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Treatment of Infections Caused by Carbapenem-Resistant Enterobacteriaceae
Opinion statement Treatment of infections by carbapenem-resistant enterobacteriaceae (CRE) is challenging because of the limited choice of active antibiotics and the scarcity of good data supporting any treatment regimen. Currently, there are no randomized controlled trials on the treatment of CRE infections and all data have been obtained from case report and retrospective cohort studies; thus, there are no treatment guidelines available. In the absence of good evidence, it is essential to tailor the treatment to the individual patient, considering different factors: • The focus of th...
Source: Current Treatment Options in Infectious Diseases - August 30, 2014 Category: Infectious Diseases Source Type: research

Therapeutic Options for Resistant Gram Positives
Opinion Statement Vancomycin remains the current gold standard for treatment of serious MRSA (methicillin resistant Staphylococcus aureus) infections despite uncertainties about rates of toxicity and the optimal dosing strategy. The only alternative for bloodstream infections (BSI) based on prospective randomised controlled trial data is daptomycin. However, higher doses should be implemented to prevent resistance emerging. Although linezolid and ceftaroline have been shown to be effective BSI treatment in retrospective cohort studies, there is no prospective randomised comparative data with vancomycin. T...
Source: Current Treatment Options in Infectious Diseases - August 16, 2014 Category: Infectious Diseases Source Type: research

HIV and Pregnancy
Opinion statement Antiretroviral therapy during pregnancy and breastfeeding is a proven strategy to help prevent mother to child transmission of HIV-1. Pharmacokinetic and physiologic changes during pregnancy affect absorption and distribution of effective antiretroviral therapy, and can result in lower therapeutic concentrations of drug although this may not impact mother to child transmission. Continued antiretroviral therapy postpartum can help to prevent transmission via breastfeeding in resource-limited settings, but more importantly, help preserve a mother’s health, which is critical to child su...
Source: Current Treatment Options in Infectious Diseases - June 1, 2014 Category: Infectious Diseases Source Type: research

Integrating Integrase Inhibitors Into an Antiretroviral Regimen
Opinion statement Integrase strand transfer inhibitors (INSTI) are the newest drug class for treating HIV-1 infections and arguably the most important class available to clinicians. The INSTIs raltegravir, elvitegravir and dolutegravir block strand transfer, the final step catalyzed by integrase, thus preventing incorporation of the viral cDNA into the host genome and subsequent replication. INSTIs are potent, safe and extremely well tolerated. They are the only class of antiretroviral medications in which all members are now recommended by the United States Department of Health and Human Services (DHHS...
Source: Current Treatment Options in Infectious Diseases - June 1, 2014 Category: Infectious Diseases Source Type: research

What to do Next? Second-line Antiretroviral Therapy
Opinion statement Highly-active antiretroviral therapy (HAART) has been one of the major advances in medicine in the 20th century. Millions of lives have been saved all over the world since triple drug combinations were adopted as the standard of care for HIV disease. First-line regimens may fail, generate side effects, and long term toxicities. In the past, HAART regimens were also complex and difficult to adhere to. So, second line regimens were necessary to preserve the main goal of ARV therapy: suppression viral replication and restoration of the immune system in order to keep patients alive and hea...
Source: Current Treatment Options in Infectious Diseases - June 1, 2014 Category: Infectious Diseases Source Type: research

Hepatitis C Direct-Acting Antiviral Agents in HIV/HCV Co-infected Patients
Opinion statement At the time this article is being written, hepatitis C treatment is being revolutionized. The recent approval of sofosbuvir in the US for both mono- and co-infection is an astounding advance in the treatment for co-infection. In the label, there is no distinction between the treatment of co-infected and mono-infected patients. This has been shown to be true of all the direct-acting antiviral agents to date, but none so far have had it in their label. In our opinion, patients in the early stages of liver fibrosis can wait for the future combinations of agents to optimize their treatment...
Source: Current Treatment Options in Infectious Diseases - June 1, 2014 Category: Infectious Diseases Source Type: research

Antimicrobial Stewardship Programs: Appropriate Measures and Metrics to Study their Impact
Opinion statement Antimicrobial stewardship is a new field that struggles to find the right balance between meaningful and useful metrics to study the impact of antimicrobial stewardship programs (ASPs). ASP metrics primarily measure antimicrobial use, although microbiological resistance and clinical outcomes are also important measures of the impact an ASP has on a hospital and its patient population. Antimicrobial measures looking at consumption are the most commonly used measures, and are focused on defined daily doses, days of therapy, and costs, usually standardized per 1,000 patient-days. Each mea...
Source: Current Treatment Options in Infectious Diseases - June 1, 2014 Category: Infectious Diseases Source Type: research

Workforce Supply and Training in Antimicrobial Stewardship
Opinion statement To improve the quality and safety of antimicrobial prescribing while minimizing unnecessary cost, antimicrobial stewardship programs (ASPs) require the unique services of a variety of healthcare and ancillary personnel with varied skill sets. At the center of such teams are pharmacists and physicians with specialty training in infectious diseases (ID). The potential implementation of regulations and accreditation standards requiring institutions to have antimicrobial stewardship programs (ASP)s, along with growing evidence to their effectiveness and their increasing presence in differe...
Source: Current Treatment Options in Infectious Diseases - June 1, 2014 Category: Infectious Diseases Source Type: research