Other Pharmacy and Pharmaceutical Sciences Commons^™

Financial Hardship From Purchasing Prescription Drugs Among Older Adults In The United States Before, During, And After The Medicare Part D “Donut Hole”: Findings From 1998, 2001, 2015, And 2021, Anthony W. Olson, Jon C. Schommer, David A. Mott, Olajide Adekunle, Lawrence M. Brown

Pharmacy Faculty Articles and Research

BACKGROUND: Cost-related nonadherence compromises successful and effective management of chronic disease. The Medicare Modernization Act of 2003 (MMA) and Patient Protection and Affordable Care Act of 2010 (ACA) aimed to increase the affordability of outpatient prescription drugs for older adults (older than age 64 years). The Medicare Part D prescription drug insurance coverage gap (“donut hole”) created by the MMA was fully closed in 2020 by the ACA.

OBJECTIVES: To (1) describe prescription drug coverage and financial hardship from purchasing prescription drugs among older American adults for 2021, (2) compare these results with findings from data collected before the MMA …

The Use Of Spectral Imaging To Reveal Inorganics And Organics Identity In The Biological Samples, Qamar Alshammari

Pharmaceutical Sciences (PhD) Dissertations

The wavelength is used to identify the exact location and quantify the number of molecules in the spectral imaging system. It aids in identifying materials and studying their quantities by examining how they interact with light. A traditional spectrometer provides spectrum information of chemical compounds, while standard imaging provides the intensity at each pixel of the image. Spectral imaging (SI) combines these two aspects by equipping intensity and spectral data for each pixel. In biomedical research, it is important to assess the inorganics/organics molecules to understand drug activity, cellular toxicity, and distribution. Using the microscopy technique, we found for the …

Assessing Nutritional Health Knowledge In Sharing Clinic Patients With Diabetes, Minden Huntrods

Capstone Experience: Master of Public Health

Effective diabetes prevention and management relies on nutritional behaviors, thus a basic level of health knowledge is important for patients with diabetes and their caregivers in their quest to acquire acute glycemic control and minimize negative health outcomes (Ley et al., 2014). The purpose of this study was to assess the nutrition-related health knowledge of patients living with diabetes who are seen at the UNMC Sharing Clinic by use of a verbal questionnaire. This nutritional health knowledge assessment was a quantitative, prospective, survey-based study utilizing descriptive statistics. Approximately 86% of patients were proficient in food group and nutritious foods knowledge …

The Potential Of Intrinsically Disordered Proteins As Drug Targets, Matt Staid

Honors Scholar Theses

Tumor necrosis factor α-induced protein 3-interacting protein 1 (TNIP1) is a negative regulator of inflammatory signaling in several diseases. TNIP1 is also an intrinsically disordered protein (IDP), which makes it difficult for current drugs to affect it. More research on IDPs could lead to novel drugs targeting TNIP1, leading to improved therapies for patients with acute and chronic inflammatory diseases. The main difference between IDPs and the more common ordered proteins is that IDPs are flexible, a characteristic of TNIP1 which was demonstrated in this study via protease sensitivity. Ordered proteins are rigid, which means that they only have one …

Discovery Of Ojt008 As A Novel Inhibitor Of Mycobacterium Tuberculosis, Collins Chidi Onyenaka

Dissertations (2016-Present)

Despite recent progress in the diagnosis of Tuberculosis (TB), the chemotherapeutic management of TB is still challenging. Mycobacterium tuberculosis (Mtb) is the etiological agent of TB, and TB is classified as the 13th leading cause of death globally [WHO 2021]. 558,000 people were reported to develop multi-drug resistant TB globally [WHO 2020]. Our research focuses on targeting Methionine Aminopeptidase (MetAP), an essential protein for the viability of Mtb. MetAP is a metalloprotease that catalyzes the removal of N-terminal methionine (NME) during translation of protein [Giglione et al., 2003]. This essential role of MetAPs makes this enzyme an auspicious target for …

Preclinical Development Of A Novel Antileishmanial Agent Ojt007: Bioanalytical Assay, In Vitro Studies And Pharmacokinetics, Maria Eugenia Rincon-Nigro

Dissertations (2016-Present)

Current treatments for cutaneous leishmaniasis suffer from toxic side effects, high cost, parenteral administration, and drug resistance. Thus, there is a critical need to develop oral drugs for the treatment of leishmaniasis. OJT007 is a novel class of drug with potent antiproliferative effects against Leishmania Major. The purpose of this project is to conduct preclinical drug development studies for OJT007 including bioanalytical assay development, pre-formulation studies, in vitro hepatic drug metabolism and in vivo pharmacokinetics. A sensitive, specific, and reproducible ultra-high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated. The separation was achieved on a UPLC BEH …

Challenge And Development Strategy For Colon-Targeted Drug Delivery System, Raditya Iswandana, Kurnia Sari Setio Putri, Fathia Amalia Putri, Maxius Gunawan, Sekar Arum Larasati

Pharmaceutical Sciences and Research

Colon-Targeted Drug Delivery System (CTDDS) is able to improve local therapeutic effects in the treatment of colon-specific diseases, such as Crohn’s disease, Ulcerative Colitis (UC), and Irritable Bowel Syndrome (IBS). A colon can also be a suitable site for systemic delivery of drugs susceptible to extreme gastric pH, such as peptides and protein therapeutics. The physiological conditions of the gastrointestinal tract and the physicochemical properties of drugs are being considered to develop strategies and approaches to overcome emerging challenges. This review will discuss factors, challenges, strategies, and approaches to developing a colon-targeted drug delivery system.

Antihypertensive And Antioxidant Activity Of Herbal Medicine (Jamu) B On Rats Induced By 10% Fructose, Aprilita Rina Yanti Eff, Reza Ayu Pertiwi, Hermanus Ehe Hurit, Sri Teguh Rahayu, Yonatan Eden

Pharmaceutical Sciences and Research

Prolonged fructose intake can activate the renin-angiotensin-aldosterone system and enhance oxidative stress conditions, causing hypertension and hyperuricemia. This study aimed to determine the antihypertensive and antioxidant activity of Jamu B on the activity of superoxide dismutase (SOD), glutathione (GSH), and malondialdehyde (MDA) in the kidneys of Sprague Dawley rats induced by 10% fructose. Thirty rats were divided into six groups. Groups B1-B3 were Jamu groups at a dose of 0.12 g/kg BW (B1), 0.24 g/kg BW (B2), and 0.36 g/kg BW (B3); group C (positive control) was given captopril 0.1 g/kg BW, group D (negative control) was given only 10% …

Association Of Environmental Pollutants Exposure With Pulmonary Fibrosis: A Mini Review Of Molecular Mechanism Mediated, Soni Siswanto, Bantari W.K. Wardhani

Pharmaceutical Sciences and Research

Pulmonary fibrosis is a specific form of chronic progressive interstitial lung disease. Deposition of extracellular matrix, mainly collagen, is the pathogenic characteristic of pulmonary fibrosis. Many reports show that environmental pollutants, particularly asbestos, silica, mercury, cadmium, and benzo(a)pyrene, are contributed in the etiology of lung injury and a risk factor in the development of idiopathic pulmonary fibrosis (IPF) in humans. Based on its physicochemical properties, environmental pollutant-induced pulmonary fibrosis can be developed after a particular type or dose of exposure. To date, some studies have focused on variant pollutants that are induced. However, the molecular mechanism of various pollutants to …

Crispr/Cas9 Genome Editing: Future Treatment Of Duane Retraction Syndrome, Muhammad Raihan Zulfikar, Editha Renesteen, Bantari W.K. Wardhani

Pharmaceutical Sciences and Research

Duane Retraction Syndrome (DRS) is characterized by limited eye movement. One of its causes is a mutation in the CHN1, MAFB, or SALL4 gene. Nowadays, the treatment for DRS is limited to glasses, occlusion, and surgery. However, this treatment has not been able to cure the disease’s hereditary issue. Another strategy to be considered for the treatment is CRISPR/Cas9, a tool for performing gene editing with a wide range of applications, including treating genetic diseases. We made sgRNA as a first step in using CRISPR/Cas9 as a treatment for DRS in silico using the CCTop website. By computing sgRNA, conducting …

Identification Of Community Knowledge On Lead Contamination And Analysis Of Lead Level In Fish, Sita Nurwulan, Sophi Damayanti, Lia Amalia

Pharmaceutical Sciences and Research

Poisoning is an event of human exposure to poisonous substances that are harmful to the body at certain doses. Lead is a heavy metal that can cause toxicity, including neurotoxic effects, hypertension, digestive system disorders, bone and tooth growth disorders, immune system disorders, infertility, and fetal disorders. Fish is a source of nutrients that are often consumed by people, however can also accumulate lead. This study aimed to analyze the lead level in fish and identify the community knowledge level regarding lead contamination in fish. Identification of community knowledge levels regarding lead. Identification of community knowledge levels regarding lead contamination …

Interactions Among Endothelial Nitric Oxide Synthase, Cardiovascular System, And Nociception During Physiological And Pathophysiological States, Niribili Sarmah, Andromeda M. Nauli, Ahmmed Ally, Surya M. Nauli

Pharmacy Faculty Articles and Research

Nitric oxide synthase (NOS) plays important roles within the cardiovascular system in physiological states as well as in pathophysiologic and specific cardiovascular (CV) disease states, such as hypertension (HTN), arteriosclerosis, and cerebrovascular accidents. This review discusses the roles of the endothelial NOS (eNOS) and its effect on cardiovascular responses that are induced by nociceptive stimuli. The roles of eNOS enzyme in modulating CV functions while experiencing pain will be discussed. Nociception, otherwise known as the subjective experience of pain through sensory receptors, termed “nociceptors”, can be stimulated by various external or internal stimuli. In turn, events of various cascade pathways …

Pharmacists Provision Of Non-Dispensing Services In Health Professional Shortage Areas, Haley L. Kessinger, Emily R. Landis

ONU Student Research Colloquium

Background: Individuals living in primary care health professional shortage areas (PCHPSAs) experience health inequities. Community pharmacists are healthcare professionals with an opportunity to provide care to underserved populations. The objective of this study was to compare non-dispensing services provided by Ohio community pharmacists in PCHPSAs and non-PCHSPAs.

Methods: An electronic, IRB-approved 19-item survey was sent to all community pharmacists practicing in full PCHPSA counties and a random sample practicing in non-PCHPSA counties in Ohio (n=324). Questions assessed current provision of non-dispensing services as well as interest and barriers regarding such services.

Results: Seventy-three usable responses were received (23% response rate). …

Cinnamon Extract Alters Mcf7 Cell Morphology, Madison M. Anderson

ONU Student Research Colloquium

Cancer prevention is one area of research that has gained interest in recent years. The anti-cancer effects of polyphenols and other nutraceuticals show great promise in prevention as well as therapeutics. In cancers that occur due to epigenetic modifications, molecules that provide these modifications are useful for both the prevention and reversal of disease. Our lab studies the effects of cinnamon extract on cell viability, growth and morphology. Cinnamon extract has high polyphenolic content and is believed to regulate a variety of transcription factors as well as epigenetic modifications. Our observations suggest that a significant change in morphology occurs in …

Bis-Cinnamamide Derivatives As Ape/Ref-1 Inhibitors For The Treatment Of Human Melanoma, Razan Alhazmi, Shirley Tong, Shaban Darwish, Elina Khanjani, Bharti Khungar, Swati Chawla, Zhonghui Zheng, Richard Chamberlain, Keykavous Parang, Sun Yang

Pharmacy Faculty Articles and Research

Human malignant melanoma exhibits imbalances in redox status, leading to activation of many redox-sensitive signaling pathways. APE/Ref-1 is a multifunctional protein that serves as a redox chaperone that regulates many nuclear transcription factors and is an important mechanism in cancer cell survival of oxidative stress. Previous studies showed that APE/Ref-1 is a potential druggable target for melanoma therapy. In this study, we synthesized a novel APE/Ref-1 inhibitor, bis-cinnamoyl-1,12-dodecamethylenediamine (2). In a xenograft mouse model, compound 2 treatment (5 mg/kg) significantly inhibited tumor growth compared to the control group, with no significant systemic toxicity observed. We further synthesized compound …

Oleyl Conjugated Histidine-Arginine Cell-Penetrating Peptides As Promising Agents For Sirna Delivery, Muhammad Imran Sajid, Dindyal Mandal, Naglaa Salem El-Sayed, Sandeep Lohan, Jonathan Moreno, Rakesh Kumar Tiwari

Pharmacy Faculty Articles and Research

Recent approvals of siRNA-based products motivated the scientific community to explore siRNA as a treatment option for several intractable ailments, especially cancer. The success of approved siRNA therapy requires a suitable and safer drug delivery agent. Herein, we report a series of oleyl conjugated histidine–arginine peptides as a promising nonviral siRNA delivery tool. The conjugated peptides were found to bind with the siRNA at N/P ratio ≥ 2 and demonstrated complete protection for the siRNA from early enzymatic degradation at N/P ratio ≥ 20. Oleyl-conjugated peptide -siRNA complexes were found to be noncytotoxic in breast cancer cells (MCF-7 and MDA-MB-231) …

Investigating The Efficacy Of Tazemetosttat For In Vitro Treatment Of Human Triple Negative Breast Cancer Cells, Harshita Indukuri

Honors Scholars Collaborative Projects

Cancer is a formidable, genetic disease that affects many people, either directly or indirectly. Breast cancer is the most commonly diagnosed cancer worldwide (31). Triple-negative breast cancer (TNBC) is a type of breast cancer that has a higher lethality compared to other breast cancers and has a poor prognosis due to its highly invasive nature and limited treatment options. Finding safe, effective, and accessible treatment for TNBC is integral to treating TNBC patients. Tazemetostat is an EZH2-inhibitor that has recently been approved for use in epithelioid sarcoma (23). EZH2 is an overexpressed protein in many cancers, including TNBC (11). However, …

A Meshless Approach To Computational Pharmacokinetics, Anthony Matthew Khoury

Doctoral Dissertations and Master's Theses

The meshless method is an incredibly powerful technique for solving a variety of problems with unparalleled accuracy and efficiency. The pharmacokinetic problem of transdermal drug delivery (TDDD) is one such topic and is of significant complexity. The locally collocated meshless method (LCMM) is developed in solution to this topic. First, the meshless method is formulated to model this transport phenomenon and is then validated against an analytical solution of a pharmacokinetic problem set, to demonstrate this accuracy and efficiency. The analytical solution provides a locus by which convergence behavior are evaluated, demonstrating the super convergence of the locally collocated meshless …

Amphiphilic Cell-Penetrating Peptides Containing Natural And Unnatural Amino Acids As Drug Delivery Agents, David Salehi, Saghar Mozaffari, Khalid Zoghebi, Sandeep Lohan, Dindyal Mandal, Rakesh Tiwari, Keykavous Parang

Pharmacy Faculty Articles and Research

A series of cyclic peptides, [(DipR)(WR)₄], [(DipR)₂(WR)₃], [(DipR)₃(WR)₂], [(DipR)₄(WR)], and [DipR]₅, and their linear counterparts containing arginine (R) as positively charged residues and tryptophan (W) or diphenylalanine (Dip) as hydrophobic residues, were synthesized and evaluated for their molecular transporter efficiency. The in vitro cytotoxicity of the synthesized peptides was determined in human epithelial ovary adenocarcinoma cells (SK-OV-3), human lymphoblast peripheral blood cells (CCRF-CEM), human embryonic epithelial kidney healthy cells (HEK-293), human epithelial mammary gland adenocarcinoma cells (MDA-MB-468), pig epithelial kidney normal cells (LLC-PK1), and human epithelial …

Combination Of Amphiphilic Cyclic Peptide [R4W4] And Levofloxacin Against Multidrug-Resistant Bacteria, Muhammad Imran Sajid, Sandeep Lohan, Shun Kato, Rakesh Kumar Tiwari

Pharmacy Faculty Articles and Research

Bacterial resistance is a growing global concern necessitating the discovery and development of antibiotics effective against the drug-resistant bacterial strain. Previously, we reported a cyclic antimicrobial peptide [R₄W₄] containing arginine (R) and tryptophan (W) with a MIC of 2.67 µg/mL (1.95 µM) against methicillin-resistant Staphylococcus aureus (MRSA). Herein, we investigated the cyclic peptides [R₄W₄] or linear (R₄W₄) and their conjugates (covalent or noncovalent) with levofloxacin (Levo) with the intent to improve their potency to target drug-resistant bacteria. The physical mixture of the Levo with the cyclic [R_{4 …}

The Large And Small Of It: The Microbiome And Metagenomics, Austin Hopkins, Elaina Gollmar, Jessica Fernandez, Shawn Wolf, Austin Hilverding, Andrew M. Roecker

Pharmacy and Wellness Review

Metagenomics, the analysis of the microbial genome, permits scientists to understand the influences of external sources including diet, metabolism and antibiotics on the human microbiome. Research has revealed the possibility of a core symbiosis between humans and bacteria. The main role of the human microbiome is to aid in digestion, but identified ancillary roles include immunologic homeostasis and infection prevention. Quantifying the composition and variability of the microbiome will help lead to future treatments or preventive strategies against unhealthy change. A variety of methods may be used to define the microbiome, and 16S amplicon sequencing is primarily utilized today. Probiotics …

Breast And Prostate Cancer Screening: Recommendations From The American Cancer Society Versus The U.S. Preventive Services Task Force, Eric Chung, Elizabeth Kramer, Katlyn Brown, Farabi Alam, Olivia Henton, Natalie Dipietro Mager

Pharmacy and Wellness Review

Over the past decades, opportunities for pharmacists to be actively involved in screening, education and referral for patients have grown. As these opportunities have increased, so too has the importance of being knowledgeable about the corresponding recommendations and guidelines. At times, various expert organizations may publish contradicting guidelines for a particular disease state or preventive medicine recommendation. This article focuses on the general background and history of two such expert groups, the American Cancer Society and the U.S. Preventive Services Task Force, and compares the two entities’ recommendations for breast and prostate cancer as of April 2017. It is critical …

Development And Management Of Depression During And After Pregnancy, Alexa Bouts, Maria Patnella, Jourdan Ujlaki, Emily Wells, Hannah Lamb, Michelle Musser

Pharmacy and Wellness Review

Depression during pregnancy is common, whether it is a new onset of the disease or emerging symptoms of the already existent disease. Due to patient and prescriber concerns with antidepressant use during pregnancy, approximately three-quarters of those diagnosed with depression remain untreated. Furthermore, up to half of pregnant women with depression remain undiagnosed due to lack of recognition. As a result, both mother and fetus are at risk for negative health outcomes including substance abuse, functional impairment, increased risk of postnatal depression and poor pregnancy outcomes. Benefits must be balanced against the risks when considering pharmacologic treatment options to manage …

Cross-Sectional Evaluation Of Chronic Medication Use Across Age Categories, Alecia N. Muwonge, Nedra Geddes-Mccarthy

NSU REACH and IPE Day

Purpose: The objective of this study was to estimate the use of chronic medications for hypertension, hyperlipidemia, hyperglycemia, and depression in adults over 18 years old. Background: Aging is associated with increased multimorbid conditions. Management of multimorbid conditions can be complex, making polypharmacy a prevalent problem in the adult population. Previous studies investigated the prevalence of chronic medication use in older adults, but none have evaluated the trends in use with increasing age. Methods: This retrospective cross-sectional study used general population data from NHANES during the 2011-2018 cohort years for a population of all adults 18 years of age and …

Late-Stage Chemoenzymatic Installation Of Hydroxy-Bearing Allyl Moiety On The Indole Ring Of Tryptophan-Containing Peptides, Nagaraju Mupparapu, Lauren Brewster, Katrina F. Ostrom, Sherif I. Elshahawi

Pharmacy Faculty Articles and Research

The late-stage functionalization of indole- and tryptophan-containing compounds with reactive moieties facilitates downstream diversification and leads to changes in their biological properties. Here, the synthesis of two hydroxy-bearing allyl pyrophosphates is described. A chemoenzymatic method is demonstrated which uses a promiscuous indole prenyltransferase enzyme to install a dual reactive hydroxy-bearing allyl moiety directly on the indole ring of tryptophan-containing peptides. This is the first report of late-stage indole modifications with this reactive group.

The Use Of Advanced Spectral Imaging To Reveal Nanoparticle Identity In Biological Samples, Qamar A. Alshammari, Rajasekharreddy Pala, Ayan K. Barui, Saud O. Alshammari, Andromeda M. Nauli, Nir Katzir, Ashraf M. Mohieldin, Surya M. Nauli

Pharmacy Faculty Articles and Research

Nanoparticles (NPs) have been used in drug delivery therapies, medical diagnostic strategies, and as current Covid-19 vaccine carriers. Many microscope-based imaging systems have been introduced to facilitate detection and visualization of NPs. Unfortunately, none can differentiate the core and the shell of NPs. Spectral imaging has been used to distinguish a drug molecule and its metabolite. We have recently integrated this technology to a resolution of 9 nm by using artificial intelligence-driven analyses. Such a resolution allowed us to collect many robust datapoints for each pixel of an image. Our analyses could recognize 45 spectral points within a pixel to …

Cilia Proteins Are Biomarkers Of Altered Flow In The Vasculature, Ankan Gupta, Karthikeyan Thirugnanam, Madhan Thamilarasan, Ashraf M. Mohieldin, Hadeel T. Zedan, Shubhangi Prabhudesai, Meghan R. Griffin, Andrew D. Spearman, Amy Pan, Sean P. Palecek, Huseyin C. Yalcin, Surya M. Nauli, Kevin R. Rarick, Rahima Zennadi, Ramani Ramchandran

Pharmacy Faculty Articles and Research

Cilia, microtubule-based organelles that project from the apical luminal surface of endothelial cells (ECs), are widely regarded as low-flow sensors. Previous reports suggest that upon high shear stress, cilia on the EC surface are lost, and more recent evidence suggests that deciliation—the physical removal of cilia from the cell surface—is a predominant mechanism for cilia loss in mammalian cells. Thus, we hypothesized that EC deciliation facilitated by changes in shear stress would manifest in increased abundance of cilia-related proteins in circulation. To test this hypothesis, we performed shear stress experiments that mimicked flow conditions from low to high shear stress …

A Semi-Physiological Three-Compartment Model Describes Brain Uptake Clearance And Efflux Of Sucrose And Mannitol After Iv Injection In Awake Mice, Behnam Noorani, Ekram Ahmed Chowdhury, Faleh Alqahtani, Md Sanaullah Sajib, Yeseul Ahn, Ehsan Nozohouri, Dhavalkumar Patel, Constantinos Mikelis, Reza Mehvar, Ulrich Bickel

Pharmacy Faculty Articles and Research

Purpose

To evaluate a three-compartmental semi-physiological model for analysis of uptake clearance and efflux from brain tissue of the hydrophilic markers sucrose and mannitol, compared to non-compartmental techniques presuming unidirectional uptake.

Methods

Stable isotope-labeled [¹³C]sucrose and [¹³C]mannitol (10 mg/kg each) were injected as IV bolus into the tail vein of awake young adult mice. Blood and brain samples were taken after different time intervals up to 8 h. Plasma and brain concentrations were quantified by UPLC-MS/MS. Brain uptake clearance (K_in) was analyzed using either the single-time point analysis, the multiple time point graphical method, …

Inhibition Of Interferon-Gamma-Stimulated Melanoma Progression By Targeting Neuronal Nitric Oxide Synthase (Nnos), Shirley Tong, Maris A. Cinelli, Naglaa Salem El-Sayed, He Huang, Anika Patel, Richard B. Silverman, Sun Yang

Pharmacy Faculty Articles and Research

Interferon-gamma (IFN-γ) is shown to stimulate melanoma development and progression. However, the underlying mechanism has not been completely defined. Our study aimed to determine the role of neuronal nitric oxide synthase (nNOS)-mediated signaling in IFN-γ-stimulated melanoma progression and the anti-melanoma effects of novel nNOS inhibitors. Our study shows that IFN-γ markedly induced the expression levels of nNOS in melanoma cells associated with increased intracellular nitric oxide (NO) levels. Co-treatment with novel nNOS inhibitors effectively alleviated IFN-γ-activated STAT1/3. Further, reverse phase protein array (RPPA) analysis demonstrated that IFN-γ induced the expression of HIF1α, c-Myc, and programmed death-ligand 1 (PD-L1), in contrast …

Evaluation Of Step-Down Oral Antibiotic Therapy For Uncomplicated Streptococcal Bloodstream Infections On Clinical Outcomes, Amy Y. Kang, Richard Beuttler, Emi Minejima

Pharmacy Faculty Articles and Research

Background: Despite the severity and frequency of streptococcal bloodstream infections (BSIs), the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the clinical outcomes of step-down oral antibiotics for the treatment of uncomplicated streptococcal BSIs.

Methods: In this retrospective cohort study, adult patients admitted with uncomplicated streptococcal BSI between June 2015 and June 2017 were included. Patients were excluded if they received <48 h of antibiotic therapy; therapy was started >48 h after first positive culture; had complicated infections of endocarditis, bone and joint infections, or central nervous system infections; Pitt bacteremia score (PBS) ⩾ 4; or failed to respond …