METHODS AND ANALYSIS: A three-step approach consensus approach will be adopted for this study for the development of a validated medical curriculum guideline on AMR. A preliminary curriculum for the programme will be drafted from reviews of published literature including syllabi as well as national and international guidelines. A total of 26 potential sources were found to be relevant, and selected for this study. Subsequently, the drafted curriculum will be subjected for validation via online surveys by various infectious disease experts. Finally, a Delphi technique will be employed to obtain consensus on heterogeneous findings to the revised curriculum. The quantitative and qualitative responses will be analysed and discussed among the panel of researchers.
ETHICS AND DISSEMINATION: This study protocol has been approved by the Institute of Health Sciences Research Ethics Committee of Universiti Brunei Darussalam (Reference: UBD/PAPRSBIHSREC/2020/124). Informed consent declaration will be collected prior to data collections as indication of agreement of participation in the study. Results will be made available to medical educators and also researchers on AMR and stewardship. The results also will be disseminated at feedback sessions to officers at Ministry of Health and Ministry of Education, Brunei Darussalam.
MATERIALS AND METHODS: Biogenically synthesized silver nanoparticles (Ag NPs) from an herbal formulation containing Zingiber officinale and Ocimum gratissimum were tested at various concentrations using the DPPH (2,2- diphenyl-1-picrylhydrazyl) assay. The absorbance was measured at 517 nm to quantify DPPH free radicals. With Ag NP concentrations, the H2O2 test exhibited increased activity. This work evaluated the antibacterial activity of Ag NPs mediated by Zingiber officinale and Ocimum gratissimum against Staphylococcus aureus, Streptococcus mutans, Candida albicans, and Enterococcus faecalis.
RESULTS: The utilization of herbal formulations from Z. officinale and O. gratissimum to synthesize Ag NPs revealed considerable therapeutic effectiveness. At a concentration of 50 μl, the maximal inhibition was 76%, which is comparable in effectiveness to that of standard ascorbic acid. Significant blood clot dissolution was observed during thrombolytic testing at a concentration of 100μg/ml, indicating promising prospects for the treatment of thrombotic disorders. Nanoparticles dose-dependently inhibited E. faecalis, C. albicans, S. aureus, and S. mutans in antibacterial testing. These results show the potential of the nanoparticles as supplementary or alternative treatments to conventional antibiotics, particularly in light of the increasing prevalence of antibiotic resistance.
CONCLUSION: The further investigation of nanoparticles into their mechanisms and efficacy in therapeutic applications, positioning Zingiber officinale and Ocimum gratissimum formulation-mediated Ag NPs as viable candidates in developing antioxidant, thrombolytic, and antimicrobial treatments.
METHODS: There were 5 patients, with a median age of 1.75 (range 0.1-6.25) years, a median weight of 10.7 (2.9-21.5) kg, and a median creatinine clearance of 179 (44-384) mL/min/1.73m2, who received intravenous infusions of colistimethate each 8 hours. The median daily dose was 0.21 (0.20-0.21) million international units/kg, equivalent to 6.8 (6.5-6.9) mg of colistin base activity per kg/day. Plasma concentrations of colistimethate and formed colistin were subjected to population pharmacokinetic modeling to explore the patient factors influencing the concentration of colistin.
RESULTS: The median, average, steady-state plasma concentration of colistin (Css,avg) was 0.88 mg/L; individual values ranged widely (0.41-3.50 mg/L), even though all patients received the same body weight-based daily dose. Although the daily doses were ~33% above the upper limit of the FDA- and EMA-recommended dose range, only 2 patients achieved Css,avg ≥2mg/L; the remaining 3 patients had Css,avg <1mg/L. The pharmacokinetic covariate analysis revealed that clearances of colistimethate and colistin were related to creatinine clearance.
CONCLUSIONS: The FDA and EMA dosage recommendations may be suboptimal for many pediatric patients. Renal functioning is an important determinant of dosing in these patients.