seguintes variáveis dependentes por meio da análise de superfícies de resposta: variação de concentração de CIP em 2 minutos; taxa inicial de degradação de CIP e variação de concentração de COT em 30 minutos. Os resultados indicaram total degradação de ciprofloxacina em menos de 15 minutos, tanto por via direta, com ataque por ozônio molecular em meio ácido, como por via indireta, com ataque por radicais hidroxila em meio básico. Os compostos resultantes da degradação da CIP mostraram-se recalcitrantes, obtendo-se maiores remoções de COT após 30 minutos apenas em meio básico ou neutro (máximo de 72,8% para pH=7, [O3]=24,9 mgO3 L-1 e [CIP]0=15,8 mg L-1). Apesar da persistência dos compostos orgânicos remanescentes, os ensaios respirométricos sugeriram que os produtos de degradação são menos tóxicos que o composto de partida, com menor inibição da atividade microbiana. No conjunto, os resultados do trabalho indicam que o processo de ozonização pode ser aplicado para pré-tratamento de efluentes aquosos contendo ciprofloxacina em baixas concentrações, podendo ser associado a processos de tratamento biológico em ETEs antes do descarte. / Conventional wastewater treatment processes are not generally efficient for the degradation of persistent substances like pharmaceutical compounds. In this work, the treatment of aqueous solutions containing the antibiotic ciprofloxacin (CIP) by means of the ozone-based advanced oxidation process is studied. With this aim, experiments were carried out in semi-batch mode with liquid circulation in a bubble column reactor with gas-liquid counter flow. Liquid samples were analyzed for CIP and total organic carbon (TOC) concentrations; ozone concentration in the gas was measured by UVvisible spectrophotometry. The effects of the following variables on CIP degradation were studied according to a Doehlert experimental design: inlet ozone concentration (8 to 25 mgO3 L-1), pH (3.5 to 10.5), initial CIP concentration (5 to 26 mg L-1). The following dependent variables were investigated by response surface analysis: variation in CIP concentration after 2 minutes; CIP initial degradation rate and variation in TOC concentration after 30 minutes. The results showed total degradation of ciprofloxacin in less than 15 minutes either by direct reaction with molecular ozone in acidic medium, or by indirect attack of hydroxyl radicals in alkaline medium. Compounds resulting from CIP degradation showed to be recalcitrant, yielding larger TOC removals after 30 minutes only in alkaline or neutral medium (maximum of 72.8% for pH=7, [O3]=24.9 mgO3 L-1, and [CIP]0=15.8 mg L-1). Despite the persistence of remaining organic compounds, respirometric assays suggested that degradation products are less toxic than the parent compound, exhibiting lower inhibition of microbial activity. Overall, the results indicate that the ozonation process can be used in the pre-treatment of aqueous effluents containing ciprofloxacin in low concentrations, and could be associated with biological treatment processes in wastewater treatment plants prior to final disposal.

[pt] As fluorquinolonas constituem uma importante classe de agentes antimicrobianos sintéticos utilizados clinicamente por mais de 30 anos. Além da atividade antibacteriana, algumas fluorquinolonas, assim como seus complexos metálicos, mostraram ter atividade citotóxica, sendo, portanto, promissores como agentes antitumorais. Neste trabalho, obtivemos complexos de Au(III), Cu(II) e Bi(III) com as seguintes fluorquinolonas: norfloxacina, levofloxacina e esparfloxacina. Esses novos complexos foram caracterizados por diversas técnicas, tais como: análise elementar, condutimetria, espectroscopia na região do infravermelho, ressonância paramagnética eletrônica (RPE), ressonância magnética nuclear (RMN) de 1H e 13C, espectroscopia UV-Vis, fluorescência estacionária e resolvida no tempo. Atividades biológicas foram realizadas para todos os complexos. Usualmente, as fluorquinolonas coordenam-se aos íons metálicos de modo bidentado, através da carbonila do ácido carboxílico e da carbonila cetônica. Esta coordenação foi confirmada para os complexos de Cu(II), entretanto, para os complexos de Au(III) e Bi(III), os resultados de infravermelho e do RMN de 1H e 13C mostraram que a coordenação foi feita através dos nitrogênios do anel piperazina, uma coordenação não encontrada usualmente para as fluorquinolonas. Os complexos de Au(III) mostraram ser ativos frente às linhagens tumorais A20 (Linfoma murino), B16-F10 (Melanoma murino) e K562 (Leucemia mielóide humana). Os complexos de Cu(II) mostraram significativa atividade antiparasitária, enquanto os complexos de Bi(III), mostraram atividade antibacteriana. / [en] The fluoroquinolones are an important class of synthetic antimicrobial agents clinically used for over 30 years. In addition to antibacterial activity, some fluoroquinolones, as well as their metal complexes, presented cytotoxic activity and are therefore promising as antitumor agents. In order to obtain new complexes of Au (III) and other metal ions that have biological activity, this work had the objective to synthesize new complexes using ligands of the group of fluoroquinolones. These new complexes were characterized by various techniques such as elemental analysis, conductometry, infrared spectroscopy, electron paramagnetic resonance (EPR), nuclear magnetic resonance (NMR) of 1H and 13C NMR, UV-Vis, stead state and time-resolved fluorimetry studies. Biological activities were analized for all complexes. Usually, the fluoroquinolones coordinate to the metal ions as bidentate through the carbonyl and carboxylic acid ketonic carbonyl group. This was confirmed Cu(II) complex, however, for Au(III) and Bi (III) complexes, the results of IR and 1H and 13C NMR showed that the coordination was trough the nitrogen using the piperazine ring, a coordination not usually found for fluoroquinolones. The complexes of Au(III) shown to be active against the A20 tumor cell lines (murine lymphoma), B16-F10 (murine melanoma) and K562 (human myeloid leukemia). Complexes of Cu(II) showed significant antiparasitic activity, whereas complexes of Bi(III) have shown antibacterial activity.

Tesis por compendio / [ES] Los procesos (foto-)Fenton fueron empleados para degradar fluoroquinolonas (FQ) (una clase de antibióticos sintéticos considerados CEC) como contaminantes modelo en diferentes condiciones: pH (3 - 8), concentración de contaminante (3 - 300 μM), número de FQ presentes (1, 3 y 5), y matrices de agua (agua ultrapura, salina y de WWTP simulada). Los experimentos se realizaron a escala banco y planta piloto, empleando luz solar (simulada y real) e irradiaciones con luz ultravioleta. Las velocidades de degradación de los contaminantes obtenidas con procesos tipo-Fenton se compararon con las análogas de fotólisis, fotocatálisis heterogénea y H2O2/UV. En igualdad de condiciones, solo a través del proceso foto-Fenton se logró una mineralización significativa de las FQs. En aquellos casos en los que el carbono orgánico total no mostró una disminución considerable, la razón se atribuye a la liberación de subproductos de oxidación. EEM-PARAFAC ha demostrado ser una técnica económica, veloz y que no requiere del uso de reactivos, para seguir simultáneamente la eliminación de la degradación de hasta 5 FQs fluorescentes presentes en una misma muestra, en presencia de interferencias sin calibrar, y obtener información sobre las posibles estructuras moleculares de los intermediarios de reacción. Los resultados indicaron que la fotólisis por sí sola no es capaz de producir cambios importantes en la estructura de las FQs, mientras que con (foto-)Fenton sí que se observó una notable disminución de los scores de los componentes PARAFAC asociados con los compuestos del tipo FQ. Los ensayos de zona de inhibición empleando E. coli mostraron que la actividad antibiótica disminuyó en paralelo con la desintegración de todos los componentes PARAFAC relacionados con las FQs y subproductos similares a estas. El otro aspecto importante de la tesis fue el uso de procesos Fenton basados en ZVI. Algunos CEC, como los compuestos nitroaromáticos, exhiben tasas de degradación lentas incluso cuando son degradadas por una AOP. El desarrollo de trenes de tratamiento ZVI para la degradación de contaminantes ha despertado un gran interés en los últimos años. Este enfoque consiste en un primer pretratamiento solo con ZVI (es decir, reducción, deshalogenación), seguido del proceso Fenton aprovechando los iones de hierro liberados en el primer paso. Con el fin de analizar las posibles ventajas e inconvenientes de esta estrategia en las aplicaciones de tratamiento de aguas residuales, se ha estudiado este enfoque empleando micropartículas de ZVI (mZVI) comerciales utilizando ácido p-nitrobenzoico (PNBA) como contaminante modelo. Se analizó el efecto de la cantidad inicial de mZVI, H2O2, pH, conductividad, aniones y oxígeno disuelto. Utilizando agua natural en condiciones aeróbicas, pH inicial 3,0, y adicionando 1,4 g/L de mZVI, se consiguió en 2 h una reducción del 83% de PNBA 6 μM en ácido p-aminobenzoico (PABA). Se investigó también la conveniencia de separar las mZVI después de la fase reductora (antes de la etapa Fenton) así como la reutilización de las mZVI. El paso de Fenton contra el PABA, más reactivo que PNBA, requirió 50 mg/L de H2O2 para lograr una eliminación de más del 96% en 15 min a pH 7,5 (pH final del pretratamiento reductivo). Las mZVI reutilizadas fueron efectivas por lo menos por un ciclo completo (reducción/oxidación). Este enfoque puede ser interesante para tratar aguas residuales que contienen contaminantes inicialmente resistentes al radical hidroxilo (HO), pero fácilmente reducibles, pudiendo disminuir su carga tóxica y aumentar su reactividad para un paso de oxidación posterior. / [CA] Fenton i foto-Fenton van ser emprats per a degradar fluoroquinolones (FQ) (una classe d'antibiòtics sintètics considerats CEC) com a contaminants model en diferents condicions: pH (3 - 8), concentració de contaminant (3 - 300 μM), nombre de FQ presents (1, 3 i 5), i matriu d'aigua (aigua ultrapura, salada i de WWTP simulada). Els experiments es van realitzar a escala de laboratori i planta pilot, emprant llum solar (simulada i real) i irradiacions amb llum ultraviolada. Les velocitats de degradació de contaminants obtingudes amb processos tipus-Fenton es van comparar amb fotòlisi, fotocatàlisi heterogènia i H2O2/UV. En igualtat de condicions, només a través del procés foto-Fenton es va aconseguir una mineralització significativa de FQ. En aquells casos en els quals el carboni orgànic total no va mostrar una disminució considerable, la raó s'atribueix a l'alliberament de subproductes d'oxidació. EEM-PARAFAC ha demostrat ser una tècnica econòmica, que no requereix de l'ús de reactius, i ràpida, per a seguir simultàniament l'eliminació de la degradació de fins a 5 FQ fluorescents presents en una mateixa mostra, en presència d'interferències sense calibrar, i obtindre informació sobre les possibles estructures moleculars dels intermediaris de reacció. Els resultats van indicar que la fotòlisi per si sola no és capaç de produir canvis importants en l'estructura de les FQ, mentre que amb (foto-)Fenton, sí que es va observar una notable disminució dels scores dels components PARAFAC associats amb el nucli de FQ. Els assajos de zona d'inhibició que empren E. coli van mostrar que l'activitat antibiòtica va disminuir en paral·lel amb la desintegració de tots els components PARAFAC relacionats amb FQ i subproductes similars a FQ. L'altre aspecte important de la tesi va ser l'ús de processos Fenton basats en ZVI. Alguns CEC, com els compostos nitroaromàtics, exhibeixen taxes de degradació lentes fins i tot quan són degradats per un AOP. El desenvolupament de trens de tractament basats en ZVI per a la degradació de contaminants ha despertat un gran interés en els últims anys. Aquesta aproximaciót consisteix en un primer pretractament amb ZVI (és a dir, reducció, deshalogenación), seguit del procés Fenton aprofitant els ions de ferro alliberats en el primer pas. Amb la finalitat d'analitzar els possibles avantatges i inconvenients d'aquesta estratègia en les aplicacions de tractament d'aigües residuals, s'han emprat micropartícules de ZVI (mZVI) comercials. Utilitzant àcid p-nitrobenzoic (PNBA) com a contaminant model, es va analitzar l'efecte de la quantitat inicial de mZVI, H2O2, pH, conductivitat, anions i oxigen dissolt. Utilitzant aigua natural en condicions aeròbiques, pH inicial 3,0, i addicionant 1,4 g/L de mZVI, es va aconseguir en 2 h una reducció del 83% de PNBA 6 μM a àcid p-aminobenzoic (PABA). Es va investigar també la conveniència d'eliminar les mZVI després de la fase reductora (abans de l'etapa Fenton) així com la reutilització de les mZVI. El pas de Fenton front el PABA, més reactiu que PNBA, va requerir 50 mg/L de H2O2 per a aconseguir una eliminació de més del 96% en 15 min a pH 7,5 (pH final del pretractament reductiu). Les mZVI reutilitzades van ser efectives almenys amb un cicle complet (reducció/oxidació). Aquest enfocament pot ser interessant per a tractar aigües residuals que contenen contaminants inicialment resistents al HO, però que es redueixen fàcilment, podent disminuir la seua càrrega tòxica i augmentar la seua reactivitat per a un pas d'oxidació posterior. / [EN] Dark Fenton and photo-Fenton were employed to degrade Fluoroquinolones (FQs) (a class of synthetic antibiotics considered CEC) as model pollutants under different conditions: pH (3 - 8), pollutant concentration (3 - 300 μM), number of present FQs (1, 3 and 5), and water matrix (ultra-pure, salty and simulated wastewater). Experiments were performed at bench and pilot plant scales, employing sunlight (simulated and real) and ultraviolet light irradiations. Obtained pollutant abatement rates with Fenton-related processes were compared with photolysis, heterogeneous photocatalysis and H2O2/UV. At equal conditions, only through photo-Fenton process significant FQs mineralization were achieved. In those cases where total organic carbon had not exhibit a considerable decrease, the reason was attributed to the release of oxidation by-products. Since FQs are fluorescent, we decided to employ fluorescence excitation-emission matrices (EEM) in combination with the chemometric tool, Parallel Factor Analysis (PARAFAC), to track their degradations. Although EEM-PARAFAC related studies are usually focused towards the characterization and monitoring of dissolved organic matter (DOM) in natural waters and wastewater effluents (work also included in this PhD Thesis following the DOM along the different stages of a drinking water plant), it is barely the first time that it is used for the purposes we have here proposed. The objective is demonstrating that EEM-PARAFAC could be a feasible complementary methodology for the study of fluorescent CECs degradations, avoiding the use of expensive and sophisticated techniques (e.g mass spectrometry), not always available. The other important aspect of the PhD Thesis was the use of ZVI-based Fenton processes. Some CECs such as nitroaromatic compounds, exhibit slow degradation rates even with AOPs. The development of new and more efficient ZVI treatment trains for pollutant degradation has been attracting great interest in the last few years. This approach consists of a first pre-treatment only with ZVI (i.e. reduction, dehalogenation), followed by a Fenton oxidation taking advantage of the released iron ions from the first step. In order to analyse the strategy's plausible advantages and potential drawbacks within wastewater treatment applications, reductive/oxidative treatment train based on commercial ZVI microparticles (mZVI) has been studied. The effect of the initial amount of mZVI, H2O2, pH, conductivity, anions, dissolved oxygen were analysed using p-nitrobenzoic acid (PNBA) as model pollutant. 83% reduction of PNBA 6 μM into p-aminobenzoic acid (PABA) was achieved in natural water at initial pH 3.0 and 1.4 g/L of mZVI under aerobic conditions in 2 h. An evaluation of the convenience of removing mZVI after the reductive phase (before the Fenton oxidation one) was investigated together with mZVI reusability. The Fenton step against the more reactive PABA required 50 mg/L of H2O2 to achieve more than 96% removal in 15 min at pH 7.5 (final pH from the pre-reductive step). At least one complete reuse cycle (reduction/oxidation) was obtained with the separated mZVI. This approach might be interesting to treat wastewater containing pollutants initially resistant to hydroxyl radical (HO), but easily reduced, being able to decrease its toxic load as well as increasing its reactivity for a subsequent oxidation step. / Sciscenko, IM. (2021). Emerging Photochemical Processes Involving Iron for Wastewater Treatment [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/177357 / TESIS / Compendio