Expert Review of Anti-infective Therapy最新文献

Introduction: Fungal infections of the scalp and hair are usually caused by fungi like Trichophyton spp. Microsporum spp. and Malassezia furfur. These are major global health concerns but are often overlooked and misdiagnosed. Moreover, antimicrobial resistance and other challenges, like early detection methods, inefficient delivery of the antifungal agents, and their side effects, are important challenges in the treatment of such infections. These challenges can be overcome by using nanomaterials, which have been emerging as promising solutions.

Area covered: Nanomaterials are reported to play a key role in combating scalp and hair infections caused by different fungi. This review highlights the major fungal infections of the scalp, conventionally used antifungal agents, nanomaterials used in diagnosis, nanocarriers for the delivery of drugs, the toxicity of nanomaterials, and safety.

Expert opinion: Nanomaterials can inhibit the growth of emerging and existing pathogens, especially those resistant to conventional fungicides used to treat scalp and hair infections. The lower efficacy of current antifungal drugs has created a need for alternative antifungal strategies to treat these infections. In this context, nanomaterials offer promising potential as fungicidal agents that could be used alone or in combination with existing antifungals to combat scalp and hair infections more effectively.

Introduction: Infection continues to be one of the most common complications after solid organ transplantation (SOT). Past years have witnessed major advances in the diagnosis, prevention and treatment of post-transplant infection. Nevertheless, controversial issues and unmet needs remain.

Areas covered: We review recent contributions to the use of organs from hepatitis C or human immunodeficiency virus-positive donors or those with positive cultures for multidrug resistant organisms (MDROs), diagnostic next-generation sequencing, selective digestive decolonization (SDD), immune monitoring strategies for individualized risk assessment, vaccines and prophylactic monoclonal antibodies, and the prospects of adoptive T-cell immunotherapy and chimeric antigen receptor cell products. Based on these lessons, plausible future developments in the prevention and management of post-transplant infection are proposed.

Expert commentary: We expect that current barriers for the acceptance of increased infection risk donors will be overcome, and that the arrival of new antibiotics will allow the use of organs from donors colonized or infected by MDROs. 'Pathogen-agnostic' high-throughput diagnostic approaches will progressively replace conventional microbiology methods. Prophylaxis will be individualized by means of peri-transplant SDD, a repertoire of immune biomarkers (including the changes in human virome), and passive pre-exposure immunization. Finally, advanced cellular therapies will become the standard care of SOT recipients.

Introduction: High worldwide prevalence and significant morbidity of vulvovaginal candidiasis (VVC) requires better therapeutic approaches to improve quality of life of affected women. Although treatment of acute episodes is often straightforward, complicated and recurrent vulvovaginal candidiasis (RVVC) presents medical challenges.

Area covered: This review focuses on therapy of VVC particularly by topical antifungals , especially imidazoles, compared to oral treatment with fluconazole, itraconazole, ibrexafungerp, or oteseconazole. Candidiasis by non-Candida albicans, VVC in pregnant women and RVVC are complex challenges . Current treatment, alternatives, and roles played by topical azoles in VVC are highlighted.

Expert opinion: VVC requires personalized treatment considering whether the woman is pregnant or not, concomitant treatments, clinical presentations (acute or recurrent) and the Candida species involved. Although therapeutic tools are increasing, the usefulness of topical drugs, such as clotrimazole and miconazole, is very relevant. In addition, we it is also necessary to expand the therapeutic tools with new antifungals and formulations, and repurposing current drugs against fluconazole-resistant species of Candida.

Introduction: Although different novel beta-lactam/beta-lactamase inhibitor combinations (BL/BLIc) were recently licensed, resistance occurrence have been reported up to 15% of Gram-negative pathogens. For this reason, novel BL/BLIc of tomorrow will be released for managing difficult-to-treat resistance (DTR) Gram-negative infections.

Areas covered: This review provides a critical reappraisal of current issues for improving the proper clinical use of the novel BL/BLIc of tomorrow. A literature search was performed on PubMed-MEDLINE (until December 2024) for retrieving available studies on cefepime-enmetazobactam, sulbactam-durlobactam, and cefepime-taniborbactam. Four different main areas were discussed according to available evidence: 1) translating findings coming from the randomized clinical trials into the real-world clinical practice; 2) defining the optimal joint pharmacokinetic/pharmacodynamic (PK/PD) target; 3) identifying proper dosing schedules in patients with renal dysfunction; 4) attributing proper relevance to the epithelial lining fluid (ELF) penetration rate in defining optimal dosing schedule for treating pneumonia.

Expert opinion: Overall, old habits die hard and issues retrieved with licensed beta-lactams emerged also with novel BL/BLIc of tomorrow, potentially affecting their efficacy when used in real-world practice. Adopting appropriate corrective measures for overcoming these issues might increase the likelihood of preserving their efficacy in the future by minimizing the propensity risk of resistance development.

Introduction: Ceftriaxone is the last available single dose therapy for gonorrhea that effectively treats infections at all sites. Over a quarter of isolates are now resistant to ceftriaxone in some countries. The introduction of carefully chosen combination therapy with ceftriaxone could retard the emergence of ceftriaxone resistance.

Areas covered: This review summarizes the findings of a PubMed search on the use of partner antimicrobial that could be used with ceftriaxone to prevent the emergence and spread of ceftriaxone resistance. We review 16 antimicrobials that could be partnered with ceftriaxone in terms of pharmacokinetic and pharmacodynamic compatibilities, activity against ceftriaxone resistant isolates and probability of antimicrobial resistance emerging.

Expert opinion: Of these 16 antimicrobials, we reject antimicrobials such as fosfomycin due to poor clinical efficacy and tigecycline due to its considerably longer half-life which would likely select for tetracycline resistance. The most promising agents for combination with ceftriaxone are zoliflodacin, delafloxacin, sitafloxacin, eravacycline and possibly gepotidacin and gentamicin. Clinical studies should be conducted to evaluate the efficacy of these combinations on the eradication of N. gonorrhoeae and their impact on AMR in N. gonorrhoeae and other bacterial species.