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25 protocols using cotrimoxazole

1

Antimicrobial Susceptibility Testing of Pathogens

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To test antibiotic resistance in Campylobacter spp., the broth microdilution method was used with 5 % sheep blood. For all other pathogens, antimicrobial susceptibilities were determined by the agar dilution method according to the Clinical and Laboratory Standards Institute (CLSI) Guidelines, 2015 [20 ]. All isolates of Salmonella spp. were tested for their minimum inhibitory concentrations (MICs) of ampicillin, ampicillin-sulbactam, ceftriaxone, cefotaxime, nalidixic acid, ciprofloxacin, levofloxacin, co-trimoxazole, azithromycin, chloramphenicol and tetracycline (Oxoid); DEC were tested for ampicillin, ampicillin-sulbactam, cefotaxime, ciprofloxacin, levofloxacin, chloramphenicol, tetracycline, cefazolin, cefuroxime, imipenem, amikacin and gentamicin (Oxoid); Campylobacter spp. were tested for ciprofloxacin, azithromycin, tetracycline, erythromycin and doxycycline (Oxoid); and Aeromonas spp. were tested for cefotaxime, ciprofloxacin, levofloxacin, co-trimoxazole, chloramphenicol, tetracycline, cefazolin, cefuroxime, imipenem, amikacin and gentamicin (Oxoid). ATCC 25922, 35218, 700603 and 27853 were used as quality control strains. Antibiotic susceptibility was interpreted according to CLSI guidelines, 2015 [20 ].
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2

Bacterial Growth Media and Antibiotic Susceptibility Testing

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Bacterial growth media including brain heart infusion agar, Mac Conkey agar, eosin methyl blue agar, sugarsbroth, triple sugar iron agar, urea broth, methyl red media, Voges-Proskauermedia, and Mueller Hinton agar (MHA) were obtained from Oxoid (Hampshire, UK). Paper discs containing standard antibiotics namely ampicillin 10 µg, amoxycillin 25 µg, chloramphenicol 30 µg, cefuroxyme 30 µg, cefotaxime 30 µg, cefoperazone 75 µg, cefepime 30 µg, meropenem 10 µg, amikacin 30 µg, tetracycline 30 µg, ciprofloxacin 5 µg, levofloxacin 5 µg, co-trimoxazole 25 µg, and ceftazidime 30 µg were purchased from Oxoid (Hampshire, UK). Reagents (chrystal violet, 96% ethanol, iodin, safranin O, ammonium oxalate, oksalat, para-dimethylaminobenzaldehyde, butanol, acid chloride, α-naphtol 5%, KOH 40%, and distilled water) were supplied by Microbiology Laboratory, Faculty of Medicine, Universitas Sumatera Utara (Medan, Indonesia).
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3

Antibiotic Resistance Profiling of E. coli

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Patterns of antibiotic resistance of the E. coli isolates were assessed using the simple disc diffusion method. The isolates were cultured onto the Mueller–Hinton agar (HiMedia Laboratories, Mumbai, India; MV1084). Antibiotic discs including kanamycin (1000 μg/disc), tetracycline (30 μg/disc), ampicillin (10 μg/disc), gentamycin (10 μg/disc), imipenem (30 μg/disc), amikacin (30 μg/disc), mezlocillin (30 μg/disc), cefotaxime (30 μg/disc), piperacillin (30 μg/disc), ciprofloxacin (5 μg/disc), cotrimoxazole (30 μg/disc), norfloxacin (30 μg/disc), ceftazidime (30 μg/disc), nitrofurantoin (300 μg/disc), ofloxacin (5 μg/disc), ceftriaxone (30 μg/disc), nalidixic acid (30 μg/disc), tobramycin (30 μg/disc), clindamycin (2 μg/disc) and cephalothin (30 μg/disc) (Oxoid) were placed on the cultured Mueller–Hinton agar and all media were incubated aerobically at 37°C for 24 hours. All examinations and also interpretation of the findings were performed according to the instructions and guidelines of the CLSI [37 ]. Escherichia coli ATCC 8739 was used as a control organism.
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4

Antibiotic Susceptibility Test of Isolates

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An antibiotic susceptibility test was performed on all the isolates by disc diffusion method (CLSI, 2005 ). The zone diameters of each of the antibiotics were interpreted as per Clinical Laboratory Standards Institute (CLSI) recommendations (CLSI, 2005 ). Sixteen different antibiotic discs commonly prescribed by clinicians in the two hospitals except cefoxitin were used. These included: gentamicin (10 μg), co-trimoxazole (25 μg), ciprofloxacin (5 μg), cefpodoxime (30 μg), ceftazidime (30 μg), ceftriaxone (30 μg), cefoxitin (30 μg), imipenem (10 μg), nalidixic acid (30 μg), amoxycillin (20 μg), ofloxacin (30 μg), levofloxacin (30 μg), nitrofurantoin (300 μg), tetracycline (30 μg), chlorampenicol (30 μg) and augmentin (30 μg) (Oxoid, UK). Escherichia coli ATCC 25922 strain was used as a control culture.
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Antimicrobial Resistance Profiling of MRSA

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The pattern of antimicrobial resistance was studied using the simple disk diffusion technique. The Mueller–Hinton agar (Merck, Germany) medium was used for this purpose. Antibiotic resistance of the MRSA strains against 18 commonly used antibiotics was determined using the instructions provided by the Clinical and Laboratory Standards Institute guidelines (18 ). Susceptibility of MRSA isolates was tested against ampicillin (10 µg/disk), gentamycin (10 µg/disk), lincomycin (2 µg/disk), cephalothin (30 µg/disk), imipenem (30 µg/disk), tetracycline (30 µg/disk), vancomycin (5 µg/disk), ciprofloxacin (5 µg/disk), norfloxacin (30 µg/disk), cotrimoxazole (30 µg/disk), clindamycin (2 µg/disk), trimethoprim-sulfamethoxazole (25 μg/disk), penicillin (10 µg/disk), oxacillin (1 µg/disk), erythromycin (15 µg/disk), azithromycin (15 µg/disk), ceftriaxone (30 µg/disk) and cefixime (5 µg/disk) antibiotic agents (Oxoid, UK). The plates containing the discs were allowed to stand for at least 30 minutes before incubation at 35°C for 24 hours. The diameter of the zone of inhibition produced by each antibiotic disc was measured and interpreted using the CLSI zone diameter interpretative standards (18 ). Staphylococcus aureus ATCC 25923 and Escherichia coli (E. coli) ATCC 25922 were used as quality control organisms in antimicrobial susceptibility determination.
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6

Antibiotic Susceptibility Screening of Bacterial Isolates

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For each isolate, a single colony was isolated and sub-cultured, prior to screening by a disc diffusion assay according to EUCAST guidelines [24 (link)]. Susceptibility to eight different antibiotics belonging to different classes was tested: cefoxitin (30 µg), a second-generation cephalosporin used to indicate MRSA; ciprofloxacin (5 µg), a fluoroquinolone; cotrimoxazole (sulfamethoxazole - trimethoprim (1.2 µg and 23.75 µg respectively)); tetracycline (30 µg); erythromycin (15 µg), a macrolide and clindamycin (2 µg), a lincosamide; gentamycin (10 µg), an aminoglycoside; and chloramphenicol (30 µg) (Oxoid).
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7

Antimicrobial Susceptibility Profiling

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Susceptibility testing was done on Mueller–Hinton agar using disk diffusion technique according to Kirby–Bauer Method (Bauer et al. 1966 ). The antimicrobial agents tested were: ampicillin (10 µg), amikacin (30 µg), ciprofloxacin (5 µg), cotrimoxazole (25 µg), piperacillin (100 µg), gentamicin (10 µg), tetracycline (30 µg), penicillin (10 IU), clindamycin (30 µg), ceftriaxone (30 µg), chloramphenicol (30 µg), ceftazidime (30 µg), erythromycin (15 µg), amoxicillin/clavulanic acid (30 µg) and oxacillin (30 µg) (Oxoid, England). The antibiotic susceptibility profiles were interpreted based on Clinical and Laboratory Standards Institute (CLSI 2014 ) guidelines.
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8

Antibiotic Susceptibility Testing of Bacterial Isolates

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Antibiotic susceptibility was tested for all the isolates by the disc diffusion techniques according to Bauer et al. [15 (link)] and Clinical Laboratory Standard Institute (CLSI) guidelines [16 ]. The pure culture colony suspension of the isolate was made using sterile physiological saline and adjusted to 0.5 McFarland standards. Muller Hinton agar plate was swabbed with the suspension using sterile cotton swap and the antibiotic discs were placed over the agar and left for 30 minutes for diffusion of the antibiotics in the disc. The plates were inverted upside down and incubated at 37°C for 18 to 24 hours. The zones of inhibition were then read as resistant and sensitive using calibrated ruler and compared with the standard chart [15 (link)]. Intermediate results were few in number and therefore were considered as resistant for convenience. Antibiotics agents employed for susceptibility testing were ampicillin (10 μg), amoxicillin (30 μg), co-trimoxazole (25 μg), gentamicin (10 μg), ciprofloxacin (5 μg), penicillin (10 IU), and erythromycin (15 μg) (Oxoid, Ltd, UK).
This study was done using the same method conducted by Moges et al., 2002 [1 (link)], 10 years back in the same study area, and the present results were compared with the previous report [1 (link)].
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9

Antibiotic Susceptibility of Lactic Acid Bacteria

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The antibiotics employed in this study were erythromycin (15 μg), streptomycin (10 μg), cefotaxime (30 μg), kanamycin (30 μg), cefradine (30 μg), gentamicin (10 μg), ciprofloxacin (5 μg), amoxicillin (10 μg), chloramphenicol (30 μg), clindamycin (2 μg), ampicillin (10 μg), cotrimoxazole (25 μg), tetracycline (30 μg), ceftazidime (30 μg), and ceftriaxone (30 μg) (Oxoid, UK). The antibiotics susceptibility was tested for all the isolated LAB using Kirby-Bauer disk diffusion test (40 (link)). Plates were incubated at 37°C for 24 h and then the diameters of the inhibition zones were measured. The resistance of the LAB strains was interpreted using the guiding principles of the Clinical and Laboratory Standards Institute (CLSI 2014).
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10

Antibiotic Susceptibility of Vibrio spp.

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The following antibiotics were used for the disk diffusion method: tetracycline (30 µg), cotrimoxazole (25 µg), ciprofloxacin (5 µg), ampicillin (10 µg), ceftriaxone (30 µg) and chloramphenicol (30 µg) (Oxoid, UK). The Clinical and Laboratory Standards Institute (CLSI) interpretative criteria for antibiotic susceptibility testing of Vibrio spp (M45 document) was used when available. For ceftriaxone, kanamycin, nalidixic acid and ciprofloxacin, the interpretative criteria for Enterobacteriaceae/Salmonella spp (M100-S27 document) was used. The presence of extended-spectrum β-lactamase activity was investigated using the combination disk methodology (double disk synergy test); ceftazidime (30 µg), cefotaxime (30 µg) and cefpodoxime (30 µg) alone and ceftazidime and cefotaxime in combination with clavulanate (10 µg) was used, as per CLSI guidelines.
Disks were manufactured by Mast Group. Escherichia coli ATCC 25922 was used for internal quality control purposes.
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