Photodegradation Assessment of Ciprofloxacin, Moxifloxacin

Total Page:16

File Type:pdf, Size:1020Kb

Photodegradation Assessment of Ciprofloxacin, Moxifloxacin Hubicka et al. Chemistry Central Journal 2013, 7:133 http://journal.chemistrycentral.com/content/7/1/133 RESEARCH ARTICLE Open Access Photodegradation assessment of ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin in the presence of excipients from tablets by UPLC-MS/MS and DSC Urszula Hubicka1*, PawełŻmudzki2, Przemysław Talik1, Barbara Żuromska-Witek1 and Jan Krzek1 Abstract Background: Ciprofloxacin (CIP), moxifloxacin (MOX), norfloxacin (NOR) and ofloxacin (OFL), are the antibacterial synthetic drugs, belonging to the fluoroquinolones group. Fluoroquinolones are compounds susceptible to photodegradation process, which may lead to reduction of their antibacterial activity and to induce phototoxicity as a side effect. This paper describes a simple, sensitive UPLC-MS/MS method for the determination of CIP, MOX, NOR and OFL in the presence of photodegradation products. Results: Chromatographic separations were carried out using the Acquity UPLC BEH C18 column; (2.1 × 100 mm, 1.7 μm particle size). The column was maintained at 40°C, and the following gradient was used: 0 min, 95% of eluent A and 5% of eluent B; 10 min, 0% of eluent A and 100% of eluent B, at a flow rate of 0.3 mL min-1. Eluent A: 0.1% (v/v) formic acid in water; eluent B: 0.1% (v/v) formic acid in acetonitrile. The method was validated and all the validation parameters were in the ranges acceptable by the guidelines for analytical method validation. The photodegradation of examined fluoroquinolones in solid phase in the presence of excipients followed kinetic of the first order reaction and depended upon the type of analyzed drugs and coexisting substances. Photodegradation process of analyzed drugs was confirmed by differential scanning calorimetry. In addition, the identification of degradation products was carried out by mass spectrometry. Conclusion: The developed UPLC-MS/MS method enables the determination of CIP, MOX, NOR and OFL in the presence of photodegradation products and identification of photodegradation products. Keywords: Ciprofloxacin, Moxifloxacin, Norfloxacin, Ofloxacin, Photodegradation, Kinetic evaluation, Ultra performance liquid chromatography, Tandem mass spectrometry, Differential scanning calorimetry Background bacteria of Chlamydia spp., Mycoplasma spp., and Legion- Ciprofloxacin (CIP), moxifloxacin (MOX), norfloxacin ella spp. genera, bacilli of genus Mycobacterium and an- (NOR) and ofloxacin (OFL), are the antibacterial syn- aerobe of Bacteroides and Clostridium genera [3-5]. thetic drugs, belonging to fluoroquinolones group. Fluoroquinolones are compounds susceptible to photo- Fluoroquinolones exhibit increased antibacterial activity degradation process, which may lead to reduction of their against the Enterobacteriaceae and other Gram-negative antibacterial activity and to induce phototoxicity as a side bacteria such as Pseudomonas aeruginosa, and exert some effect [6]. In the available literature many papers devoted activity against certain Gram-positive cocci [1,2]. Among to the studies of fluoroquinolone photodegradation in so- them, MOX also show notable efficacy against atypical lutions can be found [7-10], while only a few relate to photodegradation studies of a substance or of the pharma- * Correspondence: [email protected] ceutical preparation in the solid phase [10-13]. 1 Department of Inorganic and Analytical Chemistry, Jagiellonian University The photodegradation process of CIP in solid phase Medical College, Faculty of Pharmacy, 9 Medyczna Street, 30-688 Kraków, Poland was analyzed by thin layer chromatography method with Full list of author information is available at the end of the article © 2013 Hubicka et al.; licensee Chemistry Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Hubicka et al. Chemistry Central Journal 2013, 7:133 Page 2 of 12 http://journal.chemistrycentral.com/content/7/1/133 densitometric detection in the presence and without se- chromatographic column (3,5 μm, 100 mm × 4.6 mm). lected metal ions. Samples were prepared on Petri dishes The mobile phase consisted of triethylamine (4.5 ml), by evaporation of the test solution to obtain a dry resi- double-distilled water (830 ml) and acetonitrile (140 ml). due. They were exposed to UV radiation within the The pH was adjusted to 2.3 with 85% H3PO4 before range from 240 nm to 280 nm for 96 h [11]. Assessed addition of acetonitrile. The flow rate was 1 ml/min. The the studies performed it was found that both ion con- structure of two main degradation products of OFL has centration and ion type have an effect on the degradation been postulated from LC-MS analysis [13]. process that leads to the generation of two photoproducts. In summary, the existing research concerning the The chemical structures of the photodegradation prod- photostability of fluoroquinolones in the solid phase are ucts were identified as follows 7-[(2-aminoethyl)amino] not a comprehensive but relate of individual substances. 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-qunoline-3- The study was performed using different irradiation con- carboxylic acid and 7-amino-1-cyclopropyl-6-fluoro-1,4- ditions and exposure time. Only two papers concern the dihydro-4-oxo-qunoline-3-carboxylic acid [11]. influence of excipients on the photodegradation process. Photostability of MOX after UVA irradiation in solu- Applied methods such as TLC, HPLC and LC-MS tions and solid phase, with and without participation of allowed the separation and identification of up to three Cu(II), Zn(II), Al(III), and Fe(III) was tested. Samples for photodegradation products. In any paper not carried out testing in solid phase were prepared in the same manner studies of fluoroquinolones irradiated in the solid phase as described in a publication on CIP [11]. They were ex- by DSC. posed to UVA radiation within the range from 320 nm In the presented paper we have developed and vali- to 400 nm for 15 h [10]. The studies were carried out by dated an ultra-performance liquid chromatography the TLC-densitometric method. In solid phase, all metal method coupled with tandem mass spectrometry ions decreased the photodegradation of MOX. Identifica- (UPLC-MS/MS) for the determination of CIP, MOX, tion of the degradation three products was performed with NOR and OFL, which was used to study the effect of LC-MS/MS and 1HNMR identified them as: 1-cyclopropyl- UVA irradiation on the photostability of studied 6-fluoro-7-amino-8-methoxy-4-oxo-1,4-dihydroquinoline- fluoroquinolones in powdered tablets. In addition, the 3-carboxylic acid, 1-cyclopropyl-6-fluoro-8-methoxy-4- kinetic evaluation of the photodegradation process was oxo-7-(2-oxo-octahydro-6H-pyrrolo[3,4-b]pyridine-6-yl)-1, carried out and photodegradation products have been 4-dihydroquinoline-3-carboxylic acid, 7-[3-hydroxyamino- identified. In the presented studies next to UPLC-MS 4-(2-carboxyethyl)pyrrolidin-1-yl]-1- cyclopropyl-6-fluoro-8- /MS method, differential scanning calorimetry (DSC) methoxy-4-oxo-1,4-dihydroquinoline-3-carboxylic acid [10]. was also used to compare changes in analyzed samples Photodegradation of NOR in solid phase in the pres- before and after irradiation. ence of different excipients used for making tablets has been studied. The NOR tablets were exposed under dir- Experimental ect sunlight, fluorescent light and UV radiation (con- Chemicals and reagents tinuous 254-nm UV lamp), at ambient temperature (25°C) Ciprofloxacin hydrochloride monohydrate Cat. No. 91033- and 65% relative humidity. The separation of NOR and its 1G Fluka, Moxifloxacin hydrochloride series Strasbourg degradation products was achieved isocratically using a Cedex; Council of Europe – EDQM CS; Cat No. T30026 μ Lichrosorb® C8 chromatographic column (10 m, 20 cm × F-6081, Norfloxacin Cat. No. 9890-1G Fluka, Ofloxacin 4.6 mm) and phosphate buffer solution adjusted to Cat. No. O8757-1G Sigma. HPLC grade methanol, aceto- – pH 3.0 acetonitrile (85:15, v/v) as the eluent, pumped nitrile and formic acid (98%) were purchased from J.T. at a flow rate of 2.0 ml/min. The authors proved that Baker. HPLC grade water was obtained from HLP 5 during photodegradation diamineethyl derivative of NOR (HYDROLAB Poland) apparatus and was filtered through occurs [12]. 0.2 μm filter before use. The photostability of OFL in the solid state has been investigated. Irradiation was conducted in a chamber SUNTEST CPS + at 30°C using xenon lamp (1.5 kW) Standard solution equipped with a 6 mm special glass filter, transmitting For method validation, solutions containing different con- light corresponding to exposure behind window-glass centrations of the examined fluoroquinolones in the range – -1 (cut-off approximately 310 nm). The change in colour of 0.04 2.00 mg mL were prepared. uncoated and film coated OFL tablets and compressed OFL was studied as a function of irradiance level and Pharmaceutical preparations total exposure energy. The degradation of OFL was Proxacin 500 – film-coated tablet containing 500 mg quantified by HPLC. The separation of OFL and its two of CIP (Polfa S.A, Poland). Excipients: pregelatinized degradation products was achieved using a Symmetry C-18 starch, microcrystalline cellulose, colloidal silica hydrated, Hubicka et al. Chemistry Central Journal 2013, 7:133 Page 3 of 12 http://journal.chemistrycentral.com/content/7/1/133 magnesium stearate, croscarmellose sodium, hypromellose, detector. Compound concentration (%i) after photo- macrogol 6000, titanium dioxide. degradation was calculated from quotient of peak area Norflox- AZU – film-coated tablet containing 400 mg (Ai) to the sum of all peak areas (∑A) on chromato- of NOR (Azupharma, Germany). Excipients: microcrys- grams according to formulation %i = (Ai/∑A)100 at λ = talline cellulose, hypromellose, magnesium stearate, poly 294 nm. Spectra were analyzed in 200–700 nm range (O-carboxymethyl) starch sodium salt, povidone, propyl- with 1.2 nm resolution and sampling rate 20 points/s.
Recommended publications
  • A TWO-YEAR RETROSPECTIVE ANALYSIS of ADVERSE DRUG REACTIONS with 5PSQ-031 FLUOROQUINOLONE and QUINOLONE ANTIBIOTICS 24Th Congress Of
    A TWO-YEAR RETROSPECTIVE ANALYSIS OF ADVERSE DRUG REACTIONS WITH 5PSQ-031 FLUOROQUINOLONE AND QUINOLONE ANTIBIOTICS 24th Congress of V. Borsi1, M. Del Lungo2, L. Giovannetti1, M.G. Lai1, M. Parrilli1 1 Azienda USL Toscana Centro, Pharmacovigilance Centre, Florence, Italy 2 Dept. of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), 27-29 March 2019 Section of Pharmacology and Toxicology , University of Florence, Italy BACKGROUND PURPOSE On 9 February 2017, the Pharmacovigilance Risk Assessment Committee (PRAC) initiated a review1 of disabling To review the adverse drugs and potentially long-lasting side effects reported with systemic and inhaled quinolone and fluoroquinolone reactions (ADRs) of antibiotics at the request of the German medicines authority (BfArM) following reports of long-lasting side effects systemic and inhaled in the national safety database and the published literature. fluoroquinolone and quinolone antibiotics that MATERIAL AND METHODS involved peripheral and central nervous system, Retrospective analysis of ADRs reported in our APVD involving ciprofloxacin, flumequine, levofloxacin, tendons, muscles and joints lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, pefloxacin, prulifloxacin, rufloxacin, cinoxacin, nalidixic acid, reported from our pipemidic given systemically (by mouth or injection). The period considered is September 2016 to September Pharmacovigilance 2018. Department (PVD). RESULTS 22 ADRs were reported in our PVD involving fluoroquinolone and quinolone antibiotics in the period considered and that affected peripheral or central nervous system, tendons, muscles and joints. The mean patient age was 67,3 years (range: 17-92 years). 63,7% of the ADRs reported were serious, of which 22,7% caused hospitalization and 4,5% caused persistent/severe disability. 81,8% of the ADRs were reported by a healthcare professional (physician, pharmacist or other) and 18,2% by patient or a non-healthcare professional.
    [Show full text]
  • Fluoroquinolone Antibiotics: Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin
    21 March 2019 DDL_fluoroquinolones_March-2019 Fluoroquinolone antibiotics: ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin New restrictions and precautions due to very rare reports of disabling and potentially long-lasting or irreversible side effects • Disabling, long-lasting or potentially irreversible adverse reactions affecting musculoskeletal (including tendonitis and tendon rupture) and nervous systems have been reported with fluoroquinolone antibiotics – see Drug Safety Update for more information • Prescribers and dispensers of fluoroquinolones should advise patients to stop treatment at the first signs of a serious adverse reaction, such as tendinitis or tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy, and central nervous system effects, and to contact their doctor immediately for further advice – see MHRA sheet to discuss measures with patients • Fluoroquinolone treatment should be discontinued at the first sign of tendon pain or inflammation in patients and the affected limb or limbs appropriately treated (for example with immobilisation) Fluoroquinolones should not be prescribed for: • non-severe or self-limiting infections, or non-bacterial conditions • mild to moderate infections (such as in acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease) unless other antibiotics that are commonly recommended for these infections are considered inappropriate* • uncomplicated cystitis (for which ciprofloxacin or levofloxacin were previously authorised)
    [Show full text]
  • (-Oxacins): What You Need to Know About Side Effects of Tendons, Muscles, Joints, and Nerves March 2019
    Fluoroquinolone antibiotics (-oxacins): what you need to know about side effects of tendons, muscles, joints, and nerves March 2019 • Fluoroquinolone medicines (ciprofloxacin, levofloxacin, moxifloxacin, and ofloxacin) are effective antibiotics that treat serious and life-threatening infections in the body • Always take your doctor’s advice on when and how to take antibiotics • Fluoroquinolones have been reported to cause serious side effects involving tendons, muscles, joints, and the nerves – in a small proportion of patients, these side effects caused long-lasting or permanent disability Stop taking your fluoroquinolone antibiotic and contact your doctor immediately if you have the following signs of a side effect: o Tendon pain or swelling, often beginning in the ankle or calf - if this happens, rest the painful area until you can see your doctor o Pain in your joints or swelling in your shoulder, arms, or legs o Abnormal pain or sensations (such as persistent pins and needles, tingling, tickling, numbness, or burning), weakness in your body, especially in the legs or arms, or difficulty walking o Severe tiredness, depressed mood, anxiety, or problems with your memory or severe problems sleeping o Changes in your vision, taste, smell, or hearing • Tell your doctor if you have had one of the above effects during or shortly after taking a fluoroquinolone – this means you should avoid them in the future • Doctors will take special care with these medicines if you are older than 60 years of age, if your kidneys do not work well, or if
    [Show full text]
  • Daily Moxifloxacin, Clarithromycin, Minocycline, and Clofazimine In
    ISSN: 2643-461X Neto et al. Int J Trop Dis 2020, 3:035 DOI: 10.23937/2643-461X/1710035 Volume 3 | Issue 2 International Journal of Open Access Tropical Diseases CASE SERIES Daily Moxifloxacin, Clarithromycin, Minocycline, and Clofazimine in Nonresponsiveness Leprosy Cases to Recommended Treatment Regimen Francisco Bezerra de Almeida Neto, MD1,2,3*, Rebeca Daniele Buarque Feitosa, OT3 and Marqueline Soares da Silva, RN3 1Department of Dermatology, Mauricio de Nassau Recife University Center, Brazil Check for 2Department of Tropical Medicine, Federal University of Pernambuco (UFPE), Brazil updates 3Cabo de Santo Agostinho Health Care Hansen's Disease Specialized Center, Cabo de Santo Agostinho, Brazil *Corresponding author: Francisco Bezerra de Almeida Neto, MD, Department of Dermatology, Mauricio de Nassau Recife University Center; Department of Tropical Medicine, Federal University of Pernambuco (UFPE); Cabo de Santo Agostinho Health Care Hansen's Disease Specialized Center, Cabo de Santo Agostinho, R Jonathas de Vasconcelos, 316, Boa Viagem, Recife, PE, CEP 51021140, Brazil, Tel: +5581988484442 Abstract Introduction Background: In hyperendemic countries for leprosy, there Although leprosy is the first infectious disease at- has been a growing increase in clinical multibacillary “non- tributed to a pathogen by Gerard Amauer Hansen, it responsiveness” leprosy cases to the fixed-duration treat- remains a relevant public health problem in countries ment recommended by World Health Organization (MDT- MB). There are no defined protocols to treat these patients. considered hyper-endemic for the disease [1]. Methods: A retrospective, observational case series study The main etiologic agents areMycobacterium leprae was conducted of 4 patients with multibacillary leprosy who and Mycobacterium lepromatosis. The clinical mani- presented to a specialized Leprosy health care.
    [Show full text]
  • Allergy to Quinolones: Low Cross-Reactivity to Levofloxacin
    T Lobera, et al ORIGINAL ARTICLE Allergy to Quinolones: Low Cross-reactivity to Levofl oxacin T Lobera,1 MT Audícana,2 E Alarcón,1 N Longo,2 B Navarro,1 D Muñoz2 1Department of Allergy, Hospital San Pedro/San Millán, Logroño, Spain 2Department of Allergy, Hospital Santiago Apóstol, Vitoria, Spain ■ Abstract Background: Immediate-type hypersensitivity reactions to quinolones are rare. Some reports describe the presence of cross-reactivity among different members of the group, although no predictive pattern has been established. No previous studies confi rm or rule out cross-reactivity between levofl oxacin and other quinolones. Therefore, a joint study was designed between 2 allergy departments to assess cross-reactivity between levofl oxacin and other quinolones. Material and Methods: We studied 12 patients who had experienced an immediate-type reaction (4 anaphylaxis and 8 urticaria/angioedema) after oral administration of quinolones. The culprit drugs were as follows: ciprofl oxacin (5), levofl oxacin (4), levofl oxacin plus moxifl oxacin (1), moxifl oxacin (1), and norfl oxacin (1). Allergy was confi rmed by skin tests and controlled oral challenge tests with different quinolones. The basophil activation test (BAT) was applied in 6 patients. Results: The skin tests were positive in 5 patients with levofl oxacin (2), moxifl oxacin (2), and ofl oxacin (2). BAT was negative in all patients (6/6). Most of the ciprofl oxacin-reactive patients (4/5) tolerated levofl oxacin. Similarly, 3 of 4 levofl oxacin-reactive patients tolerated ciprofl oxacin. Patients who reacted to moxifl oxacin and norfl oxacin tolerated ciprofl oxacin and levofl oxacin. Conclusions: Our results suggest that skin testing and BAT do not help to identify the culprit drug or predict cross-reactivity.
    [Show full text]
  • Reduced Moxifloxacin Exposure in Patients with Tuberculosis and Diabetes
    AGORA | RESEARCH LETTER Reduced moxifloxacin exposure in patients with tuberculosis and diabetes To the Editor: Prevalence of diabetes mellitus (DM) in patients with tuberculosis (TB) is increasing and may negatively impact TB outcomes in patients with active disease [1]. Gastrointestinal problems, including gastroparesis, may result in delayed drug absorption or malabsorption in patients with DM, which may cause suboptimal drug exposure and poor outcome [2]. Studies on the pharmacokinetics of the first-line anti-TB drugs in patients with DM yielded conflicting results on low drug exposure [3–7]. Moxifloxacin is a potent bactericidal drug against Mycobacterium tuberculosis and is key for the treatment of multidrug-resistant tuberculosis (MDR)-TB [8]. Moreover, moxifloxacin can be recommended for TB treatment in patients with monoresistance or intolerance to first-line drugs [9]. Recently, we reported on a patient with TB and DM in whom moxifloxacin exposure was reduced [10]. In this study, we aimed to evaluate moxifloxacin drug exposure in patients with TB and DM. We retrospectively identified all patients aged ⩾16 years who underwent routine therapeutic drug monitoring (TDM) using at least three time-points for moxifloxacin as part of their TB treatment at our centre in the period 2006–2018. For this study, the Medical Ethical Committee of the University Medical Center Groningen (Groningen, the Netherlands) waived the need for written informed consent due to the retrospective nature of the study (reference 2013/492). Patient data were processed according to the Declaration of Helsinki. Controls were TB patients without DM matched for age, sex and rifampicin use (cases/controls 1/1).
    [Show full text]
  • AVELOX Or Other Quinolones (4, 5.6) AVELOX® Safely and Effectively
    HIGHLIGHTS OF PRESCRIBING INFORMATION -------------------------------CONTRAINDICATIONS-----------------------------­ These highlights do not include all the information needed to use Known hypersensitivity to AVELOX or other quinolones (4, 5.6) AVELOX® safely and effectively. See full prescribing information for AVELOX. -----------------------WARNINGS AND PRECAUTIONS-----------------------­ AVELOX® (moxifloxacin hydrochloride) Tablet, film-coated • Increased risk of tendinitis and tendon rupture. This risk is further increased AVELOX® (moxifloxacin hydrochloride) Injection, solution for IV use in older patients usually over 60 years of age, in patients taking Initial U.S. Approval: 1999 corticosteroids, and in patients with kidney, heart or lung transplants. To reduce the development of drug-resistant bacteria and maintain the Discontinue if pain or inflammation in a tendon occurs. (5.1, 8.5) effectiveness of AVELOX and other antibacterial drugs, AVELOX should be • Prolongation of the QT interval and isolated cases of torsade de pointes has used only to treat or prevent infections that are proven or strongly suspected to been reported. Avoid use in patients with known prolongation, hypokalemia, be caused by susceptible bacteria. and with drugs that prolong the QT interval. (5.2, 7.4, 8.5). Use caution in patients with proarrhythmic conditions such as clinically significant bradycardia or acute myocardial ischemia. (5.2) WARNING: • Serious and sometimes fatal hypersensitivity reactions, including Fluoroquinolones, including AVELOX®, are associated with an anaphylactic reactions, may occur after first or subsequent doses. increased risk of tendinitis and tendon rupture in all ages. This risk is Discontinue drug use at first sign of skin rash, jaundice or any other sign of further increased in older patients usually over 60 years of age, in hypersensitivity.
    [Show full text]
  • The Grohe Method and Quinolone Antibiotics
    The Grohe method and quinolone antibiotics Antibiotics are medicines that are used to treat bacterial for modern fluoroquinolones. The Grohe process and the infections. They contain active ingredients belonging to var- synthesis of ciprofloxacin sparked Bayer AG’s extensive ious substance classes, with modern fluoroquinolones one research on fluoroquinolones and the global competition of the most important and an indispensable part of both that produced additional potent antibiotics. human and veterinary medicine. It is largely thanks to Klaus Grohe – the “father of Bayer quinolones” – that this entirely In chemical terms, the antibiotics referred to for simplicity synthetic class of antibiotics now plays such a vital role for as quinolones are derived from 1,4-dihydro-4-oxo-3-quin- medical practitioners. From 1965 to 1997, Grohe worked oline carboxylic acid (1) substituted in position 1. as a chemist, carrying out basic research at Bayer AG’s Fluoroquinolones possess a fluorine atom in position 6. In main research laboratory (WHL) in Leverkusen. During this addition, ciprofloxacin (2) has a cyclopropyl group in posi- period, in 1975, he developed the Grohe process – a new tion 1 and also a piperazine group in position 7 (Figure A). multi-stage synthesis method for quinolones. It was this This substituent pattern plays a key role in its excellent achievement that first enabled him to synthesize active an- antibacterial efficacy. tibacterial substances such as ciprofloxacin – the prototype O 5 O 4 3 6 COOH F COOH 7 2 N N N 8 1 H N R (1) (2) Figure A: Basic structure of quinolone (1) (R = various substituents) and ciprofloxacin (2) Quinolones owe their antibacterial efficacy to their inhibition This unique mode of action also makes fluoroquinolones of essential bacterial enzymes – DNA gyrase (topoisomer- highly effective against a large number of pathogenic ase II) and topoisomerase IV.
    [Show full text]
  • Customs Tariff - Schedule
    CUSTOMS TARIFF - SCHEDULE 99 - i Chapter 99 SPECIAL CLASSIFICATION PROVISIONS - COMMERCIAL Notes. 1. The provisions of this Chapter are not subject to the rule of specificity in General Interpretative Rule 3 (a). 2. Goods which may be classified under the provisions of Chapter 99, if also eligible for classification under the provisions of Chapter 98, shall be classified in Chapter 98. 3. Goods may be classified under a tariff item in this Chapter and be entitled to the Most-Favoured-Nation Tariff or a preferential tariff rate of customs duty under this Chapter that applies to those goods according to the tariff treatment applicable to their country of origin only after classification under a tariff item in Chapters 1 to 97 has been determined and the conditions of any Chapter 99 provision and any applicable regulations or orders in relation thereto have been met. 4. The words and expressions used in this Chapter have the same meaning as in Chapters 1 to 97. Issued January 1, 2019 99 - 1 CUSTOMS TARIFF - SCHEDULE Tariff Unit of MFN Applicable SS Description of Goods Item Meas. Tariff Preferential Tariffs 9901.00.00 Articles and materials for use in the manufacture or repair of the Free CCCT, LDCT, GPT, UST, following to be employed in commercial fishing or the commercial MT, MUST, CIAT, CT, harvesting of marine plants: CRT, IT, NT, SLT, PT, COLT, JT, PAT, HNT, Artificial bait; KRT, CEUT, UAT, CPTPT: Free Carapace measures; Cordage, fishing lines (including marlines), rope and twine, of a circumference not exceeding 38 mm; Devices for keeping nets open; Fish hooks; Fishing nets and netting; Jiggers; Line floats; Lobster traps; Lures; Marker buoys of any material excluding wood; Net floats; Scallop drag nets; Spat collectors and collector holders; Swivels.
    [Show full text]
  • Pharmacology-2/ Dr
    1 Pharmacology-2/ Dr. Y. Abusamra Pharmacology-2 Quinolones, trimethoprim & sulfonamides Dr. Yousef Abdel - Kareem Abusamra Faculty of Pharmacy Philadelphia University 2 3 LEARNING OUTCOMES After completing studying this chapter, the student should be able to: Classify the drugs into subgroups such as quinolones and sulfonamides. Recognize the bacterial spectrum of all these antibiotic and antibacterial groups. Summarize the most remarkable pharmacokinetic features of these drugs. Numerate the most important side effects associated with these agents. Select the antibiotic of choice to be used in certain infections, as associated with the patient status including comorbidity, the species of bacteria causing the infection and concurrently prescribed drugs. Reason some remarkable clinical considerations related to the use or contraindication or precaution of a certain drug. Illustrate the mechanism of action of each of these drugs. • Following synthesis of na lidixic a c id in the early 1960s, continued modification of the quinolone nucleus expanded the spectrum of activity, improved pharmacokinetics, and stabilized compounds against common mechanisms of resistance. • Overuse resulted in rising rates of resistance in gram-negative and gram-positive organisms, increased frequency of Clostridium difficile infections, and identification of numerous tough adverse effects. • Consequently, these agents have been relegated to second-line options for various indications. 4 Pharmacology-2/ Dr. Y. Abusamra Only will be mentioned here 5 Pharmacology-2/ Dr. Y. Abusamra Most bacterial species maintain two distinct type II topoisomerases that assist with deoxyribonucleic acid Topoisomerases: Supercoiling Unwinding (DNA) replication: . DNA gyrase {supercoiling} and . Topoisomerase IV {Unwinding}. Following cell wall entry through porin channels, fluoroquinolones bind to these enzymes and interfere with DNA ligation.
    [Show full text]
  • Ehealth DSI [Ehdsi V2.2.1] European Commission
    MTC eHealth DSI [eHDSI v2.2.1] European Commission - Master Translation/Transcoding Catalogue Responsible : eHDSI Solution Provider PublishDate : Thu Jun 01 17:03:48 CEST 2017 © eHealth DSI eHDSI Solution Provider v2.2.1 Thu Jun 01 17:03:48 CEST 2017 Page 1 of 490 MTC Table of Contents epSOSActiveIngredient 4 epSOSAdministrativeGender 148 epSOSAdverseEventType 149 epSOSAllergenNoDrugs 150 epSOSBloodGroup 155 epSOSBloodPressure 156 epSOSCodeNoMedication 157 epSOSCodeProb 158 epSOSConfidentiality 159 epSOSCountry 160 epSOSDisplayLabel 167 epSOSDocumentCode 170 epSOSDoseForm 171 epSOSHealthcareProfessionalRoles 184 epSOSIllnessesandDisorders 186 epSOSLanguage 448 epSOSMedicalDevices 458 epSOSNullFavor 461 epSOSPackage 462 © eHealth DSI eHDSI Solution Provider v2.2.1 Thu Jun 01 17:03:48 CEST 2017 Page 2 of 490 MTC epSOSPersonalRelationship 464 epSOSPregnancyInformation 466 epSOSProcedures 467 epSOSReactionAllergy 470 epSOSResolutionOutcome 472 epSOSRoleClass 473 epSOSRouteofAdministration 474 epSOSSections 477 epSOSSeverity 478 epSOSSocialHistory 479 epSOSStatusCode 480 epSOSSubstitutionCode 481 epSOSTelecomAddress 482 epSOSTimingEvent 483 epSOSUnits 484 epSOSUnknownInformation 487 epSOSVaccine 488 © eHealth DSI eHDSI Solution Provider v2.2.1 Thu Jun 01 17:03:48 CEST 2017 Page 3 of 490 MTC epSOSActiveIngredient epSOSActiveIngredient Value Set ID 1.3.6.1.4.1.12559.11.10.1.3.1.42.24 TRANSLATIONS Code System ID Code System Version Concept Code Description (FSN) 2.16.840.1.113883.6.73 2017-01 A ALIMENTARY TRACT AND METABOLISM 2.16.840.1.113883.6.73
    [Show full text]
  • Therapy and Management of Pneumocystis Jirovecii Infection
    Journal of Fungi Review Therapy and Management of Pneumocystis jirovecii Infection P. Lewis White *, Jessica S. Price and Matthijs Backx Public Health Wales Microbiology Cardiff, UHW, Heath Park, Cardiff CF14 4XW, UK; [email protected] (J.S.P.); [email protected] (M.B.) * Correspondence: [email protected]; Tel.: +44-(0)29-2074-6581; Fax: +44-(0)29-2074-2161 Received: 10 October 2018; Accepted: 11 November 2018; Published: 22 November 2018 Abstract: The rates of Pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the prophylaxis and treatment of PcP in HIV, haematology, and solid-organ transplant (SOT) recipients is available, although for many other populations (e.g., auto-immune disorders) there remains an urgent need for recommendations. The main drug for both prophylaxis and treatment of PcP is trimethoprim/sulfamethoxazole, but resistance to this therapy is emerging, placing further emphasis on the need to make a mycological diagnosis using molecular based methods. Outbreaks in SOT recipients, particularly renal transplants, are increasingly described, and likely caused by human-to-human spread, highlighting the need for efficient infection control policies and sensitive diagnostic assays. Widespread prophylaxis is the best measure to gain control of outbreak situations. This review will summarize diagnostic options, cover prophylactic and therapeutic management in the main at risk populations, while also covering aspects of managing resistant disease, outbreak situations, and paediatric PcP. Keywords: Pneumocystis pneumonia; PcP therapy; PcP diagnosis 1. Introduction The incidence of Pneumocystis pneumonia (PcP) is rising as a result of an increase in the susceptible patient population.
    [Show full text]