Academic literature on the topic 'Amoxicillin-clavulanic acid'

El objetivo de esta tesis ha sido estudiar y desarrollar metodologias analíticas
usando un sistema de inyección secuencial (SIA) con un espectrofotómetro de diodos en
fila para obtener datos de segundo orden. Para tratar estos datos, las herramientas
quimiométricas usadas han sido; resolución de curvas multivariante mediante mínimos
cuadrados alternados (MCR-ALS) y otras técnicas relacionadas a ésta como el análisis
de componentes principales (PCA) y SIMPLISMA. Además se han aplicado estrategias
de diseño de experimentos para obtener las condiciones experimentales óptimas. Esta
metodología se aplicó a la determinación de amoxicilina y ácido clavulánico en
medicamentos.
El primer capítulo de la tesis contiene una descripción de la amoxicilina y del ácido
clavulánico, una explicación de los fundamentos teóricos tanto del sistema instrumental
como de las herramientas quimiométricas usadas y por último, se describen los diseños
de experimentos usados y la función de deseabilidad.
En los dos siguientes capítulos, se muestran en forma de artículos científicos los
trabajos experimentales realizados. En un primer artículo, se realizó una clasificación de
los medicamentos dependiendo si se tenían interferentes o no, para posteriormente
proponer el tipo de calibrado. Un paso previo a la diferenciación de los medicamentos,
fue buscar una secuencia analítica que permitiera obtener un sistema en evolución. Esta
etapa se llevó a cabo mediante un diseño de experimentos.
En el segundo artículo, se determinó la cantidad de amoxicilina en los
medicamentos que tenían interferentes y además no tenían zonas selectivas. Para llevar
a cabo de forma correcta la etapa de calibración se realizó un estudio de una serie de
parámetros asociados a MCR-ALS. En un tercer artículo se realizó la determinación
simultánea del ácido clavulánico y de la amoxicilina que poseían unas características
ácido-base y una sensibilidad espectral similar. Por tal de determinar simultáneamente
ambos analitos se rediseñó todo el experimental. En el cuarto artículo se hizo una
revisión bibliográfica de ambas técnicas a partir del año 2004 y se discutió el potencial de
usar un sistema de inyección secuencial para generar datos de segundo orden.
Con la experimentación realizada se comprobó que el paso clave en estas
metodologias era obtener una buen sistema en evolución, es decir diseñar una buena
secuencia analítica. Por lo que se profundizó en estrategias basadas en diseños de
experimentos. En el quinto artículo, se estudiaron qué factores podían afectar a la
secuencia analítica. También se propusieron respuestas que representaran de una forma
cuantitativa una buena resolución. Se realizó un diseño Plackett-Burman con el objetivo
de eliminar los factores no relevantes, para posteriormente modelar una superficie de
respuesta a partir de los factores relevantes que permite visualizar las condiciones
óptimas de la secuencia analítica.
El inconveniente de utilizar la metodología de superficie de respuesta es que en
los casos donde el número de factores relevantes sea superior a 3 o 4, el número de
experiencias aumenta considerablemente. En estos casos, una técnica alternativa es
simplex que dio lugar a un sexto artículo.
El último capítulo de la tesis contiene las conclusiones. Como una conclusión
general, se puede decir que la combinación de un sistema de inyección secuencial (SIA)
y una herramienta quimiométrica como la resolución de curvas multivariante mediante
mínimos cuadrados alternados (MCR-ALS) puede ser usado tanto para realizar un
análisis cualitativo y cuantitativo ya que proporciona información de los perfiles de
concentración y perfiles espectrales de las diferentes especies a estudio.
The objective of this thesis is to study and develop analytical methods to determine
amoxicillin and clavulanic acid in pharmaceuticals using sequential injection analysis (SIA)
with a diode-array spectrophotometric detector to obtain second-order data. To treat these
data, the chemometric tool used was; multivariate curve resolution with alternating least
squares (MCR-ALS) and the techniques involved in the resolution process are: principal
analysis components (PCA) and simple-to-use interactive self-modelling mixture analysis
(SIMPLISMA).
The first chapter contains a brief description of the theoretical backgrounds that
have been used during this thesis. We explain the characteristics and properties of
amoxicillin and clavulanic acid, we describes the instrumental and the chemometric tools
used and at the end, we introduce the experimental designs used and the desirability
function.
In the next two chapters contain the bulk of the work carried out for this thesis and
incorporate papers published in journals. In the first paper, the pharmaceuticals were
classified according to their selective zones in order to propose the type of calibration. In a
previous step, the experimental work was conducted to find an analytical sequence that
allows us to obtain an evolving system. This step was carried out using experimental
design. In the second paper, the quantity of amoxicillin in the pharmaceuticals with
interferents or without selective zones was determined. To carry out correctly the
calibration step, we studied different conditions related to the MCR-ALS process.
In the third paper, we propose the simultaneous determination of amoxicillin and
clavulanic acid which they have the acid-base characteristics and spectral profile similar.
To determine both analytes, a new analytical sequence was redesigned. In the fourth
paper, we describe the state of the art of sequential injection analysis (SIA) and
multivariate curve resolution with alternating least squares (MCR-ALS) by reviewing the
bibliography since 2004. We discuss the potential of SIA for generating second-order
data.
In previous papers, we found that the most critical step in the development of
analytical methods based on SIA and MCR-ALS was to obtain an analytical sequence that
provides an evolving system. To resolve so, we developed the method of experimental
design to obtain the optimal analytical sequence.
In the forth paper, we studied all the factors and analysed how they affect to the
analytical sequence. We also proposed responses to quantitatively represent a good
resolution. Once these factors and responses were proposed, we used a Plackett-Burman
design to remove the non-relevant factors and then modelled a response surface. In the
maximum of response surface, the optimum conditions for the analytical sequence could
be visualised. To transform several responses into a single response, we used the overall
desirability function. In the sixth paper, we applied an alternative optimisation method
knows as the simplex approach. We aimed to determine amoxicillin and clavulanic acid
simultaneously when the number of factors and responses was higher than in the
previous paper.
The last chapter contains the conclusions of the thesis. In general, we conclude
that a combined sequential injection analysis (SIA) with a multivariate detector (i.e. diode
array spectrophotometer) and multivariate curve resolution with alternating least squares
(MCR-ALS) can be used for both qualitative and quantitative analyses since, it provides
concentration and spectra profiles for the different species of the sample.

Dissertação de Mestrado Integrado em Medicina Veterinária
Urinary tract Infections accounts for major use of antimicrobials in veterinary medicine. Nevertheless, its overuse has led to the emergence of antimicrobial resistance and subsequent absence of effective antibiotics. Hence, new therapeutic approaches are required. A promising strategies is the encapsulation of currently available antibiotics in liposomes. The present study was undertaken to evaluate the in vitro antimicrobial activity of free and liposome-encapsulated ceftriaxone and amoxicillin and clavulanic acid, against 14 clinical isolates of companion animals with urinary tract infections. Their antimicrobial activity was measured by means of minimum inhibitory concentration determination, through the broth microdilutions method, whereas the assessment of the bacterial growth was achieved by a colorimetric method. Ceftriaxone and amoxicillin and clavulanic acid were successfully encapsulated in the liposome. However, the minimum inhibitory concentration values of the liposome-encapsulated ceftriaxone were 4 to 16 times higher than those of the corresponding free antibiotic, against the E. coli and K. pneumoniae isolates. This result was probably due to a low liposome-bacterium interaction. The liposome-encapsulated amoxicillin and clavulanic acid didn’t show antibacterial activity and none of the studied liposomal forms exhibited antibacterial activity against the P. aeruginosa isolates owing to its high bacterial resistance. Overall, the liposomal encapsulation of the antibiotics didn’t enhance the in vitro antibacterial activity when compared to the existing drug. Nevertheless, it showed antibacterial potential, suggesting that for further investigation the extent of the interaction with the bacteria should be improved through the variation of the physicochemical properties of the liposome.
RESUMO - Atividade antimicrobiana in vitro da ceftriaxona e da associação amoxicilina-ácido clavulânico encapsulados em lipossomas contra isolados clínicos de animais de companhia com infeções do trato urinário - Em medicina veterinária, as infeções do trato urinário são responsáveis por um uso significativo de antimicrobianos. No entanto, o uso excessivo conduziu ao aparecimento de resistência antimicrobiana e subsequente limitação de antibióticos eficazes, pelo que são necessárias novas abordagens terapêuticas. Uma das estratégias mais promissoras é o encapsulamento em lipossomas de antibióticos atualmente disponíveis. Neste estudo, a atividade antimicrobiana in vitro da ceftriaxona e da associação amoxicilina-ácido clavulânico na forma livre e encapsulados em lipossomas, foi avaliada em 14 estripes clínicas isoladas de animais de companhia com infeções do trato urinário. A atividade antimicrobiana foi estimada pela determinação da concentração inibitória mínima, através do método da microdiluição. O crescimento bacteriano foi avaliado utilizando um método colorimétrico. A ceftriaxona e a associação amoxicilina-ácido clavulânico foram encapsulados com sucesso no lipossoma. Contudo, os valores da concentração inibitória mínima da ceftriaxona liposomal foram 4 a 16 vezes superiores aos valores do antibiótico livre correspondente contra as estirpes de E. coli e K. pneumoniae. Este resultado é, possivelmente, fundamentado por uma baixa interação entre a bactéria e o lipossoma. A associação amoxicilina-ácido clavulânico não apresentou atividade antimicrobiana e nenhuma das formas lipossomais demonstrou atividade antimicrobiana contra as estirpes de P. aeruginosa devido à sua elevada resistência. Em suma, o encapsulamento da ceftriaxona e da associação amoxicilina-ácido clavulânico em lipossomas não melhorou a atividade antimicrobiana in vitro, quando comparado à forma livre. No entanto, mostrou potencial antibacteriano. Desta forma, para estudos futuros, a extensão da interação com a bactéria deve ser aumentada através da variação das propriedades físico-químicas do lipossoma.
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Objetivos Describir los datos de consumo de macrólidos y amoxicilina/clavulánico, suministrados por International Marketing Services (IMS), un proveedor comercial de datos de medicamentos durante el período 2007-2010 en los sectores ambulatorio y hospitalario en 10 países europeos. Determinar si, algunos cambios en estos patrones de consumo, se podrían correlacionar con algunas variables demográficas, económicas y socioculturales. Métodos Investigamos el consumo de macrólidos J01FA y amoxicilina/clavulánico J01CR02, en los sectores ambulatorio y hospitalario de 10 países europeos (Alemania, Dinamarca, España, Francia, Italia, Noruega, Países Bajos, Polonia, Reino Unido y Suecia). Los datos fueron proporcionados por IMS Health extraídos de la base de datos Multinational Integrated Data Analysis System (MIDAS). El volumen de consumo se expresa en DDD / 1.000 habitantes / día (DHD). Todos los análisis se realizaron en Excel 2007®. Los datos de consumo se correlacionaron mediante el paquete estadístico "Data Analysis and Statistical Software” (STATA) con variables demográficas: distribución de la población por edad y sexo, económicas: producto interior bruto (PIB), paridad del poder adquisitivo (PPA) per cápita, gasto total en salud como porcentaje del PIB nacional y socioculturales: puntuación de las dimensiones culturales de Hofstede (distancia al poder, individualismo, masculinidad , control de la incertidumbre, orientación a largo plazo e indulgencia) en los diferentes países estudiados. Resultados Para los macrólidos, el consumo global osciló en 2010 de 0,33 DHD en Suecia hasta 5,14 DHD en Italia. Para amoxicilina/clavulánico, el consumo osciló en 2010 de 0,30 DHD en Suecia hasta 11,95 DHD en España. Durante los 4 años de estudio, el consumo de macrólidos disminuyó ligeramente en la mayoría de los países, con excepción de Alemania, Italia y el Reino Unido. Para amoxicilina/clavulánico se observó una tendencia opuesta en 9 de 10 países. Hubo aumento en el consumo de amoxicilina/clavulánico, excepto en España que mostró un ligero descenso, y en Suecia donde se mantuvo estable en 2007 y 2010. Respecto a las correlaciones con variables demográficas se encontró correlación positiva del consumo de ambos grupos de antibióticos estudiados respecto a la proporción de mujeres expresada como ratio de género. Igualmente el consumo de ambos grupos de antibióticos se correlacionó de forma negativa con la variable económica PPA per cápita. En cuanto a las dimensiones culturales de Hofstede, respecto al consumo de amoxicilina/ ácido clavulánico se observaron correlaciones positivas estadísticamente significativas con la distancia al poder y la aversión a la incertidumbre, y negativas con la indulgencia. En cuanto al consumo de macrólidos este se correlacionó de forma positiva con la dimensión cultural masculinidad y de forma negativa con la indulgencia. Conclusiones La aplicación de la metodología ATC/DDD en el contexto de la utilización de medicamentos ambulatorios y hospitalarios permite realizar comparaciones de los dos escenarios de salud y entre diferentes países. El principal consumo de J01FA y J01CR02 es en el ámbito ambulatorio. Los datos de IMS Health ofrecen información útil sobre el consumo de medicamentos y ventas a nivel nacional de los antibióticos estudiados. Los resultados del presente estudio muestran que existe una alta variabilidad en el consumo de macrólidos y amoxicilina/clavulánico en los sectores ambulatorio y hospitalario entre los países analizados. Esta heterogeneidad significativa sugiere diferencias importantes en los hábitos de prescripción. Nuestros hallazgos de correlaciones, sugieren que el estudio de diferentes determinantes de la prescripción de antibióticos en los diferentes países europeos podrían ser en cierta medida controlados o influenciados como medidas de salud con una perspectiva colectiva. Se justifica más investigación para comprender mejor el complejo efecto de las dimensiones culturales en el contexto del consumo de antibióticos.
Objectives Describe the consumption data of macrolides and amoxicillin/clavulanic, supplied by International Marketing Services (IMS), a commercial drug data provider during 2007-2010 in the outpatient - inpatient healthcare sector in 10 European countries. Determine if changes in consumption patterns could be correlated with some demographic, economic and socio-cultural variables. Methods We investigated macrolides and amoxicillin/clavulanic acid out- and inpatient consumption, for 10 European countries (Germany, Denmark, Spain, France, Italy, Norway, Poland United Kingdom and Sweden). Data were provided by IMS Health extracted from Multinational Integrated Data Analysis System (MIDAS) database. The volume of consumption is expressed in DDD/1000 inhabitants/day (DID). All analyses were conducted in Excel 2007®. The "Data Analysis and Statistical Software” (STATA) statistical package was used to correlate consumption data with demographic variables: distribution of population by age and sex, economics: gross domestic product (GDP), purchasing power parity (PPP) per capita, total health expenditure as percentage of national GDP, cultural dimensions: Hofstede's scores (power distance, individualism, masculinity, uncertainty avoidance, long-term orientation and indulgence) for the different countries studied. Results For macrolides, total consumption ranged in 2010 from 0.33 DID in Sweden up to 5.14 DID in Italy. For amoxicillin/clavulanic acid, the consumption ranged in 2010 from 0.30 DID in Sweden up to 11.95 DHD in Spain. Over the 4 years of study, the consumption of macrolides slightly decreased in the majority of countries, except Germany, Italy and United Kingdom. For amoxicillin/clavulanic acid, an opposite trend was observed in 9 out of 10 countries. There was an increased amoxicillin/clavulanic acid consumption, except in Spain that showed a slightly decrease, and in Sweden that remained stable for 2007 and 2010. Regarding the correlations, demographic variables, consumption of two groups of antibiotics studied was found positively correlated with the proportion of women expressed as gender ratio. Likewise, the consumption of antibiotics in both groups correlated negatively with the economic variable PPP per capita. As for Hofstede’s cultural dimensions, regarding the consumption of amoxicillin/clavulanic acid, statistically significant positive correlation with power distance and uncertainty avoidance was observed, negative correlation with indulgence was found. In terms of consumption of macrolides this was correlated positively with the cultural dimension of masculinity and negatively with indulgence. Conclusions The application of the ATC / DDD methodology in the context of the use of inpatient and outpatient drugs allows for comparisons of the two health settings and among different countries. The main consumption of J01CR02 and J01FA is in the outpatient setting. IMS Health data provide useful information on the consumption of drugs and nationwide sales of the studied antibiotics. The results from the present study show that there is a high variability in the consumption of macrolides and amoxicillin/clavulanic acid among the analyzed countries in the outpatient and inpatient setting. This significant heterogeneity suggests important differences in prescription habits. Our findings of correlations suggest that the study of different determinants of antibiotic prescription in various European countries may to some extent be controlled or influenced as health measures with a collective perspective. More research to better understand the complex effect of cultural dimensions in the context of the use of antibiotics is justified.

This thesis describes a novel "Tablet-in-a-Bottle" oral suspension formulation. Ingredients with unstable physical or chemical characteristics can be placed in a core tablet, and then dry compression coated with an outer layer which provides separation from other components. The new suspension formulation comprises fast disintegrating clavulanic acid (KCA) tablets with a powder mixture containing amoxicillin. Hardness, friability, flow properties and weight uniformity of tablets for three different formulations were investigated and were all improved in a third formulation. Stability tests under different humidities were conducted. Amoxicillin and clavulanic acid in the new formulations showed the same stabilities when compared with the marketed product Augmentin��. Preliminary pharmacokinetics and bioavailability of one new formulation were evaluated by comparing in vitro release rates and in vivo urinary excretion rates. In vitro dissolution studies were carried out according to the USP XXIII paddle method. The new formulation showed faster release rates during the first hour when stirring speed was 25 rpm. However, when 75 rpm stirring speed was applied, the dissolution profiles for the new formulation and the reference marketed product were identical. A randomized two-way crossover bioequivalence study was designed to evaluate the bioavailabilities. Cmax, Tmax and AUC[subscript o--->t] of amoxicillin were within ��20% of the reference pharmacokinetic values. However, Cmax and Tmax of clavulanate were not within ��20%. Bioeqivalence between this new suspension formulation and the marketed product (Augmentin��) were evaluated using a two one-sided t-test. There is not sufficient statistical support with this test to conclude that the two products are bioequivalent. However, this is most likely due to small sample size and high intersubject variation and statistical support for bioequivalence is expected in a larger study group.
Graduation date: 1998

Professional nurses and their patients are directly influenced by insufficient medication, causing a decrease in the quality of care, delays in hospitalisation and it might lead to resistance. In some cases professional nurses have to leave the unit in search of medicine. Amoxicillin-clavulanic acid 1.2 gram for intravenous administration is prescribed to the majority of patients in the medical units in public South African hospitals. Yet there are intermitted insufficient stock levels and challenged inventory systems for amoxicillin-clavulanic acid 1.2 gram in some public hospitals. This fact is positioned against the background of a South African health system that has undergone major changes since the fall of Apartheid in 1994 and amidst major positive changes, is still challenged by overburdened hospital admissions and a quadruple disease burden. The aim of this research was to enhance optimal levels of amoxicillin-clavulanic acid 1.2 gram in medical units in public hospitals to ensure sufficient stock levels and timeous administration. The aim was achieved by identifying and describing the current supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram in two medical units in a district (level 2) public hospital in the North West Province (from here referred only as North West) by identifying inefficiencies in the current supply chain and to formulate recommendations for management to enhance the supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram to medical units in public hospitals. An exploratory case study approach was followed to explain the supply chain of amoxicillin-clavulanic acid 1.2 gram by utilising a qualitative, descriptive, explorative and contextual design. A case study approach was chosen as it examined single units within the context of real life as environment, which in this case were medical units in a level two public hospital, North West. The case selection was motivated and described, followed by case records of policies and standard operational procedures. Field participants included all levels of nurses (professional, enrolled and auxiliary) in medical male and female units on day and night duty, and the head of pharmacy [n=8]. Non-probable, purposive sampling was conducted according to inclusion criteria after all levels of ethical clearance and consent were granted. Three semi-structured individual interviews followed, after which two focus groups were conducted. Thematic analysis of transcriptions was done, followed by an analysis of case records regarding where after all results were integrated. Results indicated complex organisational, unit-specific and behavioural challenges that impact on the supply chain management of amoxicillin-clavulanic acid 1.2 gram and insufficient stock levels are predominantly positioned within retailer and customer aspects of the supply chain. Despite well-formulated standard operational procedures, the realisation thereof lacks, implicating a greater need for managerial control. Recommendations were formulated for management to enhance the supply chain of amoxicillin-clavulanic acid 1.2 gram in medical units in public South African hospitals integrated with good pharmacy practices. The close collaboration, mutual respect and effective communication between health professionals in the multi-professional team are reiterated.
MCur, North-West University, Potchefstroom Campus, 2015

Urinary tract infections (UTIs) refer to a urine culture yielding a minimum of 100 to 10,000 bacteria units/mm of urine usually from a clean catch midstream sample. This can result from infection of the lower urinary tract involving the bladder (cystitis) or an infection of the upper urinary tract involving the kidneys (pyelonephritis). Uncomplicated UTIs occur in healthy, pre-menopausal, non-pregnant women with a normal urinary tract who have a high likelihood to respond favorably to treatment, but consider local antibiotic resistance patterns. Complicated UTIs occur in women with coexisting pathology, anatomical abnormality, underlying comorbidity, or immunocompromise. Untreated UTIs can progress to pyelonephritis and urosepsis. Asymptomatic bacteriuria for pregnant women can progress very quickly; pyelonephritis carries increased risk of perinatal and neonatal mortality. Pregnant patients should be treated with cephalexin, amoxicillin, or amoxicillin-clavulanic acid (avoiding fluoroquinolones).

This chapter presents information on neonatal drugs that begin with C, including use, pharmacology, adverse effects, fetal and infant implications of maternal treatment, treatment, and supply of Cabergoline, Caffeine citrate, Calcium gluconate and other calcium salts, Captopril, Carbamazepine, Carglumic acid, Carnitine (levocarnitine [INN], L-carnitine), Caspofungin, Cefalexin = Cephalexin (USAN and former BAN), Cefotaxime, Ceftazidime, Ceftriaxone, Cefuroxime, Chloral hydrate, Chloramphenicol, Chloroquine, Chlorothiazide, Chlorphenamine = Chlorpheniramine (USAN and former BAN), Chlorpromazine, Ciprofloxacin, Citrulline, Clarithromycin, Clindamycin, Clobazam, Clonazepam, Clonidine, Co-amoxiclav = amoxicillin/ clavulanic acid (iNN), Codeine phosphate, and Co-trimoxazole

Human actinomycoses are always synergistic polymicrobial infections in which fermentative actinomycetes—predominantly Actinomyces israelii, A. gerencseriae, or Propionibacterium propionicum—are the principal pathogens, usually needing the assistance of so-called concomitant microbes to produce disease. Nearly all of the members of the mixed actinomycotic microflora belong to the indigenous microbial community of human mucous membranes, hence actinomycoses present as sporadic endogenous infections which are not transmissible. Antibacterial drugs used for treatment should be active against both the causative actinomycetes and all concomitant bacteria. For cervicofacial actinomycoses, the rare cutaneous processes, and most thoracic forms of the disease, this requirement is best fulfilled by amoxicillin plus clavulanic acid in medium to high doses. The prognosis of cervicofacial and cutaneous actinomycoses is good provided that treatment is adequate; thoracic and abdominal forms are more serious, with grave prognosis without proper treatment.

In this chapter, we report previous results about advances of an electrolysis process developed for breakdown of endocrine disrupting drugs in aqueous media. The objective is to achieve the breakdown of two drugs: trimethoprim and a mixture of clavulanic acid-amoxicillin (1:7) with an electrolytic cell by means of oxidization-reduction reactions. The evaluation of the process was carried out using spectrometry techniques UV-Vis, thin layer chromatography (TLC), chemical oxygen demand (COD), and total organic carbon (TOC). Handcrafted mineral carbon electrodes doped with titanium dioxide were designed, platinum and copper wires were placed, and a potassium hydroxide solution was used as electrolyte. The electrolyte, being an alkaline salt, allows the transport of charges from one side to the other, and electrode doped with titanium dioxide is used in order to help the electronic transfer, and the mineral carbon, having a strong affinity for organic and non-polar compounds, performs an adsorption process. Results from several performed assays showed that after 1 hour of treatment, it can be seen the breakdown of the drugs present in a synthetic wastewater solution.

Small intestinal bacterial overgrowth can be defined as the presence of excessive bacteria in the small intestine which can interfere with digestion and absorption. Predisposing causes include sustained hypochlorhydria induced by proton pump inhibitors, small intestinal dysmotility and stasis due to anatomical or motor abnormalities, and reduced antibacterial activity as seen in immunological deficiency and chronic pancreatitis. Presentation is predominantly from consequences of malabsorption, including gastrointestinal symptoms (e.g. diarrhoea or steatorrhoea) and features of specific nutrient malabsorption (e.g. osteoporosis, anaemia, neuropathy, and night blindness). Definitive diagnosis is difficult, requiring a properly collected and appropriately cultured aspirate from the proximal small intestine revealing a total concentration of a mixed growth of bacteria generally greater than 10⁵ organisms/ml. Alternative investigations frequently used include glucose/lactulose breath tests or either the ¹³C- or ¹⁴C-xylose breath test, with elevated levels of ¹³CO₂ or ¹⁴CO₂ found in the breath. There may be low levels of cobalamin (metabolized by Gram-negative anaerobes), increased serum folate (synthesized by overgrowth flora), and increased urinary indicans (intraluminal product of bacterial tryptophan metabolism). Aside from treatment of any nutritional deficiencies, specific treatment is with an antimicrobial that is effective against both aerobic and anaerobic enteric bacteria (e.g. doxycycline, amoxicillin–clavulanic acid, rifaximin, or ciprofloxacin), which can be administered in rotation to reduce antibiotic resistance. Where possible and appropriate, correction of any underlying cause should also be performed.

The dissemination of antimicrobial resistance (AMR) bacteria has been associated with the inappropriate use of antibiotics in both humans and animals and with the consumption of food contaminated with resistant bacteria. In particular, the use of antibiotics as prophylactic and growth promotion purposes in food-producing animals has rendered many of the antibiotics ineffective. The increased global prevalence of AMR poses a significant threat to the safety of the world’s food supply. Objectives: This study aims at determining the prevalence of antibiotic-resistant Escherichia coli (E. coli) isolated from local and imported retail chicken meat in Qatar. Methodology: A total of 270 whole chicken carcasses were obtained from three different hypermarket stores in Qatar. A total of 216 E. coli were isolated and subjected to antibiotic susceptibility testing against 18 relevant antibiotics using disc diffusion and micro- dilution methods. Furthermore, extended-spectrum β-lactamase (ESBL) production was determined via a double-disc synergetic test. Isolates harboring colistin resistance were confirmed using multiplex-PCR and DNA sequencing. Results: Nearly 89% (192/216) of the isolates were resistant to at least one antibiotics. In general, isolates showed relatively higher resistance to sulfamethoxazole (62%), tetracycline (59.7%), ampicillin and trimethoprim (52.3%), ciprofloxacin (47.7%), cephalothin, and colistin (31.9%). On the other hand, less resistance was recorded against amoxicillin/clavulanic acid (6%), ceftriaxone (5.1%), nitrofurantoin (4.2%) and piperacillin/tazobactam (4.2%), cefepime (2.3%), meropenem (1.4%), ertapenem (0.9%), and amikacin (0.9%). Nine isolates (4.2%) were ESBL producers. Furthermore, 63.4% were multidrug-resistant (MDR). The percentage of MDR, ESBL producers, and colistin-resistant isolates was significantly higher among local isolates compared to imported chicken samples. Conclusion: We reported a remarkably high percentage of the antibiotic-resistant E. coli in chicken meat sold at retail in Qatar. The high percentage of MDR and colistin isolates is troublesome to the food safety of raw chicken meat and the potential of antibiotic resistance spread to public health. Our findings support the need for the implementation of one health approach to address the spread of antimicrobial resistance and the need for a collaborative solution.