Pub Date : 2024-06-01Epub Date: 2024-01-31DOI: 10.1080/14787210.2024.2310004
Muhammad Zeeshan Munir, Amer Hayat Khan, Tahir Mehmood Khan
Background: To evaluate the opinions of healthcare workers regarding drug therapy problems linked to anti-infective medicines used for the treatment of COVID-19 infection in Pakistan.
Research methodology: This cross-sectional study was conducted from January to October 2022 using a self-administered questionnaire developed by the authors, having three sections: demographics, knowledge, and perception. The study was validated by research experts and pilot-tested on 30 subjects. The study included medical doctors, nurses, pharmacists from Punjab's government and private medical institutes.
Results: In this study, 382 of 400 participants replied. The mean knowledge score was 9.52 (SD 2.97), showing that participants had adequate knowledge of COVID-19 pharmacological interventions. The knowledge scores were significantly higher of those who treated COVID-19 patients and were from Lahore. Many doctors considered that elderly patients and those with blood disorders were at greater risk of experiencing drug-related problems. Most pharmacists support electronic prescription systems. Many doctors thought the lack of unified treatment guidelines, multiple prescribers, and self-medication were key obstacles in managing COVID-19 patients.
Conclusion: Most respondents had adequate knowledge. Older patients with comorbidities are at risk of adverse effects. Self-medication, polypharmacy, and multiple prescriptions can lead to misdiagnosis and complications. Electric prescriptions, team effort, and training programs can decrease these issues.
{"title":"Healthcare professionals' understanding and perception of drug-related issues linked to off-label pharmacological medications used for COVID-19.","authors":"Muhammad Zeeshan Munir, Amer Hayat Khan, Tahir Mehmood Khan","doi":"10.1080/14787210.2024.2310004","DOIUrl":"10.1080/14787210.2024.2310004","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the opinions of healthcare workers regarding drug therapy problems linked to anti-infective medicines used for the treatment of COVID-19 infection in Pakistan.</p><p><strong>Research methodology: </strong>This cross-sectional study was conducted from January to October 2022 using a self-administered questionnaire developed by the authors, having three sections: demographics, knowledge, and perception. The study was validated by research experts and pilot-tested on 30 subjects. The study included medical doctors, nurses, pharmacists from Punjab's government and private medical institutes.</p><p><strong>Results: </strong>In this study, 382 of 400 participants replied. The mean knowledge score was 9.52 (SD 2.97), showing that participants had adequate knowledge of COVID-19 pharmacological interventions. The knowledge scores were significantly higher of those who treated COVID-19 patients and were from Lahore. Many doctors considered that elderly patients and those with blood disorders were at greater risk of experiencing drug-related problems. Most pharmacists support electronic prescription systems. Many doctors thought the lack of unified treatment guidelines, multiple prescribers, and self-medication were key obstacles in managing COVID-19 patients.</p><p><strong>Conclusion: </strong>Most respondents had adequate knowledge. Older patients with comorbidities are at risk of adverse effects. Self-medication, polypharmacy, and multiple prescriptions can lead to misdiagnosis and complications. Electric prescriptions, team effort, and training programs can decrease these issues.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139541792","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 : 2024-06-01Epub Date: 2024-02-26DOI: 10.1080/14787210.2024.2322429
Ahmad Z Al Meslamani
{"title":"Is the world crippled by antimicrobial resistance, or simply lacking information?","authors":"Ahmad Z Al Meslamani","doi":"10.1080/14787210.2024.2322429","DOIUrl":"10.1080/14787210.2024.2322429","url":null,"abstract":"","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930745","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 : 2024-06-01Epub Date: 2024-03-04DOI: 10.1080/14787210.2024.2323122
Niels Frimodt-Møller, Frederik Boetius Hertz
{"title":"Antibiotic stewardship: following in the footsteps of Nordic countries?","authors":"Niels Frimodt-Møller, Frederik Boetius Hertz","doi":"10.1080/14787210.2024.2323122","DOIUrl":"10.1080/14787210.2024.2323122","url":null,"abstract":"","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021335","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 : 2024-06-01Epub Date: 2024-06-03DOI: 10.1080/14787210.2024.2362270
Adriano Focus Lubanga, Akim Nelson Bwanali, Frank Kambiri, Gracian Harawa, Steward Mudenda, Samuel L Mpinganjira, Nathan Singano, Tumaini Makole, Thandizo Kapatsa, Mapeesho Kamayani, Stuart Ssebibubbu
Introduction: Antimicrobial drugs form an essential component of medical treatment in human and animal health. Resistance associated with their use has posed a global public health threat. Multiple efforts have been made at the global level directed by the World Health Organization and associated partners to develop policies aimed at combatting antimicrobial resistance.
Areas covered: Whilst the Global Action Plan on antimicrobial resistance and people-centered framework aim to guide countries in implementing successful antimicrobial resistance policies, their adoption and success depend on different implementation contexts. Therefore, this paper highlights the challenges and opportunities for implementing the World Health Organization's people-centered approach in sub-Saharan Africa, whilst recognizing antimicrobial resistance as a multifaceted problem rooted in 'complex systems.'
Expert opinion: The people-centered approach provides a solid framework for combating antimicrobial resistance. Countries should build sustainable national action plans, adopt the One Health approach, limit over-the-counter antibiotic consumption, and educate communities on rational antibiotic use. They should also promote inter-country collaborations and innovative solutions, strengthen drug regulatory capacities, invest in infection control, water sanitation, hygiene, diagnostics, and surveillance tools, and promote vaccine uptake to prevent drug-resistant infections.
{"title":"Tackling antimicrobial resistance in sub-Saharan Africa: challenges and opportunities for implementing the new people-centered WHO guidelines.","authors":"Adriano Focus Lubanga, Akim Nelson Bwanali, Frank Kambiri, Gracian Harawa, Steward Mudenda, Samuel L Mpinganjira, Nathan Singano, Tumaini Makole, Thandizo Kapatsa, Mapeesho Kamayani, Stuart Ssebibubbu","doi":"10.1080/14787210.2024.2362270","DOIUrl":"10.1080/14787210.2024.2362270","url":null,"abstract":"<p><strong>Introduction: </strong>Antimicrobial drugs form an essential component of medical treatment in human and animal health. Resistance associated with their use has posed a global public health threat. Multiple efforts have been made at the global level directed by the World Health Organization and associated partners to develop policies aimed at combatting antimicrobial resistance.</p><p><strong>Areas covered: </strong>Whilst the Global Action Plan on antimicrobial resistance and people-centered framework aim to guide countries in implementing successful antimicrobial resistance policies, their adoption and success depend on different implementation contexts. Therefore, this paper highlights the challenges and opportunities for implementing the World Health Organization's people-centered approach in sub-Saharan Africa, whilst recognizing antimicrobial resistance as a multifaceted problem rooted in 'complex systems.'</p><p><strong>Expert opinion: </strong>The people-centered approach provides a solid framework for combating antimicrobial resistance. Countries should build sustainable national action plans, adopt the One Health approach, limit over-the-counter antibiotic consumption, and educate communities on rational antibiotic use. They should also promote inter-country collaborations and innovative solutions, strengthen drug regulatory capacities, invest in infection control, water sanitation, hygiene, diagnostics, and surveillance tools, and promote vaccine uptake to prevent drug-resistant infections.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175229","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 : 2024-06-01Epub Date: 2024-02-01DOI: 10.1080/14787210.2024.2309998
Pulin Li, Ling Huang, Rui Han, Min Tang, Guanghe Fei, Daxiong Zeng, Ran Wang
Background: Since December 2022, the Omicron variant has led to a widespread pandemic in China. The study was to explore the safety and effectiveness of Paxlovid for the treatment of coronavirus disease 2019 (COVID-19).
Research design and methods: We included patients at risk of developing severe COVID-19, all of whom exhibited mild to moderate symptoms and were admitted to three hospital centers. Patients were divided into two groups: one received Paxlovid alongside standard care, while the other was given only standard care. We compared clinical characteristics, hospital stay duration, and clinical outcomes between two groups. Multi-factor analysis determined the independent risk factors influencing the duration of hospitalization and disease progression.
Results: In the study, those treated with Paxlovid shorter hospital stays than those in the control group (p < 0.001). Multivariate analysis indicated that the absence of Paxlovid treatment was a distinct risk factor for hospitalizations lasting over 7 days (OR: 4.983, 95% CI: 3.828-6.486, p < 0.001) and 14 days (OR: 2.940, 95% CI: 2.402-3.597, p < 0.001).
Conclusion: Amid the Omicron outbreak, Paxlovid has proven to be a safe and effective treatment for reducing hospitalization durations for patients with mild to moderate COVID-19.
背景:自2022年12月以来,奥米克变异株导致中国大范围流行。该研究旨在探讨帕克洛维治疗冠状病毒病2019(COVID-19)的安全性和有效性:我们纳入了有发生严重COVID-19风险的患者,他们均表现出轻度至中度症状,并在三家医院中心住院治疗。患者被分为两组:一组在接受标准治疗的同时接受 Paxlovid 治疗,另一组仅接受标准治疗。我们比较了两组患者的临床特征、住院时间和临床结果。多因素分析确定了影响住院时间和疾病进展的独立风险因素:在研究中,与对照组相比,接受 Paxlovid 治疗的患者的住院时间更短(p p p 结论:Paxlovid 治疗的患者的住院时间更短:在Omicron疫情中,Paxlovid被证明是一种安全有效的治疗方法,可缩短轻度至中度COVID-19患者的住院时间。
{"title":"Safety and efficacy of Paxlovid in the treatment of adults with mild to moderate COVID-19 during the omicron epidemic: a multicentre study from China.","authors":"Pulin Li, Ling Huang, Rui Han, Min Tang, Guanghe Fei, Daxiong Zeng, Ran Wang","doi":"10.1080/14787210.2024.2309998","DOIUrl":"10.1080/14787210.2024.2309998","url":null,"abstract":"<p><strong>Background: </strong>Since December 2022, the Omicron variant has led to a widespread pandemic in China. The study was to explore the safety and effectiveness of Paxlovid for the treatment of coronavirus disease 2019 (COVID-19).</p><p><strong>Research design and methods: </strong>We included patients at risk of developing severe COVID-19, all of whom exhibited mild to moderate symptoms and were admitted to three hospital centers. Patients were divided into two groups: one received Paxlovid alongside standard care, while the other was given only standard care. We compared clinical characteristics, hospital stay duration, and clinical outcomes between two groups. Multi-factor analysis determined the independent risk factors influencing the duration of hospitalization and disease progression.</p><p><strong>Results: </strong>In the study, those treated with Paxlovid shorter hospital stays than those in the control group (<i>p</i> < 0.001). Multivariate analysis indicated that the absence of Paxlovid treatment was a distinct risk factor for hospitalizations lasting over 7 days (OR: 4.983, 95% CI: 3.828-6.486, <i>p</i> < 0.001) and 14 days (OR: 2.940, 95% CI: 2.402-3.597, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Amid the Omicron outbreak, Paxlovid has proven to be a safe and effective treatment for reducing hospitalization durations for patients with mild to moderate COVID-19.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650631","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 : 2024-06-01Epub Date: 2024-06-12DOI: 10.1080/14787210.2024.2362911
Aditya K Gupta, Mesbah Talukder, Avner Shemer, Eran Galili
Introduction: Terbinafine is considered the gold standard for treating skin fungal infections and onychomycosis. However, recent reports suggest that dermatophytes are developing resistance to terbinafine and the other traditional antifungal agents, itraconazole and fluconazole. When there is resistance to terbinafine, itraconazole or fluconazole, or when these agents cannot used, for example, due to potential drug interactions with the patient's current medications, clinicians may need to consider off-label use of new generation azoles, such as voriconazole, posaconazole, fosravuconazole, or oteseconazole. It is essential to emphasize that we do not advocate the use of newer generation azoles unless traditional agents such as terbinafine, itraconazole, or fluconazole have been thoroughly evaluated as first-line therapies.
Areas covered: This article reviews the clinical evidence, safety, dosage regimens, pharmacokinetics, and management algorithm of new-generation azole antifungals.
Expert opinion: Antifungal stewardship should be the top priority when prescribing new-generation azoles. First-line antifungal therapy is terbinafine and itraconazole. Fluconazole is a consideration but is generally less effective and its use may be off-label in many countries. For difficult-to-treat skin fungal infections and onychomycosis, that have failed terbinafine, itraconazole and fluconazole, we propose consideration of off-label voriconazole or posaconazole.
{"title":"Safety and efficacy of new generation azole antifungals in the management of recalcitrant superficial fungal infections and onychomycosis.","authors":"Aditya K Gupta, Mesbah Talukder, Avner Shemer, Eran Galili","doi":"10.1080/14787210.2024.2362911","DOIUrl":"10.1080/14787210.2024.2362911","url":null,"abstract":"<p><strong>Introduction: </strong>Terbinafine is considered the gold standard for treating skin fungal infections and onychomycosis. However, recent reports suggest that dermatophytes are developing resistance to terbinafine and the other traditional antifungal agents, itraconazole and fluconazole. When there is resistance to terbinafine, itraconazole or fluconazole, or when these agents cannot used, for example, due to potential drug interactions with the patient's current medications, clinicians may need to consider off-label use of new generation azoles, such as voriconazole, posaconazole, fosravuconazole, or oteseconazole. It is essential to emphasize that we do not advocate the use of newer generation azoles unless traditional agents such as terbinafine, itraconazole, or fluconazole have been thoroughly evaluated as first-line therapies.</p><p><strong>Areas covered: </strong>This article reviews the clinical evidence, safety, dosage regimens, pharmacokinetics, and management algorithm of new-generation azole antifungals.</p><p><strong>Expert opinion: </strong>Antifungal stewardship should be the top priority when prescribing new-generation azoles. First-line antifungal therapy is terbinafine and itraconazole. Fluconazole is a consideration but is generally less effective and its use may be off-label in many countries. For difficult-to-treat skin fungal infections and onychomycosis, that have failed terbinafine, itraconazole and fluconazole, we propose consideration of off-label voriconazole or posaconazole.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260763","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 : 2024-06-01Epub Date: 2024-05-20DOI: 10.1080/14787210.2024.2354828
Pompeo Costantino Kouroupis, Niall O'Rourke, Sinead Kelly, Myles McKittrick, Elne Noppe, Luis F Reyes, Alejandro Rodriguez, Ignacio Martin-Loeches
Introduction: Hospital-acquired pneumonia (HAP) represents a significant cause of mortality among critically ill patients admitted to Intensive Care Units (ICUs). Timely and precise diagnosis is imperative to enhance therapeutic efficacy and patient outcomes. However, the diagnostic process is challenged by test limitations and a wide-ranging list of differential diagnoses, particularly in patients exhibiting escalating oxygen requirements, leukocytosis, and increased secretions.
Areas covered: This narrative review aims to update diagnostic modalities, facilitating the prompt identification of nosocomial pneumonia while guiding, developing, and assessing therapeutic interventions. A comprehensive literature review was conducted utilizing the MEDLINE/PubMed database from 2013 to April 2024.
Expert opinion: An integrated approach that integrates clinical, microbiological, and imaging tools is paramount. Progress in diagnostic techniques, including novel molecular methods, the expanding utilization and accuracy of bedside ultrasound, and the emergence of Artificial Intelligence, coupled with an improved comprehension of lung microbiota and host-pathogen interactions, continues to enhance our capability to accurately and swiftly identify HAP and its causative agents. This advancement enables the refinement of treatment strategies and facilitates the implementation of precision medicine approaches.
{"title":"Hospital-acquired bacterial pneumonia in critically ill patients: from research to clinical practice.","authors":"Pompeo Costantino Kouroupis, Niall O'Rourke, Sinead Kelly, Myles McKittrick, Elne Noppe, Luis F Reyes, Alejandro Rodriguez, Ignacio Martin-Loeches","doi":"10.1080/14787210.2024.2354828","DOIUrl":"10.1080/14787210.2024.2354828","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital-acquired pneumonia (HAP) represents a significant cause of mortality among critically ill patients admitted to Intensive Care Units (ICUs). Timely and precise diagnosis is imperative to enhance therapeutic efficacy and patient outcomes. However, the diagnostic process is challenged by test limitations and a wide-ranging list of differential diagnoses, particularly in patients exhibiting escalating oxygen requirements, leukocytosis, and increased secretions.</p><p><strong>Areas covered: </strong>This narrative review aims to update diagnostic modalities, facilitating the prompt identification of nosocomial pneumonia while guiding, developing, and assessing therapeutic interventions. A comprehensive literature review was conducted utilizing the MEDLINE/PubMed database from 2013 to April 2024.</p><p><strong>Expert opinion: </strong>An integrated approach that integrates clinical, microbiological, and imaging tools is paramount. Progress in diagnostic techniques, including novel molecular methods, the expanding utilization and accuracy of bedside ultrasound, and the emergence of Artificial Intelligence, coupled with an improved comprehension of lung microbiota and host-pathogen interactions, continues to enhance our capability to accurately and swiftly identify HAP and its causative agents. This advancement enables the refinement of treatment strategies and facilitates the implementation of precision medicine approaches.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921817","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 : 2024-06-01Epub Date: 2024-05-27DOI: 10.1080/14787210.2024.2360116
Rajeev Soman, Balaji Veeraraghavan, Ashit Hegde, Subhash Varma, Subhash Todi, R K Singh, Vasant Nagavekar, Camilla Rodrigues, Subramanian Swaminathan, V Ramsubramanian, Abdul Ansari, Dhruva Chaudhry, Amullya Pednekar, Sagar Bhagat, Saiprasad Patil, Hanmant Barkate
Introduction: The rising challenge of carbapenem-resistant Enterobacterales (CRE) infections in Indian healthcare settings calls for clear clinical guidance on the management of these infections. The Indian consensus on the management of CRE infection in critically ill patients (ICONIC-II) is a follow-up of the ICONIC-I study, which was undertaken in 2019.
Areas covered: A modified Delphi method was used to build expert consensus on CRE management in India, involving online surveys, face-to - face expert meetings, and a literature review. A panel of 12 experts was formed to develop potential clinical consensus statements (CCSs), which were rated through two survey rounds. The CCSs were finalized in a final face-to - face discussion. The finalized CCSs were categorized as consensus, near consensus, and no consensus.
Expert opinion: The outcomes included 46 CCSs (consensus: 40; near consensus: 3; and no consensus: 3). The expert panel discussed and achieved consensus on various strategies for managing CRE infections, emphasizing the significance of existing and emerging resistance mechanisms, prompt and tailored empiric therapy, and use of combination therapies. The consensus statements based on the collective expertise of the panel can potentially assist clinicians in the management of CRE infections that lack high-level evidence.
{"title":"Indian consensus on the managemeNt of carbapenem-resistant enterobacterales infection in critically ill patients II (ICONIC II).","authors":"Rajeev Soman, Balaji Veeraraghavan, Ashit Hegde, Subhash Varma, Subhash Todi, R K Singh, Vasant Nagavekar, Camilla Rodrigues, Subramanian Swaminathan, V Ramsubramanian, Abdul Ansari, Dhruva Chaudhry, Amullya Pednekar, Sagar Bhagat, Saiprasad Patil, Hanmant Barkate","doi":"10.1080/14787210.2024.2360116","DOIUrl":"10.1080/14787210.2024.2360116","url":null,"abstract":"<p><strong>Introduction: </strong>The rising challenge of carbapenem-resistant Enterobacterales (CRE) infections in Indian healthcare settings calls for clear clinical guidance on the management of these infections. The Indian consensus on the management of CRE infection in critically ill patients (ICONIC-II) is a follow-up of the ICONIC-I study, which was undertaken in 2019.</p><p><strong>Areas covered: </strong>A modified Delphi method was used to build expert consensus on CRE management in India, involving online surveys, face-to - face expert meetings, and a literature review. A panel of 12 experts was formed to develop potential clinical consensus statements (CCSs), which were rated through two survey rounds. The CCSs were finalized in a final face-to - face discussion. The finalized CCSs were categorized as consensus, near consensus, and no consensus.</p><p><strong>Expert opinion: </strong>The outcomes included 46 CCSs (consensus: 40; near consensus: 3; and no consensus: 3). The expert panel discussed and achieved consensus on various strategies for managing CRE infections, emphasizing the significance of existing and emerging resistance mechanisms, prompt and tailored empiric therapy, and use of combination therapies. The consensus statements based on the collective expertise of the panel can potentially assist clinicians in the management of CRE infections that lack high-level evidence.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093207","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 : 2024-06-01Epub Date: 2024-05-08DOI: 10.1080/14787210.2024.2351552
Po-Yu Huang, Chi-Kuei Hsu, Hung-Jen Tang, Chih-Cheng Lai
Introduction: The escalating threat of multidrug-resistant organisms necessitates constant exploration for novel antimicrobial agents. Eravacycline has emerged as a promising solution due to its unique chemical structure, which enhances potency and expands its spectrum of activity.
Area covered: This review provides a thorough examination of eravacycline, encompassing its in vitro activity against Gram-positive and Gram-negative aerobes, carbapenem-non-susceptible organisms, anaerobes, and other bacterial strains. Additionally, it evaluates evidence from clinical studies to establish its clinical effect and safety.
Expert opinion: Eravacycline, a synthetic fluorocycline, belongs to the tetracyclines class. Similar to other tetracycline, eravacycline exerts its antibacterial action by reversibly binding to the bacterial ribosomal 30S subunit. Eravacycline demonstrates potent in vitro activity against many Gram-positive and Gram-negative aerobes, anaerobes, and multidrug-resistant organisms. Randomized controlled trials and its associated meta-analysis affirm eravacycline's efficacy in treating complicated intra-abdominal infections. Moreover, real-world studies showcase eravacycline's adaptability and effectiveness in diverse clinical conditions, emphasizing its utility beyond labeled indications. Despite common gastrointestinal adverse events, eravacycline maintains an overall favorable safety profile, reinforcing its status as a tolerable antibiotic. However, ongoing research is essential for refining eravacycline's role, exploring combination therapy, and assessing its performance against biofilms, in combating challenging bacterial infections.
导言:耐多药生物的威胁不断升级,因此需要不断探索新型抗菌剂。埃拉伐环素是新一代四环素衍生物,其独特的化学结构增强了药效并扩大了活性范围,因此成为一种很有前景的解决方案:本综述全面考察了伊拉瓦昔林,包括其对革兰氏阳性和革兰氏阴性需氧菌、碳青霉烯类不敏感菌、厌氧菌和其他细菌菌株的体外活性。此外,它还评估了临床研究的证据,以确定其临床效果和安全性:依拉韦辛是一种人工合成的氟环素,属于四环素类,具有基本的化学结构,并在萘甲烯酸核的 D 环上引入了特定的修饰。与其他四环素类似,埃拉伐环素通过与细菌核糖体 30S 亚基的可逆结合发挥抗菌作用,阻止氨基酸残基结合到延长的肽链中,最终破坏细菌蛋白质的合成。依拉维辛在体外对许多革兰氏阳性和革兰氏阴性需氧菌、厌氧菌和耐多药生物具有很强的活性。随机对照试验及其相关的荟萃分析证实了依拉维辛在治疗复杂的腹腔内感染方面的疗效。此外,真实世界的研究显示了依拉维辛在不同临床条件下的适应性和有效性,强调了它在标示适应症之外的作用。尽管存在常见的胃肠道不良反应,但依拉维辛的总体安全性良好,巩固了其作为可耐受抗生素的地位。然而,持续的研究对于完善依拉维辛的作用、探索联合疗法以及评估其抗生物膜的性能至关重要,这将有助于其继续成功应对具有挑战性的细菌感染。
{"title":"Eravacycline: a comprehensive review of in vitro activity, clinical efficacy, and real-world applications.","authors":"Po-Yu Huang, Chi-Kuei Hsu, Hung-Jen Tang, Chih-Cheng Lai","doi":"10.1080/14787210.2024.2351552","DOIUrl":"10.1080/14787210.2024.2351552","url":null,"abstract":"<p><strong>Introduction: </strong>The escalating threat of multidrug-resistant organisms necessitates constant exploration for novel antimicrobial agents. Eravacycline has emerged as a promising solution due to its unique chemical structure, which enhances potency and expands its spectrum of activity.</p><p><strong>Area covered: </strong>This review provides a thorough examination of eravacycline, encompassing its in vitro activity against Gram-positive and Gram-negative aerobes, carbapenem-non-susceptible organisms, anaerobes, and other bacterial strains. Additionally, it evaluates evidence from clinical studies to establish its clinical effect and safety.</p><p><strong>Expert opinion: </strong>Eravacycline, a synthetic fluorocycline, belongs to the tetracyclines class. Similar to other tetracycline, eravacycline exerts its antibacterial action by reversibly binding to the bacterial ribosomal 30S subunit. Eravacycline demonstrates potent in vitro activity against many Gram-positive and Gram-negative aerobes, anaerobes, and multidrug-resistant organisms. Randomized controlled trials and its associated meta-analysis affirm eravacycline's efficacy in treating complicated intra-abdominal infections. Moreover, real-world studies showcase eravacycline's adaptability and effectiveness in diverse clinical conditions, emphasizing its utility beyond labeled indications. Despite common gastrointestinal adverse events, eravacycline maintains an overall favorable safety profile, reinforcing its status as a tolerable antibiotic. However, ongoing research is essential for refining eravacycline's role, exploring combination therapy, and assessing its performance against biofilms, in combating challenging bacterial infections.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847306","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}