Pub Date : 2024-11-06DOI: 10.1080/14787210.2024.2420329
Sarah M Saddoris, Luis M Schang
Introduction: Despite the existence of antivirals that potently and efficiently inhibit the replication of herpes simplex virus 1 and 2 (HSV-1, -2), their ability to establish and maintain, and reactivate from, latency has precluded the development of curative therapies. Several groups are exploring the opportunities of targeting epigenetic regulation to permanently silence latent HSV genomes or induce their simultaneous reactivation in the presence of antivirals to flush the latent reservoirs, as has been explored for HIV.
Areas covered: This review covers the basic principles of epigenetic regulation with an emphasis on those mechanisms relevant to the regulation of herpes simplex viruses, as well as the current knowledge on the regulation of lytic infections and the establishment and maintenance of, and reactivation from, latency, with an emphasis on epigenetic regulation. The differences with the epigenetic regulation of viral and cellular gene expression are highlighted as are the effects of known epigenetic regulators on herpes simplex viruses. The major limitations of current models to the development of novel antiviral strategies targeting latency are highlighted.
Expert opinion: We provide an update on the epigenetic regulation during lytic and latent HSV-1 infection, highlighting the commonalities and differences with cellular gene expression and the potential of epigenetic drugs as antivirals, including the opportunities, challenges, and potential future directions.
导言:尽管抗病毒药物能够有效抑制单纯疱疹病毒 1 和 2(HSV-1、-2)的复制,但由于它们能够建立和维持潜伏期并从潜伏期重新激活,因此无法开发出治疗方法。一些研究小组正在探索针对表观遗传调控的机会,以永久沉默潜伏的 HSV 基因组,或在抗病毒药物存在的情况下诱导它们同时重新激活,以冲洗潜伏的储库,就像针对 HIV 探索的那样:这篇综述涵盖了表观遗传调控的基本原理,重点是与单纯疱疹病毒调控相关的机制,以及目前关于溶解性感染调控、潜伏期的建立和维持以及从潜伏期重新激活的知识,重点是表观遗传调控。重点介绍了病毒和细胞基因表达的表观遗传调控的不同之处,以及已知的表观遗传调控因子对单纯疱疹病毒的影响。专家意见:我们提供了表观遗传调控对单纯疱疹病毒影响的最新进展:我们提供了溶解和潜伏期 HSV-1 感染过程中表观遗传调控的最新进展,强调了与细胞基因表达的共性和差异,以及表观遗传药物作为抗病毒药物的潜力,包括机遇、挑战和潜在的未来方向。
{"title":"The opportunities and challenges of epigenetic approaches to manage herpes simplex infections.","authors":"Sarah M Saddoris, Luis M Schang","doi":"10.1080/14787210.2024.2420329","DOIUrl":"10.1080/14787210.2024.2420329","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the existence of antivirals that potently and efficiently inhibit the replication of herpes simplex virus 1 and 2 (HSV-1, -2), their ability to establish and maintain, and reactivate from, latency has precluded the development of curative therapies. Several groups are exploring the opportunities of targeting epigenetic regulation to permanently silence latent HSV genomes or induce their simultaneous reactivation in the presence of antivirals to flush the latent reservoirs, as has been explored for HIV.</p><p><strong>Areas covered: </strong>This review covers the basic principles of epigenetic regulation with an emphasis on those mechanisms relevant to the regulation of herpes simplex viruses, as well as the current knowledge on the regulation of lytic infections and the establishment and maintenance of, and reactivation from, latency, with an emphasis on epigenetic regulation. The differences with the epigenetic regulation of viral and cellular gene expression are highlighted as are the effects of known epigenetic regulators on herpes simplex viruses. The major limitations of current models to the development of novel antiviral strategies targeting latency are highlighted.</p><p><strong>Expert opinion: </strong>We provide an update on the epigenetic regulation during lytic and latent HSV-1 infection, highlighting the commonalities and differences with cellular gene expression and the potential of epigenetic drugs as antivirals, including the opportunities, challenges, and potential future directions.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1080/14787210.2024.2423359
Chinmaya Mahapatra, Sakshi Jadhav, Prasoon Kumar, Dijendra Nath Roy, Awanish Kumar, Manash K Paul
Introduction: Mucormycosis, popularly known as the black fungus, has become a worldwide concern in the continuing COVID-19 pandemic, causing increased morbidity and death in immunocompromised people. Due to multi-drug resistance and the limited number of antifungals, surgical interventions, including the excision of infected tissue, remain a standard treatment option. Surgical treatment usually results in the loss of organs or their function, long-term intensive care, and a significant risk of reinfection during the procedure. A comprehensive approach is needed to treat the disease, and nanomaterials can be a powerful alternative therapeutic approach.
Areas covered: We searched PubMed, Scopus, and Google Scholar with the keywords 'emerging role of nanomaterials,' and 'combating COVID-19-related mucormycosis,' and reviewed the related research paper. Antifungal nanomaterials and their delivery can significantly impact the treatment of COVID-19-related fungal infections like mucormycosis. However, the therapeutic options for mucormycosis are limited and drug resistance is also reported.
Expert opinion: The current review encompasses a detailed overview of the recent developments in antifungal/antiviral nanomaterials and the properties of these therapeutic nanomaterials that may contribute to formulating an efficient strategy against invasive mucormycosis. Further extensive research is needed to develop nano-based therapeutics for the management of mucormycosis-viral coinfection with a definitive end-point.
{"title":"Potential activity of nanomaterials to combat SARS-CoV-2 and mucormycosis coinfection.","authors":"Chinmaya Mahapatra, Sakshi Jadhav, Prasoon Kumar, Dijendra Nath Roy, Awanish Kumar, Manash K Paul","doi":"10.1080/14787210.2024.2423359","DOIUrl":"10.1080/14787210.2024.2423359","url":null,"abstract":"<p><strong>Introduction: </strong>Mucormycosis, popularly known as the black fungus, has become a worldwide concern in the continuing COVID-19 pandemic, causing increased morbidity and death in immunocompromised people. Due to multi-drug resistance and the limited number of antifungals, surgical interventions, including the excision of infected tissue, remain a standard treatment option. Surgical treatment usually results in the loss of organs or their function, long-term intensive care, and a significant risk of reinfection during the procedure. A comprehensive approach is needed to treat the disease, and nanomaterials can be a powerful alternative therapeutic approach.</p><p><strong>Areas covered: </strong>We searched PubMed, Scopus, and Google Scholar with the keywords 'emerging role of nanomaterials,' and 'combating COVID-19-related mucormycosis,' and reviewed the related research paper. Antifungal nanomaterials and their delivery can significantly impact the treatment of COVID-19-related fungal infections like mucormycosis. However, the therapeutic options for mucormycosis are limited and drug resistance is also reported.</p><p><strong>Expert opinion: </strong>The current review encompasses a detailed overview of the recent developments in antifungal/antiviral nanomaterials and the properties of these therapeutic nanomaterials that may contribute to formulating an efficient strategy against invasive mucormycosis. Further extensive research is needed to develop nano-based therapeutics for the management of mucormycosis-viral coinfection with a definitive end-point.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Irrational use of antibiotics is a major driver of antimicrobial resistance. Self-medication with antibiotics (SMA) may exacerbate antimicrobial resistance in the community without professional diagnosis by physicians, due to the complexity of the pharmacological mechanisms. There is still a lack of assessment of the global prevalence of SMA. We have evaluated the global prevalence of SMA and its associated factors, which could provide more reliable data to support global action.
Methods: We searched PubMed, Embase, Web of Science, and EBSCO CINAHL Plus. Quantitative studies were combined using meta-analysis with random-effects models, and qualitative synthesis was performed using interpretive meta-ethnographic methods.
Results: A total of 242 studies were included in this study. The pooled prevalence of SMA was 27.7% (95%CI: 24.9%-30.5%). Quantitative studies indicate that high income level, having family members working in the healthcare system, storing antibiotics at home, and purchasing antibiotics without prescriptions were associated with a greater likelihood of SMA. Qualitative findings revealed the following four factors: individual characteristics, healthcare, pharmacy, and social networks.
Conclusions: The prevalence of global SMA among the public remains high level. Multisectoral and community-based interventions are needed to reduce SMA, including targeted health education, improved access to healthcare, and regulation of antibiotics sales in pharmacies.
Registration: PROSPERO (CRD42023402206).
背景:不合理使用抗生素是导致抗菌药耐药性的主要原因。由于药理机制的复杂性,在未经医生专业诊断的情况下,抗生素自我药疗(SMA)可能会加剧社区中的抗菌药耐药性。目前仍缺乏对 SMA 全球流行率的评估。我们对 SMA 的全球流行率及其相关因素进行了评估,这将为支持全球行动提供更可靠的数据:我们检索了 PubMed、Embase、Web of Science 和 EBSCO CINAHL Plus。采用随机效应模型荟萃分析法对定量研究进行综合,并采用解释性荟萃人种学方法对定性研究进行综合:本研究共纳入 242 项研究。汇总的 SMA 患病率为 27.7%(95%CI:24.9%-30.5%)。定量研究表明,高收入水平、有家庭成员在医疗系统工作、在家中储存抗生素以及在没有处方的情况下购买抗生素与发生 SMA 的可能性较高有关。定性研究结果显示了以下四个因素:个人特征、医疗保健、药房和社会网络:全球公众的 SMA 患病率仍然很高。需要采取多部门和基于社区的干预措施来减少 SMA,包括开展有针对性的健康教育、改善医疗保健服务和规范药店的抗生素销售:PROCROPERO(CRD42023402206)。
{"title":"Is self-medication with antibiotics among the public a global concern: a mixed-methods systematic review.","authors":"Tenghao Wang, Jianxiong Wu, Jinxi Li, Pengfei Zhou, Qinnan Li, Xiaomin Xu, Yanhong Gong, Xiaoxv Yin","doi":"10.1080/14787210.2024.2419607","DOIUrl":"https://doi.org/10.1080/14787210.2024.2419607","url":null,"abstract":"<p><strong>Background: </strong>Irrational use of antibiotics is a major driver of antimicrobial resistance. Self-medication with antibiotics (SMA) may exacerbate antimicrobial resistance in the community without professional diagnosis by physicians, due to the complexity of the pharmacological mechanisms. There is still a lack of assessment of the global prevalence of SMA. We have evaluated the global prevalence of SMA and its associated factors, which could provide more reliable data to support global action.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, and EBSCO CINAHL Plus. Quantitative studies were combined using meta-analysis with random-effects models, and qualitative synthesis was performed using interpretive meta-ethnographic methods.</p><p><strong>Results: </strong>A total of 242 studies were included in this study. The pooled prevalence of SMA was 27.7% (95%CI: 24.9%-30.5%). Quantitative studies indicate that high income level, having family members working in the healthcare system, storing antibiotics at home, and purchasing antibiotics without prescriptions were associated with a greater likelihood of SMA. Qualitative findings revealed the following four factors: individual characteristics, healthcare, pharmacy, and social networks.</p><p><strong>Conclusions: </strong>The prevalence of global SMA among the public remains high level. Multisectoral and community-based interventions are needed to reduce SMA, including targeted health education, improved access to healthcare, and regulation of antibiotics sales in pharmacies.</p><p><strong>Registration: </strong>PROSPERO (CRD42023402206).</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To investigate the effectiveness of oral antiviral agents - nirmatrelvir - ritonavir or molnupiravir in non-hospitalized COVID-19 patients aged < 60 years.
Methods: This retrospective cohort study analyzed data of patients aged 18-60 years diagnosed with COVID-19 between 1 January 2022, and 30 June 2023. Propensity score matching was used to balance the demographic and clinical characteristics of patients receiving oral antivirals (nirmatrelvir - ritonavir or molnupiravir) and untreated controls. The primary outcome was a composite of all-cause emergency department visits, hospitalizations, or mortality within 30 days. The secondary outcomes included each individual component of the primary composite outcome.
Results: Two matched cohorts (antiviral group and control group) comprising 52,585 patients with balanced baseline characteristics were created using propensity score-matching. During follow-up period, the antiviral group demonstrated a lower risk of the primary outcome than the control group (hazard ratio [HR] 0.772, 95% confidence interval [CI] 0.736-0.808, p < 0.001). The antiviral group also exhibited a reduced risk of individual secondary outcomes, including emergency department visits (HR 0.780, 95% CI, 0.738-0.825), hospitalization (HR 0.755, 95% CI, 0.715-0.840), and mortality (HR 0.297, 95% CI, 0.147-0.600).
Conclusion: Oral antiviral agents were associated with lower risks of all-cause emergency department visits, hospitalizations, and mortality in non-hospitalized COVID-19 patients aged < 60 years.
{"title":"Clinical effectiveness of oral antivirals for non-hospitalized adult COVID-19 patients aged 18-60 years.","authors":"Wan-Hsuan Hsu, Bo-Wen Shiau, Ya-Wen Tsai, Jheng-Yan Wu, Ting-Hui Liu, Po-Yu Huang, Min-Hsiang Chuang, Chih-Cheng Lai","doi":"10.1080/14787210.2024.2419579","DOIUrl":"https://doi.org/10.1080/14787210.2024.2419579","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of oral antiviral agents - nirmatrelvir - ritonavir or molnupiravir in non-hospitalized COVID-19 patients aged < 60 years.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data of patients aged 18-60 years diagnosed with COVID-19 between 1 January 2022, and 30 June 2023. Propensity score matching was used to balance the demographic and clinical characteristics of patients receiving oral antivirals (nirmatrelvir - ritonavir or molnupiravir) and untreated controls. The primary outcome was a composite of all-cause emergency department visits, hospitalizations, or mortality within 30 days. The secondary outcomes included each individual component of the primary composite outcome.</p><p><strong>Results: </strong>Two matched cohorts (antiviral group and control group) comprising 52,585 patients with balanced baseline characteristics were created using propensity score-matching. During follow-up period, the antiviral group demonstrated a lower risk of the primary outcome than the control group (hazard ratio [HR] 0.772, 95% confidence interval [CI] 0.736-0.808, <i>p</i> < 0.001). The antiviral group also exhibited a reduced risk of individual secondary outcomes, including emergency department visits (HR 0.780, 95% CI, 0.738-0.825), hospitalization (HR 0.755, 95% CI, 0.715-0.840), and mortality (HR 0.297, 95% CI, 0.147-0.600).</p><p><strong>Conclusion: </strong>Oral antiviral agents were associated with lower risks of all-cause emergency department visits, hospitalizations, and mortality in non-hospitalized COVID-19 patients aged < 60 years.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1080/14787210.2024.2412988
Merceditas S Villanueva, Darrell P Wheeler, Shauna Applin, Theo W Hodge, Barry Zack, Peter F Rebeiro
Introduction: Modern antiretroviral therapy is associated with reduced rates of HIV-related morbidity and mortality. HIV viral suppression and retention in care are critically important outcomes requiring successful continuous patient engagement. However, barriers to such engagement are complex and require innovative solutions.
Areas covered: A multistakeholder group of experts comprising clinicians and service delivery researchers assembled to clarify what constitutes engagement in HIV care and identify overarching themes that inform strategies in this field. This article captures this expert opinion and adds relevant literature on selected current best practices.
Expert opinion: The multistakeholder group felt strongly that a better understanding of the facilitators of continuous care engagement was critical. Unlike 'retention in care,' 'engagement in care' for an individual is nuanced, flexible, evolves and requires ongoing communication between patients, providers, and other key stakeholders. The following approaches highlight care engagement strategies at different stakeholder levels: 1) patient-level: personalized care and incentivization; 2) clinic-level: wraparound, co-localized, patient-centered low-barrier care, a diverse multidisciplinary team, patient support networks, and expanded use of telemedicine; 3) healthcare system-level: utilization of external partnerships. We propose a series of diverse and complementary approaches based on a more nuanced understanding of the qualitative aspects of engagement in care.
{"title":"Continuous care engagement in clinical practice: perspectives on selected current strategies for people with HIV in the United States.","authors":"Merceditas S Villanueva, Darrell P Wheeler, Shauna Applin, Theo W Hodge, Barry Zack, Peter F Rebeiro","doi":"10.1080/14787210.2024.2412988","DOIUrl":"https://doi.org/10.1080/14787210.2024.2412988","url":null,"abstract":"<p><strong>Introduction: </strong>Modern antiretroviral therapy is associated with reduced rates of HIV-related morbidity and mortality. HIV viral suppression and retention in care are critically important outcomes requiring successful continuous patient engagement. However, barriers to such engagement are complex and require innovative solutions.</p><p><strong>Areas covered: </strong>A multistakeholder group of experts comprising clinicians and service delivery researchers assembled to clarify what constitutes engagement in HIV care and identify overarching themes that inform strategies in this field. This article captures this expert opinion and adds relevant literature on selected current best practices.</p><p><strong>Expert opinion: </strong>The multistakeholder group felt strongly that a better understanding of the facilitators of continuous care engagement was critical. Unlike 'retention in care,' 'engagement in care' for an individual is nuanced, flexible, evolves and requires ongoing communication between patients, providers, and other key stakeholders. The following approaches highlight care engagement strategies at different stakeholder levels: 1) patient-level: personalized care and incentivization; 2) clinic-level: wraparound, co-localized, patient-centered low-barrier care, a diverse multidisciplinary team, patient support networks, and expanded use of telemedicine; 3) healthcare system-level: utilization of external partnerships. We propose a series of diverse and complementary approaches based on a more nuanced understanding of the qualitative aspects of engagement in care.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1080/14787210.2024.2412628
Samuel A Cornelius, Ujjaini Basu, Philippe E Zimmern, Nicole J De Nisco
Introduction: Urinary tract infection (UTI) is a major global health concern. While acute UTIs can usually be effectively treated, recurrent UTIs (rUTIs) impact patients for years, causing significant morbidity and can become refractory to front-line antibiotics.
Areas covered: This review discusses the risk factors associated with rUTI, current rUTI treatment paradigms, prophylactic strategies, and challenges in rUTI diagnostics. We specifically discuss common risk factors for rUTI, including biological sex, age, menopause status, and diabetes mellitus. We also review recently available evidence for commonly used treatments, from oral antibiotic therapy to intravesical antimicrobials, electrofulguration of chronic cystitis, and the last-resort treatment, cystectomy. We discuss the most current literature evaluating prophylactic strategies for rUTI including long-term antibiotic prophylaxis, estrogen hormone therapy, and dietary supplements. Finally, we address the important role of UTI diagnostics in effective rUTI management and review the strengths and limitations of both current and emerging UTI diagnostic platforms as well as their ability to operate at point-of-care.
Expert opinion: We discuss the current challenges faced by clinicians in managing rUTI in women and the steps that should be taken so that clinicians, scientists, and patients can work together to better understand the disease and develop better strategies for its management.
简介尿路感染(UTI)是全球关注的主要健康问题。虽然急性尿路感染通常可以得到有效治疗,但反复发作的尿路感染(rUTI)会影响患者数年,造成严重的发病率,并且可能对一线抗生素产生耐药性:本综述讨论了与复发性尿路感染相关的风险因素、当前的复发性尿路感染治疗范例、预防策略以及复发性尿路感染诊断方面的挑战。我们特别讨论了rUTI的常见风险因素,包括生理性别、年龄、绝经状态和糖尿病。我们还回顾了常用治疗方法的最新证据,包括口服抗生素治疗、膀胱内抗菌药、慢性膀胱炎电切术以及最后的治疗方法--膀胱切除术。我们讨论了评估 rUTI 预防策略的最新文献,包括长期抗生素预防、雌激素荷尔蒙疗法和膳食补充剂。最后,我们探讨了 UTI 诊断在有效治疗 rUTI 中的重要作用,并回顾了当前和新兴 UTI 诊断平台的优势和局限性,以及它们在护理点操作的能力:我们讨论了临床医生目前在管理女性尿路感染方面所面临的挑战以及应采取的措施,以便临床医生、科学家和患者能够共同努力,更好地了解这种疾病并制定更好的管理策略。
{"title":"Overcoming challenges in the management of recurrent urinary tract infections.","authors":"Samuel A Cornelius, Ujjaini Basu, Philippe E Zimmern, Nicole J De Nisco","doi":"10.1080/14787210.2024.2412628","DOIUrl":"10.1080/14787210.2024.2412628","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary tract infection (UTI) is a major global health concern. While acute UTIs can usually be effectively treated, recurrent UTIs (rUTIs) impact patients for years, causing significant morbidity and can become refractory to front-line antibiotics.</p><p><strong>Areas covered: </strong>This review discusses the risk factors associated with rUTI, current rUTI treatment paradigms, prophylactic strategies, and challenges in rUTI diagnostics. We specifically discuss common risk factors for rUTI, including biological sex, age, menopause status, and diabetes mellitus. We also review recently available evidence for commonly used treatments, from oral antibiotic therapy to intravesical antimicrobials, electrofulguration of chronic cystitis, and the last-resort treatment, cystectomy. We discuss the most current literature evaluating prophylactic strategies for rUTI including long-term antibiotic prophylaxis, estrogen hormone therapy, and dietary supplements. Finally, we address the important role of UTI diagnostics in effective rUTI management and review the strengths and limitations of both current and emerging UTI diagnostic platforms as well as their ability to operate at point-of-care.</p><p><strong>Expert opinion: </strong>We discuss the current challenges faced by clinicians in managing rUTI in women and the steps that should be taken so that clinicians, scientists, and patients can work together to better understand the disease and develop better strategies for its management.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Acinetobacter baumannii complex (Abc) is currently a significant cause of difficult-to-treat pneumonia. Due to the high prevalence rates of carbapenem- and extensively drug-resistant (CR, XDR) phenotypes, limited antibiotic options are available for the effective treatment of pneumonia caused by CR/XDR-Abc.
Areas covered: In vitro susceptibility data, relevant pharmacokinetic profiles (especially the penetration ratios from plasma into epithelial-lining fluid), and pharmacodynamic indices of key antibiotics against CR/XDR-Abc are reviewed.
Expert opinion: Doubling the routine intravenous maintenance dosages of conventional tigecycline (100 mg every 12 h) and minocycline (200 mg every 12 h) might be recommended for the effective treatment of pneumonia caused by CR/XDR-Abc. Nebulized polymyxin E, novel parenteral rifabutin BV100, and new polymyxin derivatives (SPR206, MRX-8, and QPX9003) could be considered supplementary combination options with other antibiotic classes. Regarding other novel antibiotics, the potency of sulbactam-durlobactam (1 g/1 g infused over 3 h every 6 h intravenously) combined with imipenem-cilastatin, and the β-lactamase inhibitor xeruborbactam, is promising. Continuous infusion of full-dose cefiderocol is likely an effective treatment regimen for CR/XDR-Abc pneumonia. Zosurabalpin exhibits potent anti-CR/XDR-Abc activity in vitro, but its practical use in clinical therapy remains to be evaluated. The clinical application of antimicrobial peptides and bacteriophages requires validation.
{"title":"Potentially effective antimicrobial treatment for pneumonia caused by isolates of carbapenem-resistant and extensively drug-resistant <i>Acinetobacter baumannii</i> complex species: what can we expect in the future?","authors":"Shio-Shin Jean, Chia-Ying Liu, Tzu-Yu Huang, Chih-Cheng Lai, I-Min Liu, Po-Chuen Hsieh, Po-Ren Hsueh","doi":"10.1080/14787210.2024.2412637","DOIUrl":"https://doi.org/10.1080/14787210.2024.2412637","url":null,"abstract":"<p><strong>Introduction: </strong><i>Acinetobacter baumannii</i> complex (Abc) is currently a significant cause of difficult-to-treat pneumonia. Due to the high prevalence rates of carbapenem- and extensively drug-resistant (CR, XDR) phenotypes, limited antibiotic options are available for the effective treatment of pneumonia caused by CR/XDR-Abc.</p><p><strong>Areas covered: </strong>In vitro susceptibility data, relevant pharmacokinetic profiles (especially the penetration ratios from plasma into epithelial-lining fluid), and pharmacodynamic indices of key antibiotics against CR/XDR-Abc are reviewed.</p><p><strong>Expert opinion: </strong>Doubling the routine intravenous maintenance dosages of conventional tigecycline (100 mg every 12 h) and minocycline (200 mg every 12 h) might be recommended for the effective treatment of pneumonia caused by CR/XDR-Abc. Nebulized polymyxin E, novel parenteral rifabutin BV100, and new polymyxin derivatives (SPR206, MRX-8, and QPX9003) could be considered supplementary combination options with other antibiotic classes. Regarding other novel antibiotics, the potency of sulbactam-durlobactam (1 g/1 g infused over 3 h every 6 h intravenously) combined with imipenem-cilastatin, and the β-lactamase inhibitor xeruborbactam, is promising. Continuous infusion of full-dose cefiderocol is likely an effective treatment regimen for CR/XDR-Abc pneumonia. Zosurabalpin exhibits potent anti-CR/XDR-Abc activity in vitro, but its practical use in clinical therapy remains to be evaluated. The clinical application of antimicrobial peptides and bacteriophages requires validation.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The optimal strategy for using hydroxychloroquine to prevent coronavirus disease 2019 (COVID-19) in patients, either before or after exposure, remains unclear. We evaluated the safety and efficacy of different doses and treatment durations of hydroxychloroquine for COVID-19 prevention.
Method: Databases including PubMed, Web of Science, Cochrane Library, EMBASE, Medline, and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing different doses of hydroxychloroquine for COVID-19 prevention, from their inception to February 2024.
Results: A total of 20 RCTs involving 12,372 patients were included. Meta-analysis results showed no significant difference between the hydroxychloroquine and control groups in reducing the incidence of syndrome coronavirus type 2 (SARS-CoV-2) positivity (OR = 0.83, 95% CI = 0.67, 1.03). However, the subgroup receiving a daily dose of 200-400 mg (OR = 0.62, 95% CI = 0.51, 0.75) and a treatment duration of 5-8 weeks (OR = 0.52, 95% CI = 0.31, 0.88) showed statistically significant reductions in SARS-CoV-2 positivity. According to the surface under the cumulative ranking curve (SUCRA), the most effective intervention was a 200-400 mg dose for 5-8 weeks. .
Conclusions: A hydroxychloroquine dose of 200-400 mg for a duration of 5-8 weeks may moderately reduce the risk of COVID-19 with a relatively low risk of adverse events.
导言:使用羟氯喹预防患者冠状病毒病2019(COVID-19)的最佳策略是在暴露前还是暴露后,目前仍不清楚。我们评估了不同剂量和疗程的羟氯喹预防COVID-19的安全性和有效性:我们在PubMed、Web of Science、Cochrane Library、EMBASE、Medline和ClinicalTrials.gov等数据库中系统检索了从开始到2024年2月期间比较不同剂量羟氯喹预防COVID-19的随机对照试验(RCT)。使用Review Manager 5.4进行传统荟萃分析,使用Stata 17/SE进行网络荟萃分析。研究方案已在PROSPERO(CRD42024559057)注册:结果:共纳入 20 项 RCT,涉及 12 372 名患者。Meta分析结果显示,羟氯喹组和对照组在降低综合征冠状病毒2型(SARS-CoV-2)阳性发生率方面无明显差异(OR = 0.83,95% CI = [0.67,1.03],P = 0.10)。然而,每日剂量为 200-400 毫克的亚组(OR = 0.62,95% CI = [0.51,0.75],p p p 8 周)中,SARS-CV-2 阳性率为 0.83,95% CI = [0.67,1.03],p = 0.10:羟氯喹剂量为 200-400 毫克,持续 5-8 周,可适度降低 COVID-19 的风险,且不良事件风险相对较低。
{"title":"The efficacy and safety of hydroxychloroquine at different doses and courses for COVID-19 prevention: a systematic review and network meta-analysis.","authors":"Hang Wang, Qiyuan Yang, Yinjun Mao, Haibo Ding, Pinfang Huang, Zhikun Zhan","doi":"10.1080/14787210.2024.2413419","DOIUrl":"10.1080/14787210.2024.2413419","url":null,"abstract":"<p><strong>Background: </strong>The optimal strategy for using hydroxychloroquine to prevent coronavirus disease 2019 (COVID-19) in patients, either before or after exposure, remains unclear. We evaluated the safety and efficacy of different doses and treatment durations of hydroxychloroquine for COVID-19 prevention.</p><p><strong>Method: </strong>Databases including PubMed, Web of Science, Cochrane Library, EMBASE, Medline, and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing different doses of hydroxychloroquine for COVID-19 prevention, from their inception to February 2024.</p><p><strong>Results: </strong>A total of 20 RCTs involving 12,372 patients were included. Meta-analysis results showed no significant difference between the hydroxychloroquine and control groups in reducing the incidence of syndrome coronavirus type 2 (SARS-CoV-2) positivity (OR = 0.83, 95% CI = 0.67, 1.03). However, the subgroup receiving a daily dose of 200-400 mg (OR = 0.62, 95% CI = 0.51, 0.75) and a treatment duration of 5-8 weeks (OR = 0.52, 95% CI = 0.31, 0.88) showed statistically significant reductions in SARS-CoV-2 positivity. According to the surface under the cumulative ranking curve (SUCRA), the most effective intervention was a 200-400 mg dose for 5-8 weeks. .</p><p><strong>Conclusions: </strong>A hydroxychloroquine dose of 200-400 mg for a duration of 5-8 weeks may moderately reduce the risk of COVID-19 with a relatively low risk of adverse events.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1080/14787210.2024.2409401
Mahendra Rai, Avinash P Ingle, Gréta Törős, József Prokisch
Introduction: The threat of new, emerging, and multidrug-resistant microbes is increasing which has created the necessity for new antimicrobials. In this regard, nanotechnology can be an alternative for the treatment of infectious microbes. Curcumin has been used since ancient times as antimicrobials; however, it has limitations due to its less aqueous solubility, bioavailability, and biocompatibility. This problem can be solved by curcumin-derived carbon nanodots, which are emerging antimicrobials of <10 nm size, water-soluble, biocompatible, less toxic, and fluorescent.
Areas covered: The review discusses the application of curcumin-derived carbon nanodots against various pathogenic microbes including bacteria and dreaded viruses like SARS-CoV-2. In addition, the role of curcumin carbon nanodots in biolabelling of pathogenic microbes, mechanism of action, bioimaging, and therapy has been critically examined.
Expert opinion: Carbon nanodots play an important role in combating pathogenic microbes by early diagnosis, bioimaging, nanocarrier for antimicrobial drugs, and therapy of infectious diseases. Curcumin carbon nanodots have already demonstrated their benefits of being water soluble, bioavailable, and biocompatible. However, more thorough research is needed to understand the efficacy and safety of curcumin carbon nanodots. In the future, curcumin-derived carbon nanodots can be used as alternative antimicrobial agents to fight microbial infections including multidrug-resistant microbes.
{"title":"Assessing the efficacy of carbon nanodots derived from curcumin on infectious diseases.","authors":"Mahendra Rai, Avinash P Ingle, Gréta Törős, József Prokisch","doi":"10.1080/14787210.2024.2409401","DOIUrl":"10.1080/14787210.2024.2409401","url":null,"abstract":"<p><strong>Introduction: </strong>The threat of new, emerging, and multidrug-resistant microbes is increasing which has created the necessity for new antimicrobials. In this regard, nanotechnology can be an alternative for the treatment of infectious microbes. Curcumin has been used since ancient times as antimicrobials; however, it has limitations due to its less aqueous solubility, bioavailability, and biocompatibility. This problem can be solved by curcumin-derived carbon nanodots, which are emerging antimicrobials of <10 nm size, water-soluble, biocompatible, less toxic, and fluorescent.</p><p><strong>Areas covered: </strong>The review discusses the application of curcumin-derived carbon nanodots against various pathogenic microbes including bacteria and dreaded viruses like SARS-CoV-2. In addition, the role of curcumin carbon nanodots in biolabelling of pathogenic microbes, mechanism of action, bioimaging, and therapy has been critically examined.</p><p><strong>Expert opinion: </strong>Carbon nanodots play an important role in combating pathogenic microbes by early diagnosis, bioimaging, nanocarrier for antimicrobial drugs, and therapy of infectious diseases. Curcumin carbon nanodots have already demonstrated their benefits of being water soluble, bioavailable, and biocompatible. However, more thorough research is needed to understand the efficacy and safety of curcumin carbon nanodots. In the future, curcumin-derived carbon nanodots can be used as alternative antimicrobial agents to fight microbial infections including multidrug-resistant microbes.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1080/14787210.2024.2412991
Minna Rodrigo, Christopher Hartley, Trung Van, Paul Wasuwanich, Wikrom Karnsakul
Introduction: Hepatitis B virus (HBV) affects hundreds of millions globally, with many cases stemming from perinatal transmission. Chronic hepatitis B (CHB) in children can progress to cirrhosis and hepatocellular carcinoma (HCC) in adulthood. Treatment options include interferons and nucleos(t)ide reverse transcriptase inhibitors (N[t]RTIs) such as tenofovir alafenamide (TAF).
Areas covered: This review covers the epidemiology of pediatric CHB and current treatments, with a focus on tenofovir-based therapies, particularly tenofovir disoproxil fumarate (TDF) and TAF. TDF has been used for years, but its risks of bone mineral density loss and renal impairment have raised concerns. TAF, with lower systemic exposure, appears to mitigate these risks. Ongoing trials are evaluating TAF's safety in younger children. There are knowledge gaps in long-term safety and the potential for combination therapies.
Expert opinion: TAF offers a safer alternative to TDF for children with CHB, showing high antiviral efficacy and fewer side effects. However, more data is needed on its use in younger children and long-term safety. The future of CHB treatment in pediatrics may include combination therapies and personalized approaches, potentially improving outcomes and minimizing risks over a lifetime of treatment. As research progresses, TAF is likely to become a cornerstone in pediatric CHB management.
{"title":"From tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF): perspectives in pediatric patients.","authors":"Minna Rodrigo, Christopher Hartley, Trung Van, Paul Wasuwanich, Wikrom Karnsakul","doi":"10.1080/14787210.2024.2412991","DOIUrl":"https://doi.org/10.1080/14787210.2024.2412991","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatitis B virus (HBV) affects hundreds of millions globally, with many cases stemming from perinatal transmission. Chronic hepatitis B (CHB) in children can progress to cirrhosis and hepatocellular carcinoma (HCC) in adulthood. Treatment options include interferons and nucleos(t)ide reverse transcriptase inhibitors (N[t]RTIs) such as tenofovir alafenamide (TAF).</p><p><strong>Areas covered: </strong>This review covers the epidemiology of pediatric CHB and current treatments, with a focus on tenofovir-based therapies, particularly tenofovir disoproxil fumarate (TDF) and TAF. TDF has been used for years, but its risks of bone mineral density loss and renal impairment have raised concerns. TAF, with lower systemic exposure, appears to mitigate these risks. Ongoing trials are evaluating TAF's safety in younger children. There are knowledge gaps in long-term safety and the potential for combination therapies.</p><p><strong>Expert opinion: </strong>TAF offers a safer alternative to TDF for children with CHB, showing high antiviral efficacy and fewer side effects. However, more data is needed on its use in younger children and long-term safety. The future of CHB treatment in pediatrics may include combination therapies and personalized approaches, potentially improving outcomes and minimizing risks over a lifetime of treatment. As research progresses, TAF is likely to become a cornerstone in pediatric CHB management.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}