@phdthesis{Hertlein2014,
  author    = {Hertlein, Tobias},
  title     = {Visualization of Staphylococcus aureus infections and antibiotic therapy by bioluminescence and 19F magnetic resonance imaging with perfluorocarbon emulsions},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-105349},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2014},
  abstract  = {Staphylococcus aureus is a major threat to public health systems all over the globe. This second most cause of nosocomial infections is able to provoke a wide variety of different types of infection in humans and animals, ranging from superficial skin and skin structure infections to invasive disease like sepsis or pneumonia. But not enough, this pathogen is also notorious in acquiring and/or developing resistance to antimicrobial compounds, thus limiting available treatment options severely. Therefore, development of new compounds and strategies to fight S. aureus is of paramount importance. But since only 1 out of 5 compounds, which entered clinical trials, becomes a drug, the preclinical evaluation of promising compounds has to be reconsidered, too. The aim of this thesis was to address both sides of this problem: first, to improve preclinical testing by incorporating in vivo imaging technologies to the preclinical testing procedure in order to acquire additional and clearer data about efficacy of promising compounds and second, by evaluating lysostaphin, which is a promising, new option to fight S. aureus infections. The first aim of this thesis focused on the establishment of a dual modality in vivo imaging platform, consisting of Bioluminescence Imaging (BLI) and Magnetic Resonance Imaging (MRI), to offer detailed insights into the course and gravity of S. aureus infection in the murine thigh infection model. Since luciferase-expressing S. aureus strains were generated in former studies and enabled thus bioluminescence imaging of bacterial infection, this technology should be implemented into the compound evaluation platform in order to non-invasively track the bacterial burden over time. MRI, in contrast, was only rarely used in earlier studies to visualize and measure the course of infection or efficacy of anti-bacterial therapy. Thus, the first set of experiments was performed to identify benefits and drawbacks of visualizing S. aureus infections in the mouse model by different MR methods. Native, proton-based MR imaging showed in this regard increased T2 relaxation times in the infected thigh muscles, but it was not possible to define a clear border between infected and uninfected tissue. Iron oxide nanoparticles and perfluorocarbon emulsions, two MR contrast agents or tracer, in contrast, offered this distinction. Iron oxide particles were detected in this regard by their distortion of 1H signal in proton-based MRI, while perfluorocarbon emulsion was identified by 19F MRI. Mammals do not harbor sufficient intrinsic amounts of 19F to deliver specific signal and therefore, 19F MR imaging visualizes only the signal of administered perfluorocarbon emulsion. The in vivo accumulation of perfluorocarbon emulsion can be imaged by 19F MRI and overlayed on a simultaneously acquired 1H MR image, which shows the anatomical context in clear detail. Since this is advantageous compared to contrast agent based MR methods like iron oxide particle-based MRI, further experiments were performed with perfluorocarbon emulsions and 19F MRI. Experimental studies to elucidate the accumulation of perfluorocarbon emulsion at the site of infection showed robust 19F MR signals after administration between day 2 and at least day 8 p.i.. Perfluorocarbon emulsion accumulated in all investigated mice in the shape of a 'hollow sphere' at the rim of the abscess area and the signal remained stable as long as the infection prevailed. In order to identify the mechanism of accumulation, flow cytometry, cell sorting and histology studies were performed. Flow cytometry and cell sorting analysis of immune cells at the site of infection showed that neutrophils, monocytes, macrophages and dendritic cells carried contrast media at the site of infection with neutrophils accounting for the overwhelming portion of perfluorocarbon signal. In general, most of the signal was associated with immune cells, thus indicating specific immune cell dependent accumulation. Histology supported this observation since perfluorocarbon emulsion related fluorescence could only be visualized in close proximity to immune cell nuclei. After establishing and testing of 19F MRI with perfluorocarbon emulsions as infection imaging modality, the effects of antibiotic therapy upon MR signal was investigated in order to evaluate the capability of this modality for preclinical testing procedure. Thus, the efficacy of vancomycin and linezolid, two clinically highly relevant anti - S. aureus compounds, were tested in the murine thigh infection model. Both of them showed reduction of the colony forming units and bioluminescence signal, but also of perfluorocarbon emulsion accumulation strength and volume at the site of infection, which was visualized and quantified by 19F MRI. The efficacy pattern with linezolid being more efficient in clearing bacterial infection was shown similarly by all three methods. In consequence, 19F MRI with perfluorocarbon emulsion as MR tracer proved to be capable to visualize antibacterial therapy in preclinical testing models. The next step was consequently to evaluate a promising new compound against S. aureus infections. Thus, lysostaphin, an endo-peptidase that cleaves the cell wall of S. aureus, was tested in different concentrations alone or in combination with oxacillin for efficacy in murine thigh and catheter associated infection models. Lysostaphin only in the concentration of 5 mg/kg body weight or combined with oxacillin in the concentration of 2 mg/kg showed strong reduction of bacterial burden by colony forming unit determination and bioluminescence imaging in both models. The perfluorocarbon accumulation was investigated in the thigh infection model by 19F MRI and was strongly reduced in terms of volume and signal strength in both above-mentioned groups. In general, lysostaphin showed comparable or superior efficacy than vancomycin or oxacillin alone. Therefore, further development of lysostaphin for the treatment of S. aureus infections is recommended by these experiments. Overall, the antibiotic efficacy pattern of all applied antibiotic regimens was similar with all three applied methods, demonstrating the usefulness of MRI for antibiotic efficacy testing. Importantly, treatment with oxacillin either alone or in combination with lysostaphin resulted in stronger perfluorocarbon emulsion accumulation at the site of infection than expected compared to the results from bioluminescence imaging and colony forming unit determination. This might be an indication for immunomodulatory properties of oxacillin. Further murine infection experiments demonstrated in this context a differential release of cytokine and chemokines in the infected thigh muscle in dependence of the applied antibacterial therapy. Especially treatment with oxacillin, but to a less degree with minocycline or linezolid, too, exhibited high levels of various cytokines and chemokines, although they reduced the bacterial burden efficiently. In consequence, possible immunomodulatory effects of antibacterial compounds have to be taken into account for future applications of imaging platforms relying on the visualization of the immune response. However, this observation opens a new field for these imaging modalities since it might be extraordinary interesting to study the immunomodulatory effects of compounds or even bacterial factors in vivo. And finally, a two modality imaging platform which combines methods to visualize on the one hand the bacterial burden and on the other hand the immune response offers an innovative, new platform to study host-pathogen interaction in vivo in a non-invasive fashion. In summary, it could be shown that perfluorocarbon emulsions accumulate in immune cells at the site of infection in the murine S. aureus thigh infection model. The accumulation pattern shapes a 'hollow sphere' at the rim of the abscess area and its size and perfluorocarbon content is dependent on the severity of disease and/or efficacy of antibiotic therapy. Thus, 19F MRI with perfluorocarbon emulsions is a useful imaging modality to visualize sites and course of infection as well as to evaluate promising antibacterial drug candidates. Furthermore, since the accumulation of tracer depends on immune cells, it might be additionally interesting for studies regarding the immune response to infections, auto-immune diseases or cancer, but also to investigate the efficacy of immunomodulatory compounds and immunization.},
  subject      = {Staphylococcus aureus},
  language  = {en}
}
@phdthesis{vonRueden2022,
  author    = {von R{\"u}den, Martin Frederik},
  title     = {The Venus flytrap - Role of oxylipins in trap performance of Dionaea muscipula},
  doi       = {10.25972/OPUS-27385},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-273854},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2022},
  abstract  = {A part of the plant kingdom consists of a variety of carnivorous plants. Some trap their prey using sticky leaves, others have pitfall traps where prey cannot escape once it has fallen inside. A rare trap type is the snap-trap: it appears only twice in the plant kingdom, in the genera Aldrovanda and Dionaea. Even Charles Darwin himself described Dionaea muscipula, the Venus flytrap, with the following words "This plant, commonly called Venus' fly-trap, from the rapidity and force of its movements, is one of the most wonderful in the world". For a long time now, the mechanisms of Dionaea's prey recognition, capture and utilization are of interest for scientists and have been studied intensively. Dionaea presents itself with traps wide-open, ready to catch insects upon contact. For this, the insect has to touch the trigger hairs of the opened trap twice within about 20-30 seconds. Once the prey is trapped, the trap lobes close tight, forming a hermetically sealed "green stomach". Until lately, there was only limited knowledge about the molecular and hormonal mechanisms which lead to prey capture and excretion of digestive fluids. It is known that the digestion process is very water-consuming; therefore, the interplay of digestion-inducing and digestion inhibiting substances was to be analyzed in this work, to elucidate the fine-tuning of the digestive pathway. Special attention was given to the impact of phytohormones on mRNA transcript levels of digestion-related proteins after various stimuli as well as their effect on Dionaea's physiological responses. Jasmonic acid (JA) and its isoleucine-conjugated form, JA-Ile, are an important signal in the jasmonate pathway. In the majority of non-carnivorous plants, jasmonates are critical for the defense against herbivory and pathogens. In Dionaea, this defense mechanism has been restructured towards offensive prey catching. One question in this work was how the frequency of trigger hair bendings is related to the formation of jasmonates and the induction of the digestion process. Upon contact of a prey with the trigger hairs in the inside of the trap, the trap closes and jasmonates are produced biosynthetically. JA-Ile interacts with the COI1- receptor, thereby activating the digestion pathway which leads to the secretion of digestive fluid and production of transporters needed to take up prey-derived nutrients. In this work it could be shown that the number of trigger hair bendings is positively correlated with the level and duration of transcriptional induction of several digestive enzymes/hydrolases. Abscisic acid (ABA) acts, along with many other functions, as the plant "drought stress hormone". It is synthesized either by roots as the primary sensor for water shortage or by guard cells in the leaves. ABA affects a network of several thousand genes whose regulation prepares the plant for drought and initiates protective measurements. It was known from previous work that the application of ABA for 48 hours increased the required amount of trigger hair bendings to achieve trap closure. As the digestion process is very water-intensive, the question arose how exactly the interplay between the jasmonate- and the ABA-pathway is organized, and if ABA could stop the running digestion process once it had been activated. In the present work it could be shown that the application of ABA on intact traps prior to mechanically stimulating the trigger hairs (mechanostimulation) already significantly reduced the transcription of digestive enzymes for an incubation time as short as 4 h, showing that already short-term exposure to ABA counteracts the effects of jasmonates when it comes to initiating the digestion process, but does not inhibit trap closure. Incubation for 24 and 48 hours with 100 μM active ABA had no effect on trap reopening, only very high levels of 200 μM of active ABA inhibited trap reopening but also led to tissue necrosis. As the application of ABA could reduce the transcription of digestive hydrolases, it is likely that Dionaea can stop the digestion process, if corresponding external stimuli are received. Another factor, which only emerged later, was the effect of the wounding-induced systemic jasmonate burst. As efficient as ABA was in inhibiting marker hydrolase expression after mechanostimulation in intact plants, the application of ABA on truncated traps was not able to inhibit mechanostimulation-induced marker hydrolase expression. One reason might be that the ABA-signal is perceived in the roots, and therefore truncated traps were not able to react to it. Another reason might be that the wounding desensitized the tissue for the ABAsignal. Further research is required at this point. Inhibitors of the jasmonate pathway were also used to assess their effect on the regulation of Dionaea´s hunting cycle. Coronatine-O-methyloxime proved to be a potent inhibitor of mechanostimulation-induced expression of digestive enzymes, thus confirming the key regulatory role of jasmonates for Dionaea´s prey consumption mechanism. In a parallel project, the generation of in vitro cultures from sterilized seeds and single plant parts proved successful, which may be important for stock-keeping of future transgenic lines. Protoplasts were generated from leaf blade tissue and transiently transformed, expressing the reporter protein YFP after 24 h of incubation. In the future this might be the starting point for the generation of transgenic lines or the functional testing of DNA constructs.},
  subject      = {Venusfliegenfalle},
  language  = {en}
}
@phdthesis{Scheuplein2023,
  author    = {Scheuplein, Nicolas Julian},
  title     = {Synthesis and Characterization of Antimicrobial Inhibitors of the "Macrophage Infectivity Potentiator" Protein and Fluorescent Probes},
  doi       = {10.25972/OPUS-32189},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-321892},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {This dissertation focuses on Mip (macrophage infectivity potentiator protein) inhibitors in response to increasing antibiotic resistance. The study follows an antivirulence approach, which aims to inhibit the non-essential Mip protein without exerting too much selective pressure. Three focus areas were (1) development and synthesis of a fluorescent probe for screening Mip inhibitors via fluorescence polarization; (2) design and synthesis of broad spectrum Mip inhibitors bearing a side chain; and (3) understanding the metabolism of Mip inhibitors and identification of active metabolites. A sub-study addressed the biotinylation of anti-leishmanial compounds from Valeriana wallichii rhizomes, with three tracer molecules synthesized for future pull-down experiments.},
  subject      = {Antibiotikum},
  language  = {en}
}
@phdthesis{Saedtler2021,
  author    = {Saedtler, Marco},
  title     = {Pharmaceutical formulation strategies for novel antibiotic substances utilizing salt formation and two- and three-dimensional printing techniques},
  doi       = {10.25972/OPUS-21978},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-219784},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Salt formation is a routinely used strategy for poorly water-soluble drugs and traditionally performed with small inorganic counterions. High energy crystal lattices as well as effects on the local pH within the aqueous boundary layer during dissolution drive the increased dissolution rate and apparent solubility. Ionic liquids however, by definition low melting ionic salts with often large organic counterions, combine an increased dissolution rate with solubilization of the drug by the counterion itself. Long lasting supersaturation profiles of increased kinetic solubility were reported for several drugs formulated as ionic liquids increasing their overall bioavailability. Furthermore, aggregation and micellization between highly lipophilic compounds and amphiphilic bile acids was described before, demonstrating the capabilities of the human body itself to utilize solubilization of poorly water-soluble compounds. Development of novel counterions not only tailoring the desired physicochemical properties e.g. dissolution rate of the parent drug but adding - in a best-case scenario synergistic - pharmacological activity has been driven forward in the last years. However, salt formation can only be applied for ionizable i.e. acidic or basic compounds. While co-crystals can be used as a nonionized alternative, their formation is not always successful leading to an urgent need for other formulation strategies. In these lines, development of 2D and 3D printing techniques has been ongoing for the last decades and their pharmaceutical application has been demonstrated. The versatile nature and commercial availability allow a decentralized production further elaborating this technique for a highly flexible and patient-oriented supply with medication. This thesis focuses on the theoretical background and potential application of salt formation in the pharmaceutical development of a drug candidate. The first section presents the current knowledge and state of the art in preparation of low melting ionic liquids i.e. salts and is translated to the in vitro investigation of molecular interaction between the poorly water-soluble drug imatinib and components of the human intestinal fluid in the second section. Development of novel antibiotic counterions and assessment of their potential use in pharmaceutical formulations with fluoroquinolones is described in the last two sections. Chapter I describes the application of low melting ionic liquids in pharmaceutical formulation and details their development in the last two decades from versatile organic solvents in chemical synthesis towards amorphous strategies for drug delivery. The chapter gives a general overview on molecular structure and physicochemical properties of several drug containing ionic liquids and details the mechanisms which attribute to a typically fast dissolution, increased aqueous solubility as well as enhanced permeation which was reported in several publications. Chapter II translates the increased aqueous solubility of drugs by an organic counterion to the human gastrointestinal tract with taurocholate and lecithin as main drivers for the solubilization of highly lipophilic and poorly water-soluble drugs. Investigation of the interaction of imatinib - a poorly water-soluble weak base - with fasted- and fed state simulated intestinal fluids revealed a complex interplay between the components of the intestinal fluid and the drug. Mixed vesicles and micelles were observed in concentration dependent aggregation assays and revealed differences in their size, molecular arrangement as well as composition, depending on the tested drug concentration. Overall, the study outlines the effective interaction of weakly basic drugs with taurocholate and lecithin to minimize recrystallization during intestine passage finally leading to favorable supersaturation profiles. Chapter III focuses on the development of novel antibiotic counterions which potentially move the evolution of ionic liquids from a pharmaceutical salt with tailored physicochemical properties to a synergistic combination of two active pharmaceutical ingredients. The natural occurring anacardic acid derived from the cashew nut shell inspired a series of antibacterial active acidic compounds with increasing alkyl chain length. Their physicochemical properties, antibacterial activity, bacterial biofilm inhibition and cytotoxicity were detailed and in vivo activity in a Galleria mellonella model was assessed. This group of anacardic acid derivatives is synthetically accessible, easily modifiable and yielded two compounds with favorable activity and physicochemical profile for further drug development. Chapter IV outlines the potential application of anacardic acid derivatives in pharmaceutical formulations by salt formation with fluoroquinolone antibiotics as well as novel techniques such as 2D/3D printing for preparation of drug imprinted products. Despite anacardic acid derivatives demonstrated promising physicochemical properties, salt formation with fluoroquinolone antibiotics was not feasible. However, 2D/3D printed samples with anacardic acid derivative alone or in combination with ciprofloxacin demonstrated physical compatibility between drug and matrix as well as antibacterial activity against three S. aureus strains in an agar diffusion assay. Conclusively, drug printing can be applied for the herein tested compounds, but further process development is necessary. In summary, preparation of low melting ionic liquids, salts or co-crystals is an appropriate strategy to increase the aqueous solubility of poorly water-soluble drugs and tailor physicochemical properties. The counterion itself solubilizes the drug and furthermore potentially interferes with the complex micellar environment in the human intestine. However, salt formation as routinely used formulation strategy is not feasible in every case and development of alternative techniques is crucial to hurdle challenges related to unfavorable physicochemical properties. The outlined techniques for 2D/3D drug printing provide versatile production of drug products while extending the design space for novel drug development.},
  subject      = {L{\"o}slichkeit},
  language  = {en}
}
@phdthesis{Rachid2000,
  author    = {Rachid, Shwan},
  title     = {Molecular investigation of the influence of environmental factors and subinhibitory antibiotic concentrations on the biofilm formation in Staphylococcus epidermidis},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-1882},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2000},
  abstract  = {Biofilm production is an important step in the pathogenesis of S. epidermidis polymer-associated infections and depends on the expression of the icaADBC operon leading to the synthesis of a polysaccharide intercellular adhesin (PIA). The PIA represents a sugar polymer consisting of ß-1,6 linked N-acetyl glucosaminoglycans and mediates the intercellular adherence of the bacteria to each other and the accumulation of a multilayered biofilm. Epidemiological and experimental studies strongly suggest that PIA-production and subsequently biofilm formation contributes significantly to the virulence of specific S. epidermidis strains. This work aimed on the investigation of external factors regulating the ica expression in S. epidermidis. For this purpose, a reporter gene fusion between the ica promoter and the beta-galactosidase gene lacZ from E. coli was constructed and integrated into the chromosome of an ica positive S. epidermidis clinical isolate. The reporter gene fusion was used to investigate the influence of external factors and of sub-MICs of different antibiotics on the ica expression. It was shown that the S. epidermidis biofilm formation is growth phase dependent with a maximum expression in the late logarithmic and early stationary growth phase. The optimal expression was recorded at 42 °C at a neutral pH ranging from 7.0 to 7.5. The glucose content of the medium was found to be essential for biofilm formation, since concentrations of 1.5 to 2 per cent glucose induced the ica expression. In addition, external stress factors as high osmolarity (mediated by 3 to 5 per cent sodium chloride), and sub-lethal concentrations of detergents, ethanol, hydrogene peroxide, and urea significantly enhanced the biofilm production. Subinhibitory concentrations of tetracyline, the semisynthetic streptogramin quinupristin/dalfopristin and the streptogramin growth promoter virginiamycin were found to enhance the ica expression 8 to 11-fold, respectively, whereas penicillin, oxacillin, gentamicin, clindamycin, vancomycin, teicoplanin, ofloxacin, and chloramphenicol had no effects. A weak induction was recorded for sub-MICs of erythromycin. Both quinupristin/ dalfopristin and tetracyline exhibited a strong postexposure effect on the S. epidermidis ica expression, respectively, even when the substances were immediately removed from the growth medium. The results were confirmed by Northern blot analysis of the ica transcription and quantitative analysis of biofilm formation in a colorimetric assay. Expression of the icaprom::lacZ reporter gene plasmid in Bacillus subtilis and S. epidermidis revealed that the ica induction by sub-MICs of streptogramins and tetracycline might depend on unidentified regulatory elements which are specific for the staphylococcal cell. In contrast, the activation by external stress signals seems to be mediated by factors which are present both in Staphylococci and in Bacillus subtilis. Construction and analysis of an agr-mutant in a biofilm-forming S. epidermidis strain excluded the possibility that the Agr-quorum-sensing system significantly contributes to the ica expression in the stationary growth phase. However, clear evidence was provided that in S. aureus the ica transcription depends on the expression of the alternative transcription factor sigmaB, which represents a global regulator of the stress response in S. aureus as well as in B. subtilis. For this purpose, a sigB knockout mutant had been constructed in a biofilm-forming S. aureus. This mutant showed a markedly decrease of the ica transcription and biofilm-production, whereas a complement strain carrying the sigB gene on an expression vector completely restored the biofilm-forming phenotype of the S. aureus wild type. Southern blot analysis indicated that the the sigB gene is also present in S. epidermidis and Northern analyses of the sigB and the ica transcription revealed that both genes are activated under identical conditions (i. e. in the stationary growth phase and by external stress factors) suggesting a similar regulatory pathway as in S. aureus. However, since neither in S. aureus nor in S. epidermidis the ica promoter has obvious similiarities to known SigB-dependent promotoer sequences it is tempting to speculate that the ica activation is not directely mediated by SigB, but might be indirectely controlled by other SigB-dependent regulatory elements which remain to be elucidated.},
  subject      = {Staphylococcus epidermidis},
  language  = {en}
}
@phdthesis{Rasheed2019,
  author    = {Rasheed, Huma},
  title     = {Development of simple and cost-effective High Performance Liquid Chromatography methods for quality control of essential beta-lactam antibiotics in low- and middle-income countries},
  doi       = {10.25972/OPUS-17721},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-177214},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2019},
  abstract  = {Assay and impurity profiling of the pharmaceuticals are the key routine quality control methods employed worldwide for which High Performance Liquid Chromatography (HPLC) is the most widely used technique. The ability to carry out these routine laboratory procedures in low- and middle- income countries (LMICs) need the methods to be based upon simple instruments manageable with moderate levels of personnel skill and costs involved. Simple, convenient, and cost effective reverse phase HPLC methods were developed using phosphate buffer and methanol as mobile phase with C18 column as stationary phase for the impurity profiling and assay of beta lactam antibiotics. Isocratic elution and UV detection was employed in these methods. Impurity profiling method was developed for coamoxiclav tablets and ceftriaxone bulk drug. The method for ceftriaxone included a supplementary method to quantify one of its known impurity (Impurity D of ceftriaxone). This method involved use of acetonitrile where as the two main methods were achieved on the targeted method design, described above. With the exception of impurity A of ceftriaxone, the methods developed can successfully quantify impurities to the concentration as low as ≤0.05\%, which is in accordance with the current guidelines for the impurity profiling of antibiotics issued by European Medicines Agency. As ensuring cost reduction was one of the key objectives of carrying out the method development exercise, in situ methods for the preparation of impurities were also identified and some new methods were introduced. The stability of beta lactam antibiotics and the choice of solvent were given due attention during the process of method development revealing information on the presence of new impurities. Deacetyl cefotaxime and 2-mercaptobenzathiazole were identified in this process as new impurities of ceftriaxone currently not listed under known impurities by United States Pharmacopoeia and European Pharmacopoeia. However, deacetyl cefotaxime is a known impurity of cefotaxime whereas the latter molecule is a degradation product of one of the synthesis impurities of ceftriaxone. This substance is reported to be carcinogenic and is resolved using the supplementary method developed for ceftriaxone, hence making its detection and quantification possible. A known inactive impurity of ceftriaxone (Impurity A, E-isomer of ceftriaxone) was` also shown to be produced by exposure to day light, thus warranting the light protection of the ceftriaxone solution, an information that is of critical importance in the clinical settings. A series of experimentation was carried out on the finished products of beta lactam antibiotics sampled from Pakistan and few other countries, to identify key quality issues in the samples. Though the limited sample size and convenient sampling did not provide results that could yield a decisive figure for the country status for prevalence of substandard and falsified medical products, but the experiments have clearly indicated that the problems in drug quality do exist and beta lactam antibiotics form a class of high-risk medicine with respect to surveillance for poor-quality medicines. Isolation of unknown impurities was also carried out along with the introduction of new and modified methods for preparation of impurities of beta-lactam antibiotics. In addition, detailed literature survey was carried out for understanding the complex problem of the poor-quality medicine, impact of poor quality antimicrobials on health care system and the magnitude of the problem at the global level. The country status of Pakistan regarding quality of medicines was recorded based upon the available documentary evidence. The current technologies and strategic options available for low- and middle-income countries in aiding fight for combating poor quality medicines was also laid down to design recommendations for Pakistan. A comprehensive review of the information technology tools used for identification and control of substandard and falsified medicines was also conducted.},
  subject      = {HPLC},
  language  = {en}
}