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Expert Review of Anti-infective Therapy

Silvano Esposito, Tiziana Ascione, Pasquale Pagliano
Skin and Soft Tissue Infections (SSTIs) are some of the most commonly occurring bacterial infections, with a wide range of possible aetiological pathogens and a considerable variety of clinical presentations and severity; from mild to severe life-threatening infections. Several classifications have been proposed based on a specific variable, such as anatomical localization, skin extension, progression rate, clinical presentation, severity and etiological agent. Areas covered: The last criteria allows the differentiation of SSTIs as mono-microbial and poly-microbial...
December 6, 2018: Expert Review of Anti-infective Therapy
Temmy Sunyoto, Marleen Boelaert, Filip Meheus
Leishmaniasis is a poverty-related disease that causes a significant socioeconomic burden to affected households. Visceral leishmaniasis is fatal if untreated, yet illness costs may lead to delays in accessing care. Skin manifestations of leishmaniasis cause a psychological burden and even longer treatment trajectories. The objective of this review is to evaluate illness costs associated with leishmaniasis across different settings (Asia, Africa, and Latin America) and the consequences to households. Areas covered: Through a systematic review of cost-of-illness studies, we documented the distribution of costs, the health-seeking behavior, and the consequences of leishmaniasis...
December 4, 2018: Expert Review of Anti-infective Therapy
Caroline Dillon, Anthony J Guarascio, Jordan R Covvey
Community-acquired bacterial pneumonia (CABP) represents a significant clinical and financial burden within infectious disease. In the advent of increasing resistance from bacteria such as Streptococcus pneumoniae to available antibiotic therapies, there is a need for new drugs with novel mechanisms to treat such infections. Areas covered: Lefamulin, the first semi-synthetic pleuromutilin for systemic administration, is nearing completion of phase III studies for CABP; the manufacturer plans to file for a new drug application (NDA) in fourth-quarter 2018...
December 4, 2018: Expert Review of Anti-infective Therapy
Helen McIlleron, Maxwell T Chirehwa
Drug concentrations in tuberculosis patients on standard regimens vary widely with clinically important consequences. Areas covered: We review the available literature identifying factors correlated with pharmacokinetic variability of antituberculosis drugs. Based on population pharmacokinetic models and the weight, height and sex distributions in a large data base of African tuberculosis patients, we propose simplified weight-based doses of the available fixed dose combination(FDC) for adults with drug susceptible tuberculosis...
December 1, 2018: Expert Review of Anti-infective Therapy
Armando E Gonzalez, Ellen E Codd, John Horton, Hector H Garcia, Robert H Gilman
Oxfendazole (methyl [5-(phenylsulphinyl)-1H benzimidazole- 2-yl] carbamate) has a particularly long metabolic half-life in ruminants, and its metabolite fenbendazole also has anthelminthic action. A very limited number of drugs are available for the treatment of some zoonotic helminth infections, such as neurocysticercosis and echinococcosis. More recent work has expanded oxfendazole's non-clinical safety profile and demonstrated its safety and bioavailability in healthy human volunteers, thus advancing the possibility of a new and greatly needed option for antiparasitic treatment of geohelminths and tissue parasites...
December 1, 2018: Expert Review of Anti-infective Therapy
Candace M Marr, Thomas A Russo
No abstract text is available yet for this article.
November 30, 2018: Expert Review of Anti-infective Therapy
Matthew W McCarthy
No abstract text is available yet for this article.
November 17, 2018: Expert Review of Anti-infective Therapy
Jee-Fu Huang, Chung-Feng Huang, Ming-Lun Yeh, Chia-Yen Dai, Ming-Lung Yu, Wan-Long Chuang
Chronic hepatitis C (CHC) genotype-3 (G-3) infection is the next most prevalent genotype with 54.3 million patients globally. It is associated with an increasing risk of fibrosis, liver-related events, hepatocellular carcinoma, and overall mortality. G-3 infection may have a negative impact on histological and clinical outcomes in CHC patients. In addition, its characteristic features of steatosis and metabolic abnormalities may add more difficulty in the disease management. Area covered: Fortunately, the landscape of management has been drastically changed in the past decade with the blooming of all oral direct antiviral agents (DAAs)...
November 6, 2018: Expert Review of Anti-infective Therapy
Martina Properzi, Paola Magro, Francesco Castelli, Eugenia Quiros-Roldan
New strategies for HIV treatment are being investigated to reduce drug-exposure, toxicities, and costs. Dolutegravir (DTG) 50 mg/rilpivirine (RPV) 25 mg was approved in November 2017 by FDA and in May 2018 by the European Medicines Agency (EMA). It is indicated as a complete regimen for HIV-1 infected adults with undetectable plasmatic HIV-RNA for at least 6 months on their current HIV treatment combination. Its approval was based on the data of two randomized, multicenter, non-inferiority trials (SWORD-1 and SWORD-2)...
November 5, 2018: Expert Review of Anti-infective Therapy
Mario Fernández-Ruiz, José María Aguado
The advent, more than two decades ago, of monoclonal antibodies and soluble receptors targeting tumor necrosis factor (TNF)-α has revolutionized the therapeutic approach to otherwise difficult-to-treat autoimmune and inflammatory diseases. However, due to the pleiotropic functions played by this pro-inflammatory cytokine (with particular relevance in granuloma maintenance), TNF-α blockade may increase the incidence of serious infections. Areas covered: The present review summarizes the biological rationale supporting the impact of anti-TNF-α therapy on the host's susceptibility to infection...
November 2, 2018: Expert Review of Anti-infective Therapy
Marwa Ghazaly, Simon Nadel
Respiratory Syncytial Virus (RSV) is the most common cause of Acute Bronchiolitis (AVB) in infants. AVB causes significant morbidity and mortality worldwide, most deaths occurring in the developing world. AVB causes respiratory distress in infants, leading to respiratory failure in some cases. Disease is more severe in infants with risk factors, such as prematurity, chronic cardiac and lung disease and immunodeficiency. Areas covered: Despite major advances in supportive care in the developed world, which has led to a significant reduction in mortality, treatment remains symptomatic and supportive...
November 1, 2018: Expert Review of Anti-infective Therapy
Justin J Choi, Matthew W McCarthy
There remains significant controversy behind the Surviving Sepsis Campaign Guidelines, as evidenced by the Infectious Diseases Society of America refusing to endorse the latest iteration put forth by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. An important stakeholder in this debate has not yet been adequately represented: hospitalists. Areas covered: In this perspective piece, we review the key points in this controversy; specifically, the current guidelines for the identification and management of sepsis...
December 2018: Expert Review of Anti-infective Therapy
Aditya K Gupta, Rachel R Mays, Sarah G Versteeg, Neil H Shear, Vincent Piguet
Onychomycosis is a chronic fungal infection of the nail bed, matrix or plate. It accounts for roughly 50% of all nail disease. As the prevalence of onychomycosis is increasing, a critical review of diagnostic techniques and treatment options is required. Areas covered: This review discusses the current diagnostic techniques associated with diagnosing onychomycosis, such as microscopy, culture, periodic acid Schiff stain (PAS) and polymerase chain reaction (PCR). Oral and topical therapies are also discussed, as well as, the utility of device-based treatments and combination therapy...
December 2018: Expert Review of Anti-infective Therapy
Rainer Tan, Olivier Hugli, Matthias Cavassini, Katharine Darling
The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate. Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient's journey from registration, via triage and the waiting room, to the bedside...
December 2018: Expert Review of Anti-infective Therapy
Owen R Albin, Twisha S Patel, Keith S Kaye
Complicated urinary tract infections are increasingly caused by multidrug-resistant organisms. Carbapenem-resistant Enterobacteriaceae (CRE) constitute a rising threat among uropathogens with significant morbidity and mortality. Meropenem-vaborbactam is a novel carbapenem and cyclic boronic acid-based beta-lactamase inhibitor combination with potent activity against subtypes of CRE. Areas covered: This article reviews mechanisms of carbapenem resistance, existing treatment options for CRE, and the current evidence to support the use of meropenem-vaborbactam for the treatment of infections caused by subtypes of CRE including complicated urinary tract infections...
December 2018: Expert Review of Anti-infective Therapy
Ravindra Kumar Garg, Imran Rizvi, Hardeep Singh Malhotra, Ravi Uniyal, Neeraj Kumar
Drug-resistant tuberculous meningitis has been reported worldwide. Isoniazid mono-resistance is the most frequent cause of drug-resistant tuberculous meningitis, a life-threatening disease. Extensive drug-resistant tuberculous meningitis has also been reported in some isolated case reports. Areas covered: We reviewed the current literature on drug-resistant tuberculous meningitis, as well as drug-resistant tuberculosis. Expert commentary: Drug-resistant tuberculous meningitis is a life-threatening disease and needs prompt diagnosis and treatment...
November 2018: Expert Review of Anti-infective Therapy
Elisabetta Loggi, Ranka Vukotic, Pietro Andreone
Direct acting antivirals have completely changed the landscape of the treatment of chronic hepatitis C. The management of the few patients who relapse to direct acting antivirals requires a careful analysis of the chances to achieve therapeutic success with a second antiviral course. In this context, the usefulness of viral resistances testing, able to detect resistance-associated substitutions in the viral sequence, is at present a matter of debate. Areas covered: The role of resistance associated substitutions is examined through the evaluation of the data from clinical trials that have assessed the impact of viral resistances on the treatment outcome...
November 2018: Expert Review of Anti-infective Therapy
Matthew W McCarthy, Thomas J Walsh
The presence of Candida species in the blood is known as candidemia and may constitute a medical emergency for patients with cancer. Despite advances in diagnosis and treatment of this fungal infection, mortality remains unacceptably high. Areas covered: This paper reviews recent advances in molecular diagnostics to detect species of Candida as well as novel antifungal agents that have been developed to address candidiasis. We also review prophylaxis strategies to prevent candidiasis in high-risk cancer patients...
November 2018: Expert Review of Anti-infective Therapy
Stephanie Noviello, David B Huang, G Ralph Corey
Iclaprim is a selective bacterial dihydrofolate reductase (DHFR) inhibitor. Although there are alternative options for the treatment of acute bacterial skin and skin structure infections (ABSSSI), iclaprim is differentiated from other available antibiotics. Areas covered: Iclaprim is under clinical development for ABSSSI. This review summarizes the mechanism of action, pharmacokinetics, microbiology, clinical development program, and the differentiation of iclaprim from other antibiotics. Expert commentary: Iclaprim has a different mechanism of action (DHFR inhibitor) compared to most other antibiotics, is active and rapidly bactericidal against Gram-positive pathogens including antibiotic-resistant pathogens, and suppresses bacterial exotoxins (alpha hemolysin, Panton Valentine leukocidin, and toxic shock syndrome toxin-1)...
November 2018: Expert Review of Anti-infective Therapy
Kuan Shion Ong, Christina Injan Mawang, Delhousie Daniel-Jambun, Yau Yan Lim, Sui Mae Lee
Biofilm formation is a strategy for microorganisms to adapt and survive in hostile environments. Microorganisms that are able to produce biofilms are currently recognized as a threat to human health. Areas covered: Many strategies have been employed to eradicate biofilms, but several drawbacks from these methods had subsequently raised concerns on the need for alternative approaches to effectively prevent biofilm formation. One of the main mechanisms that drives a microorganism to transit from a planktonic to a biofilm-sessile state, is oxidative stress...
November 2018: Expert Review of Anti-infective Therapy
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