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Which antibiotics have anti inflammatory effect? Azithromycin (A), roxithromycin (R), erythromycin (E), and clarithromycin (C) are commonly used in dermatology practice for their immunomodulatory and anti-inflammatory potential.

Can amoxicillin treat inflammation?

Introduction – Acute otitis media (AOM) is one of the most common infections diagnosed in early childhood. By 4 years of age, about 80% of all children will have experienced at least one episode of AOM.1 The three species of bacteria isolated most frequently in middle ear infections are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, 2, 3 three organisms with different potentials for causing severe disease.

Antimicrobial treatment of AOM is standard practice in most countries, independent of causative agent, and middle ear infections are currently the most common reason for outpatient antimicrobial therapy in the USA.4 The basis for this practice is the attribution of the rapid decline in incidence of mastoiditis and other intracranial complications of AOM seen in the late 1940s to the use of antibiotics.5 About 80–85% of all AOM episodes are cured with antimicrobial therapy.6 This should be compared with spontaneous clearance rates of 20% for pneumococci, 50% for H.

influenzae, and 80% for M. catarrhalis within 2–7 days.6 With increasing problems of antibiotic resistance worldwide, questions have arisen about the consequences and the efficacy of the routine use of antimicrobial agents for a relatively benign infection.7, 8 Furthermore, six out of seven children with AOM do not need or will not respond to antibiotic treatment, 9 and effusion might persist in the middle ear for weeks after an AOM, irrespective of antimicrobial therapy.6, 10 Despite the extensive use of antimicrobial agents, the data on the effects of these agents on host–parasite interactions in the middle ear cavity are limited.

• To optimize the treatment of AOM, basic knowledge of the events that take place in the middle ear during treated and untreated AOM is necessary.
• It was demonstrated recently in a rat otitis model that the majority of cytokine mRNAs had passed their peaks before the diagnosis of AOM could be made clinically, 11 indicating that the antibiotic treatment may be introduced too late to have a major impact on the inflammation or the presence of effusion.

However, amoxicillin treatment started at the clinical peak of the infection in the same model has been shown to reduce the inflammation and the histological changes induced by bacteria.12 To investigate the effects of amoxicillin in the middle ear cavity, the expression of mRNA for cytokines involved in inflammatory responses was measured during the natural course and during amoxicillin treatment of non-typeable H.

What is the best treatment to reduce inflammation?

How is inflammation treated? – Inflammation does not always require treatment. For acute inflammation, rest, ice and good wound care often relieve the discomfort in a few days. If you have chronic inflammation, your healthcare provider may recommend:

Supplements : Certain vitamins (vitamin A, vitamin C, vitamin D) and supplements (zinc) may reduce inflammation and enhance repair. For example, your healthcare provider may prescribe a fish oil supplement or vitamin(s). Or you may use spices with anti-inflammatory properties, such as turmeric, ginger or garlic. Nonsteroidal anti-inflammatory drugs (NSAIDs) : These over-the-counter medicines lower inflammation. Your healthcare provider may recommend ibuprofen (Advil®), aspirin (Bayer®) or naproxen (Aleve®). Steroid injections : Corticosteroid shots decrease inflammation at a specific joint or muscle. For example, if you have rheumatoid arthritis that affects your back, your healthcare provider may give a steroid shot in your spine. You should not have more than three to four steroid injections in the same body part per year.

How does inflammation speed up healing?

Inflammation is Natural Healing Process – The inflammatory process occurs immediately in an acute injury as the body’s natural way of protecting that area. By increasing blood flow, this process alerts the body to injury, stimulates healing and attempts to remove harmful stimuli.

1. More specifically, the inflammatory response is a histological response, affecting the blood vessels and surrounding tissue in the injured area.
2. The arterioles dilate which increases blood flow to the area.
3. The capillary bed becomes more permeable which allows fluid, proteins, Neutrophils and Macrophages to move into the interstitial space.

The interstitial space is only supposed to have “x” amount of fluid in it and this process added more volume. The space then has “x+” amount of fluid leading to increased pressure. This increase in volume is a result of the “chemical” process of inflammation.

How long does inflammation stay?

Inflammation is a process by which your body’s white blood cells and the things they make protect you from infection from outside invaders, such as bacteria and viruses. But in some diseases, like arthritis, your body’s defense system – your immune system – triggers inflammation when there are no invaders to fight off.

1. In these autoimmune diseases, your immune system acts as if regular tissues are infected or somehow unusual, causing damage.
2. Inflammation can be either short-lived ( acute ) or long-lasting ( chronic ).
3. Acute inflammation goes away within hours or days.
4. Chronic inflammation can last months or years, even after the first trigger is gone.

Conditions linked to chronic inflammation include:

Cancer Heart disease Diabetes Asthma Alzheimer’s disease

Some types of arthritis are the result of inflammation, such as:

Rheumatoid arthritis Psoriatic arthritis Gouty arthritis

Other painful conditions of the joints and musculoskeletal system that may not be related to inflammation include osteoarthritis, fibromyalgia, muscular low back pain, and muscular neck pain, Symptoms of inflammation include:

RednessA swollen joint that may be warm to the touch Joint pain Joint stiffness A joint that doesn’t work as well as it should

Often, you’ll have only a few of these symptoms. Inflammation may also cause flu-like symptoms including:

Fever Chills Fatigue /loss of energy Headaches Loss of appetiteMuscle stiffness

When inflammation happens, chemicals from your body’s white blood cells enter your blood or tissues to protect your body from invaders. This raises the blood flow to the area of injury or infection. It can cause redness and warmth. Some of the chemicals cause fluid to leak into your tissues, resulting in swelling. Your doctor will ask about your medical history and do a physical exam, focusing on:

The pattern of painful joints and whether there are signs of inflammationWhether your joints are stiff in the morningAny other symptoms

They’ll also look at the results of X-rays and blood tests for biomarkers such as:

C-reactive protein (CRP)Erythrocyte sedimentation rate (ESR)

Inflammation can affect your organs as part of an autoimmune disorder. The symptoms depend on which organs are affected. For example:

Inflammation of your heart ( myocarditis ) may cause shortness of breath or fluid buildup.Inflammation of the small tubes that take air to your lungs may cause shortness of breath.Inflammation of your kidneys (nephritis) may cause high blood pressure or kidney failure.

You might not have pain with an inflammatory disease, because many organs don’t have many pain-sensitive nerves. Treatment for inflammatory diseases may include medications, rest, exercise, and surgery to correct joint damage, Your treatment plan will depend on several things, including your type of disease, your age, the medications you’re taking, your overall health, and how severe the symptoms are.

Correct, control, or slow down the disease processAvoid or change activities that aggravate painEase pain through pain medications and anti-inflammatory drugsKeep joint movement and muscle strength through physical therapy Lower stress on joints by using braces, splints, or canes as needed

Medications Many drugs can ease pain, swelling and inflammation. They may also prevent or slow inflammatory disease. Doctors often prescribe more than one. The medications include:

Nonsteroidal anti-inflammatory drugs ( NSAIDs, such as aspirin, ibuprofen, or naproxen )Corticosteroids (such as prednisone)Antimalarial medications (such as hydroxychloroquine )Other medicines known as disease-modifying antirheumatic drugs (DMARDs), including azathioprine, cyclophosphamide, leflunomide, methotrexate, and sulfasalazine Biologic drugs such as abatacept, adalimumab, certolizumab, etanercept, infliximab, golimumab, rituximab, and tocilizumab

Some of these are also used to treat conditions such as cancer or inflammatory bowel disease, or to prevent organ rejection after a transplant. But when ” chemotherapy ” types of medications (such as methotrexate or cyclophosphamide) are used to treat inflammatory diseases, they tend to have lower doses and less risk of side effects than when they’re prescribed for cancer treatment,

Quit smoking,Limit how much alcohol you drink.Keep a healthy weight, Manage stress,Get regular physical activity,Try supplements such as omega-3 fatty acids, white willow bark, curcumin, green tea, or capsaicin, Magnesium and vitamins B6, C, D, and E also have some anti-inflammatory effects. Talk with your doctor before starting any supplement.

Surgery You may need surgery if inflammation has severely damaged your joints. Common procedures include:

Arthroscopy. Your doctor makes a few small cuts around the affected joint. They insert thin instruments to fix tears, repair damaged tissue, or take out bits of cartilage or bone, Osteotomy. Your doctor takes out part of the bone near a damaged joint. Synovectomy. All or part of the lining of the joint (called the synovium) is removed if it’s inflamed or has grown too much. Arthrodesis, Pins or plates can permanently fuse bones together. Joint replacement. Your doctor replaces a damaged joint with an artificial one made of metal, plastic, or ceramic.

The things you eat and drink can also play a role in inflammation. For an anti-inflammatory diet, include foods like:

Tomatoes Olive oilLeafy green vegetables (spinach, collards)Nuts (almonds, walnuts)Fatty fish ( salmon, tuna, sardines)Fruits (berries, oranges )

These things can trigger inflammation, so avoid them as much as you can:

Refined carbohydrates (white bread )Fried foods (French fries)Sugary drinks (soda)Red and processed meats (beef, hot dogs)Margarine, shortening, and lard

What fights inflammation naturally?

The health risks of inflammatory foods – Not surprisingly, the same foods on an inflammation diet are generally considered bad for our health, including sodas and refined carbohydrates, as well as red meat and processed meats. “Some of the foods that have been associated with an increased risk for chronic diseases such as type 2 diabetes and heart disease are also associated with excess inflammation,” Dr.

1. Hu says. “It’s not surprising, since inflammation is an important underlying mechanism for the development of these diseases.” Unhealthy foods also contribute to weight gain, which is itself a risk factor for inflammation.
2. Yet in several studies, even after researchers took obesity into account, the link between foods and inflammation remained, which suggests weight gain isn’t the sole driver.

“Some of the food components or ingredients may have independent effects on inflammation over and above increased caloric intake,” Dr. Hu says.

An should include these foods: tomatoes olive oil green leafy vegetables, such as spinach, kale, and collards nuts like almonds and walnuts fatty fish like salmon, mackerel, tuna, and sardines fruits such as strawberries, blueberries, cherries, and oranges

How do you know if you need antibiotics?

Story highlights – Many doctors prescribe useless antibiotics for bronchitis Most sinus infections are caused by viruses and don’t require antibiotics Strep throat is a bacterial infection and should be treated with antibiotics CNN — You’re sick. You’re not sure what it is, but you know you would really love for this achy feeling, stuffed-up head or painful cough to go away.

1. So you go to the doctor and demand drugs.
2. If recent research is any indication, your physician will probably prescribe you an antibiotic, even if he or she knows it won’t make you better any faster.
3. This overuse of antibiotics has led to ‘superbugs,’ and now bacterial resistance is on the rise,” said Amanda Helberg, a physician’s assistant at Scott & White Lago Vista Clinic in Lago Vista, Texas.

“Research has shown that several common infections do not require antibiotics. Yet we continue to unnecessarily take them,” Helberg said. A 2014 review in the Journal of the American Medical Association found that doctors prescribe antibiotics for acute bronchitis approximately 70% of the time, despite decades of evidence demonstrating that these drugs don’t work against respiratory illness.

“Despite clear evidence, guidelines, quality measures and more than 15 years of educational efforts stating that the antibiotic prescribing rate should be zero physicians continue to prescribe expensive, broad-spectrum antibiotics,” wrote Dr. Michael Barnett and Dr. Jeffrey Linder with Brigham and Women’s Hospital in Boston.

Save yourself some money at the doctor’s office by knowing which common ailments require antibiotics and which don’t: Upper respiratory infections, better known as the common cold, and influenza are caused by viruses. Antibiotics kill only bacteria. “Antibiotics are not needed and are of no benefit” for cold and flu, said Dr.

John Joseph, a family medicine physician at Scott & White Killeen Clinic in Killeen, Texas. The best way to prevent the flu is to get vaccinated every year, according to the CDC. If you’ve got it, talk to your doctor about taking an antiviral drug to speed your recovery. Colds usually last seven to 10 days, Helberg said, and will go away on their own with plenty of rest and fluids.

You can take over-the-counter medications to relieve some of the symptoms. As the journal letter mentions, “acute bronchitis in otherwise healthy adults does not need to be treated with antibiotics,” Joseph said. But there are exceptions. “Patients with complicating factors such as emphysema or chronic obstructive pulmonary disease may receive antibiotics since these patients are more susceptible to developing secondary bacterial infections,” he said.

It’s probably best to let your doctor make the call on ear infections. Ear infections can be caused by viruses or bacteria, and “the only definitive method for determining the cause of the ear infection is to puncture the eardrum and culture the fluid,” Joseph said. “In the U.S., most physicians treat with antibiotics instead of obtaining the culture.” Some doctors recommend waiting to see whether the infection clears up on its own, according to WebMD, but others worry that letting bacteria go untreated could do more damage.

Pneumonia can be caused by a variety of things: bacteria, viruses and fungi, according to Mayo Clinic, Antibiotics will work if the doctor has identified the specific type of bacteria causing your infection. Antiviral medications can also be used to treat viral pneumonia.

• Sinusitis is inflammation of the sinuses, according to the Cleveland Clinic,
• The infection can be bacterial, viral or fungal, or due to allergies.
• Most sinus infections are caused by viruses, Joseph said, and do not require antibiotics.
• Once again, there are exceptions.
• Your doctor may prescribe antibiotics if the symptoms are severe and include high fever along with nasal drainage and a productive cough.

Antibiotics may also be necessary if you feel better after a few days and then your symptoms return or if the infection lasts more than a week. Strep throat is a bacterial infection, and as such, antibiotics are required to fight it, Helberg said. But only a tiny portion of sore throats are actually strep throat, so be sure your doctor makes the right diagnosis based on a physical exam and lab test.

Is 3 days worth of amoxicillin enough?

For many years, prescribers have instructed patients to finish their entire course of antibiotics even after they start feeling better. However, recent study results have shown that longer durations of antibiotics are not always beneficial. For many years, prescribers have instructed patients to finish their entire course of antibiotics even after they start feeling better.

However, recent study results have shown that longer durations of antibiotics are not always beneficial. The question many patients and prescribers are starting to ask is whether or not shorter courses are superior. The idea behind finishing the full course of antibiotics was that it was thought to increase the chance of curing the infection, as well as decrease the risk of antibiotic resistance.

New study results, though, have shown that shorter course antibiotics are equally efficacious, and in some cases, may be preferred in certain disease processes. It’s important to recognize that not all patients, nor all infections are to be treated equally.

Many cases are viral and cannot be treated by antibiotics According to the Infectious Disease Society of America’s guidelines, the duration of treatment for bacterial infections should be 5 to 10 days A meta-analysis completed in Britain determined that a 5-day course is as effective as a 10-day course

Acute Otitis Media 2,3 :

Some cases are self-limiting and viral; therefore, recommend pain relievers such as acetaminophen Treatment guidelines vary from 5 to 10 days depending on age and severity Children <2 years of age, who've had recurrent infections, and who've had ruptured eardrums should receive 10 days of therapy Uncomplicated infections ≥2 years of age should receive 3 days or fewer

Uncomplicated Adult Urinary Tract Infections (UTI) 4,5 :

3-day courses are equally effective as 5- to 10-day treatment courses Encourage practitioners and patients to use trimethoprim/sulfamethoxazole for 3 days and nitrofurantoin for 5 days Note: patients with complicated UTIs, patients who are pregnant, and elderly patients will still require longer lasting courses

Cellulitis 6 :

Uncomplicated infections can be treated with a 5-day course versus a 10-day course Complicated infections or immunosuppressed should receive longer courses (typically 10 days or longer)

Strep Throat 7 :

Group A strep will require 10 days of amoxicillin/penicillin Alternative to 10-day oral treatment is a one-time intramuscular dose of benzathine penicillin G 10-day treatment with a first-generation cephalosporin for all patients except anaphylactic penicillin allergic patients 5 days of azithromycin in patients with an anaphylactic allergy to penicillin

****Note: strep throat should be treated with the appropriate antibiotic and for a longer duration to prevent complications such as rheumatic fever*** There are many benefits to using shorter courses of antibiotics. By limiting the normal flora to antibiotic exposure, this lowers the risk of antibiotic resistance. Shorter courses may be cheaper for some patients in addition to increasing the likelihood of adherence. Due to a decreased exposure to antibiotics, the number of unwanted adverse effects is also lowered. Although some disease processes can be treated with shorter courses, it’s important to recognize when shorter courses are inappropriate. References 1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis.2012;54(8):72-112. doi: 10.1093/cid/cir1043.2. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The Diagnosis and Management of Acute Otitis Media. Pediatrics.2013;131(3): 964-999.3. Effectiveness of shortened course (<3 days) of antibiotics for treatment of acute otitis media in children: a systematic review of randomized controlled trials.2009. World Health Organization website. http://apps.who.int/iris/bitstream/10665/44177/1/9789241598446_eng.ped?ua=1&ua=1. Accessed November 4, 2016.4. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Disease Society of America and the European Society for Microbiology and Infections Diseases. Clin Infect Dis.2011;52(5):103-120. doi: 10.1093/cid/ciq257.5. Genao L, Buhr GT. Urinary tract infections in older adults residing in long-term care facilities. Ann Longterm Care.2012;20:33-38.6. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections; 2014 update by the Infectious Diseases Society of America. Clin Infect Dis.2014;59(2):147-159. doi: 10.1093/cid/ciu296.7. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guidelines for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the Infections Diseases Society of America. Clin Infect Dis.2012;55(10):86-102. doi: 10.1093/cid/cis629.

Why do I feel better after taking amoxicillin?

Amoxicillin starts fighting bacteria in your body soon after you take it. However, it needs some time before it starts to make a difference. You may begin to feel better after 2 to 3 days of taking the medication. But it may take longer to feel fully back to normal.

What does amoxicillin help heal?

1. About amoxicillin – Amoxicillin is a penicillin antibiotic. It is used to treat bacterial infections, such as chest infections (including pneumonia ) and dental abscesses, It can also be used together with other antibiotics and medicines to treat stomach ulcers,

Does amoxicillin promote healing?

Results and Discussion – Figure 1A shows the XRD patterns of LDH, doxycycline and doxycycline/LDH. The XRD results confirm the structure of the LDH relative to ICDD card no (00-048-0601) 18, The average crystallite size (L) was calculated using the Debye–Scherer formula, L = kλ/Bcosθ, where k is the shape factor, B is the spectral line width at half maximum intensity, λ is the X-ray wavelength and θ is the Bragg diffraction angle.

• The Mg-Al LDHs were indexed to a rhombohedral crystal structure with a space group of R-3m and unit cell parameters a = b = 3.04 Å and c = 23.5 Å.
• The basal planes (003) and (006) as well as the broadening of the (015) and (018) planes confirmed the layered structure of the LDHs.
• The crystallite size was 16.441 nm.

All peaks of doxycycline/LDH are similar to those of the diffraction pattern of the LDHs, confirming the stability of the structure after loading. Figure 1B shows that all patterns indicate the formation of a well-crystallized hydrotalcite-like phase of amoxicillin–LDH.

Interestingly, the basal spacing gaps in the case of DOX/LDH and AMOX/LDH were 0.112 and 0.419 Å, respectively, after loading with DOX and AMOX. These results suggest that the change in the d spacing was very small; indicating that DOX or AMOX exhibits less effective penetration into the Mg-Al/LDH interlayer 19,

Therefore, the change in the XRD pattern provides indirect evidence that the drugs were are adsorbed on the surface of the positive LDH. No material has been contaminated by atmospheric CO 2, which was also confirmed by the EDAX. Figure 1 ( A ) XRD patterns of ICCD, Mg-Al/LDH, Doxycycline and Doxycycline/LDH. ( B ) ICCD card no (00-048-0601), Mg-Al/LDH, Amoxicillin and Amoxicillin-LDH. ( C ) FTIR spectra of Mg Al LDH, Doxycycline and Doxycycline -LDH. ( D ) FTIR spectra of Mg Al LDH, Amoxicillin and Amoxicillin -LDH.

1. The FT-IR spectrum was investigated to estimate the structure of the Mg-Al/LDH, amoxicillin/LDH and doxycycline/LDH nanocomposites, as shown in Fig.1(C,D),
2. The chemical bonds in the Mg-Al-NO 3 LDH were identified by the band centered at 622 cm −1 and attributed to M–O–M vibration 20, 21,
3. This band, similarly to that associated with M–O–H bending 21, involves the translational motion of oxygen metal ions in brucite-like layers 22, 23,

The strong broad band at 3441 cm −1 is related to the stretching vibrations of the H-bond of the OH group (ν O–H) in brucite-like layers 21, The bending vibration (δ H 2 O) of H 2 O molecules in the interlayers 20 appeared at 1638 cm −1, The peak located at 1381 cm −1 is related to the ν3 stretching vibration of the NO 3 groups in the LDH interlayer.

Interestingly, Fig.1C,D shows the presence of important bands of AMOX and DOXY in the spectra of Mg-Al LDH/AMOX and Mg-Al LDH/DOXY composites, indicating the successful loading of drugs in the Mg-Al LDH host 24, 25, In addition, the intensity of the NO 3 peak at 1381 cm −1 decreased, indicating the exchange of nitrate anions by the antibiotics 24,

In addition, some peaks shifted to new values; for example, the NO 3 group peak at 1381 cm −1 shifted to 1375 cm −1, while some peaks, such as the peak related to the carbonyl group C=O stretching vibration of COO − in AMOX at 1775 cm −1, disappeared for the Mg-Al LDH/AMOX nanocomposite, confirming the loading process. ( A, B ) FESEM of Mg-Al LDH. The HRTEM micrographs presented further confirmation on the observations of XRD, In Fig.3A,B, the HRTEM images showed the layered structures Mg-Al/LDH. While in Fig.3C,D show Mg-Al/LDH after loading Doxycycline and finally Fig.3E,F show Amoxicillin drugs on Mg-Al/LDH. HRTEM of ( A, B ) Mg-Al LDH, ( C, D ) Doxycycline –LDH, and ( E, F ) Amoxicillin–LDH. The Z-average diameters and potentials of Mg-Al/LDH, doxycycline/LDH and amoxicillin/LDH at different pH values, as determined by dynamic light scattering, are listed in Table 1, The diameters of doxycycline/LDH and amoxicillin/LDH were 723.1 and 1217.8 nm, respectively, larger than that of Mg-Al/LDH. This discrepancy could be attributed to the adsorption of amoxicillin and doxycycline on the surface of LDH. The optimized zeta potentials of Mg-Al/LDH, doxycycline/LDH and amoxicillin/LDH at different pH values are shown in Table 1, The positive zeta potential of Mg-Al/LDH at different pH values is attributed to the nature of the LDH. The zeta potential decreased for AMOX/LDH and DOX/LDH compared with that of pure LDH. It reflected that AMOX and DOX were extensively successful nanocomposites formulations 26 Table 1 Zeta potential and particle size of Mg-Al LDH values at different pH for Doxycycline-LDH and Amoxicillin-LDH. Data in Tables ( 2 and 3) present the results of the acute toxicity studies of DOX/LDH and AMOX/LDH nanocomposite in mice after the oral administration. Symptoms of toxicity were observed following DOX/LDH and AMOX/LDH nanocomposites administration in diseases like tremors, rapid respiration, arched back, convulsions and coma followed by death. In DOX/LDH Nanocomposites, mortality probabilities were found to initiate at 600 mg/kg b.wt. compared to 1100 mg/kg b.wt. in AMOX/LDH. The LD 50 was calculated to be 1100 and 1210 mg/kg b.wt. in DOX/LDH and AMOX/LDH respectively and 100% mortality (LD 100 ) was achieved at dose of 1600 and 1500 mg/kg b.wt. in both Nanocomposites respectively. These results indicated the safe use of both DOX/LDH and AMOX/LDH Nanocomposites in pharmacological studies. Table 2 Determination the LD 50 of DOX/LDH after oral administration in mice (n = 5). Table 3 Determination the LD 50 of AMOX/LDH after oral administration in mice (n = 5). We considered LD 50 values of 1/200 and 1/30 for the DOX/LDH nanocomposite and the AMOX/LDH nanocomposite, respectively, to evaluate the ulcer treatment in this study. Toxicological studies for both nanocomposites had been investigated in mice and the wound and ulcer applications had been investigated in rats as in our study no significant difference observed between the LD 50 between the rats and mice. In many studies the therapeutic dose in rats is almost equivalent to that dose in mice, but if you ask about the toxic dose it varies in significant aspects. If you establish an acute toxicity study to settle a new and safest therapeutic dose using mice you can certainly sure that in that dose is safe enough for rat. For selecting the perfect therapeutic dose in rats compared to mice you need to adjust a few (e.g. only +/−5%) dosage regimen only in some cases or not differs. So, dose adjustment in mice is suggested and then you can easily convert and adjust it in rats, which as well as ensures economic benefit too as previously mentioned in other studies 27, 28, 29, 30, 31, 32, 33, 34 (1–7). According to the LD 50 and with increasing drug dose, the toxicity increased in the study, as shown in Tables 2 and 3, In addition, we chose these doses at first for a pilot study, and calculated the LD 50 based on the results obtained. Furthermore, we found the same dose for both amoxicillin and doxycycline based on in previous literature 35, 36, The dosage of the active drug component (only AMOX or DOX) was as follows: amoxicillin-loaded NPs or amoxicillin powder was orally administered to the SD rats (250–300 g, six rats for each group) fasted for 8 h at an amoxicillin dose of 40 mg/kg 35, The doxycycline dose was selected according to the LD 50 and according to a previous study that reported that doxycycline has a pH of approximately 3.3 and a dose of 5 mg/kg b.wt.36, Rats treated with topical application of DOX/LDH (G4) and AMOX/LDH (G2) nanocomposites ointment showed a significant increase in the wound healing percentages and in the wound closure size at 4 (p  <  0,001, p  <  0,00), 8 (p  <  0,001, p  <  0,001),12 (p  <  0,001, p  <  0,00) and 16 day (p  <  0,001, p  <  0,001) of topical administration on the wound area in DOX/LDH and AMOX/LDH respectively when compared to non-treated control group. In addition, a significant increase in the wound healing activity was revealed for G3 (AMOX), G5 (DOX), G6 (standard) and G7 (Mg AL) at 4 ( p  <  0,5, p  <  0,001, p  <  0,001, p  <  0,5 ), 8 ( p  <  0,001 ), 12 ( p  <  0,001 ) and 16 days ( p  <  0,001 ) of treatment respectively in comparison to the non-treated control groups. Non-significant variation was observed between G3, G5, G6 and G7. Significant increase in the wound closure rate is shown in G2 and G4 as compared to other groups other than control G3, G5, G6 and G7 (Table 4 ), (Fig.4 ) and (Chart 1). Complete wound healing was achieved after 18 days in DOX/LDH (G4) and AMOX/LDH (G2) nanocomposites and G6 (standard), compared to 24 days for complete closure in other groups; indicating a faster highly efficient wound healing process in the nanocomposites with anti-microbial drugs. Table 4 Wound healing activity of DOX/LDH and AMOX/LDH Nano composite in rats. (n = 6). Figure 4 Wound healing activity of G1 (CNT), G2 (AMOX/LDH), G3 (AMOX), G4 (DOX/LDH), G5 (DOX), G6 (standard), and G7 (Mg AL) in rats (n = 6), at Zero, 4, 8, 12 and 16 days of treatment. Histopathological investigations for the skin specimens of the different treatments revealed that both AMOX/LDH and DOX/LDH nanocomposites led to complete wound healing with normal epithelial forming and vasculature. Histopathological investigation of the different treatments on Skin wound showed complete epithelial healing with normal vasculature and cellular infiltration. Amoxicillin and Doxycycline groups showed complete epithelial healing with congestion while standard group reveal normal epithelial forming on the other hand control group and Mg/Al showed severe damage on the epithelial surface. Oral administration of biotechnological Absolute Ethanol 98.9% to 24-hour fasting rats induced higher ulcer index in a control non-treated group (P  <  0,00) compared to other treated groups. Significant decrease in the ulcer index was observed in groups pre-treated with DOX/LDH ( p  <  0,000) and AMOX/LDH (p  <  0,000) with higher protection rate when compared to a control non-treated group. A Standard group administered with Ranitidine ® also showed significant decrease ( p  <  0,000) in the ulcer index compared to a control group. Rats treated with AMOX/LDH (G2) (p  >  0,05), DOX/LDH (G4) (p  >  0,05), AMOX (G3) (p  >  0,05) and standard group (G6) (p  >  0,05), on the other hand, showed non-significant variation in comparison with each other, however it revealed significant difference when compared to DOX (G5) (p  <  0,05) and Mg-Al (G7) (p  <  0,05), These two groups G5 (p  >  0,05) and G7 (p  >  0,05) showed non-significant variation between each other but significantly differed from the non-treated control group. The maximum percentage of gastric protection was observed in the DOX/LDH, AMOX/LDH and standard group in comparison to other groups (Table 5 ) and (Fig.6 ). Table 5 Anti-Ulcerogenic effect of DOX/LDH and AMOX/LDH Nano composite in rats. (n = 6). Figure 6 Anti-Ulcerogenic effect of G1 (CNT), G2 (AMOX/LDH), G3 (AMOX), G4 (DOX/LDH), G5 (DOX), G6 (standard), and G7 (Mg AL) in rats. (n = 6). Histopathological investigation into the different treatments of the stomach revealed good gastric and mucosal protection with normal structure in the DOX/LDH, AMOX/LDH, Standard and Mg/Al, while deep gastric ulcer was observed in DOX, AMOX. Histopathological studies of the different treatment on stomach’s Ulcer in rats. (n = 3). Both AMOX/LDH and DOX/LDH revealed normal gastric structure with complete gastric protection from ulcer. Amoxicillin, Doxycycline and Control groups showed severe mucosal damage with high congestion.

• Standard and Mg/Al showed good mucosal protection with normal structure.
• Rapid clearance and metabolism, instability in the biological fluids, high dosing, systemic adverse effects and limitation to reach to the site of action are the major drawbacks for the antimicrobial use 37,
• Drug Delivery system using nanotechnology is now a very important model for increasing drugs therapeutic efficacy, active or passive targeting, controlled release and eliminating the systemic drug adverse effects 38,

To the best of our knowledge, although both doxycycline and amoxicillin are commonly-used broad spectrum anti-microbial drugs for the treatment of multiple diseases in humans and animals. No previous studies were conducted concerning the loading of such drugs into Layered Double Hydroxide (LDH) nanocomposite for exploring novel applications.

1. Similarly no previous data referred to wound healing activity or ulcer treatment of DOX/LDH or AMOX/LDH Nanocomposites.
2. The plan of this study included two main targets, as follows: Incorporation of doxycycline and amoxicillin into Mg/Al LDH in the form of antimicrobial nanocomposites, as well as investigating their ability for wound healing and ulcer treatment in vivo besides screening their acute toxicity.

Layered double hydroxide (LDH) demonstrated a great significance as a novel model for drug delivery system in the branch of pharmacology because of their safety and low toxicity 38, In the acute toxicity study, LD 50 was used to determine the acute toxicity of both DOX/LDH and AMOX/LDH nanocomposites.

1. In DOX/LDH nanocomposites, mice showed toxic symptoms and mortality starting at 600 mg/kg b.wt., and maximum mortality (LD 100 ) was reached at 1600 mg/kg b.wt.
2. By contrast, the mortality of AMOX/LDH nanocomposites started at 1000 mg/kg b.wt., with the maximum mortality (LD 100 ) reached at 1500 mg/kg b.wt.

The LD 50 of DOX/LDH was 1100, whereas that of AMOX/LDH was 1210; thus, both were considered safe drugs. Mice treated with either DOX/LDH or AMOX/LDH showed no toxic symptoms or mortality after treatment with normal dosing, which indicates the drugs’ safety for use.

1. Drugs or materials with an LD 50 value of 1000 mg/kg b.wt.
2. |are considered safe or of low toxicity after oral administration 39 ; therefore, both DOX/LDH or AMOX/LDH are considered safe drugs.
3. Similarly, LDHs based on magnesium or aluminium are considered the safest nanomaterials for drug delivery and the least toxic compared to other LDH types 40,

Therefore, LDH is widely used as a nanomaterial carrier for drug delivery systems or other substances, such as proteins or genes 41, Nanotechnology displays great appropriateness in improving wound healing treatments. The Nano-Meter scale opened the way for the evolution of novel materials for use in highly advanced medical technologies and revival targeting efficiency of the multifunctional Nano carriers.

• Incorporation of small molecules of drugs into nanoparticles or layers might modulate their safety, bioavailability and efficiency 42,
• The pharmacokinetics and Pharmacodynamics of drugs are greatly affected by the Nano carrier size 43,
• Wound healing still remains a challenging clinical problem for which efficient wound handling and care is necessary.

Moreover, the effective repair of wound and tissues is still a major healthcare and biomedical challenge in the 21 st century. Infected or chronic wounds often lead to loss of life through loss of the ability to perform the desired function and the increased pain severity in addition to being a load on healthcare system resources 1, so searching for methods or drugs that can help in accelerating the wound healing process and shortening the period of wounds complete recovery would disclose a therapy of great importance.

Percentage of healing activity and closure size of wound throughout 22 days were used as a marker for wound healing activity besides the histopathological findings. After Topical Application, DOX/LDH Nanocomposites showed a rapid and complete wound healing process in a shorter time, as with AMOX/LDH nanocomposites, and better than free drugs alone and non-treated group.

In the same way, DOX, AMOX, LDH (Mg/Al) and standard group showed good healing activity but in longer time periods than DOX/LDH and AMOX/LDH nanocomposites ointment. The good healing activity of DOX/LDH and AMOX/LDH nanocomposites may be attributed to the good wound penetration power of the nanomaterial carrying the anti-microbial agents.

The main cause of the un-healed wounds is the bacterial infections 44, thus Doxycycline and Amoxicillin broad-spectrum Antibiotics against gram-positive and gram-negative bacteria are used for loading on LDH Nanomaterial. Staphylococcus is one of the most common bacterial pathogens responsible for the majority of wound infections and is considered as one of the major causes of hospital-acquired infections.

Weak Antimicrobial agents or that of poor invasion ability can lead to bacteremia, sepsis and/or toxic shock syndrome 45, The good penetration power of both Doxycycline and Amoxicillin to the wound area through the Nano materials prevents the occurrence of any bacterial infection and helps in accelerating the wound recovery process with complete fur formation and without the presence of scabs.

• Histopathological findings indicated that the Amoxicillin and Doxycycline nanocomposites showed rapid contraction, which is very important for fast wound closure, especially for animals with lose skins (mouse, rat).
• Re-epithelialization was a common stage for all animals during the wound healing process and contact epithelial surface 46,

Nanoparticles enhanced the activity of the carrier materials such as drugs due to their large surface-to-volume ratio. Besides, the efficacy of the antimicrobial activity of the doxycycline and amoxicillin increases when using LDH Nano layers 47, Both Magnesium and Aluminum ions of LDH have antimicrobial activity and act as free radical scavengers for ROS (Reactive Oxygen Species).

Oxidative stress, in addition, leads to an increased ROS production and also postpones the cellular processes involved in wound healing. Consequently Mg/Al helps in gaining a good healing activity in a shorter time 48, The main reason for the mucosal un-healed wound is the bacterial infection leading to gastrointestinal ulcer (GIU), which is mainly caused by Helicobacter pyloriis bacteria in adults and children worldwide.

Failure of treatment with sufficient antibiotics concentration is due to that H, pyloriis lives beneath the gastric mucous lining supporting the gastric epithelium 5, Nanoparticles loaded with antibiotics had shown effective treatment of gastrointestinal infections as their small size particles adhere efficiently on the gastric mucosa and act well against the bacteria living there 7,

1. On that basis, both DOX/LDH and AMOX/LDH nanocomposites treated groups showed a significant decrease in the ulcer index or in the severity of the induced ulcer after 7 days of treatment.
2. The decrease in ulcer induction might be attributed to the perfect adhesion of the Mg/Al-LDH nanomaterial due to their small size which later allows controlled antibiotic release.

The possible mechanism of gastrointestinal protection form ulcer or wound through the ulcerated tissue especially in stomachs producing large amounts of mucous which favors adhesion of small size particles due to their small mass. In addition, gastric inflammation increases the mucous production and fine particles adhere more perfectly 49,

• At the inflammation site, immune cells, such as macrophages, engulf small particles and consequently load the antibiotics that release and produce localized effects 50,
• In addition, both Doxycycline and Amoxicillin Antibiotics treated groups also showed a significant decrease in the number of ulcers.

This decrease might be attributed to their antibacterial activity in wound or ulcer treatment 51, On the same ground, Mg/Al LDH showed a decrease in the ulcers numbers when compared to control non-treated rats. This decrease or that gastric protection was caused by the protective layer formed by the Mg/Al LDH which was commonly used as an anti-acid 52,

1. Ulcer diseases treated with LDH Nano-carrier in the form of oral anti-acid and anti-pepsin confirmed the safety and biocompatibility of this Nanos delivery system, which is also confirmed by the histopathological findings.
2. To the best of our knowledge, there were no reported previous studies dealing with the efficacy of the antibiotics mentioned herein above for wound or ulcer treatment, however there exists multiple studies showing the importance of topical antibiotic administration in the healing rate and prevention of infection.

Nowadays topical antimicrobial therapy for ulcers or wounds has become more firmly established due to its importance with regard to the healing rate. Healing time is the most important endpoint in wound management 53, Some researchers have noted a healing rate of 83% in 30 weeks 54 while others have reported that 62/90 (69%) of venous leg ulcers had been healed within 12 weeks.

Moffatt et al,55 found that 70% of venous ulcers healed after 48 weeks of treatment; the authors also noted that much of the evidence on healing rates is drawn from the results of randomized controlled trials. These trials typically achieve 24-week healing rates in excess of 60% for patients but may not reflect the complex issues faced in clinical practice.

Due to these studies, the conversion of antibiotics to the nano form will have an important effect on the healing rate within a shorter time, as in our study. The main idea of this study revolves around the topical application of antibiotics with high penetration power and prolonged release rate through loading it on Nanomaterials.

1. Applying such antibiotics topically on wounds prevents from the infections that delay the healing rate, so that the wounds and ulcers’ curing process takes a shorter time.
2. Consequently, we found that adding antibiotics accelerates the healing process and lessens the healing time through preventing infections.

The advantages of topical therapy include the ability to deliver a high local concentration with small doses of the agent, even in patients with limb ischaemia, to avoid the first-pass effect in the gastrointestinal tract, as well as reducing the risks of systemic side effects.

Topical formulations achieve very high local concentrations 56, In addition, the eradication or reduction of microorganisms in the wound alone is not a sufficient endpoint for drug efficacy 57 but also depends mainly on their penetration power and its efficacy. Finally, no clinical data support the use of topical antibiotic treatment for the prevention of wound infection recurrences.

All open wounds are colonized by microorganisms, which generally affect the healing process. However, if the colonization develops into local infection, which consequently becomes systemic, the result can be life-threatening. Accordingly, wound care not only comprises cleansing, debridement and management of the underlying aetiology but also takes measures for preventing the probability of colonized wounds becoming locally, or even systemically, infected 58,

• It has been demonstrated that local antibiotic treatments play a role in promoting healing, although treatment of the underlying aetiology remains a crucial element 59,
• Local factors that can delay healing include the number of bacteria present on the wound surface 60,
• Moreover, both magnesium and aluminium hydroxide essentially act as antacid agents through the gastric coating 61,

Besides, Amoxicillin plays a role against Helicobacter bacteria and exhibits the broad-spectrum activity of Doxycycline. All these factors are the main reasons for selecting such materials for evaluating their activity in wound and ulcer healing. The use of antibiotics with any injury (Wound or Ulcer) is the main treatment for rapid healing in a shorter time.

• This is done through Infection Prevention which is the main cause for delaying the healing of the wound or ulcer.
• As infection is a common reason for poor wound healing.
• Accordingly, a significant reduction in the number of bacteria is important for the management of either acute or chronic wounds especially the bacterial growth inhibited inside the induced or opened wounds by lowering the pH values 62,

Wound surface induction lowers the pH of the infected surfaces and establishes an unsuitable environment for the growth and multiplication of the bacteria. In addition, the pH of a wound can additionally influence the effectiveness of antibiotics and antiseptics 63,

• The pH may modulate the effectiveness; and success of antibiotic performance potentially altering the metabolic state of bacteria 23, allowing bacterial growth and acquired resistance to occur.
• For example, multiple antibiotics and silver antiseptic’s effectiveness is reduced in acidic environments which is also the favorable media in our study 64,

The main role of antibiotics in wound healing is inhibiting the growth of drug-resistant bacteria and promoting healing in a rodent wound model 65, Both amoxicillin and doxycycline fulfil these roles as broad-spectrum and bactericidal antibiotics that help prevent bacterial growth and help ulcers and wounds heal within a short period.

Thus, the nanoparticles implemented in this study exhibited much higher antibacterial potency against Gram-negative and Gram-positive bacteria as they increased the penetration power into the bacterial cell wall or membrane. The enhanced inhibitory effect compared with that of the normal antibiotic alone was due to the ability of the designed nanoparticles to disintegrate the bacterial membrane.

These nanoparticles accelerated the healing of ulcers and wounds by regulating inflammation and angiogenesis. In addition, they allowed for an increase in the skin absorptivity of the nanoscale mixture. The majority of these nanoparticle carriers, such as LDH, have been used for the delivery of therapeutic agents with antibacterial properties, and they have been explored as Nano carriers of wound-healing drugs, chosen based on wound needs 13,

• These Nano carriers help drug delivery, as they promote cell growth, accelerate cutaneous wound healing, and reduce scar formation 66,
• In particular, H,
• Pylori lives deep within the gastric mucus, and prolonged local drug application is needed for sufficient diffusion to the bacteria 67,
• No single antibiotic is effective in eradicating H,

pylori when administered in vivo, The treatment of such infectious disease in peptic ulcers usually requires a triple therapy that includes antibiotic, antibacterial, and proton pump inhibitors. The failure of a single antibiotic therapy could be due to poor stability of the drug in the acidic pH of the stomach, poor permeability of antibiotics across the mucus layer, or the availability of sub-therapeutic antibiotic concentrations at the infection site after oral administration in a conventional dosage form 68,

1. Therefore, synthesis of antibiotics in nano form helps the antibiotics penetrate into the deep mucous layer and improves bactericidal efficacy against H, pylori,
2. To improve the efficiency of such therapeutic modalities, site-specific antibiotic drug delivery systems have been developed for localized treatment of H,

pylori infections of the stomach. Some attempts have been made to develop localized antibiotic delivery systems in the acidic environment of the stomach. For this reason, we also chose pH 4 as an acidic medium to improve drug stability. Amoxicillin (“-amino-hydroxy-benzyl penicillin) is a semi-synthetic, orally absorbed and broad-spectrum antibiotic.

The antibiotic is widely used in the standard eradication treatment of gastric H, pylori infection, and using nanosynthesis will help achieve greater drug penetration and therefore higher bactericidal efficiency 27, Ideal candidates for the dressing of infectious wounds should sufficiently deliver high concentrations of antibiotics to the wound site; mimic the structure and biological function of native extracellular matrix proteins, which provide support and regulate cellular activities; maintain the normal state of differentiation within the cellular compartment; be biocompatible and/or biodegradable; and have no adverse effects on the surrounding tissue 69,

Based on these factors, the main objective and the principle step for wound healing is to prevent infection through the use of broad-spectrum and bactericidal antibiotics in particular, such as those employed in our research study. In addition, the loading of broad-spectrum and bactericidal antibiotics on nanomaterials helps the drugs achieve greater penetration power inside the wound or ulcer induced.

Internationally, antibiotic-resistant bacteria and multidrug-resistant bacteria are increasing as a clinical problem; these bacteria have been found in isolates from a substantial proportion of patients with pressure ulcers and even in community settings 51, Another mechanism by which these results were obtained, other than the antimicrobial efficacy achieved, is through the LDH itself, which helps improve antibiotic efficacy, as layered hydroxides have been considered unique Nano-carriers for efficient cellular delivery of drugs.

This ability is due to the excellent features of LDHs, especially the unique surface modification achieved due to their favourable ion-exchange properties, In addition, the positively charged layers of layered hydroxides significantly improve the efficient cellular delivery of drugs.

1. The negatively charged membrane of cells prevents drugs with a negative charge from entering.
2. By incorporating anionic drugs into the layers of layered hydroxides, these drug-nanohybrids with positively charged surfaces are able to properly enter the cell and enhance the cellular delivery of drugs 51, 70, 71,

By increasing the particle size of LDH layers or sheets, the cellular uptake of LDH is decreased, but interestingly, it has been observed that the cellular uptake of all sizes of layered hydroxides is completed within 15 min through the retention time mechanism 72, 73, 74,

LDHs have an added advantage in delivering negatively charged drugs because they bear a net positive charge on their surface that facilitates adsorption as well as internalization through the negatively charged biological membranes without the need for any additional post-modification/functionalization, as in the case of other materials.

Thus, many researchers have conjugated a variety of negatively charged cytotoxic drugs into the interspaces of LDHs and successfully delivered them into cells with controlled release properties 75, 76, In conclusion, the doxycycline-amoxicillin nanocomposites developed in this study (i.e., Mg/Al LDH) hold great prospects for treating wounds (ointments) within a shorter time and for ulcer prevention (oral dosing).

Why does amoxicillin relieve pain?

Benefits of Taking Amoxicillin For a Tooth Infection – All antibiotics work by stopping the growth of bacteria that cause an infection, which can also alleviate your pain. Amoxicillin, a type of antibiotic known as a penicillin class antibiotic, is one of the most common antibiotics prescribed by doctors; for that reason, it’s considered a “front-line” antibiotic.

• Other front-line antibiotics include penicillin, cephalexin, clindamycin, and azithromycin.
• Along with treating pneumonia, bronchitis, urinary tract infections, and ear infections, amoxicillin also works well for tooth infections.
• While a mild abscessed tooth may resolve on its own, dentists often prescribe amoxicillin if they’re concerned the infection could spread, or when a patient has a weakened immune system.

There are many types of antibiotics that work for tooth infection, but amoxicillin is one of the most common because of how effective it is against the type of bacteria involved. Compared to other antibiotics, amoxicillin also generally causes fewer major side effects, making it a great first option for treating an abscessed tooth.