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Healthcare professionals' understanding and perception of drug-related issues linked to off-label pharmacological medications used for COVID-19. 医护人员对与 COVID-19 标签外用药相关的药物问题的理解和看法。
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-01-31 DOI: 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.

研究背景目的:评估巴基斯坦医护人员对用于治疗 COVID-19 感染的抗感染药物相关药物治疗问题的看法:这项横断面研究于 2022 年 1 月至 10 月进行,采用的是作者自制的调查问卷,包括三个部分:人口统计学、知识和认知。该研究经研究专家验证,并在 30 名受试者中进行了试点测试。研究对象包括旁遮普省政府和私立医疗机构的医生、护士和药剂师:在这项研究中,400 名参与者中有 382 人作答。平均知识得分为 9.52(标准差为 2.97),表明参与者对 COVID-19 药物干预措施有足够的了解。治疗 COVID-19 患者和来自拉合尔的参与者的知识得分明显更高。许多医生认为,老年患者和患有血液疾病的患者遇到药物相关问题的风险更大。大多数药剂师支持电子处方系统。许多医生认为,缺乏统一的治疗指南、多个处方者和自行用药是管理 COVID-19 患者的主要障碍:结论:大多数受访者有足够的知识。有合并症的老年患者面临不良反应的风险。自我用药、多重用药和多次开药会导致误诊和并发症。电子处方、团队合作和培训计划可以减少这些问题。
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引用次数: 0
Is the world crippled by antimicrobial resistance, or simply lacking information? 是抗菌药耐药性导致世界瘫痪,还是仅仅缺乏信息?
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-02-26 DOI: 10.1080/14787210.2024.2322429
Ahmad Z Al Meslamani
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引用次数: 0
Antibiotic stewardship: following in the footsteps of Nordic countries? 抗生素管理:跟随北欧国家的脚步?
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-03-04 DOI: 10.1080/14787210.2024.2323122
Niels Frimodt-Møller, Frederik Boetius Hertz
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引用次数: 0
Tackling antimicrobial resistance in sub-Saharan Africa: challenges and opportunities for implementing the new people-centered WHO guidelines. 应对撒哈拉以南非洲的抗菌药耐药性:实施以人为本的世卫组织新准则的挑战与机遇。
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-06-03 DOI: 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.

导言:抗菌药物是人类和动物健康医疗的重要组成部分。与抗菌药物使用相关的抗药性已对全球公共卫生构成威胁。世界卫生组织和相关合作伙伴在全球范围内做出了多种努力,以制定旨在消除抗菌药耐药性的政策:尽管抗菌药耐药性全球行动计划和以人为本的框架旨在指导各国成功实施抗菌药耐药性政策,但这些政策的采用和成功与否取决于不同的实施环境。因此,本文强调了在撒哈拉以南非洲实施世界卫生组织以人为本的方法所面临的挑战和机遇,同时认识到抗菌药耐药性是一个植根于'复杂系统'的多方面问题:以人为本的方法为抗击抗生素耐药性提供了一个坚实的框架。各国应制定可持续的国家行动计划,采用 "一体健康 "方法,限制非处方抗生素的消费,并教育社区合理使用抗生素。各国还应促进国家间合作和创新解决方案,加强药物监管能力,投资于感染控制、水质卫生、个人卫生、诊断和监测工具,并促进疫苗接种,以预防耐药性感染。
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引用次数: 0
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. 奥米克龙流行期间,帕克洛维治疗轻中度COVID-19成人患者的安全性和有效性:一项来自中国的多中心研究。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-02-01 DOI: 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。
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引用次数: 0
Safety and efficacy of new generation azole antifungals in the management of recalcitrant superficial fungal infections and onychomycosis. 新一代唑类抗真菌药治疗顽固性浅部真菌感染和甲癣的安全性和有效性。
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-06-12 DOI: 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.

简介特比萘芬被认为是治疗皮肤真菌感染和甲癣的金标准。然而,最近的报告显示,皮癣菌正在对特比萘芬和其他传统抗真菌药物(伊曲康唑和氟康唑)产生抗药性。如果对特比萘芬、伊曲康唑或氟康唑产生抗药性,或者由于这些药物可能与患者目前服用的药物发生相互作用等原因而无法使用,临床医生可能需要考虑在标签外使用新一代唑类药物,如伏立康唑、泊沙康唑、福斯拉康唑或奥替康唑。必须强调的是,我们不主张使用新一代唑类药物,除非特比萘芬、伊曲康唑或氟康唑等传统药物已被彻底评估为一线疗法:本文回顾了新一代唑类抗真菌药物的临床证据、安全性、剂量方案、药代动力学和管理算法:专家观点:在处方新一代唑类抗真菌药物时,抗真菌管理应是重中之重。特比萘芬和伊曲康唑是一线抗真菌治疗药物。氟康唑也在考虑之列,但其疗效通常较差,而且在许多国家,氟康唑的使用可能不在标签范围内。对于特比萘芬、伊曲康唑和氟康唑治疗无效的难治性皮肤真菌感染和甲真菌病,我们建议考虑标签外使用伏立康唑或泊沙康唑。
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引用次数: 0
Hospital-acquired bacterial pneumonia in critically ill patients: from research to clinical practice. 重症患者在医院获得的细菌性肺炎:从研究到临床实践。
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-20 DOI: 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.

简介:医院获得性肺炎(HAP医院获得性肺炎(HAP)是导致重症监护病房(ICU)重症患者死亡的一个重要原因。为了提高疗效和改善患者预后,及时准确的诊断势在必行。然而,诊断过程面临着检验局限性和广泛的鉴别诊断清单的挑战,尤其是在患者表现出氧需求增加、白细胞增多和分泌物增多的情况下:本叙述性综述旨在更新诊断方法,以便及时识别非典型肺炎,同时指导、制定和评估治疗干预措施。我们利用 MEDLINE/PubMed 数据库对 2013 年至 2024 年 4 月期间的文献进行了全面综述:整合临床、微生物学和影像学工具的综合方法至关重要。诊断技术(包括新型分子方法)的进步、床旁超声波的使用和准确性的提高、人工智能的出现,再加上对肺部微生物群和宿主-病原体相互作用的进一步了解,不断增强了我们准确、迅速地识别 HAP 及其致病因子的能力。这一进步有助于完善治疗策略,促进精准医疗方法的实施。
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引用次数: 0
Statement of Retraction: Ivermectin role in COVID-19 treatment (IRICT): single-center, adaptive, randomized, double-blind, placebo-controlled, clinical trial. 撤回声明:伊维菌素在COVID-19治疗中的作用(IRICT):单中心、适应性、随机、双盲、安慰剂对照临床试验。
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-06-04 DOI: 10.1080/14787210.2024.2362097
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引用次数: 0
Indian consensus on the managemeNt of carbapenem-resistant enterobacterales infection in critically ill patients II (ICONIC II). 印度重症患者耐碳青霉烯类肠杆菌感染管理共识 II(ICONIC II)。
IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-06-01 Epub Date: 2024-05-27 DOI: 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.

导言:印度医疗机构中耐碳青霉烯类肠杆菌(CRE)感染的挑战日益严峻,这就要求对此类感染的管理提供明确的临床指导。印度重症患者 CRE 感染管理共识(ICONIC-II)是 2019 年开展的 ICONIC-I 研究的后续研究:采用改良德尔菲法就印度的 CRE 管理达成专家共识,包括在线调查、面对面专家会议和文献综述。由 12 位专家组成的小组制定了潜在的临床共识声明 (CCS),并通过两轮调查对这些声明进行了评级。在最后的面对面讨论中,最终确定了临床共识声明。最终确定的 CCS 被分为共识、接近共识和无共识:结果包括 46 份综合传播战略(共识:40 份;接近共识:3 份;无共识:3 份)。专家小组就处理 CRE 感染的各种策略进行了讨论并达成了共识,强调了现有和新出现的耐药机制、及时和有针对性的经验疗法以及使用联合疗法的重要性。基于专家组集体专业知识的共识声明有可能帮助临床医生处理缺乏高级别证据的 CRE 感染。
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引用次数: 0
Eravacycline: a comprehensive review of in vitro activity, clinical efficacy, and real-world applications. 依拉维辛:体外活性、临床疗效和实际应用的全面回顾。
IF 5.7 2区 医学 Q1 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-08 DOI: 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。
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引用次数: 0
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Expert Review of Anti-infective Therapy
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