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From tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF): perspectives in pediatric patients. 从富马酸替诺福韦二吡呋酯(TDF)到替诺福韦阿拉非酰胺(TAF):儿科患者的视角。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-03 DOI: 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.

导言:乙型肝炎病毒(HBV)影响着全球数亿人,其中许多病例源于围产期传播。儿童慢性乙型肝炎(CHB)成年后可发展为肝硬化和肝细胞癌(HCC)。治疗方案包括干扰素和核苷(t)ide 逆转录酶抑制剂(N[t]RTIs),如替诺福韦阿拉非酰胺(TAF):本综述涵盖了儿科慢性阻塞性肺病的流行病学和当前的治疗方法,重点是基于替诺福韦的疗法,尤其是富马酸替诺福韦二吡呋酯(TDF)和TAF。TDF已使用多年,但其骨质密度下降和肾功能损害的风险引起了人们的关注。TAF的全身暴露较低,似乎可以减轻这些风险。正在进行的试验正在评估TAF对年幼儿童的安全性。在长期安全性和联合疗法的潜力方面还存在知识空白:TAF为CHB患儿提供了比TDF更安全的替代药物,显示出较高的抗病毒疗效和较少的副作用。专家观点:TAF为CHB患儿提供了更安全的替代品TDF,具有较高的抗病毒疗效和较少的副作用,但还需要更多关于其在年龄较小患儿中的使用和长期安全性的数据。儿科 CHB 治疗的未来可能包括联合疗法和个性化方法,从而有可能改善疗效,并将终生治疗的风险降至最低。随着研究的深入,TAF 有可能成为儿科 CHB 治疗的基石。
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引用次数: 0
New and emerging roles for inhalational and direct antifungal drug delivery approaches for treatment of invasive fungal infections. 吸入式和直接抗真菌给药方法在治疗侵袭性真菌感染方面的新作用。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-29 DOI: 10.1080/14787210.2024.2409408
Chin Fen Neoh, Wirawan Jeong, David C M Kong, Justin Beardsley, Philip Chi Lip Kwok, Monica A Slavin, Sharon C-A Chen

Introduction: The rising prevalence of difficult-to-treat, deep-seated invasive fungal diseases (IFD) has led to high mortality. Currently available antifungal treatments, administered predominantly orally or intravenously, may not sufficiently penetrate certain body sites, and/or are associated with systemic toxicity. Little is known about how to position alternative administration approaches such as inhalational and direct drug delivery routes.

Areas covered: This review provides an updated overview of unconventional drug delivery strategies for managing IFD, focusing on inhalational (to target the lungs) and direct delivery methods to the central nervous system, bone/joint, and eyes. Novel compounds (e.g. opelconazole) and existing antifungals with innovative drug delivery systems currently undergoing clinical trials and/or used off-label in the clinical setting are discussed.

Expert opinion: For both inhalational agents and direct delivery approaches, there are similar challenges that include the absence of: approved formulations for specific administration routes, delivery vehicles that are simple and safe to use whilst maintaining potency and efficiency of delivery, animal models suitable for investigating pharmacokinetic/pharmacodynamic profiles of inhaled antifungals, and consensus on the composite endpoints and intervals for of follow-up in clinical trials. To meet these challenges, cooperation of all stakeholders in drug development and regulation is required.

导言:难以治疗的深部侵袭性真菌病(IFD)发病率不断上升,导致死亡率居高不下。目前可用的抗真菌治疗方法主要通过口服或静脉注射,可能无法充分渗透某些身体部位,和/或与全身毒性有关。人们对如何定位吸入和直接给药途径等替代给药方法知之甚少:本综述对治疗 IFD 的非常规给药策略进行了最新概述,重点关注吸入(针对肺部)和直接给药到中枢神经系统、骨/关节和眼睛的方法。本文讨论了目前正在进行临床试验和/或在临床环境中标签外使用的新型化合物(如奥培康唑)和具有创新给药系统的现有抗真菌药物:对于吸入制剂和直接给药方法来说,都面临着类似的挑战,其中包括:缺乏针对特定给药途径的经批准的制剂;缺乏既简单安全又能保持药效和给药效率的给药载体;缺乏适合研究吸入抗真菌药物的药代动力学/药效学特征的动物模型;以及缺乏对临床试验中综合终点和随访间隔的共识。为了应对这些挑战,需要药物开发和监管方面的所有利益相关者通力合作。
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引用次数: 0
Recent updates in treating carbapenem-resistant infections in patients with hematological malignancies. 治疗血液恶性肿瘤患者耐碳青霉烯类感染的最新进展。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-29 DOI: 10.1080/14787210.2024.2408746
Abdullah Tarık Aslan, Murat Akova

Introduction: Patients with hematological malignancies (PHMs) are at increased risk for infections caused by carbapenem-resistant organisms (CROs) due to frequent exposure to broad-spectrum antibiotics and prolonged hospital stays. These infections result in high mortality and morbidity rates along with delays in chemotherapy, longer hospitalizations, and increased health care costs.

Areas covered: Treatment alternatives for CRO infections in PHMs.

Expert opinion: The best available treatment option for KPC and OXA-48 producers is ceftazidime/avibactam. Imipenem/cilastatin/relebactam and meropenem/vaborbactam remain as the alternative options. They can also be used as salvage therapy in KPC-positive Enterobacterales infections resistant to ceftazidime/avibactam, if in vitro susceptibility is shown. Treatment of metallo-β-lactamase producers is an unmet need. Ceftazidime/avibactam plus aztreonam or aztreonam/avibactam seems to be the most reliable option for metallo-β-lactamase producers. As a first-line option for carbapenem-resistant Pseudomonas aeruginosa infections, ceftolozane/tazobactam is preferable and ceftazidime/avibactam and imipenem/cilastatin/relebactam constitute alternative regimens. Although sulbactam/durlobactam is the most reliable option against carbapenem-resistant Acinetobacter baumannii infections, its utility as monotherapy and in PHMs is not yet known. Cefiderocol can be selected as a 'last-resort' option for CRO infections. New risk score models supported by artificial intelligence algorithms can be used to predict the exact risk of infections in previously colonized patients.

简介:血液恶性肿瘤(PHMs)患者由于频繁接触广谱抗生素和住院时间延长,感染耐碳青霉烯类病菌(CROs)的风险增加。这些感染导致死亡率和发病率居高不下,同时还会延误化疗、延长住院时间并增加医疗费用:PHM 中 CRO 感染的替代治疗方案:专家观点:针对 KPC 和 OXA-48 生产者的最佳治疗方案是头孢他啶/阿维菌素。亚胺培南/西司他丁/雷巴坦和美罗培南/伐硼内酰胺仍然是替代选择。在对头孢他啶/阿维巴坦耐药的 KPC 阳性肠杆菌感染中,如果体外试验显示对头孢他啶/阿维巴坦敏感,也可将它们用作挽救疗法。金属-β-内酰胺酶产生者的治疗需求尚未得到满足。头孢唑肟/阿维巴坦加阿曲南或阿曲南/阿维巴坦似乎是治疗金属-β-内酰胺酶产生者的最可靠选择。作为耐碳青霉烯类的铜绿假单胞菌感染的一线治疗方案,头孢洛氮烷/他唑巴坦是首选,头孢唑肟/阿维菌素和亚胺培南/西司他丁/雷巴坦是替代方案。虽然舒巴坦/杜洛巴坦是治疗耐碳青霉烯类鲍曼不动杆菌感染的最可靠方案,但其作为单一疗法和在 PHM 中的作用尚不清楚。头孢哌酮可作为 CRO 感染的 "最后选择"。在人工智能算法的支持下,新的风险评分模型可用于预测既往定植患者的确切感染风险。
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引用次数: 0
Ceftolozane/Tazobactam treatment for patients with hospital-acquired and ventilatory-associated bacterial pneumonia in Canada in 2022-2024: results from the CLEAR registry. 2022-2024 年加拿大医院获得性和呼吸机相关细菌性肺炎患者的头孢唑烷/他唑巴坦治疗:CLEAR 登记结果。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1080/14787210.2024.2405930
George G Zhanel, Rita Dhami, Melanie Baxter, Maggie Wong, Yazdan Mirzanejad, Justin Kosar, Carlos Cervera, Neal Irfan, Sergio Borgia, Alex Serebryanskyy, Robert Ariano, Michel Savoie, Carlo Tascini, Andrew Walkty, James A Karlowsky

Background: We report results from the national CLEAR (Canadian Leadership on Antimicrobial Real-Life Usage) registry on the usage of ceftolozane/tazobactam in Canada from 2022 to 2024.

Research design and methods: The authors reviewed the final data using the national ethics approved CLEAR study. Thereafter, the literature is surveyed regarding the usage of ceftolozane/tazobactam to treat patients with HABP and VABP via PubMed (up to May 2024).

Results: Ceftolozane/tazobactam was primarily used as directed therapy to treat HABP and VABP caused by Pseudomonas aeruginosa. It was primarily used alone, or in combination with another agent, to treat resistant and multidrug-resistant (MDR) P. aeruginosa infections. Despite primarily being used to treat severely ill patients in intensive care units, its use was associated with relatively high microbiological/clinical cure rates, along with an excellent safety profile. Several reports attest to the microbiological/clinical efficacy and safety of using ceftolozane/tazobactam to treat HABP and VABP.

Conclusions: In Canada, ceftolozane/tazobactam is primarily used as directed therapy alone, or in combination, to treat MDR P. aeruginosa infections. Though mostly used to treat severely ill patients in the ICU, ceftolozane/tazobactam use in HABP and VABP is associated with relatively high microbiological/clinical cure rates and an excellent safety profile.

背景:我们报告了全国性 CLEAR(加拿大抗菌药物真实使用情况领导力)登记的结果,该登记涉及 2022 年至 2024 年期间加拿大头孢唑烷/他唑巴坦的使用情况:作者通过国家伦理批准的 CLEAR 研究审查了最终数据。之后,通过 PubMed 调查了有关使用头孢唑烷/他唑巴坦治疗 HABP 和 VABP 患者的文献(截至 2024 年 5 月):头孢唑烷/他唑巴坦主要用于治疗铜绿假单胞菌引起的HABP和VABP。头孢唑烷/他唑巴坦主要用于治疗由铜绿假单胞菌引起的 HABP 和 VABP,也可单独或与其他药物联合用于治疗耐药和耐多药(MDR)铜绿假单胞菌感染。尽管该药主要用于治疗重症监护室的重症患者,但其微生物/临床治愈率相对较高,且安全性极佳。多份报告证实了使用头孢唑烷/他唑巴坦治疗HABP和VABP的微生物/临床疗效和安全性:在加拿大,头孢妥仑/他唑巴坦主要用于单独或联合治疗MDR铜绿假单胞菌感染。虽然头孢唑烷/他唑巴坦主要用于治疗重症监护室的重症患者,但在HABP和VABP中使用头孢唑烷/他唑巴坦具有相对较高的微生物/临床治愈率和极佳的安全性。
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引用次数: 0
Management of calcified cysticerci in the brain parenchyma: treating the dead parasite. 脑实质内钙化囊尾蚴的治疗:治疗死亡的寄生虫。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-26 DOI: 10.1080/14787210.2024.2409404
Oscar H Del Brutto

Introduction: Calcifications are the end stage of many parenchymal brain cysticerci and may occur either spontaneously or as the result of treatment with cysticidal drugs. These lesions, traditionally considered inert and asymptomatic, have been associated with several complications that seem to be mostly related to brain damage and inflammation ensuing as the result of the exposure of the host's immune system to parasitic antigens trapped within calcifications.

Areas covered: This review, based on the search of different electronic databases up to May 2024, focuses on the reported correlates and complications of calcified cysticerci (chronic headaches, seizures/epilepsy, hippocampal atrophy/sclerosis, gliomas), and the different interventions developed for their prevention and treatment. Common analgesics, non-steroidal anti-inflammatory drugs, corticosteroids, and antiseizure medications have been used with success but, with the exception of the latter, these drugs offer temporary relief of symptoms and support for their use is based on level 3 evidence.

Expert opinion: Several strategies may reduce the severity of clinical consequences of calcified cysticerci. Probably, the most relevant intervention would be the prevention of their occurrence or reduction in their size. In this view, the use of bisphosphonates appears as a potential option that needs to be tested in humans.

简介钙化是许多脑实质囊尾蚴的终末阶段,可能自发发生,也可能是使用杀囊虫药物治疗的结果。这些病变传统上被认为是惰性和无症状的,但却与多种并发症有关,这些并发症似乎主要与宿主的免疫系统暴露于钙化内的寄生虫抗原而导致的脑损伤和炎症有关:本综述基于截至 2024 年 5 月对不同电子数据库的检索,重点关注已报道的钙化囊尾蚴的相关性和并发症(慢性头痛、癫痫发作、海马体萎缩/硬化、胶质瘤),以及为预防和治疗这些疾病而开发的不同干预措施。常见的镇痛药、非甾体类抗炎药、皮质类固醇激素和抗癫痫药物已被成功使用,但除后者外,这些药物只能暂时缓解症状,对其使用的支持基于三级证据:有几种策略可以减轻钙化囊尾蚴临床后果的严重性。最相关的干预措施可能是预防钙化囊尾蚴的发生或缩小其体积。因此,使用双膦酸盐似乎是一种潜在的选择,需要在人体中进行试验。
{"title":"Management of calcified cysticerci in the brain parenchyma: treating the dead parasite.","authors":"Oscar H Del Brutto","doi":"10.1080/14787210.2024.2409404","DOIUrl":"https://doi.org/10.1080/14787210.2024.2409404","url":null,"abstract":"<p><strong>Introduction: </strong>Calcifications are the end stage of many parenchymal brain cysticerci and may occur either spontaneously or as the result of treatment with cysticidal drugs. These lesions, traditionally considered inert and asymptomatic, have been associated with several complications that seem to be mostly related to brain damage and inflammation ensuing as the result of the exposure of the host's immune system to parasitic antigens trapped within calcifications.</p><p><strong>Areas covered: </strong>This review, based on the search of different electronic databases up to May 2024, focuses on the reported correlates and complications of calcified cysticerci (chronic headaches, seizures/epilepsy, hippocampal atrophy/sclerosis, gliomas), and the different interventions developed for their prevention and treatment. Common analgesics, non-steroidal anti-inflammatory drugs, corticosteroids, and antiseizure medications have been used with success but, with the exception of the latter, these drugs offer temporary relief of symptoms and support for their use is based on level 3 evidence.</p><p><strong>Expert opinion: </strong>Several strategies may reduce the severity of clinical consequences of calcified cysticerci. Probably, the most relevant intervention would be the prevention of their occurrence or reduction in their size. In this view, the use of bisphosphonates appears as a potential option that needs to be tested in humans.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"1-12"},"PeriodicalIF":4.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344377","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}
引用次数: 0
Clinical pharmacokinetics of antimicrobials in critical care: a narrative review. 重症监护中抗菌药物的临床药代动力学:叙述性综述。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-24 DOI: 10.1080/14787210.2024.2406466
Ritika Kondel Bhandari, Rachna Rohilla, Nusrat Shafiq, Avaneesh Kumar Pandey, Samir Malhotra

Introduction: The management of critically ill septic patients presents considerable challenges due to multifaceted physiological alterations. Rapid changes such as fluid shifts, hyperdynamic states, and altered renal clearance often require special attention for better clinical outcomes. Vital organ dysfunction, with or without MODS, often necessitates supportive management like RRT, ventilatory support, and ECMO. These interventions can significantly affect the PK/PD of administered antimicrobials, complicating effective treatment.

Area covered: Patient-specific parameters such as age, weight, and comorbid illnesses (e.g. cystic fibrosis, burns, and immunocompromised states) are critical determinants of antimicrobial pharmacokinetics. Understanding PK/PD determinants is crucial for developing optimized dosing regimens that enhance therapeutic efficacy and minimize toxicity in critically ill patients.

Expert opinion: Incorporating pharmacometrics approaches in dose optimization can significantly improve patient outcomes. This review focuses on the nuances of PK/PD for optimized antimicrobial dosing in critically ill septic patients, emphasizing the importance of individualized treatment plans to address the complex and dynamic needs of this patient population. The adoption of these advanced pharmacokinetic and pharmacodynamic principles into clinical practice is essential for advancing patient care and optimizing therapeutic outcomes in critically ill patients.

导言:脓毒症重症患者由于多方面的生理变化,其管理面临着相当大的挑战。液体转移、高动力状态和肾清除率改变等快速变化往往需要特别关注,以获得更好的临床效果。无论是否出现 MODS,生命器官功能障碍通常都需要支持性治疗,如 RRT、通气支持和 ECMO。这些干预措施会严重影响抗菌药物的 PK/PD,使有效治疗变得复杂:患者特异性参数,如年龄、体重和合并症(如囊性纤维化、烧伤、免疫功能低下等)是抗菌药物药代动力学的关键决定因素。了解 PK/PD 决定因素对于制定优化的给药方案至关重要,这些方案可提高重症患者的疗效并将毒性降至最低:将药物计量学方法纳入剂量优化可显著改善患者预后。这篇综述重点探讨了 PK/PD 在优化脓毒症重症患者抗菌药物剂量方面的细微差别,强调了个体化治疗方案的重要性,以满足这类患者复杂多变的需求。在临床实践中采用这些先进的药代动力学和药效学原理对于促进患者护理和优化重症患者的治疗效果至关重要。
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引用次数: 0
Now that griseofulvin is not available, what to do with tinea capitis treatments? 现在没有了格列齐芬,该如何治疗头癣呢?
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-19 DOI: 10.1080/14787210.2024.2405936
Alexandro Bonifaz, Paola Lumbán-Ramírez, Roxana S García-Sotelo, Helena Vidaurri de la Cruz, Mirna Toledo-Bahena, Adriana Valencia-Herrera

Introduction: Griseofulvin, discovered in 1939 and commercially available since 1959, was the first oral antifungal agent effective against dermatophytosis, particularly tinea capitis. Although it was eventually superseded by azole antifungals due to its long treatment duration and reliance on keratopoiesis, griseofulvin remains notable for its effectiveness and safety in treating tinea capitis, especially when caused by Microsporum canis. However, due to a decline in cases and commercial unavailability, alternative treatments are now required.

Areas covered: The following topics regarding to other treatments were discussed: (I) The efficacy of alternative antifungal agents such as terbinafine, itraconazole, and fluconazole, in the treatment of tinea capitis. (II) The use and role of topical therapies. (III) Experience in the management of tinea capitis.

Expert opinion: The usefulness of oral terbinafine as a replacement for griseofulvin in the treatment of tinea capitis and why it is the preferred drug in elderly patients was discussed. Challenges with Microsporum spp. and the use of fluconazole in pediatric patients were also analyzed. Support for the use of topical treatment as an adjunctive treatment for tinea capitis was highlighted.

简介格列齐芬于 1939 年被发现,1959 年开始在市场上销售,是第一种有效治疗皮肤癣菌病(尤其是头癣)的口服抗真菌药物。虽然由于其疗程长且依赖角化生成,最终被唑类抗真菌药所取代,但格列卫在治疗头癣,尤其是由犬小孢子菌引起的头癣方面的有效性和安全性仍然值得注意。然而,由于病例减少和商业上的不可得性,现在需要替代疗法:讨论了以下有关其他治疗方法的主题:(I)特比萘芬、伊曲康唑和氟康唑等替代抗真菌剂在治疗头癣中的疗效。(II) 局部疗法的使用和作用。(专家意见:讨论了口服特比萘芬替代格列齐芬治疗头癣的作用,以及为什么口服特比萘芬是老年患者的首选药物。还分析了小孢子菌属所面临的挑战以及氟康唑在儿童患者中的应用。会议还强调了支持使用局部治疗作为头癣的辅助治疗方法。
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引用次数: 0
MazEF toxin-antitoxin systems: their role in Mycobacterium tuberculosis stress response and drug resistance. MazEF 毒素-抗毒素系统:它们在结核分枝杆菌应激反应和抗药性中的作用。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-12 DOI: 10.1080/14787210.2024.2403021
Zoozeal Thakur, Renu Chaudhary, Promod K Mehta
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引用次数: 0
Inflammatory response to SARS-CoV 2 and other respiratory viruses. sars-CoV 2 和其他呼吸道病毒的炎症反应。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-11 DOI: 10.1080/14787210.2024.2400548
André Emilio Viñán Garcés, Eder Cáceres, Juan Olivella Gómez, Ignacio Martín-Loeches, Luis Felipe Reyes

Introduction: Lower respiratory tract infections (LRTI) remain a significant global cause of mortality and disability. Viruses constitute a substantial proportion of LRTI cases, with their pandemic potential posing a latent threat. After the SARS-CoV-2 pandemic, the resurgence of other respiratory viruses, including Influenza and Respiratory Syncytial Virus responsible for LRTI has been observed especially in susceptible populations.

Areas covered: This review details the inflammatory mechanisms associated with three primary respiratory viruses: SARS-CoV-2, Influenza, and Respiratory Syncytial Virus (RSV). The focus will be on elucidating the activation of inflammatory pathways, understanding cellular contributions to inflammation, exploring the role of interferon and induced cell death in the response to these pathogens and detailing viral evasion mechanisms. Furthermore, the distinctive characteristics of each virus will be explained.

Expert opinion: The study of viral pneumonia, notably concerning SARS-CoV-2, Influenza, and RSV, offers critical insights into infectious and inflammatory mechanisms with wide-ranging implications. Addressing current limitations, such as diagnostic accuracy and understanding host-virus interactions, requires collaborative efforts and investment in technology. Future research holds promise for uncovering novel therapeutic targets, exploring host microbiome roles, and addressing long-term sequelae. Integrating advances in molecular biology and technology will shape the evolving landscape of viral pneumonia research, potentially enhancing global public health outcomes.

导言:下呼吸道感染(LRTI)仍然是导致全球死亡和残疾的一个重要原因。病毒在下呼吸道感染病例中占很大比例,其大流行的潜力构成了潜在威胁。在 SARS-CoV-2 大流行之后,其他呼吸道病毒,包括导致 LRTI 的流感病毒和呼吸道合胞病毒再次出现,尤其是在易感人群中:本综述详细介绍了与三种主要呼吸道病毒相关的炎症机制:本综述详细介绍了与三种主要呼吸道病毒(SARS-CoV-2、流感和呼吸道合胞病毒 (RSV))相关的炎症机制。重点将放在阐明炎症途径的激活、了解细胞对炎症的贡献、探索干扰素和诱导细胞死亡在对这些病原体的反应中的作用以及详细介绍病毒的逃避机制。此外,还将解释每种病毒的独特特征:病毒性肺炎的研究,特别是有关 SARS-CoV-2、流感和 RSV 的研究,为我们提供了有关感染和炎症机制的重要见解,具有广泛的影响。要解决目前存在的局限性,如诊断准确性和了解宿主与病毒之间的相互作用,需要各方的共同努力和技术投资。未来的研究有望发现新的治疗靶点,探索宿主微生物组的作用,并解决长期后遗症问题。整合分子生物学和技术的进步将塑造病毒性肺炎研究不断发展的格局,并有可能提高全球公共卫生成果。
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引用次数: 0
Alternative drugs for the treatment of gonococcal infections: old and new. 治疗淋球菌感染的替代药物:新旧药物。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-10 DOI: 10.1080/14787210.2024.2401560
Susannah Franco, Margaret R Hammerschlag

Introduction: The rise in antibiotic resistance to N. gonorrhoeae poses a substantial threat to effective gonorrhea treatment. Historical progression of resistance from sulfonamides to the more recent declines in efficacy of fluoroquinolones and susceptibilities of ceftriaxone highlight the urgent need for novel therapeutic approaches, necessitating the examination of alternative and new antibiotics.

Areas covered: This review examines the potential of repurposing older antibiotics for gonorrhea treatment with a focus on their efficacy and limitations. These include aztreonam, ertapenem, and fosfomycin. New oral drugs zoliflodacin and gepotidacin are in late clinical development, but there are concerns regarding their effectiveness for extragenital infections and the development of resistance.

Expert opinion: While ceftriaxone remains the best treatment for gonorrhea across all anatomic sites, resistance may eventually limit its use. Among older antibiotics, ertapenem shows the most potential as an alternative but shares the same administrative drawbacks as ceftriaxone. New oral drugs zoliflodacin and gepotidacin initially appeared promising, but their efficacy for pharyngeal infections and potential for resistance development are concerning. Phase 3 trial results have not been made available except through press releases, which perpetuates concerns. Understanding pharmacokinetic and pharmacodynamic profiles of antibiotics will be key in optimizing future treatment recommendations.

导言:淋球菌对抗生素耐药性的上升对淋病的有效治疗构成了巨大威胁。从磺胺类药物耐药性的历史演变到近期氟喹诺酮类药物疗效和头孢曲松敏感性的下降,都凸显了对新型治疗方法的迫切需求,因此有必要对替代抗生素和新型抗生素进行研究:本综述探讨了将旧抗生素重新用于淋病治疗的潜力,重点关注其疗效和局限性。这些抗生素包括:阿曲南、厄他培门和磷霉素。新的口服药物唑氟达嗪和格泊他嗪正处于临床开发后期,但人们担心它们对生殖器外感染的疗效以及耐药性的产生:专家观点:虽然头孢曲松仍是治疗所有解剖部位淋病的最佳药物,但耐药性可能最终会限制其使用。在老式抗生素中,厄他培南是最有潜力的替代品,但与头孢曲松一样存在用药缺陷。新型口服药物唑氟达嗪和盖泊他星最初似乎很有前景,但它们对咽部感染的疗效和产生耐药性的可能性令人担忧。除新闻稿外,第三阶段试验结果尚未公布,这让人们更加担忧。了解抗生素的药代动力学和药效学特征是优化未来治疗建议的关键。
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引用次数: 0
期刊
Expert Review of Anti-infective Therapy
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