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[PMID]:29505534
[Au] Autor:Wu X; Yu C; Li T; Lin L; Xu Q; Zhu Q; Ye L; Gao X
[Ad] Endereço:Department of Urology, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian, PR China.
[Ti] Título:Obesity was an independent risk factor for febrile infection after prostate biopsy: A 10-year single center study in South China.
[So] Source:Medicine (Baltimore);97(1):e9549, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To detect the best antibiotic protocol for prostate biopsy and to assess the potential risk factors postbiopsy in Chinese patients.A total of 1526 patients underwent biopsy were assessed retrospectively. The effect of 3 antibiotic protocols was compared, including fluoroquinolone (FQ) monotherapy, third-generation cephalosporin combined with FQ and targeted antibiotics according to the prebiopsy rectal swab culture result. Postbiopsy infection (PBI) was defined as fever and/or active urinary tract symptoms such as dysuria or frequency with pyuria and/or leucocytosis, sepsis is defined as the presence of clinically or microbiologically documented infection in conjunction with systemic inflammatory response syndrome. The relationship between infections and clinical characteristics of patients was assessed. Data were first picked out in univariate analysis and then enter multivariate logistic regression.Thirty-three (2.2%) patients developed febrile infection. The combination antibiotic prophylaxis could significantly decrease the rate of PBI than FQ monotherapy (1.0% vs 4.0%, P = .000). The infection rate of the targeted antibiotic group was 1.1%, but there was no significant statistic difference compared with FQ alone (P = .349). Escherichia coli was the most predominant pathogen causing infection. Rectal swab revealed as high as 47.1% and 36.0% patients harbored FQ resistant and ESBL-producing organisms, respectively. In univariate analysis, overweight (BMI between 25 and 28 kg/m), obesity (BMI > 28 kg/m), diabetes were picked out as potential risk factors. Obesity remained as risk factor (OR = 12.827, 95% CI: 0.983-8.925, P = .001) while overweight and diabetes were close to significance (P = .052, .053, respectively).The combined cephalosporin with FQ prophylaxis could significantly decrease the risk of infectious complications. Obesity was an independent risk factor for PBI.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Antibioticoprofilaxia
Obesidade/complicações
Próstata/cirurgia
Prostatite/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Biópsia/efeitos adversos
Cefalosporinas/uso terapêutico
China
Fluoroquinolonas/uso terapêutico
Seres Humanos
Infecção/etiologia
Masculino
Meia-Idade
Prostatite/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 0 (Fluoroquinolones)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009549


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[PMID]:29390276
[Au] Autor:Li HY; Guo Q
[Ad] Endereço:Department of Primary Care.
[Ti] Título:Could Chinese herbs accelerate the resolution of reversible bronchiectasis in adults?: A case report.
[So] Source:Medicine (Baltimore);96(50):e8883, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: The classic definition of bronchiectasis is of permanent bronchial dilatation. Therefore, bronchiectasis is generally considered irreversible in the adult population. PATIENT CONCERNS: A 27-year-old woman presented to an affiliated hospital with a 1-year history of productive cough. DIAGNOSIS: Bronchiectasis. INTERVENTIONS: The patient was treated with cephalosporin and a mucus clearance regimen for 6 days and then with Chinese herbs for 3 months. OUTCOMES: Reversible bronchial dilatation was evidenced by sequential chest high-resolution computed tomography 6 months later. CONCLUSION: The current report demonstrated that, although rare in adult, bronchial dilatation might resolve completely in such a short period if receiving adequate regimens, for example, Chinese herbs.
[Mh] Termos MeSH primário: Bronquiectasia/tratamento farmacológico
Medicamentos de Ervas Chinesas/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Antibacterianos/uso terapêutico
Bronquiectasia/diagnóstico por imagem
Cefalosporinas/uso terapêutico
Quimioterapia Combinada
Feminino
Seres Humanos
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 0 (Drugs, Chinese Herbal)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008883


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[PMID]:29260224
[Au] Autor:Gerber JS; Ross RK; Bryan M; Localio AR; Szymczak JE; Wasserman R; Barkman D; Odeniyi F; Conaboy K; Bell L; Zaoutis TE; Fiks AG
[Ad] Endereço:Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
[Ti] Título:Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections.
[So] Source:JAMA;318(23):2325-2336, 2017 12 19.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment. Objective: To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children. Design, Setting, and Participants: A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score-matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts. Exposures: Broad-spectrum antibiotics vs narrow-spectrum antibiotics. Main Outcomes and Measures: In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events. Results: Of 30 159 children in the retrospective cohort (19 179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3% [95% CI, -0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868 (35%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotics were associated with a slightly worse child quality of life (score of 90.2 for broad-spectrum antibiotics vs 91.5 for narrow-spectrum antibiotics; score difference for full matched analysis, -1.4% [95% CI, -2.4% to -0.4%]) but not with other patient-centered outcomes. Broad-spectrum treatment was associated with a higher risk of adverse events documented by the clinician (3.7% for broad-spectrum antibiotics vs 2.7% for narrow-spectrum antibiotics; risk difference for full matched analysis, 1.1% [95% CI, 0.4% to 1.8%]) and reported by the patient (35.6% for broad-spectrum antibiotics vs 25.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 12.2% [95% CI, 7.3% to 17.2%]). Conclusions and Relevance: Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events. These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.
[Mh] Termos MeSH primário: Antibacterianos/efeitos adversos
Otite Média/tratamento farmacológico
Qualidade de Vida
Infecções Respiratórias/tratamento farmacológico
[Mh] Termos MeSH secundário: Doença Aguda
Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico
Antibacterianos/uso terapêutico
Cefalosporinas/efeitos adversos
Cefalosporinas/uso terapêutico
Criança
Pré-Escolar
Feminino
Seres Humanos
Macrolídeos/efeitos adversos
Macrolídeos/uso terapêutico
Masculino
Faringite/tratamento farmacológico
Atenção Primária à Saúde
Estudos Retrospectivos
Sinusite/tratamento farmacológico
Infecções Estreptocócicas/tratamento farmacológico
Streptococcus pyogenes
Falha de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 0 (Macrolides); 74469-00-4 (Amoxicillin-Potassium Clavulanate Combination)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.18715


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[PMID]:29318906
[Au] Autor:Choi JJ; McCarthy MW
[Ad] Endereço:a Department of Medicine , Weill Cornell Medical College , New York , NY , USA.
[Ti] Título:Cefiderocol: a novel siderophore cephalosporin.
[So] Source:Expert Opin Investig Drugs;27(2):193-197, 2018 Feb.
[Is] ISSN:1744-7658
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The emergence of multidrug-resistant bacterial pathogens has led to a global public health emergency and novel therapeutic options and drug-delivery systems are urgently needed. Cefiderocol is a siderophore cephalosporin antibiotic that has recently been developed to combat a variety of bacterial pathogens, including ß-lactam- and carbapenem-resistant organisms. Areas covered: This paper provides an overview of the mutational and plasmid-mediated mechanisms of ß-lactam and carbapenem resistance, the biochemical pathways of siderophores in bacterial iron metabolism, and how cefiderocol may be able to provide better targeted antimicrobial therapy that escape these drug-resistant mechanisms. We also explore the pharmacokinetics of this new compound as well as results from preclinical and clinical studies. Expert opinion: There is an urgent need for novel antimicrobial agents to address the emergence of multidrug-resistant pathogens, which are an increasing cause of morbidity and mortality worldwide. Our understanding of multidrug-resistance and bacterial biochemical pathways continues to expand, and the development of cefiderocol specifically targeting siderophore-mediated iron transport shows potential in escaping mechanisms of drug resistance. Cefiderocol, which demonstrates a favorable side effect profile, has the potential to become first-line therapy for our most aggressive and lethal multidrug-resistant Gram-negative pathogens.
[Mh] Termos MeSH primário: Antibacterianos/farmacologia
Cefalosporinas/farmacologia
Infecções por Bactérias Gram-Negativas/tratamento farmacológico
[Mh] Termos MeSH secundário: Antibacterianos/administração & dosagem
Antibacterianos/efeitos adversos
Cefalosporinas/administração & dosagem
Cefalosporinas/efeitos adversos
Sistemas de Liberação de Medicamentos
Desenho de Drogas
Farmacorresistência Bacteriana Múltipla
Bactérias Gram-Negativas/efeitos dos fármacos
Infecções por Bactérias Gram-Negativas/microbiologia
Seres Humanos
Sideróforos/administração & dosagem
Sideróforos/efeitos adversos
Sideróforos/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 0 (Siderophores); 0 (cefiderocol)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1080/13543784.2018.1426745


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[PMID]:29254478
[Au] Autor:Zhang H; Yang Q; Liao K; Ni Y; Yu Y; Hu B; Sun Z; Huang W; Wang Y; Wu A; Feng X; Luo Y; Chu Y; Chen S; Cao B; Su J; Duan Q; Zhang S; Shao H; Kong H; Gui B; Hu Z; Badal R; Xu Y
[Ad] Endereço:Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
[Ti] Título:Update of incidence and antimicrobial susceptibility trends of Escherichia coli and Klebsiella pneumoniae isolates from Chinese intra-abdominal infection patients.
[So] Source:BMC Infect Dis;17(1):776, 2017 12 18.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To evaluate in vitro susceptibilities of aerobic and facultative Gram-negative bacterial (GNB) isolates from intra-abdominal infections (IAIs) to 12 selected antimicrobials in Chinese hospitals from 2012 to 2014. METHODS: Hospital acquired (HA) and community acquired (CA) IAIs were collected from 21 centers in 16 Chinese cities. Extended spectrum beta-lactamase (ESBL) status and antimicrobial susceptibilities were determined at a central laboratory using CLSI broth microdilution and interpretive standards. RESULTS: From all isolated strains the Enterobacteriaceae (81.1%) Escherichia coli accounted for 45.4% and Klebsiella pneumoniae for 20.1%, followed by Enterobacter cloacae (5.2%), Proteus mirabilis (2.1%), Citrobacter freundii (1.8%), Enterobacter aerogenes (1.8%), Klebsiella oxytoca (1.4%), Morganella morganii (1.2%), Serratia marcescens (0.7%), Citrobacter koseri (0.3%), Proteus vulgaris (0.3%) and others (1.0%). Non- Enterobacteriaceae (18.9%) included Pseudomonas aeruginosa (9.8%), Acinetobacter baumannii (6.7%), Stenotrophomonas maltophilia (0.9%), Aeromonas hydrophila (0.4%) and others (1.1%). ESBL-screen positive Escherichia coli isolates (ESBL+) showed a decreasing trend from 67.5% in 2012 to 58.9% in 2014 of all Escherichia coli isolates and the percentage of ESBL+ Klebsiella pneumoniae isolates also decreased from 2012 through 2014 (40.4% to 26.6%), which was due to reduced percentages of ESBL+ isolates in HA IAIs for both bacteria. The overall susceptibilities of all 5160 IAI isolates were 87.53% to amikacin (AMK), 78.12% to piperacillin-tazobactam (TZP) 81.41% to imipenem (IMP) and 73.12% to ertapenem (ETP). The susceptibility of ESBL-screen positive Escherichia coli strains was 96.77%-98.8% to IPM, 91.26%-93.16% to ETP, 89.48%-92.75% to AMK and 84.86%-89.34% to TZP, while ESBL-screen positive Klebsiella pneumoniae strains were 70.56%-80.15% susceptible to ETP, 80.0%-87.5% to IPM, 83.82%-87.06% to AMK and 63.53%-68.38% to TZP within the three year study. Susceptibilities to all cephalosporins and fluoroquinolones were less than 50% beside 66.5% and 56.07% to cefoxitin (FOX) for ESBL+ Escherichia coli and Klebsiella pneumoniae strains respectively. CONCLUSIONS: The total ESBL+ rates decreased in Escherichia coli and Klebsiella pneumoniae IAI isolates due to fewer prevalence in HA infections. IPM, ETP and AMK were the most effective antimicrobials against ESBL+ Escherichia coli and Klebsiella pneumoniae IAI isolates in 2012-2014 and a change of fluoroquinolone regimens for Chinese IAIs is recommended.
[Mh] Termos MeSH primário: Abdome/microbiologia
Antibacterianos/farmacologia
Infecções por Escherichia coli/microbiologia
Escherichia coli/efeitos dos fármacos
Infecções por Klebsiella/microbiologia
Klebsiella pneumoniae/efeitos dos fármacos
[Mh] Termos MeSH secundário: Cefalosporinas/farmacologia
China/epidemiologia
Infecções Comunitárias Adquiridas/epidemiologia
Infecções Comunitárias Adquiridas/microbiologia
Infecção Hospitalar/microbiologia
Escherichia coli/classificação
Escherichia coli/genética
Escherichia coli/isolamento & purificação
Infecções por Escherichia coli/epidemiologia
Seres Humanos
Imipenem/farmacologia
Incidência
Infecções Intra-Abdominais/microbiologia
Infecções por Klebsiella/epidemiologia
Klebsiella pneumoniae/classificação
Klebsiella pneumoniae/genética
Klebsiella pneumoniae/isolamento & purificação
Testes de Sensibilidade Microbiana
beta-Lactamas/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 0 (beta-Lactams); 71OTZ9ZE0A (Imipenem); G32F6EID2H (ertapenem)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2873-z


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Texto completo
[PMID]:28464828
[Au] Autor:Popejoy MW; Long J; Huntington JA
[Ad] Endereço:Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA. myra.popejoy@merck.com.
[Ti] Título:Analysis of patients with diabetes and complicated intra-abdominal infection or complicated urinary tract infection in phase 3 trials of ceftolozane/tazobactam.
[So] Source:BMC Infect Dis;17(1):316, 2017 05 02.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Diabetes mellitus and hyperglycemia are associated with increased susceptibility to bacterial infections and poor treatment outcomes. This post hoc evaluation of the treatment of complicated intra-abdominal infections (cIAI) and complicated urinary tract infections (cUTI) aimed to evaluate baseline characteristics, efficacy, and safety in patients with and without diabetes treated with ceftolozane/tazobactam and comparators. Ceftolozane/tazobactam is an antibacterial with potent activity against Gram-negative pathogens and is approved for the treatment of cIAI (with metronidazole) and cUTI (including pyelonephritis). METHODS: Patients from the phase 3 ASPECT studies with (n = 245) and without (n = 1802) diabetes were compared to evaluate the baseline characteristics, efficacy, and safety of ceftolozane/tazobactam and active comparators. RESULTS: Significantly more patients with than without diabetes were 65 years of age or older; patients with diabetes were also more likely to weigh ≥75 kg at baseline (57.1% vs 44.5%), to have renal impairment (48.5% vs 30.2%), or to have APACHE II scores ≥10 (33.8% vs 17.0%). More patients with diabetes had comorbidities and an increased incidence of complicating factors in both cIAI and cUTI. Clinical cIAI and composite cure cUTI rates across study treatments were lower in patients with than without diabetes (cIAI, 75.4% vs 86.1%, P = 0.0196; cUTI, 62.4% vs 74.7%, P = 0.1299) but were generally similar between the ceftolozane/tazobactam and active comparator treatment groups. However, significantly higher composite cure rates were reported with ceftolozane/tazobactam than with levofloxacin in patients without diabetes with cUTI (79.5% vs 69.9%; P = 0.0048). Significantly higher rates of adverse events observed in patients with diabetes were likely due to comorbidities because treatment-related adverse events were similar between groups. CONCLUSIONS: In this post hoc analysis, patients with diabetes in general were older, heavier, and had a greater number of complicating comorbidities. Patients with diabetes had lower cure rates and a significantly higher frequency of adverse events than patients without diabetes, likely because of the higher rates of medical complications in this subgroup. Ceftolozane/tazobactam was shown to be at least as effective as comparators in treating cUTI and cIAI in this population. TRIAL REGISTRATION: cIAI, NCT01445665 and NCT01445678 (both trials registered prospectively on September 26, 2011); cUTI, NCT01345929 and NCT01345955 (both trials registered prospectively on April 28, 2011).
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Infecções Bacterianas/tratamento farmacológico
Diabetes Mellitus
Infecções Intra-Abdominais/tratamento farmacológico
Infecções Urinárias/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Antibacterianos/efeitos adversos
Infecções Bacterianas/microbiologia
Cefalosporinas/uso terapêutico
Complicações do Diabetes
Diabetes Mellitus/microbiologia
Feminino
Seres Humanos
Infecções Intra-Abdominais/microbiologia
Levofloxacino/uso terapêutico
Masculino
Metronidazol/uso terapêutico
Meia-Idade
Ácido Penicilânico/análogos & derivados
Ácido Penicilânico/uso terapêutico
Pielonefrite/tratamento farmacológico
Infecções Urinárias/microbiologia
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 140QMO216E (Metronidazole); 37A4IES95Q (ceftolozane); 6GNT3Y5LMF (Levofloxacin); 87-53-6 (Penicillanic Acid); SE10G96M8W (tazobactam)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2414-9


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[PMID]:28454524
[Au] Autor:Kauf TL; Prabhu VS; Medic G; Borse RH; Miller B; Gaultney J; Sen SS; Basu A
[Ad] Endereço:Shire International GmbH, Zug, Switzerland.
[Ti] Título:Cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam as empiric therapy based on the in-vitro surveillance of bacterial isolates in the United States for the treatment of complicated urinary tract infections.
[So] Source:BMC Infect Dis;17(1):314, 2017 04 28.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A challenge in the empiric treatment of complicated urinary tract infection (cUTI) is identifying the initial appropriate antibiotic therapy (IAAT), which is associated with reduced length of stay and mortality compared with initial inappropriate antibiotic therapy (IIAT). We evaluated the cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam (one of the standard of care antibiotics), for the treatment of hospitalized patients with cUTI. METHODS: A decision-analytic Monte Carlo simulation model was developed to compare the costs and effectiveness of empiric treatment with either ceftolozane/tazobactam or piperacillin/tazobactam in hospitalized adult patients with cUTI infected with Gram-negative pathogens in the US. The model applies the baseline prevalence of resistance as reported by national in-vitro surveillance data. RESULTS: In a cohort of 1000 patients, treatment with ceftolozane/tazobactam resulted in higher total costs compared with piperacillin/tazobactam ($36,413 /patient vs. $36,028/patient, respectively), greater quality-adjusted life years (QALYs) (9.19/patient vs. 9.13/patient, respectively) and an incremental cost-effectiveness ratio (ICER) of $6128/QALY. Ceftolozane/tazobactam remained cost-effective at a willingness to pay of $100,000 per QALY compared to piperacillin/tazobactam over a range of input parameter values during one-way and probabilistic sensitivity analysis. CONCLUSIONS: Model results show that ceftolozane/tazobactam is likely to be cost-effective compared with piperacillin/tazobactam for the empiric treatment of hospitalized cUTI patients in the United States.
[Mh] Termos MeSH primário: Antibacterianos/economia
Antibacterianos/uso terapêutico
Ácido Penicilânico/análogos & derivados
Infecções Urinárias/tratamento farmacológico
Infecções Urinárias/economia
[Mh] Termos MeSH secundário: Adulto
Cefalosporinas/economia
Cefalosporinas/uso terapêutico
Análise Custo-Benefício
Hospitalização/economia
Seres Humanos
Meia-Idade
Método de Monte Carlo
Mortalidade
Ácido Penicilânico/economia
Ácido Penicilânico/uso terapêutico
Piperacilina/economia
Piperacilina/uso terapêutico
Anos de Vida Ajustados por Qualidade de Vida
Estados Unidos
Infecções Urinárias/complicações
Infecções Urinárias/microbiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 157044-21-8 (piperacillin, tazobactam drug combination); 37A4IES95Q (ceftolozane); 87-53-6 (Penicillanic Acid); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180120
[Lr] Data última revisão:
180120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2408-7


  8 / 18211 MEDLINE  
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[PMID]:28457572
[Au] Autor:Toullec L; Dupouey J; Vigne C; Marsot A; Allanioux L; Blin O; Leone M; Guilhaumou R
[Ad] Endereço:Service de pharmacologie clinique et pharmacovigilance, pharmacologie intégrée et interface clinique industrielle, institut des Neurosciences, AP-HM, 13385 Marseille, France.
[Ti] Título:Analytical interference during cefepime therapeutic drug monitoring in intensive care patient: About a case report.
[So] Source:Therapie;72(5):587-592, 2017 Oct.
[Is] ISSN:0040-5957
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:ß-lactams therapeutic drug monitoring (TDM) appears as an essential tool to ensure the achievement of pharmacokinetic-pharmacodynamic targets and prevent induced toxicity in intensive care unit patients. Indeed, those patients exhibit important pharmacokinetic variabilities that could lead to unpredictable plasma concentrations, potentially associated with poor clinical outcome, development of antibiotic resistance or increased side effects. Here, we report the case of a 48-year-old-patient admitted to intensive care unit and treated by cefepime using TDM. Due to inconsistency between observed cefepime plasma concentrations and patient clinical examination, investigations were started. After analytical tests, we highlighted an underlying analytical interference that overestimated cefepime plasma concentration with our in-house high performance liquid chromatography with ultraviolet detection (HPLC-UV) method. Only the inadequacy between plasmatic concentration and patient situation alerted pharmacologists and clinicians. As we found no previous case in literature, we believe this report must serve as an example of analytical limits that required pharmacologist awareness and expertise in TDM realization.
[Mh] Termos MeSH primário: Antibacterianos/sangue
Antibacterianos/uso terapêutico
Cefalosporinas/sangue
Cefalosporinas/uso terapêutico
[Mh] Termos MeSH secundário: Cromatografia Líquida de Alta Pressão
Monitoramento de Medicamentos
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 807PW4VQE3 (cefepime)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


  9 / 18211 MEDLINE  
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[PMID]:28454494
[Au] Autor:Qu S; Zhao L; Zhu J; Wang C; Dai C; Guo H; Hao Z
[Ad] Endereço:a Agricultural Bio-Pharmaceutical Laboratory, Qingdao Agricultural University , Qingdao , China and.
[Ti] Título:Preparation and testing of cefquinome-loaded poly lactic-co-glycolic acid microspheres for lung targeting.
[So] Source:Drug Deliv;24(1):745-751, 2017 Nov.
[Is] ISSN:1521-0464
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to prepare cefquinome-loaded poly lactic-co-glycolic acid (PLGA) microspheres and to evaluate their in vitro and in vivo characteristics. Microspheres were prepared using a spry drier and were characterized in terms of morphology, size, drug-loading coefficient, encapsulation ratio and in vitro release. The prepared microspheres were spherical with smooth surfaces and uniform size (12.4 ± 1.2 µm). The encapsulation efficiency and drug loading of cefquinome was 91.6 ± 2.6 and 18.3 ± 1.3%, respectively. In vitro release of cefquinome from the microspheres was sustained for 36 h. In vivo studies identified the lung as the target tissue and the region of maximum cefquinome release. A partial lung inflammation was observed but disappeared spontaneously as the microspheres were removed through in vivo decay. The sustained cefquinome release from the microspheres revealed its applicability as a drug delivery system that minimized exposure to healthy tissues while increasing the accumulation of therapeutic drug at the target site. These results indicated that the spray-drying method of loading cefquinome into PLGA microspheres is a straightforward method for lung targeting in animals.
[Mh] Termos MeSH primário: Microesferas
[Mh] Termos MeSH secundário: Animais
Cefalosporinas
Glicóis
Ácido Láctico
Pulmão
Tamanho da Partícula
Ácido Poliglicólico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cephalosporins); 0 (Glycols); 0 (polylactic acid-polyglycolic acid copolymer); 26009-03-0 (Polyglycolic Acid); 33X04XA5AT (Lactic Acid); Z74S078CWP (cefquinome)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171212
[Lr] Data última revisão:
171212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1080/10717544.2017.1321058


  10 / 18211 MEDLINE  
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[PMID]:28462738
[Au] Autor:Volkova VV; Cazer CL; Gröhn YT
[Ad] Endereço:Department of Diagnostic Medicine/Pathobiology,Institute of Computational Comparative Medicine, College of Veterinary Medicine, Kansas State University,Mosier Hall, KS 66506,USA.
[Ti] Título:Models of antimicrobial pressure on intestinal bacteria of the treated host populations.
[So] Source:Epidemiol Infect;145(10):2081-2094, 2017 07.
[Is] ISSN:1469-4409
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Antimicrobial drugs are used to treat pathogenic bacterial infections in animals and humans. The by-stander enteric bacteria of the treated host's intestine can become exposed to the drug or its metabolites reaching the intestine in antimicrobially active form. We consider which processes and variables need to be accounted for to project the antimicrobial concentrations in the host's intestine. Those include: the drug's fraction (inclusive of any active metabolites) excreted in bile; the drug's fractions and intestinal segments of excretion via other mechanisms; the rates and intestinal segments of the drug's absorption and re-absorption; the rates and intestinal segments of the drug's abiotic and biotic degradation in the intestine; the digesta passage time through the intestinal segments; the rates, mechanisms, and reversibility of the drug's sorption to the digesta and enteric microbiome; and the volume of luminal contents in the intestinal segments. For certain antimicrobials, the antimicrobial activity can further depend on the aeration and chemical conditions in the intestine. Model forms that incorporate the inter-individual variation in those relevant variables can support projections of the intestinal antimicrobial concentrations in populations of treated host, such as food animals. To illustrate the proposed modeling framework, we develop two examples of treatments of bovine respiratory disease in beef steers by oral chlortetracycline and injectable third-generation cephalosporin ceftiofur. The host's diet influences the digesta passage time, volume, and digesta and microbiome composition, and may influence the antimicrobial loss due to degradation and sorption in the intestine. We consider two diet compositions in the illustrative simulations. The examples highlight the extent of current ignorance and need for empirical data on the variables influencing the selective pressures imposed by antimicrobial treatments on the host's intestinal bacteria.
[Mh] Termos MeSH primário: Complexo Respiratório Bovino/tratamento farmacológico
Cefalosporinas/administração & dosagem
Cefalosporinas/farmacologia
Clortetraciclina/administração & dosagem
Clortetraciclina/farmacologia
Microbioma Gastrointestinal/efeitos dos fármacos
Modelos Biológicos
[Mh] Termos MeSH secundário: Administração Oral
Animais
Anti-Infecciosos/administração & dosagem
Anti-Infecciosos/farmacologia
Complexo Respiratório Bovino/microbiologia
Injeções/veterinária
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Infective Agents); 0 (Cephalosporins); 83JL932I1C (ceftiofur); WCK1KIQ23Q (Chlortetracycline)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171125
[Lr] Data última revisão:
171125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1017/S095026881700084X



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