Bacillus clausii is a rod-shaped, Gram-positive, motile and spore-forming bacterium which lives in the soil.

It is presently classified as probiotic; microorganisms that maintain a symbiotic relationship with the host organism. It is currently being studied in respiratory infections and some gastrointestinal disorders Description and significance Bacillus clausii is Gram-positive, motile, and spore-forming and like most of the Bacillus bacteria, it is rod-shaped. Colonies of B. clausii form filamentous margins that appear cream-white in color. B. clausii is alkaliphilic and produces a class of subtilisins known as high-alkaline proteases. The protease from Bacillus clausii strain 221, the H-221 protease, was the first enzyme to be identified in an alkaliphilic Bacillus. The alkaliphilic nature of the organism has also proved it to be useful in preventing and treating various gastrointestinal disorders as an oral bacteriotherapy. This organism can be found in many alkaline environments, including soil and marine habitat. The B. clausii strain KSM-K16 was obtained from soil samples, and its phylogenic position as a member of B. clausii was identified using Bacillus clausii DSM 8716 as a reference strain- also isolated from a soil sample. DSM 8716 was identified as a novel Bacillus species by Nielsen et. all, with unique characteristics detailed in Cell Structure and Metabolism. The techniques used to determine the classification of KSM-K16 included 16S rRNA sequencing, which directly compares two or more strains of rRNA sequences to determine sequence homology- in this case the sequence of KSM-K16 with that of DSM 8716. Other classification techniques including fatty acid analysis, which identifies fatty acids in the membrane, and carbohydrate utilization tests, which establish the metabolic characteristics of the organism. Growth of KSM-K16 was observed in the temperature range of 1550C and the pH range of 7-10.5, with optimal growth at 40C and pH 9.0. The KSM-K16 strain produces the high-alkaline protease, M-protease, which is hyperproduced by a mutant used in industrial scale compact heavy-duty laundry detergent. This protease, among other enzymes used by B. clausii organisms, are being extensively studied to understand their ability to function in such alkaline conditions for possible biotechnology use, making the genome of B. clausii a necessary tool. Genome structure The Bacillus clausii KSM-K16 complete genome is one circular chromosome. The chromosome is composed of 4,303,871 nucleotides. This genome contains 4204 genes, of which 4096 are protein coding and 96 code for RNAs. The GC content of B. clausii KSM-K16 is 44%, one of the highest GC contents amongst the Bacillus microbes. The most studied genes on the chromosome include Mprotease and other alkaline-adapted proteases which have been X-ray crystallized based on genome sequence and erm-related genes (see Current Research). Cell structure and metabolism Bacillus clausii is a rod shaped, gram-positive microbe, meaning it is surrounded by a thick cell wall. The cell wall is made up of the peptidoglycan murien. B. clausii cells tend to line up into chain-like formation, observable as a long rod cell. B. clausii is an endospore producing microbe that creates ellipsoidal spored located subterminally or paracentrally in the sporangium. Spores of B. clausii are resistant to many antibiotics including erythromycin, lincomycin, cephalosporins, and cycloserine. Bacillus clausii strain DSM 8716 was originally noticed as a novel species upon the characteristics of ability to hydrolyze casein, ability to reduce nitrate, and ability to grow at 50C. Further tests showed Bacillus clausii were able to use multiple sources of carbon including: L-aribose, xylitol, galactose, dulcitol, sorbitol, methyl a-D-mannoside, mannose, N-acetylglucosamine, D-tagose, 2-ketogluconate.

Part of current classification tests probe for which carbon sources are used by a Bacillus strands to identify its species. Nitrate reduction uses nitrate as the terminal electron acceptor during anaerobic respiration. The use of nitrate as the electron acceptor into reduced nitrite is not as efficient as the use of oxygen- and microbes such as B. clausii will prefer the use of oxygen over nitrate in terms of energy production. But in environments of low oxygen such as soil, where B. clausii is usually found, nitrate reduction can be used to keep electron transport in operation to maintain an electron gradient for ATP synthesis. Ecology Bacillus clausii is found in the soil where it can reduce nitrate to nitrite. The use of nitrite to become other reduced forms of nitrogenous compounds is possible, and some bacteria such as Pseudomonas aeruginosa are capable of the complete reduction of nitrite. But the extent of nitrate reduction has not been studied thoroughly in Bacillus clausii. A possible relationship with other organisms that use nitrites may therefore exist. B. clausii DSM 8716 were oberved in linked chain form with each other. In terms of other organisms, no published journals discuss a direct relationship with B. clausii. B. clausii spores have been used in a European probiotic called Enterogermina, which stimulates GI tract immune system function by increasing production of secretory A immunoglobulin- indirectly acting as an antagonist to other bacterial pathogens that infect the gastrointestinal tract (see Current Research and Application to Biotechnology). Pathology Bacillus clausii resistance to many antibiotics makes it seem capable of harm to humans, but Bacillus clausii sporulated strains are actually used in the treatment of gastrointestinal illnesses to restore intestinal flora because of their antibiotic resistance and ability to stimulate immune activity- a class of bacteria dubbed probiotics (see Application to Biotechnology) Application to Biotechnology The spores of B. clausii and other related Bacilli are used as probiotics to improve the intestinal microbial balance during periods of antibiotic usage, modify the immune system function of the GI tract, and act as anti-microbial agents themselves. Probiotic-containing treatments are available for human nutrition, animal feed supplements, and also for aquaculture. An antibiotic resistant probiotic known as Enterogermina consists of 4 strains of Bacillus microbes (O/C, N/R, SIN, and T), all of which were recently reclassified from B. subtilis to B. clausii. Enterogermina is notably used in the treatment of diarrhea and prevention of infectious gastrointestinal diseases. Though not completely understood, the enzyme secretions of B. clausii during sporulation are believed to lead to these positive effect on the GI tract; during sporulation, strains from Enterogermina were found to release antimicrobial compounds and modulate immune activity by increasing production of secretory immunoglobin A. The spore resistance to antibiotics makes it especially useful for use in conjunction with antibiotic treatment for other pathogens. With further knowledge of the function of B. clausii activity as Enterogermina, the usage of this mibrobe in medicine can be optimized and implemented in more effective ways.

DRUG DESCRIPTION

MERREM I.V. (meropenem for injection) is a sterile, pyrogen-free, synthetic, broad-spectrum, carbapenem antibiotic for intravenous administration. It is (4R,5S,6S)-3-[[(3S,5S)-5(Dimethylcarbamoyl)-3-pyrrolidinyl]thio]-6-[(1R)-1-hydroxyethyl]-4-methyl-7-oxo-1azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid trihydrate. Its empirical formula is C17H25N3O5S3H2O with a molecular weight of 437.52. Its structural formula is:

MERREM I.V. (meropenem) is a white to pale yellow crystalline powder. The solution varies from colorless to yellow depending on the concentration. The pH of freshly constituted solutions is between 7.3 and 8.3. Meropenem is soluble in 5% monobasic potassium phosphate solution, sparingly soluble in water, very slightly soluble in hydrated ethanol, and practically insoluble in acetone or ether. When constituted as instructed (see DOSAGE AND ADMINISTRATION; PREPARATION OF SOLUTION), each 1 g MERREM I.V. vial will deliver 1 g of meropenem and 90.2 mg of sodium as sodium carbonate (3.92 mEq). Each 500 mg MERREM I.V. vial will deliver 500 mg meropenem and 45.1 mg of sodium as sodium carbonate (1.96 mEq).
Vesicare Oral Uses

This medication is used to treat an overactive bladder. By relaxing the muscles in the bladder, solifenacin improves your ability to control your urination. It helps to reduce leaking of urine, feelings of needing to urinate right away, and frequent trips to the bathroom. This medication belongs to the class of drugs known as antispasmodics.
How to use Vesicare Oral

Read the Patient Information Leaflet provided by your pharmacist before you start using solifenacin and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist. Take this medication by mouth, with or without food, usually once a day, or as directed by your doctor. Swallow this medication whole with a full glass of liquid. Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day. Dosage is based on your medical condition (especially kidney and liver disease), response to therapy, and use of certain interacting medicines. Consult your doctor or pharmacist for more details.

Do not increase your dose or take this medication more often without your doctor's approval. Your condition will not improve any faster and the risk of serious side effects may be increased. Inform your doctor if your condition does not improve or if it worsen
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Drugs & Medications - VESIcare Oral

Vesicare Oral

Brand Name(s): Vesicare

Review this Drug224 User ReviewsView Images Vesicare Oral Side Effects

Dry mouth, constipation, stomach upset, stomach pain, blurred vision, dry eyes, or unusual tiredness/weakness may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use a saliva substitute. To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated, consult your pharmacist for help in choosing a laxative (e.g., stimulanttype with stool softener). Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these unlikely but serious side effects occur: severe stomach/abdominal pain, constipation for 3 or more days, difficulty urinating, signs of kidney infection (e.g., burning/painful urination, lower back pain, fever). A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Before taking solifenacin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: problems emptying your bladder (urinary retention), severe blockage of stomach/intestines (gastric retention), a certain eye condition (uncontrolled narrow angle glaucoma), severe liver disease. Before using this medication, tell your doctor or pharmacist your medical history, especially of: other bladder problems (e.g., bladder outflow obstruction), stomach/intestinal disease (e.g., ulcerative colitis), slowed movement of stomach/intestines, severe constipation, controlled narrow angle glaucoma, kidney disease, liver disease, enlarged prostate, a certain muscle disease (myasthenia gravis). This drug may cause blurred vision. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages. This medication can cause decreased sweating. Avoid becoming overheated in hot weather, saunas, or during exercise or other strenuous activities since heatstroke may occur. Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be more sensitive to this drug.
Vesicare Oral Interactions

Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change the dosage of any medicine before checking with them first. This drug should not be used with the following medication because very serious interactions may occur: pramlintide. If you are currently using the medication listed above, tell your doctor or pharmacist before starting solifenacin. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: potassium tablets/capsules, other drugs that can cause dry mouth and constipation (e.g., anticholinergic medications such as atropine, antihistamines including diphenhydramine and scopolamine, other antispasmodics including dicyclomine, belladonna alkaloids), drugs affecting liver enzymes that remove solifenacin from your body (such as azole antifungals including itraconazole; macrolide antibiotics including erythromycin; cimetidine; rifamycins including rifabutin; St. John's wort; certain anti-seizure medicines including carbamazepine). This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

What is solifenacin (VESIcare)?

Solifenacin reduces muscle spasms of the bladder and urinary tract. Solifenacin is used to treat symptoms of overactive bladder, such as frequent or urgent urination, and incontinence (urine leakage). Solifenacin may also be used for other purposes not listed in this medication guide.
What are the possible side effects of solifenacin (VESIcare)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using solifenacin and call your doctor at once if you have any of these serious side effects:

hot, dry skin and extreme thirst; severe stomach pain, or constipation for 3 days or longer; pain or burning when you urinate; or urinating less than usual or not at all.

Less serious side effects may include:

dry mouth; dry eyes, blurred vision; mild constipation; nausea, mild stomach pain or upset; dizziness, tired feeling; or fever, sore throat, body aches, or other flu symptoms.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.
What is the most important information I should know about solifenacin (VESIcare)?

You should not use this medication if you are allergic to solifenacin, or if you have untreated or uncontrolled narrow-angle glaucoma, a blockage in your digestive tract (stomach or intestines), or if you are unable to urinate. Before using solifenacin, tell your doctor if you have glaucoma, liver disease, kidney disease, a blockage in your stomach or intestines, or a history of "Long QT syndrome." Avoid becoming overheated or dehydrated during exercise and in hot weather. Solifenacin can decrease perspiration and you may be more prone to heat stroke. Solifenacin can cause side effects that may impair your vision or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. There are many other medicines that can interact with solifenacin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal

products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you. Stop using this medication and call your doctor if you have serious side effects such as hot and dry skin, extreme thirst, severe stomach pain or constipation, pain or burning when you urinate, or if you stop urinating. Indications Listed in Dosage. Dosage Adult: IV Susceptible infections 0.5-1 g 8 hrly. Meningitis 2 g 8 hrly. Cystic fibrosis Up to 2 g 8 hrly. Skin infections 500 mg 8 hrly. Diabetic foot; Intra-abdominal infections 1 g 8 hrly. Click to view meropenem Dosage by Indications Overdosage For action to be taken in the event of accidental overdose ... click to view meropenem Contraindications Hypersensitivity. Special Precautions History of hypersensitivity to carbapenem, pencillins or other -lactam antibiotics; infants <3 mth; renal insufficiency; neurological disorders; pregnancy, lactation. Not recommended for use in MRSA. Adverse Drug Reactions Diarrhoea, nausea, vomiting, abdominal pain; headache; constipation; rash, pruritus, uticaria; apnoea; phlebitis, thrombophlebitis, swelling and pain at inj site; disturbances in LFTs (may cause increases in serum transaminases, alkaline phosphatase, lactic dehydrogenase). Rarely: erythema multiforme; eosinophilia, thrombocytopenia, leucopenia, neutropenia; seizures and CNS effects reported in patients with underlying CNS disorders or renal impairment. Potentially Fatal: Anaphylaxis; pseudomembranous colitis; Stevens-Johnsons sydrome. Drug Interactions Serum levels may be increased by probenecid. May reduce serum valproic acid levels; sub-therapeutic levels may be reached in some patients. Pregnancy Category (US FDA) Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters). Mechanism of Action For details of the mechanism of action, pharmacology and pharmacokinetics and toxicology ... click to view meropenem MIMS Class Other Beta-Lactams ATC Classification J01DH02 meropenem ; Belongs to the class of carbapenems. Used in the systemic treatment of infections.

MEROMAX

Generic : PPD Drug Class: Needs a Prescription: Indications: Recommended Dosage:

Meropenem Anti-infectives/ Antibiotics/ Carbapenems Yes (please see your doctor for proper supervision) Used for the treatment of aerobic & anaerobic Gram (+) & Gram (-) infections. For dosage information of prescription medicine, please consult with your doctor.

Contraindication: Precaution: Drug Interaction: Side Effect:

Hypersensitivity. Hypersensitivity to -lactam antibiotics, renal & hepatic impairment, pregnancy & lactation. Reduces plasma concentration of valproate & contraceptive effect of oestrogens. Probenecid prolongs effect of meropenem. Nausea, vomiting, diarrhea (antibiotic-associated colitis reported), abdominal pain; disturbance in liver function tests; thrombocytopenia, positive Coomb's test, eosinophilia, leucopenia, neutropenia; headache, paresthesia; hypersensitivity reactions including rash, pruritus, urticaria, angioedema, & anaphylaxis; convulsions, Steven-Johnson syndrome & toxic epidermal necrolysis; local reactions including pain & thrombophlebitis at inj site. Vial 500 mg, 1 g. The Cathay Drug Company, Inc.

Available Forms: Company:

GENERIC NAME: Potassium Citrate BRAND NAME: Acalka CLASSIFICATION: Antiurolithic DOSAGE: 10 mEq MECHANISM OF ACTION: The aim of the treatment is to restore the level of the urinary citrate and to increase the pH of urine to 6-7, and to this end, the dosage pattern are: - In patients with slight hypocitraturia start the treatment with a dose of 30mEq (3 tabs/day, divided into 3 takings daily. It is recommended to take the tablets 30 minutes after meals. Approx 24 hrs after having started the treatment, make a determination of urinary citrate and pH, and adjust the dose in accordance with the needs of the patient. If necessary, the dose can be increased, though it is not advisable to exceed the dose of 100 mEq (10 tablets)/day. INDICATION: -Treatment of patients with renal lithiasis and hypocitraturia, chronic formers of calcium oxalate, phospate calculia. - Uric acid lithiasis alone or accompanied by calcium lithiasis CONTRAINDICATIONS: - Renal insufficiency Persistent alkaline urinary infections

- Obstruction of the urinary tract - HyperpotassemiaAdrenal insufficiency - Respiratory or metabolic alkalosis - Active peptic ulcer - Intestinal obstruction - Patients submitted to anticholinergic therapy - Patients with slow gastric emptying. SIDE EFFECTS/ ADVERSE EFFECTS: - Slight gastrointestinal disorders may appear which can be palliated by means of the joint administration of food. NURSING IMPLICATIONS/RESPONSIBILITIES: - The tablets must not be masticated or diluted. The active component of Acalka is contained with a porous wax matrix. As this was matrix is insoluble, it can be eliminated in visible form in the feces. The active component, however, has been released in the gastrointestinal tract. - Must not be administered to patients receiving potassium-sparing diuretics (traimterene, spirolactone, or amyloride). - It is advisable to carry out an evaluation of electrolytes (Na-K-Cl) and CO2, creatinine and hemogram every 4 hrs. - It is recommended that the patients in treatment with Acalka follow a diet w/o salt and increase the intake of fluids. - The recommended treatment in case of hyperpotassemia is: IV administratioin f 10% dextrose solution, containing 10-12 units of insulin/1000ml. Correction of the possible acidosis with IV sodium bicarboate and hemodialysis or peritoneal dialysis.