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. Recent systematic reviews and meta-analyses have suggested increased risk of death in patients receiving tigecycline compared to other antibiotics. The Food and Drug Administration has warned clinicians about increased risk for death in patients who received tigecycline with certain severe infections and have issued a black box warning. 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.
Purpose of Review
In the last 50 years, vancomycin has been the agent of choice to treat infections due to methicillin-resistant
Staphylococcus aureus
(MRSA). However, vancomycin treatment failure is ...not uncommon, even when MRSA strains are fully susceptible to vancomycin. Treatment with vancomycin requires careful monitoring of drug levels as there is a potential for nephrotoxicity. Resistance to clindamycin is not infrequent, which also limits therapeutic options for treating infections due to MRSA in children. This paper reviews the current data on pharmacokinetics and pharmacodynamics and clinical efficacy of vancomycin in children.
Recent Findings
Resistance to vancomycin in MRSA (MIC >2 mg/L) is infrequent; there is increasing evidence in the literature that vancomycin maybe ineffective against increasing proportion of isolates with MICs between 1 and 2 mg/L. Recent studies and meta-analyses have demonstrated that strains with high vancomycin MICs are associated with poor outcomes especially in patients with bacteremia and deep tissue infections due to MRSA. This gradual increase in vancomycin MIC has been reported as MIC creep or vancomycin heteroresistance. Patients infected with MRSA isolates that exhibit MIC creep experience poorer clinical outcomes, including delayed treatment response, increased mortality, increase rate of relapse, and extended hospitalization. There are limited data to guide vancomycin dosing in children with MRSA. Although the vancomycin area under the curve AUC
24
/MIC ratio > 400 has been shown to predict clinical efficacy in adults, this relationship has not been documented very well for treatment outcomes in MRSA infections in children. Use of higher vancomycin dosages in attempts to achieve higher trough concentrations has been associated with increased nephrotoxicity.
Summary
New recently approved antibiotics including ceftaroline, dalbavancin, and tedizolid offer a number of advantages over vancomycin to treat staphylococcal infections: improved antimicrobial activity, superior pharmacokinetics, pharmacodynamics, tolerability, and dosing, including once-daily and weekly regimens, and less need for monitoring drug levels.
Gemination in primary central incisor Neena, Indavara; Sharma, Roopali; Poornima, Parameshwarappa ...
Journal of Oral Research and Review,
07/2015, Letnik:
7, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Geminated teeth are the consequences of developmental anomalies leading to the eruption of joined elements. According to the current definitions, gemination occurs when one tooth bud tries to divide, ...whereas fusion occurs if two tooth buds unite. This article presents one such case report of germination of a primary tooth which was endodontically treated due to deep carious involvement.
The use of antithrombotic therapy may increase morbidity and mortality in patients with infective endocarditis (IE). This study evaluated the use of oral anticoagulant and antiplatelet agents on the ...development of embolic complications and bleeding episodes within 30 days of IE diagnosis.
This pilot study was a retrospective medical record review of patients receiving treatment for IE between July 1, 2012, and July 31, 2017. The 2 study arms were patients receiving long-term anticoagulant/antiplatelet therapy versus patients not receiving therapy at the time of IE. Patients were eligible for inclusion if they had definite IE per modified Duke criteria and received at least 48 h of antibiotic therapy. The primary and secondary outcomes evaluated the incidence of embolic phenomenon and bleeding events in each group, respectively.
Of 129 patients with IE, 34 met the eligibility criteria, with 20 patients on receiving anticoagulant/antiplatelet therapy and 14 patients not receiving anticoagulant/antiplatelet therapy. The median age was 63 years, with 50% male patients. Staphylococcus aureus was the infecting pathogen in 41% of patients. Embolic events occurred in 30% of patients receiving anticoagulant/antiplatelet therapy versus 7.1% of those not receiving therapy. No patients in the anticoagulant/antiplatelet therapy arm experienced a bleeding event, whereas 7.1% of those in the comparator arm did.
This retrospective pilot study indicates that patients with IE receiving anticoagulant/antiplatelet agents may be at an increased risk for embolic episodes versus those who are not. Larger, prospective studies are necessary to find a definitive correlation.
To describe challenges in the management of prophylaxis against infections for patients receiving medicinal leech therapy given changes in antimicrobial resistance patterns in the normal flora of ...leeches.
This article presents a patient case of reconstructive surgery complicated by infection associated with the use of medicinal leeches, as well as a discussion of prophylaxis in medicinal leech therapy, focusing on considerations for choosing a prophylactic agent.
Our case report highlights resistance changes in Aeromonas isolates associated with medicinal leeches and the potential for complications if isolates resistant to chosen prophylactic agents arise. When administering antimicrobial prophylaxis in patients receiving medicinal leech therapy, clinicians should be familiar with the susceptibilities of Aeromonas species but also conscious of evolving antimicrobial resistance given the extent of the consequences of infected surgical grafts.
This retrospective, cross-sectional study evaluated whether HIV-infected patients received aspirin and statins for the primary prevention of myocardial infarction and stroke. Among the 258 patients ...included, 50.4% (n = 130/258) of the patients had a high risk of myocardial infarction and 14% (n = 36/258) of stroke. Overall, 43.1% (n = 56/130) and 50% (n = 18/36) of the patients were prescribed aspirin for the primary prevention of myocardial infarction and stroke, respectively. Among the patients who required statin therapy, 42.5% (n = 34/80) and 37.1% (n = 13/35) of patients received it for the primary prevention of myocardial infarction and stroke, respectively. The patients who had hypertension (odds ratio 3.8, 95% confidence interval 1.5-10.9) and diabetes mellitus (odds ratio 5.6, 95% confidence interval 2.6-12.4) were more likely to receive aspirin. Interventions are needed to improve provider awareness of the use of aspirin and statins in the primary prevention of myocardial infarction and stroke in HIV-infected patients.
Several new antimicrobial agents-daptomycin, ceftaroline, telavancin, dalbavancin, and-tedizolid have been approved for the treatment of staphylococcal infections, including methicillin-resistant ...Staphylococcus aureus (MRSA), in adults. Ceftaroline and daptomycin have been approved by the US Food and Drug Administration for use in children. Ceftaroline, a beta-lactam antibiotic with activity against MRSA, has been approved for treatment of community-acquired bacterial pneumonia and complicated skin and skin structure infections. Daptomycin has been approved for treatment of complicated skin and skin structure infections. In this article, we review the pharmacokinetics and pharmacodynamics of these antibiotics and available data on use in children.
The first one-pot molecular iodine catalyzed direct aminoacetylation of terminal epoxides in ionic liquid bmimOH is reported. Herein, 2-phenyl-1,3-oxazolon-5-one and a variety of terminal epoxides ...afford 3-(N-substituted)aminofuran-2-ones in high yield (84–95%) and excellent cis diastereoselectivity (>94%) via ring-opening of terminal epoxides and aminoacetylative cyclization cascade. Operation simplicity, absence of by-product formation, and ambient temperature are the salient features of the present synthetic protocol. After isolation of the product, the ionic liquid bmimOH could be easily recycled for further use without any loss of efficiency.
Abstract
Introduction
Breast cancer survivors (BCS) may experience a cascade of negative reactions during the entire treatment process in the form of psychiatric morbidity. However, exposure to a ...traumatic event also has the fertile ground for the potential to catalyze a host of positive changes, including development in personal, interpersonal, and spiritual levels, commonly referred to as posttraumatic growth (PTG). PTG is defined as “positive psychological change experienced due to a struggle with highly challenging life circumstances.”
Objective
This study aims to measure the prevalence and correlates of PTG among BCS.
Materials and Methods
It was a cross-sectional study carried in a tertiary care center of North India from January 2021 to April 2021. Total 700 BCS were approached and screened using the purposive sampling technique. Data were analyzed using the
Statistical Package for Social Sciences
, version 20.
Results
The mean age (standard deviation SD) of the patients was 43.14 (8.53) years. The mean (SD) PTG score was 37 (13.66). Among the subdomain of PTG, most respondents showed growth in personal strength, relating to others, followed by an appreciation of life, spiritual change, and less growth in new possibilities. PTG was found to be significantly positively correlated with treatment completion time (
r
= 2.260,
p
= 0.02) and negatively correlated with depression, anxiety, and stress (
r
= –0.152,
p
= 0.04;
r
= –0.145,
p
= 0.05;
r
= –0.162,
p
= 0.02).
Conclusion
Psychological morbidities must be addressed along with medical treatment of breast cancer so that growth post trauma can be further facilitated.
Purpose Multidrug-resistant gram-negative bacterial infections have emerged as a major threat in hospitalized patients. Treatment options are often inadequate and, as a result, these infections are ...associated with high mortality. A cephalosporin and a novel synthetic non-β-lactam, β-lactamase inhibitor, ceftazidime-avibactam, is approved for the treatment of serious infections caused by resistant gram-negative bacteria. This article reviews the spectrum of activity, clinical pharmacology, pharmacodynamic and pharmacokinetic properties, clinical efficacy and tolerability, and dosing and administration of ceftazidime-avibactam. Methods Searches of MEDLINE and International Pharmaceutical Abstracts from 1980 to September 2015 were conducted by using the search termsceftazidime,avibactam, andceftazidime-avibactam. Abstracts from Infectious Disease Week (2014-2015), the Interscience Conference on Antimicrobial Agents and Chemotherapy (2014-2015), and the European Congress of Clinical Microbiology and Infectious Diseases were also searched. Findings Ceftazidime, a third-generation cephalosporin, when combined with avibactam has a significant improvement in its activity against β-lactamase-producing gram-negative pathogens, including extended-spectrum β-lactamases, AmpC β-lactamases,Klebsiella pneumoniaecarbapenemase-producingEnterobacteriaceae, and multidrug-resistantPseudomonas aeruginosa. Data from 2 Phase II and 1 Phase III clinical trial are available. In the Phase II trial of patients with complicated intra-abdominal infections, ceftazidime-avibactam produced clinical cure rates comparable to meropenem (91.2% vs 93.4%). Similarly, patients receiving ceftazidime-avibactam in a Phase II study of complicated urinary tract infections had clinical and microbiologic response rates similar to those receiving imipenem-cilastatin (70.4% and 71.4% microbiologic success rates, respectively). A Phase III trial compared ceftazidime-avibactam to best available therapy for the treatment of ceftazidime-resistant organisms. Clinical response and microbiological response for ceftazidime-avibactam versus best available therapy was comparable (90.9% and 91.2% clinical response, respectively); (81.8% and 63.5% microbiological response, respectively). Implications Currently, ceftazidime-avibactam is approved for the indications of complicated intra-abdominal infections (with metronidazole) and complicated urinary tract infections. Clinical trials published to date on this antimicrobial agent have shown its excellent safety and tolerability. This new combination agent has a role, but its use should be limited to patients without other treatment options in the empiric and documented treatment of multidrug-resistant gram-negative organisms. Further investigation is needed in patients with carbapenemase-producingEnterobacteriaceaeand multidrug-resistantP aeruginosawho have bacteremia or nosocomial or ventilator-associated pneumonia. It is imperative that ceftazidime-avibactam be used in a responsible manner so that its effectiveness can be retained.
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