Expert review of anti-infective therapy
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Expert Rev Anti Infect Ther · Mar 2009
ReviewSide effects of benznidazole as treatment in chronic Chagas disease: fears and realities.
Chagas disease is caused by a parasite, Trypanosoma cruzi, transmitted primarily by a triatomine insect and affects approximately 8 million people in Latin American countries. The principal aim of the management of the disease is to avoid the development of cardiomyopathy and transmission by blood transfusion, congenital and organ transplants. Currently, benznidazole is the only etiological treatment commercially available for the disease until new and better drugs can be developed and tested. ⋯ The side effects are systematically evaluated only in controlled studies designed for that purpose. However, the true clinical impact of the side effects could be different, considering that the treatment is for a short duration (between 30 and 60 days) and only carried out once. In this article, we discuss the benefits and risks of the treatment with benznidazole from a clinical point of view to be considered for the management of the treatment of chronic adult Chagas disease patients in the current medical practice.
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Expert Rev Anti Infect Ther · Dec 2008
ReviewOptimal duration of the antimicrobial treatment of ventilator-acquired pneumonia.
The optimal duration of antimicrobial treatment of patients with ventilator-associated pneumonia is a major concern for clinicians. We looked for the evidence that a short course of therapy (< or =10 days) is as effective as a traditional long-course therapy (14-21 days). Unfortunately, only one trial (PneumA trial) has focused directly on this question. ⋯ Nine such trials were identified; all reported a decrease in the total length of antibiotic administration (statistically significant in seven) with the application of the intervention studied. Short, as opposed to long, courses of antibiotics did not adversely affect mortality, length of intensive care unit stay or recurrence rates. In conclusion, the available evidence seems to support the use of short-course antimicrobial treatments (< or =10 days) for patients with ventilator-acquired pneumonia not caused by nonfermenting Gram-negative bacilli.
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Expert Rev Anti Infect Ther · Oct 2008
ReviewEstablishing the role of tigecycline in an era of antimicrobial resistance.
Tigecycline is a glycylcycline antibacterial agent derived from minocycline with a broad spectrum of activity. Like tetracycline agents, it inhibits bacterial protein synthesis but is able to bind to target sites with higher affinity and overcome tetracycline-resistance mechanisms due to structural modifications. ⋯ Aside from approved indications and in vitro data, growing clinical experience suggests a potential role for tigecycline in the management of multi-drug resistant infections due to drug-resistant pathogens. Further study is necessary to determine the ultimate role of tigecycline in treating these types of infections.
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Expert Rev Anti Infect Ther · Oct 2008
ReviewExtensively drug-resistant tuberculosis: new strains, new challenges.
Extensively drug-resistant (XDR)-TB, defined as TB with resistance to at least isoniazid, rifampin, a fluoroquinolone and either amikacin, kanamycin or capreomycin, is a stark setback for global TB control. Overburdened public-health systems with inadequate resources for case detection and management and high HIV coinfection rates in many regions have contributed to the emergence of XDR-TB. Patients with XDR-TB have poor outcomes, prolonged infectious periods and limited treatment options. To prevent an epidemic of untreatable XDR-TB, improvements in XDR-TB surveillance, increased laboratory capacity for rapid detection of drug-resistant strains, better infection control and the development of new therapeutics are urgently needed.
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Community-acquired pneumonia (CAP) is the leading cause of death due to bacterial infection. It accounts for 10 million physician office visits in the USA annually. However, 80% of these are managed in the community, usually with oral antibiotic therapy. ⋯ Gemifloxacin is a potent agent, active against pneumococci and atypical pathogens. Administered once daily for 5 days, gemifloxacin is highly efficacious and well tolerated. Gemifloxacin administered for 5-7 days is a cost effective and safe alternative to both parenteral and oral antimicrobials, which may not cover the emerging resistant respiratory pathogens.