Update on the diagnostic considerations for neurogenic nasal and sinus symptoms: A current review suggests adding a possible diagnosis of migraine.
Antibiotics; Failed treatment; Migraine; Paranasal sinuses; Rhinology; Rhinosinusitis; Sinus CT scan; sinusitis
BACKGROUND: Treatment of rhinosinusitis (RS) is one of the leading reasons for prescriptions of antibiotics, although they often fail to provide symptomatic relief. Appropriately diagnosing and treating patients presenting with RS for whom antibiotic therapy has failed or who have normal CT findings is a controversial topic. One explanation is that what these patients are experiencing is misinformation from the trigeminal nerve and autonomic nervous system. Midfacial pain and pressure with rhinorrhea and nasal congestion do not represent an infectious, or even inflammatory, condition within the sinus or nasal cavities, but a mirage that is best treated as a migraine variant. Observations Although there is not enough research to definitively prove this alternate etiology, we are reaching a tipping point where the clinical implications, real-world experience, and evolving literature support this possible alternate etiology. Four key factors support a midfacial migraine that mimics RS: 1) Pathophysiology: current pathophysiology literature offers a model of how migraine attacks could replicate clinical presentations of RS; 2) Clinical presentation: patients with infectious RS and midfacial migraine have similar symptomatic presentation, similar demographics, but poorly correlated radiological information; 3) Diagnosis: clinical studies support the proposition that there are alternative diagnostic tools for distinguishing patients with midfacial migraine; and 4) Prognosis: Select RS patients show significant improvement with migraine treatment. CONCLUSIONS: We encourage medical professionals to consider migraine disease as a form of sensory misinformation and as a possible etiology of RS complaints. Clinicians can ask validated questions to determine if possible migraine could be an underlying cause, and there are standard preventative treatments for migraine that could alleviate patient symptoms. Dysfunctional vasomotor activity may be the root of the disturbances, particularly when antibiotic therapy fails and CT findings are discordant with symptoms. Until there is a diagnostic test for migraine, clinicians need to question a patient's self-diagnosis of rhinosinusitis. More research is needed to definitively answer this important question.
Godley Frederick A; Casiano Roy R; Mehle Mark; McGeeney Brian; Gottschalk Christopher
American journal of otolaryngology
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.amjoto.2018.09.021" target="_blank" rel="noreferrer noopener">10.1016/j.amjoto.2018.09.021</a>
Injury-induced gp130 cytokine signaling in peripheral ganglia is reduced in diabetes mellitus.
*Axon regeneration; *Axotomy; *Diabetes; *Neuropathy; *Peripheral nervous system; Animal; Animals; Antibiotics; Antineoplastic/toxicity; Blood Glucose/drug effects; Body Weight/drug effects; Cytokine Receptor gp130/genetics/*metabolism; Cytokines/metabolism; Diabetes Mellitus; Disease Models; Experimental/chemically induced/complications/*pathology; Fasting/blood; Gene Expression Regulation/*physiology; Hyperalgesia/etiology; Hyperglycemia/etiology; Inbred C57BL; Male; Mice; Nerve Degeneration/*etiology/pathology; Nerve Tissue Proteins/metabolism; Pain Measurement; Signal Transduction/drug effects/*physiology; Streptozocin/toxicity; Superior Cervical Ganglion/drug effects/*metabolism; Sweating/drug effects
Neuropathy is a major diabetic complication. While the mechanism of this neuropathy is not well understood, it is believed to result in part from deficient nerve regeneration. Work from our laboratory established that gp130 family of cytokines are induced in animals after axonal injury and are involved in the induction of regeneration-associated genes (RAGs) and in the conditioning lesion response. Here, we examine whether a reduction of cytokine signaling occurs in diabetes. Streptozotocin (STZ) was used to destroy pancreatic beta cells, leading to chronic hyperglycemia. Mice were injected with either low doses of STZ (5x60mg/kg) or a single high dose (1x200mg/kg) and examined after three or one month, respectively. Both low and high dose STZ treatment resulted in sustained hyperglycemia and functional deficits associated with the presence of both sensory and autonomic neuropathy. Diabetic mice displayed significantly reduced intraepidermal nerve fiber density and sudomotor function. Furthermore, low and high dose diabetic mice showed significantly reduced tactile touch sensation measured with Von Frey monofilaments. To look at the regenerative and injury-induced responses in diabetic mice, neurons in both superior cervical ganglia (SCG) and the 4th and 5th lumbar dorsal root ganglia (DRG) were unilaterally axotomized. Both high and low dose diabetic mice displayed significantly less axonal regeneration in the sciatic nerve, when measured in vivo, 48h after crush injury. Significantly reduced induction of two gp130 cytokines, leukemia inhibitory factor and interleukin-6, occurred in diabetic animals in SCG 6h after injury compared to controls. Injury-induced expression of interleukin-6 was also found to be significantly reduced in the DRG at 6h after injury in low and high dose diabetic mice. These effects were accompanied by reduced phosphorylation of signal transducer and activator of transcription 3 (STAT3), a downstream effector of the gp130 signaling pathway. We also found decreased induction of several gp130-dependent RAGs, including galanin and vasoactive intestinal peptide. Together, these data suggest a novel mechanism for the decreased response of diabetic sympathetic and sensory neurons to injury.
Niemi Jon P; Filous Angela R; DeFrancesco Alicia; Lindborg Jane A; Malhotra Nisha A; Wilson Gina N; Zhou Bowen; Crish Samuel D; Zigmond Richard E
Experimental neurology
2017
2017-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.expneurol.2017.06.020" target="_blank" rel="noreferrer noopener">10.1016/j.expneurol.2017.06.020</a>
Rifampicin induction of CYP3A4 requires pregnane X receptor cross talk with hepatocyte nuclear factor 4alpha and coactivators, and suppression of small heterodimer partner gene expression.
Antibiotics; Antitubercular/*pharmacology; Blotting; Cell Line; Chromatin/metabolism; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme System/*biosynthesis; Cytoplasmic and Nuclear/*biosynthesis/*drug effects/genetics; Electrophoretic Mobility Shift Assay; Enzyme Induction/drug effects; Glutathione Transferase/metabolism; Hepatocyte Nuclear Factor 4/genetics/*metabolism; Hepatocytes/drug effects/metabolism; Humans; Immunoprecipitation; Messenger/biosynthesis; Plasmids/genetics; Pregnane X Receptor; Receptor Cross-Talk/drug effects; Receptors; Reverse Transcriptase Polymerase Chain Reaction; Rifampin/*pharmacology; RNA; Steroid/*drug effects/genetics; Transfection; Tumor; Western
Bile acids and drugs activate pregnane X receptor (PXR) to induce CYP3A4, which is the predominant cytochrome P450 enzyme expressed in the liver and intestine and plays a critical role in detoxifying bile acids and drugs, and protecting against cholestasis. The aim of this study is to investigate the molecular mechanism of PXR cross talk with other nuclear receptors and coactivators in regulating human CYP3A4 gene transcription. Rifampicin dose dependently induced the CYP3A4 but inhibited small heterodimer partner (SHP) mRNA expression levels in primary human hepatocytes. Rifampicin strongly stimulated PXR and hepatocyte nuclear factor 4alpha (HNF4alpha) interaction, and CYP3A4 reporter activity, which was further stimulated by peroxisome proliferators-activated receptorgamma co-activator 1alpha (PGC-1alpha) and steroid receptor coactivator-1 (SRC-1) but inhibited by SHP. Mutation of the putative HNF4alpha binding site in the distal xenobiotic responsive element module did not affect CYP3A4 basal promoter activity and synergistic stimulation by PXR and HNF4alpha. Chromatin immunoprecipitation assays revealed that rifampicin-activated PXR recruited HNF4alpha and SRC-1 to the CYP3A4 chromatin. On the other hand, SHP reduced PXR recruitment of HNF4alpha and SRC-1 to the CYP3A4 chromatin. The human SHP promoter was stimulated by HNF4alpha and PGC-1alpha. Upon activation by rifampicin, PXR inhibited SHP promoter activity. Results suggest that PXR strongly induces CYP3A4 gene transcription by interacting with HNF4alpha, SRC-1, and PGC-1alpha. PXR concomitantly inhibits SHP gene transcription and maximizes the PXR induction of the CYP3A4 gene in human livers. Drugs targeted to PXR may be developed for treating cholestatic liver diseases induced by bile acids and drugs.
Li Tiangang; Chiang John Y L
Drug metabolism and disposition: the biological fate of chemicals
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1124/dmd.105.007575" target="_blank" rel="noreferrer noopener">10.1124/dmd.105.007575</a>
Antibiotic Dosing in Sustained Low-Efficiency Dialysis in Critically Ill Patients.
antibiotics; extended daily dialysis; pharmacokinetics; SLED; sustained low-efficiency dialysis
Purpose of review: Sustained low-efficiency dialysis (SLED) is increasingly used as a renal replacement modality in critically ill patients with acute kidney injury (AKI) and hemodynamic instability. There is, therefore, a greater need for the understanding of the antibiotic dosage and pharmacokinetics in these patients, to provide them with optimal therapy. Sources of information: PubMed/Medline, Embase, and Google Scholar. Methods: PubMed/Medline, Embase, and Google Scholar databases were searched using a combination of key words: dialysis, end stage renal disease, renal failure, sustained low efficiency dialysis, extended daily dialysis, prolonged intermittent renal replacement therapy (PIRRT), and antibiotic dosing. Studies that investigated antibiotic dosing and pharmacokinetics during SLED/extended daily dialysis/PIRRT were selected for this review. Key findings: Eleven studies met inclusion criteria and selected for data extraction. The data with regard to dialysis specifications, type of antibiotic including dosages, drug clearances, and dosage recommendations are summarized in Table 1. It is a challenge to find therapeutic doses for antibiotics during SLED therapy because, in general, only aminoglycosides and vancomycin can be assayed in clinical laboratories. Limitations: Although current studies on antibiotic dosing in SLED are limited due to diverse and undersized patient populations, antibiotic dosage adjustments for patients receiving SLED discussed here will serve as a valuable guide. Future large-scale research should focus on establishing guidelines for antibiotic dosage in SLED. Implications: Pharmacokinetic principles should be taken into consideration for the appropriate dosing of drugs during SLED, yet it is vital to monitor response to drug to make sure therapeutic goals are achieved. Antibiotic dosing and timing relative to the initiation of SLED may be important to maximize either the time above the minimum inhibitory concentration (MIC) (time-dependent) or the peak to MIC ratio (concentration-dependent), balancing efficacy and toxicity concerns. Critical care physicians should liaise with nephrologists to make decisions regarding appropriate antibiotic dosing in patients undergoing SLED.
Sethi Sidharth Kumar; Krishnappa Vinod; Nangethu Nisha; Nemer Paul; Frazee Lawrence A; Raina Rupesh
Canadian journal of kidney health and disease
2018
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/2054358118792229" target="_blank" rel="noreferrer noopener">10.1177/2054358118792229</a>
Current trends in the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria.
Acinetobacter baumannii; antibiotics; Enterobacteriaceae; Pseudomonas aeruginosa
Pneumonia is one of the most common infections worldwide. Morbidity, mortality, and healthcare costs increase substantially when pneumonia is caused by multidrug-resistant Gram-negative bacteria (MDR-GNB). The ongoing spread of antimicrobial resistance has made treating MDR-GNB pneumonia increasingly difficult. Fortunately, there have been some recent additions to our antibiotic armamentarium in the US and Europe for MDR-GNB, along with several agents that are in advanced stages of development. In this article, we review the risk factors for and current management of MDR-GNB pneumonia as well as novel agents with activity against these important and challenging pathogens.
Watkins Richard R; van Duin David
F1000Research
2019
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.12688/f1000research.16517.2" target="_blank" rel="noreferrer noopener">10.12688/f1000research.16517.2</a>
The Hidden Value of Variation in Practice.
Length of Stay; Hospitals; Pediatric; ANTIBIOTICS; CHILDREN'S hospitals; CYSTIC fibrosis; DISEASE exacerbation; LENGTH of stay in hospitals; LUNG diseases; Antibiotics – Administration and Dosage; Cystic Fibrosis – Drug Therapy; Disease Exacerbation – Drug Therapy; Lung Diseases – Drug Therapy
McBride John T; Stokes Dennis C
Pediatrics
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1542/peds.2016-3876" target="_blank" rel="noreferrer noopener">10.1542/peds.2016-3876</a>
Brain-targeted delivery of doxorubicin using glutathione-coated nanoparticles for brain cancers.
Antibiotics; Animals; *Drug Delivery Systems; Rats; Cell Line; Polylactic Acid-Polyglycolic Acid Copolymer; Blood-Brain Barrier/*metabolism; Brain cancer; Brain Neoplasms/drug therapy/metabolism; brain-targeted delivery; doxorubicin; Doxorubicin/*administration & dosage/pharmacokinetics; Drug Carriers/*chemistry/metabolism; Glutathione/*chemistry/metabolism; Lactic Acid/chemistry/metabolism; Nanoparticles/*chemistry/metabolism; PLGA-PEG NP; Polyethylene Glycols/chemistry/metabolism; Polyglycolic Acid/chemistry/metabolism; Tumor; Antineoplastic/*administration & dosage/pharmacokinetics
OBJECTIVES: To prepare and characterize in vitro a novel brain-targeted delivery of doxorubicin using glutathione-coated nanoparticles (NPs) for the treatment of brain cancer. METHODS: Doxorubicin-loaded NPs were prepared by the nanoprecipitation method using PLGA-COOH (dl-lactide-co-glycolide). The NPs were coated with a glutathione-PEG conjugate (PEG-GSH) in order to target delivery to the brain. The NPs were characterized via in vitro studies to determine particle size, drug release, cellular uptake, immunofluorescence study, cytotoxic assay, and in vitro blood-brain barrier (BBB) assay. RESULTS: The NPs showed a particle size suitable for BBB permeation (particle size around 200 nm). The in vitro release profile of the NPs exhibited no initial burst release and showed sustained drug release for up to 96 h. The immunofluorescence study showed the glutathione coating does not interfere with the drug release. Furthermore, in vitro BBB Transwell study showed significantly higher permeation of the doxorubicin-loaded NPs compared with the free doxorubicin solution through the coculture of rat brain endothelial (RBE4) and C6 astrocytoma cells (p \textless 0.05). CONCLUSIONS: We conclude that the initial in vitro characterization of the NPs demonstrates potential in delivering doxorubicin to cancer cells with possible future application in targeting brain cancers in vivo.
Geldenhuys Werner; Wehrung Daniel; Groshev Anastasia; Hirani Anjali; Sutariya Vijaykumar
Pharmaceutical development and technology
2015
2015-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/10837450.2014.892130" target="_blank" rel="noreferrer noopener">10.3109/10837450.2014.892130</a>
Vancomycin Combined with Piperacillin-Tazobactam Increases the Risk for Acute Kidney Injury.
Antibiotics; Drug Interactions; Kidney Failure; Drug Therapy; Vancomycin; Ampicillin – Therapeutic Use; Vancomycin – Therapeutic Use; Acute – Risk Factors; Cefepime Hydrochloride – Therapeutic Use; Combination – Adverse Effects; Lactam – Adverse Effects
The article comments on the retrospective cohort study "Risk of acute kidney injury in patients on concomitant vancomycin and piperacillin-tazobactam compared to those on vancomycin and cefepime" by B. Navalkele and colleagues. The study found that vancomycin paired with piperacillin-tazobactam increases the risk of acute kidney injury. It recommends clinicians to weigh the risks and benefits of vancomycin and piperacillin-tazobactam given the onset of acute kidney injury.
Watkins Richard R
Infectious Disease Alert
2017
2017-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Growing Threat of Pyelonephritis Caused by Antibiotic-resistant Escherichia coli.
Antibiotics; Practice Guidelines; Escherichia Coli; Escherichia Coli Infections; Pyelonephritis; Urinary Tract Infections
Watkins Richard R
Hospital Medicine Alert
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Reported Beta-lactam Allergy Is Associated with More Adverse Events Among Inpatients...MacFadden DR, LaDelfa A, Leen J, et al. Impact of reported beta-lactam allergy on inpatient outcomes: A multicenter prospective cohort study. Clin Infect Dis 2016;63:904-910
Antibiotics; Treatment Outcomes; Drug Hypersensitivity; Adverse Health Care Event – Risk Factors; Lactam
The article focuses on a study conducted on patients allergic to Beta-Lactam antibiotics by increasing its dose. Topics discussed include collection of patients' demographic and allergy history data and performing penicillin skin testing (PST), occurrence of any treatment related adverse event, and comparison of patients given beta-lactam treatment inspite of allergy with the patients who did not report any allergy.
Watkins Richard R
Infectious Disease Alert
2016
2016-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Antibiotics for Acute Appendicitis.
Postoperative Complications; Antibiotics; Length of Stay; Decision Making; Appendectomy; Tomography; Human; Multicenter Studies; X-Ray Computed; Intravenous; Administration; Treatment Outcomes; Patient Education; Randomized Controlled Trials; Emergency Treatment; Antibiotics – Therapeutic Use; Appendicitis – Ultrasonography; Appendicitis – Drug Therapy; Appendicitis – Surgery
The article reports that patients with uncomplicated acute appendicitis can fair well without surgery as compared to clinical trial patients who underwent surgery, and states that patients had lower risk of complications during the one-year follow-up period.
Watkins Richard R
Internal Medicine Alert
2015
2015-09-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Hospital wards with higher antibiotic prescribing rates may have associated increased CDI risk.
Antibiotics; Prescribing Patterns; Clostridium Difficile; Hospital Units; Clostridium Infections – Risk Factors
A retrospective observational study found that among hospitalized patients, ward-level antibiotic prescribing was associated with a significantly increased risk for Clostridium difficile infection beyond what would be expected with patient-level antibiotic use.
Watkins Richard R
Hospital Infection Control & Prevention
2015
2015-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Using Procalcitonin to Differentiate Bacterial from Viral Meningitis.
Antibiotics; Viral; Bacterial; Meningitis; Biological Markers; Calcitonin; Meningitis – Diagnosis
The article presents a study which reveals the consideration of an elevated serum procalcitonin to be an accurate test for differentiating bacterial from viral meningitis in adults.
Watkins Richard R
Internal Medicine Alert
2015
2015-12-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Subglottic Secretion Suctioning Reduces Vent-Associated Pneumonia, Antibiotic Use.
Antibiotics; Odds Ratio; Academic Medical Centers; Confidence Intervals; Human; Pneumonia; Randomized Controlled Trials; Belgium; Secretions; Endotracheal – Utilization; Suctioning; Ventilator-Associated – Prevention and Control
Watkins Richard R
Infectious Disease Alert
2014
2014-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Increased Risk for Statin Toxicity in the Elderly While on Macrolide Therapy.
Antibiotics; Aged; Education; Drug Interactions; Retrospective Design; Treatment Duration; Continuing (Credit); Clarithromycin – Adverse Effects; Azithromycin – Therapeutic Use; Clarithromycin – Metabolism; Drug Toxicity – Risk Factors; Erythromycin – Adverse Effects; Erythromycin – Metabolism; Macrolide – Therapeutic Use; Statins – Adverse Effects – In Old Age; Statins – Metabolism
Watkins Richard R
Infectious Disease Alert
2013
2013-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The Science of Selecting Antimicrobials for Community-Acquired Pneumonia (CAP)
Antibiotics; Human; Practice Guidelines; Drug Resistance; Pneumonia; Drug Therapy; Microbial; Combination; Microbial Culture and Sensitivity Tests; Antiinfective Agents; Streptococcus; Gram-Negative Bacteria; Antibiotics – Therapeutic Use; Community-Acquired Infections – Drug Therapy; Bacterial – Drug Therapy; Macrolide – Therapeutic Use; Quinolone – Therapeutic Use; Lactam – Therapeutic Use; Legionnaires' Disease – Drug Therapy
File T M
Journal of Managed Care Pharmacy
2009
2009-03-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.18553/jmcp.2009.15.s2.5" target="_blank" rel="noreferrer noopener">10.18553/jmcp.2009.15.s2.5</a>
Polycystic kidney disease: detecting and managing extrarenal complications.
Adult; Female; Antibiotics; Male; Middle Age; Hereditary Diseases; Kidney Diseases – Complications; Kidney Diseases – Diagnosis; Kidney Diseases – Therapy
Autosomal dominant polycystic kidney disease (ADPKD), the most common inherited disorder in this country, is more than just a renal disease. Major extrarenal sites are the cardiovascular system, liver, and GI tract. The most devastating cardiovascular abnormalities are occult CNS aneurysms; screening for such lesions is indicated in selected patients, including those with a family history of both ADPKD and berry aneurysms. Liver cysts are a common manifestation of ADPKD; hormonal factors may cause these cysts to enlarge during pregnancy. Colonic diverticula affect most patients with ADPKD; consider diverticular rupture in your differential diagnosis when a patient presents with abdominal pain or peritoneal signs. Instrumentation (eg, cystoscopy) increases the risk of urinary tract infection in ADPKD patients and should be avoided when possible.
Rutecki G W; Whittier F C
Consultant (00107069)
1995
1995-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Evolution of amoxicillin/clavulanate in the treatment of adults with acute bacterial rhinosinusitis and community-acquired pneumonia in response to antimicrobial-resistance patterns.
Antibiotics; Drug Resistance; Microbial; Microbial Culture and Sensitivity Tests; Pneumonia – Drug Therapy; Community-Acquired Infections – Drug Therapy; Pneumonia – Microbiology; Community-Acquired Infections – Microbiology; Bacteria – Drug Effects; Combined – Therapeutic Use; Rhinosinusitis – Drug Therapy; Rhinosinusitis – Microbiology
Current treatment guidelines for community-acquired respiratory tract infections no longer depend solely on the characteristics of the patient and the clinical syndrome, but on those of the offending pathogen, including presence and level of antimicrobial resistance. The most common respiratory tract pathogens known to cause acute bacterial rhinosinusitis (ABRS) and community-acquired pneumonia (CAP) include Streptococcus pneumoniae and Haemophilus influenzae. The prevalence of antimicrobial resistance, especially b-lactum and macrolide resistance, among S pneumoniae and H influenzae has increased dramatically during the past 2 decades, diminishing the activity of many older antimicrobials against resistant organisms. A pharmacokinetically enhanced formulation of amoxicillin/clavulanate has been developed to fulfill the need for an oral b-lactam antimicrobial that achieves a greater time that the serum drug concentration exceeds the minimum inhibitory concentration (T \textgreater MIC) of antimicrobials against pathogens than conventional formulations to improve activity against S pneumoniae with reduced susceptibility to penicillin. The b-lactamase inhibitor clavulanate allows for coverage of b-lactamase-producing pathogens, such as H influenzae and M catarrhalis. This article reviews the rationale for, and evolution of, oral amoxicillin clavulanate for ABRS and CAP. Copyright © 2004 by Elsevier Science (USA).
File T M Jr; Benninger MS; Jacobs MR
Clinics in Laboratory Medicine
2004
2004-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.cll.2004.03.003" target="_blank" rel="noreferrer noopener">10.1016/j.cll.2004.03.003</a>
Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia.
Antibiotics; United States; Canada; Europe; Comparative Studies; Practice Guidelines; Drug Resistance; Pneumonia; Microbial; Antiinfective Agents; Community-Acquired Infections – Drug Therapy; Bacterial – Drug Therapy; Antibiotics – Administration and Dosage; Fluoroquinolone – Therapeutic Use; Macrolide – Therapeutic Use; Lactam – Therapeutic Use
Empiric antimicrobial prescribing for community-acquired pneumonia remains a challenge, despite the availability of treatment guidelines. A number of key differences exist between North American and European guidelines, mainly in the outpatient setting. The North American approach is to use initial antimicrobial therapy, which provides coverage for Streptococcus pneumoniae plus atypical pathogens. Europeans tend to focus on providing pneumococcal coverage with less emphasis on covering for an atypical pathogen. Ambulatory patients without comorbidity are more likely to receive macrolide therapy in North America, whereas in Europe these patients would probably receive a beta-lactam agent. Major issues that are fundamental to this difference include the importance of providing therapy for atypical pathogens and the clinical significance of macrolide-resistant S pneumoniae. Prospective data are required to evaluate which of these two approaches offers clinical superiority.
File T M Jr; Garau J; Blasi F; Chidiac C; Klugman K; Lode H; Lonks JR; Mandell L; Ramirez J; Yu V
Chest
2004
2004-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1378/chest.125.5.1888" target="_blank" rel="noreferrer noopener">10.1378/chest.125.5.1888</a>
International guidelines for the treatment of community-acquired pneumonia in adults: the role of macrolides.
Antibiotics; Outpatients; Risk Assessment; Methicillin Resistance; Inpatients; Clinical Trials; Practice Guidelines; Drug Resistance; Microbial; Nonexperimental Studies; Pneumonia – Drug Therapy; Community-Acquired Infections – Drug Therapy; Pneumonia – Etiology; Macrolide – Therapeutic Use; Streptococcal Infections – Drug Therapy; Community-Acquired Infections – Etiology; Immune System – Drug Effects; Macrolide – Pharmacodynamics
The significance of community-acquired pneumonia (CAP) has led to the publication of guidelines from numerous international organisations. Because the macrolide class of antimicrobials is active against most of the key pathogens associated with CAP, agents from this class are commonly included in recommendations from these guidelines. However, there are differences among the various guidelines concerning the positioning of the macrolides for empirical therapy. An important factor concerning the use of macrolides for CAP is the emergence of resistance of Streptococcus pneumoniae over the past decade. The rate of S. pneumoniae resistance to macrolides ranges from 4 to 70% of strains in worldwide surveillance studies. The most common mechanisms of resistance include methylation of a ribosomal target encoded by the erm gene and efflux of the macrolides by a cell membrane protein transporter, encoded by the mef gene. S. pneumoniae strains with the mef gene are resistant at a lower level (with minimum inhibitory concentration [MIC] values generally 1-16 microg/ml) than erm resistant strains; and it is possible that such strains may be inhibited if sufficiently high levels of macrolide can be obtained at the infected site. Currently mef-associated resistance predominates in North America, whereas erm predominates in Europe. Until recently, reports of failure of treatment of CAP with macrolides has been rare, particularly for patients with low-risk for drug-resistant strains. However, since 2000, several patients treated with an oral macrolide who have subsequently required admission to the hospital for macrolide-resistant S. pneumoniae (MRSP) bacteraemia have been reported in the literature. Major issues, which are fundamental to the use of the macrolides as recommended in the various guidelines, include the importance of providing therapy for 'atypical' pathogens and the clinical significance of MRSP. Presently, the macrolides are more prominently recommended in the North American guidelines than in other parts of the world. The difference in the emphasis placed on the importance of the atypical pathogens as well as the expression of MRSP in North America compared with Europe partly explains this variance.
File T M Jr; Tan J S
Drugs
2003
2003-01-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2165/00003495-200363020-00005" target="_blank" rel="noreferrer noopener">10.2165/00003495-200363020-00005</a>
Safety of Intravenous Infusion of Doripenem
antibiotics; carbapenems; ertapenem; history; hypersensitivity; imipenem; Immunology; Infectious Diseases; meropenem; Microbiology; penicillin allergy; seizures
Carbapenems remain a mainstay for the empirical treatment of serious nosocomial infection. Although the tolerance and safety profile of the carbapenems as a class is favorable, the primary safety concern is the potential for treatment-emergent seizures. In preclinical testing, doripenem, a new carbapenem antibiotic, showed negligible neurotoxic effects. The safety and tolerability of intravenous doripenem was evaluated in 1 phase 2 and in 6 phase 3 clinical trials conducted with patients with nosocomial pneumonia, including ventilator-associated pneumonia; complicated intra-abdominal infection; and complicated urinary tract infection. Safety data were available from 1817 patients who received doripenem and 1325 patients who received 1 of 4 active comparator drugs as part of this development program. Overall, intravenous doripenem was found to be safe and well tolerated, demonstrating a safety profile comparable to that of comparator agents and a limited propensity to induce seizures, including when administered via 1-h or 4-h infusion.
Redman R; File T M
Clinical Infectious Diseases
2009
2009-08
Journal Article
<a href="http://doi.org/10.1086/599813" target="_blank" rel="noreferrer noopener">10.1086/599813</a>
Acute otitis media
acute otitis media; antibacterial therapy; antibiotics; bacterial resistance; care; children; efficacy; era; expectations; Infectious Diseases; management; Streptococcus pneumoniae; vaccine
At least 1 episode of acute otitis media is seen in 94% of children before age 2. Attendance in a day-care setting is among the major risk factors. Middle ear fluid may be sterile or may grow viruses and/or bacteria. Accurate diagnosis and distinction from otitis media with effusion is essential for proper management, but physicians often have difficulty in making the correct diagnosis. Since overuse of antibacterial agents contributes to an increase in bacterial resistance, physicians should consider delaying treatment for 2 to 3 days, during which therapy is aimed at controlling pain. High-dose amoxicillin is the preferred antibacterial agent in a young child with a purulent middle ear effusion, but amoxicillin-clavulanate, cefuroxime axetil, and ceftriaxone are options when resistant bacteria are. encountered.
Scott E G; Powell K R
Infections in Medicine
2003
2003-05
Journal Article
<a href="http://doi.org/10.1016/b978-1-4160-4417-8.50020-6" target="_blank" rel="noreferrer noopener">10.1016/b978-1-4160-4417-8.50020-6</a>
A clinician's guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria
acute exacerbations; antibiotic therapy resistance; antibiotics; antimicrobials; cefuroxime axetil; chronic bronchitis; clarithromycin; community-acquired pneumonia; double-blind; efficacy; General & Internal Medicine; pharmacodynamics; respiratory-tract infections; Streptococcus pneumoniae
In response to the overuse and misuse of antibiotics, leading to increasing bacterial resistance and decreasing development of new antibiotics, the Council for Appropriate and Rational Antibiotic Therapy (CARAT) has developed criteria to guide appropriate and accurate antibiotic selection. The criteria, which are aimed at optimizing antibiotic therapy, include evidence-based results, therapeutic benefits, safety, optimal drug for the optimal duration, and cost-effectiveness. (C) 2005 Elsevier Inc. All rights reserved.
Slama T G; Amin A; Brunton S A; File T M; Milkovich G; Rodvold K A; Sahm D F; Varon J; Weiland D; Carat
American Journal of Medicine
2005
2005-07
Journal Article
<a href="http://doi.org/10.1016/j.amjmed.2005.05.007" target="_blank" rel="noreferrer noopener">10.1016/j.amjmed.2005.05.007</a>
Physical Compatibility Of 4% Sodium Citrate With Selected Antimicrobial Agents
Aminoglycosides; antibiotic-lock technique; antibiotics; Anticoagulants; Antiinfective agents; catheter-related infection; Concentration; Daptomycin; Gentamicin; hemodialysis; Hydrogen ion concentration; Incompatibilities; Injections; Linezolid; management; Pharmacology & Pharmacy; Photodecomposition; Precipitation; prevention; Sodium citrate; Spectrometry; Stability; Storage; Temperature; Tobramycin; Turbidity; Vancomycin
Dotson B; Lynn S; Savakis K; Churchwell M D
American Journal of Health-System Pharmacy
2010
2010-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.2146/ajhp090505" target="_blank" rel="noreferrer noopener">10.2146/ajhp090505</a>
Performance Measurement In Community-acquired Pneumonia: Consequences Intended And Unintended
america; antibiotics; care; guidelines; hospitals; Immunology; Infectious Diseases; infectious-diseases-society; Microbiology; quality
File T M; Gross P A
Clinical Infectious Diseases
2007
2007-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1086/512436" target="_blank" rel="noreferrer noopener">10.1086/512436</a>
A Multicenter, Randomized Study Comparing The Efficacy And Safety Of Intravenous And/or Oral Levofloxacin Versus Ceftriaxone And/or Cefuroxime Axetil In Treatment Of Adults With Community-acquired Pneumonia
activity; antibacterial; antibiotics; chlamydia-pneumoniae; ciprofloxacin; dr-3355; invitro activities; Microbiology; optically-active ofloxacin; Pharmacology & Pharmacy; respiratory-tract infections; therapy
File T M; Segreti J; Dunbar L; Player R; Kohler R; Williams R R; Kojak C; Rubin A
Antimicrobial Agents and Chemotherapy
1997
1997-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1128/aac.41.9.1965" target="_blank" rel="noreferrer noopener">10.1128/aac.41.9.1965</a>
Antimicrobial Treatment Of Lower Respiratory Tract Infections In The Hospital Setting
5-day levofloxacin; acute exacerbations; antibiotic-therapy; antibiotics; chronic-bronchitis; community-acquired pneumonia; community-associated pneumonia; drug-interaction; General & Internal Medicine; healthcare-associated; hospital-acquired; open-label; quinolones; randomized-trial; streptococcus-pneumoniae; ventilator-associated; ventilator-associated pneumonia
Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a beta-lactam and macrolide combination or a fluoroquinolone. The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against >98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended. High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance. (C) 2005 Elsevier Inc. All rights reserved.
Grossman R F; Rotschafer J C; Tan J S
American Journal of Medicine
2005
2005-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.amjmed.2005.05.011" target="_blank" rel="noreferrer noopener">10.1016/j.amjmed.2005.05.011</a>
Comparison of narrow-versus broad-spectrum antibiotics in elderly patients with acute exacerbations of chronic obstructive pulmonary disease
elderly; pneumonia; adults; chronic obstructive pulmonary disease; society; antibiotics; exacerbations; neutrophil
Background Little evidence is available regarding the choice of empiric antibiotic therapy in elderly patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The primary objective of this study is to compare the outcomes of elderly patients receiving broad- versus narrow-spectrum antibiotics during hospitalization for AECOPD. Design A multicenter, retrospective, cohort analysis was performed. Inpatients 65 years and older with a primary discharge diagnosis of AECOPD who received >= 48 hours of antibiotic therapy were included in the study population. Patients were compared based on the spectrum of their antibiotic therapy. Narrow-spectrum antibiotics included: azithromycin, doxycycline, sulfamethoxazole/trimethoprim, or aminopenicillin. The primary outcome was a composite of mechanical ventilation 48 hours after admission, transfer to the intensive care unit 48 hours after admission, 30-day chronic obstructive pulmonary disease (COPD) readmission, and oxygen saturation less than 90% on room air or increased oxygen requirements from baseline 48 hours after admission. Results Two hundred fifty-three patients were included in this analysis; 127 patients were included in the narrow-spectrum group, and 126 patients were included in the broad-spectrum group. Patient demographics and comorbid conditions were similarly distributed in each group. The incidence of the primary composite outcome occurred in 50 (39.3%) and 60 (47.6%) of patients in the narrow- and broad-spectrum groups, respectively (P= .19). Conclusions and Relevance No difference was found in the primary outcome in inpatients aged >= 65 years with AECOPD who received empiric broad-spectrum or narrow-spectrum antibiotics.
Joyner KR; Walkerly A; Seidel K; Walsh N; Damshekan N; Perry T; Soric MM
Journal of Pharmacy Practice
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/0897190020938190" target="_blank" rel="noreferrer noopener">10.1177/0897190020938190</a>
Overview: The ongoing threat of antimicrobial resistance.
Antibiotics; Antimicrobial resistance; Public health
The effectiveness of antibiotics continues to erode because of the relentless spread of antimicrobial resistance (AMR). Public and private foundations, professional organizations, and international health agencies recognize the threat posed by AMR and have issued calls for action. One of the main drivers of AMR is overprescription of antibiotics, both in human and in veterinary medicine. The One Health concept is a response from a broad group of stakeholders to counter the global health threat posed by AMR. In this article, we discuss current trends in AMR and suggest strategies to mitigate its ongoing dissemination. (Copyright © 2020 Elsevier Inc. All rights reserved.)
Watkins RR;Bonomo RA
Infectious Disease Clinics Of North America
2020
2020-09-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.idc.2020.04.002" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2020.04.002</a>
The role of antibiotic stewardship and telemedicine in the management of multidrug-resistant infections.
Antibiotics; Antimicrobial resistance; Antimicrobial stewardship; Telemedicine
This article summarizes the literature describing how antimicrobial stewardship and telemedicine interventions affect antimicrobial resistance. Discussion includes why we need stewardship, how to collaborate with team members, and the evidence of stewardship's and telemedicine's impact on resistance.
File TM Jr;Jump RLP;Goff DA
Infectious Disease Clinics of North America
2020
2020-12
journalArticle
<a href="http://doi.org/10.1016/j.idc.2020.05.002" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2020.05.002</a>
Comparison of Narrow-Versus Broad-Spectrum Antibiotics in Elderly Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Background: Little evidence is available regarding the choice of empiric antibiotic therapy in elderly patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The primary objective of this study is to compare the outcomes of elderly patients receiving broad- versus narrow-spectrum antibiotics during hospitalization for AECOPD.
Design: A multicenter, retrospective, cohort analysis was performed. Inpatients 65 years and older with a primary discharge diagnosis of AECOPD who received ≥48 hours of antibiotic therapy were included in the study population. Patients were compared based on the spectrum of their antibiotic therapy. Narrow-spectrum antibiotics included: azithromycin, doxycycline, sulfamethoxazole/trimethoprim, or aminopenicillin. The primary outcome was a composite of mechanical ventilation 48 hours after admission, transfer to the intensive care unit 48 hours after admission, 30-day chronic obstructive pulmonary disease (COPD) readmission, and oxygen saturation less than 90% on room air or increased oxygen requirements from baseline 48 hours after admission.
Results: Two hundred fifty-three patients were included in this analysis; 127 patients were included in the narrow-spectrum group, and 126 patients were included in the broad-spectrum group. Patient demographics and comorbid conditions were similarly distributed in each group. The incidence of the primary composite outcome occurred in 50 (39.3%) and 60 (47.6%) of patients in the narrow- and broad-spectrum groups, respectively (P = .19).
Conclusions and relevance: No difference was found in the primary outcome in inpatients aged ≥65 years with AECOPD who received empiric broad-spectrum or narrow-spectrum antibiotics.
Kayla R Joyner
Autumn Walkerly
Kelsey Seidel
Nicholas Walsh
Neda Damshekan
Tyler Perry
Mate M Soric
J Pharm Pract
. 2022 Feb;35(1):26-31. doi: 10.1177/0897190020938190. Epub 2020 Jul 10.
2022
English