minocycline and Pressure-Ulcer

An ointment base for better treatment of bedsores was developed to improve the release rate of minocycline hydrochloride (MH) and the water absorption capacity using various types of hydrophobic to hydrophilic ointment bases. The effect of purified lanolin (PL) on the release behavior of MH from a hydrophilic ointment (HO) base was the primary focus. It was found that the drug release rate from the ointment base was modified according to the method of preparation of the ointment base and the type of cyclodextrins admixed. The physicochemical properties, such as viscosity, elution volume, and water absorption, of the ointment base were also modified by those factors. To develop an ointment formulation suitable for the recovery stages of bedsores, including the proliferation period of granulation and the formative period of epidermis, the physicochemical properties of Macrogol ointment containing various hydrophilic polymers, which have gel-forming ability, were tested. A novel ointment base suitable for the treatment in the recovery stage of bedsores was developed using hydrophobically modified hydroxypropyl methylcellulose (HM-HPMC). Considerably sustained release of MH (T50 of 170 at a min) was attained with a macrogol ointment mixed with HM-HPMC and Carbopol formulation ratio of 3:7. We clinically evaluated the effectiveness of bedsore treatment by applying different ointment bases to patients with different stages of bedsores.

Topics: Absorption; Acrylic Resins; Chemical Phenomena; Chemistry, Pharmaceutical; Chemistry, Physical; Controlled Clinical Trials as Topic; Cyclodextrins; Delayed-Action Preparations; Drug Design; Gels; Humans; Hypromellose Derivatives; Lanolin; Methylcellulose; Minocycline; Ointment Bases; Ointments; Polyethylene Glycols; Polyvinyls; Pressure Ulcer; Severity of Illness Index; Water

A novel ointment base suitable for the treatment of bedsore at the recovery stage was developed by the use of hydroxypropyl methylcellulose (HM-HPMC) modified on the basis of the hydrophobicity. A considerable sustained release of drug (minocycline hydrochloride) formulated to the ointment (T50 of 170 min) was attained with a macrogol ointment (MO) mixed with the HM-HPMC and Carbopol (CP) of the formulating ratio of 3:7. It was also found that a change in the formulating ratio of HM-HPMC and CP lead to a change in the drug release rate. The water absorption property of the ointment base, required to absorb on exudative solution in applying to the bedsore treatment, was as high as that of an ointment base containing hydroxypropyl cellulose (HPC) and CP reported in our previous paper. We clinically evaluated the effectiveness of the bedsore treatment, in which different ointment bases were applied to patients at different stages of the bedsore. A total of 22 cases were divided into two categories for applying to the different treatments. One category comprised of 11 subjects was treated with a povidone-iodine sugargel, which was the conventional method in our hospital, while the other 11 subjects were treated by the use of the newly developed ointment bases in consideration for the different stages of the bedsore. In comparison of the clinical results with the healing index, we ascertained that the latter method was significantly more efficacious (p < 0.01-0.05) than the conventional one. The effectiveness was emphasized in treating the intractable bedsore classified into the grades IV and V. Therefore, we confirmed that the newly developed ointment base formulation is useful in treating bedsore at each stage.

Topics: Acrylic Resins; Aged; Chemical Phenomena; Chemistry, Physical; Female; Gels; Humans; Hypromellose Derivatives; Male; Methylcellulose; Middle Aged; Minocycline; Ointment Bases; Ointments; Polyvinyls; Pressure Ulcer; Severity of Illness Index; Treatment Outcome

A case of coagulopathy in association with tigecycline use is described.. A 63-year-old morbidly obese, wheelchair-bound man was hospitalized for assessment of a possibly infected decubitus ulcer and surgical evaluation for placement of a diverting colostomy; he had been transferred from another facility after initiation of triple-agent antimicrobial therapy for suspected fecal infection of the ulcer. Based on the results of an ulcer swab culture, the patient's antibiotic regimen was modified (initially to i.v. ertapenem and then to tigecycline on hospital day 10). An International Normalized Ratio (INR) value obtained incidentally within days of tigecycline initiation was slightly elevated (1.2), but no workup was performed at that time. It was determined that the patient would benefit from a colostomy procedure, which was performed about three weeks later (he spent most of the intervening time at a rehabilitation facility, where i.v. tigecycline therapy was continued). During a routine preoperative workup, the patient's INR was found to be elevated (2.1). No identifiable causes for the INR elevation were noted, and the coagulopathy was treated successfully with fresh frozen plasma; the colostomy procedure was uncomplicated. Postoperatively, it was theorized that the development of coagulopathy in this case might have been secondary to tigecycline use. After discontinuation of tigecycline therapy and a switch to an alternative antimicrobial regimen, the patient's INR values normalized within a few days.. A patient with a possibly infected decubitus ulcer was treated with tigecycline and subsequently developed a coagulopathy.

Topics: Anti-Bacterial Agents; Blood Coagulation Disorders; Colostomy; Humans; International Normalized Ratio; Male; Middle Aged; Minocycline; Plasma; Pressure Ulcer; Tigecycline

Modification to find the best physicochemical properties of minocycline hydrochloride ointment for optimum treatment of bedsore was investigated by coformulating various types of cyclodextrins (CyD) in the ointment base. It was found that the drug release rate from the ointment base was modified according to the preparation method of ointment base and the type of CyD admixed. The physicochemical properties, such as viscosity, elution volume, water absorption of ointment base were also modified by those factors. The mechanism of physicochemical modification with CyD was explained by the structural change of ointment base and the change of surface tension of emulsifying agent solution with the CyD. The stability of ointment was investigated by confirming the reproducibility of drug release rate after storage at ambient and cooled temperature conditions. In conclusion, a fused mixed ointment with beta-CyD was found to be preferable for treatment of bedsore, because of the improved drug release rate, lowered viscosity and increased elution volume of the resultant ointment.

Topics: Absorption; Anti-Bacterial Agents; Chemical Phenomena; Chemistry, Physical; Cyclodextrins; Excipients; Minocycline; Ointment Bases; Ointments; Pressure Ulcer; Surface Tension; Viscosity

A desired ointment bases for better treatment of bedsores was developed to improve the release rate of minocycline hydrochloride (MH) and the water absorption capacity using various types of hydrophobic to hydrophilic ointment base. The influence of purified lanolin (PL) on the release behavior of MH from hydrophilic ointment (HO) base was primarily focused on. It was found that the release rate of drug increased with increase in the hydrophilicity of the base. A linear correlation between the apparent release rate constant of drug from the HO and PL mixed ointment base at various combination ratios and the elution of ointment base was noted. The HO ointment base containing 30% PL had the highest apparent release rate constant of MH. The mixed ointment base with the lowest viscosity showed the highest absorption of water and elution of ointment base. In conclusion, it was found that HO (70%) and PL (30%) mixed ointment base was a promising candidate for better treatment of bedsores.

Topics: Anti-Bacterial Agents; Diffusion; Lanolin; Minocycline; Ointment Bases; Ointments; Pressure Ulcer; Skin Absorption; Viscosity

Scattering Vitamin C of a small dose on a bedsore, enhances remarkably bactericidal effect of antibiotics. With scattering of it, 1% cream of Sulfadiazine made antibiotics-resistant bacteria (Methicillin-resistant Staphylococcus aureus = MRSA, Pseudomonas aeruginosa etc.) negative on a bedsore. Also in MRSA-infection of respiratory organs, combined administration of Vitamin C gives more effective bactericidal efficacy to some antibiotics. In a case infected with MRSA, of which the Minocycline-therapy had been ineffective, the combined administration of Vitamin C with Minocycline led him successfully to the negativeness of MRSA.

Topics: Administration, Oral; Administration, Topical; Aged; Aged, 80 and over; Ascorbic Acid; Drug Therapy, Combination; Female; Humans; Male; Methicillin Resistance; Minocycline; Pressure Ulcer; Respiratory Tract Infections; Staphylococcal Infections

We did a statistical study of 294 strains of Staphylococcus aureus (S. aureus) isolated from skin infections during the period from January of 1989 to December of 1991 in the Department of Dermatology, Kansai Medical University Hospital. We especially examined methicillin-resistant S. aureus (MRSA) from the point of view of incidence, variety of skin infections with MRSA, coagulase type, phase type, and resistance against antimicrobial agents. The frequency of isolation of MRSA has been increasing. In 1991, the proportion of MRSA isolates among all S. aureus strains isolated from skin infections was 41.5%. MRSA was isolated most often from infectious decubitus. Coagulase type II and phage group NT (not typable) MRSA were most frequently isolated. The resistance of MRSA to OFLX and IMP/CS had remarkably increased. Notably, the resistance to MINO was low before 1991.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteriophage Typing; Child; Cilastatin; Coagulase; Colony Count, Microbial; Drug Resistance, Microbial; Humans; Imipenem; Impetigo; Methicillin Resistance; Middle Aged; Minocycline; Ofloxacin; Pressure Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus