Expert review of anti-infective therapy
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Expert Rev Anti Infect Ther · Apr 2014
EditorialThe role of tigecycline in the treatment of infections in light of the new black box warning.
Tigecycline is an antibiotic with a broad spectrum of activity. Similar to tetracycline antibiotics, tigecycline exerts bacteriostatic activity. Earlier studies documented the safety and efficacy of tigecycline for complicated intra-abdominal and complicated skin and skin-structure infections, which led to its approval. ⋯ The increased mortality risk with tigecycline is most apparent in patients treated for hospital-acquired pneumonia, particularly ventilator-associated pneumonia. The cause of excess deaths in these trials is uncertain, but it is likely that most deaths in patients with these severe infections were related to progression of the infection. Further experience with tigecycline for serious infections with drug-resistant pathogens is currently warranted.
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Expert Rev Anti Infect Ther · Mar 2014
CommentTuberculosis screening and isoniazid preventive therapy implementation: a Brazilian experience.
Tuberculosis Preventive therapy has been used since the 1960s for both mass treatment of populations and for targeted therapy to high-risk groups such as children. The World Health Organization (WHO) recommends the use of Isoniazid preventive therapy (IPT) as one of the strategies to reduce the TB burden among people living with HIV infection. ⋯ WHO, in its revised guidelines on IPT, recommends the use of a symptom-based algorithm for TB screening. The randomized clinical trial evaluated here explores the effect of an intervention, in the form of training the clinic staff to screen for TB, use of tuberculin skin test and IPT to treat latent TB infection, and assess its effect on rates of TB and death in HIV infected.
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Expert Rev Anti Infect Ther · Feb 2014
EditorialProphylaxis against hepatitis B reactivation among patients with lymphoma receiving rituximab.
Hepatitis B virus (HBV) reactivation occurs commonly in patients with non-Hodgkin lymphoma, receiving rituximab-based therapeutic regimen. Guidelines from different organizations are not all in agreement with regard to screening and antiviral prophylaxis, given the limited evidence. ⋯ Incidence of HBV reactivation varies in different geographical locations and the decision to start antiviral prophylaxis should consider local incidence data. Given the increased rates of rituximab-associated HBV reactivation and potentially fatal outcome, it is prudent that all patients who receive rituximab should be screened for HBV markers.
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Expert Rev Anti Infect Ther · Jan 2014
ReviewThe spread and acquisition of NDM-1: a multifactorial problem.
bla NDM is a major mechanism of resistance of Gram-negative bacteria to β-lactam antibiotics including the carbapenems. bla NDM has been acquired by a large range of Gram-negative bacilli, especially by the Enterobacteriaceae and Acinetobacter spp. The combination of human factors (suboptimal antibiotic stewardship and infection control, movement of people between countries) plus bacterial factors (hospital adapted clones, environmental persistence and prolific horizontal gene transfer) have led to global spread of bla NDM at a rapid pace. ⋯ However, resistance to polymyxins is emerging. Clearly, substantial international efforts must be made to control the spread of NDM producers or else many of the advances of modern medicine may be undermined by untreatable infections.