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Assessing the appropriateness of antifungal prescribing: key results from the implementation of a novel audit tool in Australian hospitals.
DOI: 10.1093/jac/dkaf044
Authors: Khanna A et al
Abstract
Objectives: To utilize the Antifungal National Antimicrobial Prescribing Survey (Antifungal NAPS), a novel tool utilizing international consensus metrics for antifungal stewardship, to assess the quality of systemic antifungal prescribing in Australian hospitals, in order to identify quality improvement targets.
Methods: Participating hospitals were directed to audit all systemic antifungals or focus on a specific antifungal drug or class. Data entry into the Antifungal NAPS online portal occurred between October 2022 and June 2023. The data collection tool comprised patient details, reasons precluding use of antifungals, prescription details (guideline compliance, appropriateness, and reasons for inappropriate prescribing) and patient outcomes. Descriptive statistics were used to analyse the data.
Results: Eleven hospitals contributed data for 516 prescriptions for 438 patients. Of these, 77.1% of prescriptions were appropriate, with the highest appropriateness for prophylactic (189/222; 85.1%), followed by directed (105/130; 80.8%) and empirical therapy (104/164; 63.4%). Fluconazole was the most commonly prescribed agent, which had the lowest rate of appropriateness (132/209; 63.2%). The most common reasons for inappropriate prescribing were no antifungal required (35/105; 33.3%), incorrect dose or frequency (30/105; 28.6%) and incorrect duration (19/105; 18.1%). Compliance with guidelines was 73.6%.
Conclusions: This study outlines the successful implementation of the Antifungal NAPS, a standardized electronic audit tool for the assessment of antifungal prescribing quality. Key areas for quality improvement identified were the overuse of empirical fluconazole for urinary tract and intra-abdominal infections, the importance of invasive fungal infection risk assessment to guide prophylaxis prescribing and greater infectious diseases and antifungal stewardship oversight of antifungal prescribing to guide optimal prescribing.
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Managing Helicobacter pylori as an Infectious Disease: Implementation of Antimicrobial Stewardship.
DOI: 10.1111/hel.70013
Authors: Hsu JY et al
Abstract
Helicobacter pylori is prevalent globally and implicated in various gastric diseases and malignancies. Rising antibiotic resistance has increasingly compromised the effectiveness of standard H. pylori eradication therapies. This review explores the role of antimicrobial stewardship (AMS) as a structured approach to optimizing H. pylori management through the “5D” strategy: Diagnosis-utilizing advanced diagnostic tools to accurately detect bacterial resistance; Drug-selecting antibiotics tailored to resistance profiles and patient-specific factors; Dosage-optimizing dosing and frequency based on pharmacokinetic properties to maximize efficacy; Duration-employing shorter treatment courses where supported by evidence; and Discontinuation-balancing the benefits and risks of repeated antibiotic treatments. We discuss recent advances in diagnostic technologies, such as polymerase chain reaction and next-generation sequencing, and their impact on therapeutic decision-making. Additionally, we evaluate treatment regimens, with a particular focus on emerging alternatives such as regimens containing potassium-competitive acid blockers. Given the growing global resistance and limited pipeline for new antibiotics, we advocate for a more strategic and resource-conscious approach to H. pylori management, integrating AMS principles within the “One Health” framework to address the pathogen’s transmission across humans, animals, and the environment. With advancements in resistance testing and diagnostics, H. pylori therapies are likely to become increasingly personalized and precise. To achieve this, effective AMS implementation necessitates interdisciplinary collaboration to maximize therapeutic outcomes, minimize adverse effects, combat resistance, and reduce healthcare costs.
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Mechanisms of resistance against allylamine and azole antifungals in Trichophyton: A renewed call for innovative molecular diagnostics in susceptibility testing.
Authors: Gupta AK et al
Abstract
The emergence of antifungal resistance calls for continued research efforts to better guide healthcare providers in treatment selection and outcomes. Unlike bacterial infections, treatment of superficial fungal infections is mainly limited to allylamines (terbinafine) and azoles (itraconazole). Here, we aim to update our current understanding of resistance mechanisms against allylamine and azole antifungals in the Trichophyton genus. Resistance development has been demonstrated in vitro by challenging Trichophyton isolates with allylamines or azoles at levels below the minimum inhibitory concentration (MIC), which corroborates the observation of clinical resistance. Frequently reported mechanisms of resistance include: (I) Alterations of the drug target by single-nucleotide variations (SNVs) of the SQLE/ERG1 and ERG11 genes; in particular, SQLE SNVs (Leu393Phe, Leu393Ser, and Phe397Leu) have been frequently reported in isolates with high terbinafine MICs; (II) overexpression of the target enzyme for azoles (ERG11) and downstream genes in the ergosterol biosynthesis pathway can decrease the effective drug concentration as well as prevent the depletion of ergosterol and the accumulation of toxic sterol intermediates; (III) the up-regulation of drug efflux channels-belonging to the ABC superfamily (PDR1, MDR2, MDR3, MDR4), MFS superfamily (MFS1), or Pma1 (plasma membrane ATPase 1)-can reduce the effective concentrations of terbinafine and azoles. The possibility of multidrug resistance has been shown in Trichophyton strains, of both human and animal origins, harboring multiple resistance mechanisms (e.g., target alteration/overexpression and drug efflux channels). Tackling the issue of antifungal resistance will require an integrated approach with multidisciplinary efforts including surveillance initiatives and antifungal stewardship programs. However, these efforts are hampered by the current limited accessibility of antifungal susceptibility testing as well as the limited choice of antifungals available in routine practice. A better understanding of resistance mechanisms could help develop targeted, molecular-based assays.
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Azithromycin as host-directed therapy for pulmonary tuberculosis – a randomized pilot trial
Authors: Bart GJ Dekkers et al
Abstract
Background: Adjunctive host-directed therapies are investigated that modulate host immune responses to reduce excessive inflammation and prevent tissue damage in tuberculosis (TB). Macrolides, including azithromycin, were shown to possess anti-inflammatory and immunemodulatory effects in addition to their antibacterial effects. In the current trial, we investigated whether azithromycin enhances resolution of systemic and pulmonary inflammation and decreases extracellular matrix-related tissue turnover in TB patients.
Methods: An open label, randomised controlled trial was performed. Adult patients with drugsusceptible, pulmonary TB aged above 18 years were randomly assigned to receive standard antiTB care or azithromycin 250 mg orally once daily on top of standard care (SoC) for 28 days. Results: Twenty-eight patients were included within 4 weeks after initiating anti-TB treatment. Twelve patients in both arms completed the trial. Participants were mostly young, male, had a smoking history and had no co-morbidities. No differences in baseline characteristics were observed between both arms. In blood, azithromycin treatment significantly reduced the TB marker interferon gamma-induced protein-10 (-38% vs -24% vs SoC, P<0.05) and the collagen type IV degradation product C4M (-26% vs -11%, P<0.05). In sputum, treatment with azithromycin significantly reduced neutrophils (-24% vs 0%, P<0.001), neutrophil elastase (-88% vs 75%, P<0.01), and transforming growth factor-β (-86% vs -68%, P<0.05). No significant effectswere observed on other parameters. Treatment with azithromycin appeared to be safe.
Conclusions: The addition of azithromycin to standard anti-TB treatment appears to diminish excess neutrophilic inflammation in patients with pulmonary TB
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Outcomes of switching from protease inhibitor-based antiretroviral therapy to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in virologically suppressed adults with nucleos(t)ide analogue resistance- a phase IV randomised, open-label study (PIBIK study)
Authors: BCollins Iwuji
Abstract
Background: There are limited data on how historical nucleoside reverse transcriptase inhibitor (NRTI) resistance-associated mutations (RAMs) other than M184V/I, affect the activity of B/F/TAF. We evaluated the outcomes of switching virologically suppressed (HIV-1 RNA < 50 copies/mL) individuals harbouring major RAMs from boosted protease inhibitor (bPI)-based therapy to B/F/TAF.
Methods: Participants had various historical genotypic patterns including M184V/I, ≤2 thymidine analogue mutations (TAMs), and other NRTI RAMs (NAMs), and no integrase resistance. Baseline RAMs were explored by retrospective sequencing of cellular HIV-1 DNA. Participants were randomised (1:1) to switching to B/F/TAF either immediately or after 24 weeks. The primary outcome was the proportion of participants maintaining virological suppression (pure virologic response) at week-24; secondary outcomes were proportion of participants with virological suppression at week-48, pre-specified safety measures, and treatment-emergent resistance.
Results: Historically, 21/72 (29.2%) participants had M184V/I, 5 (6.9%) M184V/I + 1 NAM, 31 (43.1%) 1 TAM ± M184V/I ± 1 NAM, and 15 (20.8%) 2 TAMs ± M184V/I ± 1 NAM. At week-24, proportions maintaining virological suppression were 33/33 (100%) on B/F/TAF vs. 38/39 (97.4%) on bPI (difference 2.6%; 95% CI -2.4%, 7.5%). Drug-related adverse events (AEs) were reported in 10/33 (30.3%) vs. 1/39 (2.6%), respectively. The immediate switch arm had improved lipid parameters but increased HbA1c and weight. Virological suppression was maintained at week-48. There were six discontinuations; four on B/F/TAF were drug-related and the two on bPI were not drug-related.
Conclusions: Historical NRTI resistance did not compromise the effectiveness of B/F/TAF in virologically suppressed adults. 12% experienced treatment-limiting AEs after switching.
Registration: EudraCT no: 2018-004732-30.
Keywords: Archive; Bictegravir; Boosted protease inhibitor; Drug resistance; HIV; Integrase strand transfer inhibitor; Switch; Tenofovir alafenamide.
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Safety, bactericidal activity, and pharmacokinetics of the antituberculosis drug candidate BTZ-043 in South Africa (PanACEA-BTZ-043-02): an open-label, dose-expansion, randomised, controlled, phase 1b/2a trial
Authors: Norbert Heinrich
Abstract
Background: The broad use of bedaquiline and pretomanid as the mainstay of new regimens to combat tuberculosis is a risk due to increasing bedaquiline resistance. We aimed to assess the safety, bactericidal activity, and pharmacokinetics of BTZ-043, a first-in-class DprE1 inhibitor with strong bactericidal activity in murine models.
Methods: This open-label, dose-expansion, randomised, controlled, phase 1b/2a trial was conducted in two specialised tuberculosis sites in Cape Town, South Africa. Adults aged 18-64 years with newly diagnosed pulmonary tuberculosis sensitive to rifampicin and isoniazid, who weighed at least 40 kg, had a positive sputum smear graded at least 1+, were HIV negative, and had no history of hypertension or other substantial comorbidities were admitted to hospital. In stage 1 (multiple-ascending dose phase 1b with an adaptive continual reassessment method), the starting dose of BTZ-043 was 250 mg, with planned dose increments of 250 mg up to 2000 mg, and cohorts of three participants were enrolled sequentially. In stage 2 (phase 2a dose-expansion stage), participants were randomly assigned (3:3:3:2) to receive one of three doses of oral BTZ-043 (decided after stage 1) or standard of care (isoniazid, rifampicin, pyrazinamide, and ethambutol) using sealed opaque envelopes. The BTZ-043 groups also received oral dolutegravir (a third of participants) or a probe drug cocktail (caffeine [probe for CYP1A2], tolbutamide [CYP2C9], dextromethorphan [CYP2D6], midazolam [CYP3A4], and digoxin [P-glycoprotein]; two-thirds of participants). Study staff and participants were not masked, but laboratory staff were masked to treatment assignment. The primary outcome was to assess the safety and tolerability of BTZ-43 over 14 days of dosing by evaluation of adverse events in the safety analysis population. Secondary outcomes were bactericidal activity, measured by time to positivity (TTP) and colony-forming unit (CFU) count; pharmacokinetics (stage 2; including the food effect on BTZ-043); and drug-drug interactions with CYP450 enzymes, P-glycoprotein, and dolutegravir. This study is registered with ClinicalTrials.gov, NCT04044001 (completed).
Findings: In stage 1, 61 patients were assessed for eligibility and 24 were enrolled into seven dose cohorts between Nov 13, 2019, and Aug 13, 2020. Dose escalations were performed safely up to 1750 mg of BTZ-043 with three participants per dose cohort (and two dose cohorts for the highest dose). In stage 2, 151 patients were assessed for eligibility and 54 were enrolled and randomly assigned between Feb 2, 2021, and Feb 9, 2022, to receive 250, 500, and 1000 mg of BTZ-043 or standard of care. 66 (85%) of 78 participants were male and 12 (15%) were female. The most frequently observed adverse events were nausea (12 [8%] of 154), headache (11 [7%]), dizziness (11 [7%]), and vomiting (eight [5%]). Most participants had adverse events of mild (46 [60%] of 77 participants) or moderate (22 [29%]) severity. Transient increases in alanine aminotransferase were observed in both stages, which declined again despite continued dosing and were classified as signs of adaptation of hepatic metabolism rather than hepatotoxicity. The worsening of pre-existing anaemia and QTcF interval prolongation in one individual each were rated as possibly related to the study drug. One patient died before the first scheduled dose of BTZ-043 500 mg due to a pulmonary embolism. In stage 1, bactericidal activity measured as CFU counts on solid media was highest at doses 750-1500 mg; in stage 2, all doses of BTZ-043 showed 14-day bactericidal activity, highest at 1000 mg on solid media (log10 CFU/mL per day -0·115 [95% CI -0·162 to -0·069]) and TTP estimates were highest at 500 mg in liquid media (log10 h per day 0·015 [0·010 to 0·019]). BTZ-043 pharmacokinetics showed increased exposure with high-fat food versus fasting (area under the curve [AUC]0-last geometric mean ratio 4·13 [90% CI 1·65 to 10·30] for BTZ-043; 2·99 [1·39 to 6·41] for BTZ-043total [BTZ-043 plus metabolite 2]; and 1·25 [0·66 to 2·39] for metabolite 1). When taken with a standard breakfast, BTZ-043total AUC showed a dose-proportional increase up to 33 200 ng/mL × h (range 12 500 to 48 200) at 1000 mg. The maximum concentration (Cmax) increased to 5060 ng/mL (2450 to 8020); and median half-life was 3·72 h (2·45 to 6·60). Probe drug evaluations showed bioequivalence (ie, 90% CI of the AUC0-infinity geometric mean ratio from administration to day 14 entirely within the range of 80 to 125%) for caffeine (100·0% [90% CI 86·3 to 115·9]), digoxin (113·4% [105·9 to 121·5]), and dolutegravir (106·1% [91·5 to 122·9]). Dextromethorphan (116·2% [104·6 to 129·1]), tolbutamide (252·7% [230·7 to 276·9]), and midazolam (77·0% [69·2 to 85·6]) did not meet the bioequivalence criterion.
Interpretation: Based on a small sample size, BTZ-043 is a promising antituberculosis drug candidate with favourable safety and good bactericidal activity. Larger follow-up studies are needed to detect any less frequent safety signals, further explore drug-drug interactions, identify the best dose, and evaluate efficacy in combination with other drugs.
Funding: EDCTP2 programme; German Ministry for Education and Research; German Center for Infection Research; InfectControl; Bavarian Ministry for Science and the Arts; Swiss State Secretariat for Education, Research, and Innovation; and Nederlandse Organisatie voor Wetenschappelijk Onderzoek.
Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Clinical analysis of 45 cases of chronic respiratory failure treated by noninvasive ventilator combined with bronchodilator and anti-infective drugs
Authors: Huwei Huang
Abstract
Background: The aim of this study is to investigate the therapeutic effects of a non-invasive ventilator combined with bronchodilator and anti-infective drugs in the treatment of 45 cases of chronic respiratory failure.
Methods: 45 chronic respiratory failure patients who were hospitalized to our hospital between August 2019 and January 2022 were chosen as research subjects. They were randomly allocated into two groups using the random number table approach, the control group (n = 21) and the observation group (n = 24), and they were given numbers according to the sequence of treatment. Treatment as usual was given to the control group. The observation group was further treated with a bronchodilator (tiotropium bromide) and an anti-infective drug (piperacillin). The curative effect of each group after treatment was observed and compared.
Results: After running a statistical analysis on demographic information from both groups, including gender, age, BMI, and disease severity, the results showed no significant difference between the groups (P > 0.05). There was a statistically significant (P < 0.05) difference between the observation group and the control group in terms of the time it took for temperatures to recover and pulmonary rales to disappear, as well as the time it took for asthma attacks to occur. Prior to therapy, there were no statistically significant differences between the two groups on blood gas indices or inflammatory indices (P > 0.05). After therapy, patients in the experimental group had lower levels of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) compared to the controls. The oxygenation index and bacterial partial pressure of oxygen (PaO2) were both considerably higher in the experimental group compared to the control group (P < 0.05). There was no significant difference between the two groups’ baseline values for any of the lung function indices (P > 0.05). Following treatment, patients in the treated group had significantly higher forced vital capacity (first second forced vital capacity, first second forced vital capacity, contents of FEV1), forced expiratory volume at first second to forced vital capacity (FEVl/FVC), and forced expiratory volume at first second to predicted value (FEV1% predicted value) compared to those in the control group. This difference was statistically significant (P < 0.05). There was a statistically significant (P < 0.05) improvement in clinical efficacy between the observation group and the control group. In neither group did any patients stop taking the medication due to unwanted side effects.
Conclusion: A noninvasive ventilator combined with tiotropium bromide and piperacillin has accurate efficacy in the treatment of patients with chronic respiratory failure, which can improve the indexes of arterial blood gas and lung function, reduce inflammatory response, promote disease recovery and have high safety.
Keywords: Chronic respiratory failure; Non-invasive ventilator; Piperacillin; Tiotropium bromide.
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Therapeutic Potential of Bifidobacterium longum subsp. infantis B8762 on Gut and Respiratory Health in Infant
DOI: 10.3390/ijms26031323
Authors: Rocky Vester Richmond
Abstract
Respiratory tract and gastrointestinal infections in pediatric populations are major public health concerns. Addressing these challenges necessitates effective preventative and therapeutic strategies. This study assessed the efficacy of the probiotic Bifidobacterium longum subsp. infantis B8762 (0.5 × 1010 CFU) in reducing the duration and frequency of these infections in young children. In a randomized trial, 115 eligible children were assigned to either the probiotic (n = 57; 3.51 ± 0.48 months old) or placebo (n = 58; 2.78 ± 0.51 months old) group, with daily consumption for 4 weeks. The probiotic group demonstrated a lower duration of infections than the placebo group (p < 0.05). The probiotic group also showed fewer clinical visits due to respiratory and gastrointestinal problems as compared to the placebo group (p = 0.009 & p = 0.004, respectively). Oral swab samples revealed that the placebo group had higher levels of pro-inflammatory cytokine TNF-α after 4 weeks (p = 0.033), while the probiotic group demonstrated a balanced cytokine response, indicating modulation of the immune system. Genomic analysis showed that B8762 harbors various genes for the synthesis of proteins and vitamins crucial for the gut health of children. Both the clinical and genomic findings suggested that B8762 offered a therapeutic effect on gut and respiratory health in children, highlighting its potential in managing common pediatric infections.
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Patient-Reported Outcomes Following Systemic Antibiotic Adjunct to Nonsurgical Treatment of Periodontitis: A Randomized Controlled Clinical Trial
DOI: 10.1002/cre2.70067
Authors: Parastoo Parhizkar
Abstract
Objectives: Considering the importance of patient-centered care, we aimed to evaluate the impact of systemic antibiotics on oral health-related quality of life during nonsurgical periodontal treatment. This controlled trial addresses a gap in understanding how systemic antibiotics influence patient-reported outcomes, focusing on Stage III periodontitis.
Materials and methods: Sixty-one adults participated in a double-blind, randomized clinical trial, with participants divided into two groups: the test group, which received antibiotics, and the control group. All the participants received nonsurgical periodontal treatment. We conducted follow-up assessments at one and 3 months posttreatment, including recording clinical parameters and administering the Oral Health Impact Profile-14 (OHIP-14) questionnaire.
Results: The results showed a notable improvement in the quality of life for patients in the test group compared to the control group at 1 month (p value = 0.012) and 3 months (p value = 0.014) after treatment. While there were improvements in pocket probing depth, gingival index, and clinical attachment loss in both groups, it is worth noting that only bleeding on probing exhibited a significant improvement in the test group after 3 months compared to the control group (p value = 0.008).
Conclusions: In summary, incorporating systemic antibiotics alongside nonsurgical periodontal treatments appears to bring about positive outcomes for individuals dealing with Stage III periodontitis during nonsurgical treatment, ultimately enhancing their oral health-related quality of life.
Trial registration: Iranian Registry of Clinical Trials (IRCT Id): IRCT20201221049786N1.
Keywords: antibiotic; health‐related quality of life (HRQOL); periodontitis.
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Comparison of local minocycline hydrochloride delivery and antimicrobial photodynamic therapy as adjuncts to mechanical debridement for the treatment of peri‑implant mucositis: A randomized controlled trial
Authors: Abdulrahman M AlMubarak
Abstract
Objective: The aim was to compare the efficacy of local minocycline hydrochloride delivery (LMHD) and antimicrobial photodynamic therapy (aPDT) as adjuncts to mechanical debridement (MD) for the treatment of peri‑implant mucositis (PM).
Methods: Patients with PM were included. The following information was retrieved from patients’ digital dental records: (a) age, (b) gender, (c) duration of implants in function, (d) number of implants, (e) depth of implant placement, and (f) mode of prosthesis retention. Information related to daily toothbrushing and flossing of interproximal spaces and the most recent visit to an oral healthcare provider was also recorded. Participants were randomly divided into three groups as follows: (a) MD + LMHD; (b) MD + aPDT, and (c) MD alone. Peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 45 days follow-up. Peri-implant crestal bone levels were measured at baseline. Group comparisons were done using One-way analysis of variance and Bonferroni post-hoc adjustment tests. The correlation between peri‑implant clinical parameters and age, gender, and duration of implants in function was assessed using linear regression analysis. Level of significance was set at P < 0.05.
Results: Twenty-two and 22 patients underwent MD with adjunct LMDH and aPDT, respectively. Twenty-two participants underwent MD alone. There was no difference in the mean ages of all individuals. At baseline, there was no difference in mPI, mGI and PD in all groups. At follow-up, mPI (P < 0.05), mGI (P < 0.05) and PD (P < 0.05) were higher among patients who underwent MD alone than individuals who received LMHD or aPDT as adjuncts to MD. There was no difference in mPI, mGI, and PD among individuals who underwent LMHD and aPDT as adjuvants to MD.
Conclusion: In the short term, MD with adjunct LMHD or aPDT is effective for managing PM.
Keywords: Antimicrobial photodynamic therapy; Mechanical debridement; Minocycline hydrochloride; Peri-implant mucositis; Probing depth.
Copyright © 2024 The Author. Published by Elsevier B.V. All rights reserved.
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The Effectiveness of Topical Treatment for Plantar Warts: A Retrospective Cohort Study
DOI: 10.3390/idr16060090
Authors: Ana Mª Rayo Pérez
Abstract
Background: Plantar warts, caused by human papillomavirus (HPV), are a common condition that can be painful and resistant to treatment. There are various therapeutic options for managing them, but it is not always clear which are the most effective and tolerated by patients. Among the most commonly used treatments are a zinc and nitric complex (nitrizinc complex), cantharidin, and bleomycin, each with different mechanisms of action and profiles in terms of pain and patient satisfaction.
Objectives: We aimed to evaluate and compare the clinical efficacy, posttreatment pain, and patient satisfaction among three common treatments (zinc and nitric complex, cantharidin, and bleomycin) in subjects with plantar warts, as well as identify the most effective and best-tolerated treatment.
Materials and Methods: This is a retrospective case series study analyzing 60 records of subjects aged 18 to 40 years diagnosed with plantar warts without systemic diseases or allergies and without any prior treatment. Complete records from 2020 to 2023 were selected. Subjects were divided into three groups according to the treatment received (zinc and nitric complex, cantharidin, bleomycin), and demographic variables, post-treatment pain (measured using the visual analog scale), the number of sessions required, and satisfaction after discharge (evaluated with the Likert scale) were analyzed.
Results: Of the 60 subjects included, the group treated with bleomycin experienced higher levels of pain after the first session (mean of 7.1 points on the VAS) compared to the cantharidin group (2.7 points) and the zinc and nitric complex group (1.1 points). However, the bleomycin group required fewer sessions for complete healing (an average of 1.8 sessions), while the nitric acid group needed more (3.4 sessions), with cantharidin falling in between (2.5 sessions). Regarding post-discharge satisfaction, all groups showed comparable scores (between 7.9 and 8.5 points), although cantharidin demonstrated slightly higher satisfaction. A statistical analysis showed significant differences in the number of sessions and post-treatment pain between treatments (p < 0.05) but not in final satisfaction.
Conclusions: Although bleomycin treatment is more painful, it is the most effective in terms of reducing the number of sessions required for complete healing. Cantharidin offers a good balance between efficacy and patient satisfaction, while a zinc and nitric complex, although less painful, requires more sessions for complete treatment. Each treatment has specific advantages, suggesting that therapeutic choices should be personalized according to the patient’s needs and preferences.
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Safety and Efficacy of a 48-Month Efinaconazole 10% Solution Treatment/Maintenance Regimen: 24-Month Daily Use Followed by 24-Month Intermittent Use
DOI: 10.3390/idr17010007
Authors: Aditya K. Gupta
Abstract
Background/Objectives: In an 18- to 24-month Treatment Phase with once-daily efinaconazole 10% solution, subjects with onychomycosis showed an increased rate of cure at Month 24 versus the phase III trials. In order to further improve efficacy, we initiated an extended intermittent efinaconazole Maintenance Phase with use 2–3 times weekly for an additional 24 months from Month 24 to Month 48. These are the first data presented for a 48-month efinaconazole use period.
Methods: For patients completing 18–24 months of once-daily efinaconazole, the target great toenail from the Treatment Phase was graded as ‘Clinical Cure’ (≤10% affected area) or ‘No Clinical Cure’ (>10% affected area) at Month 24. Mycological and clinical outcomes were assessed every 4 months from Month 24 to Month 48. There were 35 patients who enrolled in the extension and continued intermittent efinaconazole use to Month 48. Patients with ‘Clinical Cure’ at M24 were reviewed for sustained cure at M48; patients with ‘No Clinical Cure’ were reviewed for development of ‘Cure’ at M48. All patients were reviewed at all visits for adverse events that may be related to efinaconazole use.
Results: ‘Clinical Cure’ was found in 6 of 35 enrolled patients at Month 24, and clinical cure status was sustained to Month 48 with intermittent efinaconazole maintenance use. For 29 patients with ‘No Clinical Cure’, 3/29 achieved ‘Clinical Cure’ status at Month 48 with intermittent efinaconazole. Effective Cure and Complete Cure rates improved over the maintenance period to Month 48 in subjects without clinical cure at Month 24. Younger patients showed higher cure rates over the maintenance period, but age group cure differences did not reach statistical significance in this dataset, and 49% of the ≥70-year population had at least a 20% reduction in nail area with maintenance therapy to Month 48. There was only 1 case of possible efinaconazole application site reaction in the Intermittent Maintenance Period to Month 48; prolonged efinaconazole use to Month 48 does not appear to increase the risk of reaction. Efinaconazole use periods are associated with very low positive culture rates in this dataset, including typical contaminant organisms, suggesting efinaconazole presence in the nail plate is providing prophylactic therapy.
Conclusions: Intermittent efinaconazole may provide suitable prophylaxis of onychomycosis relapse. Prolonged efinaconazole therapy to Month 48 appears to be safe for all ages and can continue to provide prophylaxis of onychomycosis with Intermittent Maintenance use beyond Month 24 to Month 48.
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Optimizing Antibiotic Use in Older Adults Through Digital Health Initiatives
Authors: Micheal Bear
Abstract
The goal of this paper is to explore the impact of digital health technologies (DHTs) on antibiotic utilization in older adults. The paper aims to address how these technologies are implemented to improve antibiotic stewardship, address age-specific challenges, and manage infection risks in this vulnerable population while assessing limitations, ethical issues, educational barriers, and potential benefits.
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Bone Voyage: Navigating Updates in the Management of Bone and Joint Infections
Authors: Santevecchi, B.A.,
Abstract
Advancements in the management of bone and joint infections (BJIs) aim to improve outcomes while challenging long-standing treatment practices. This review discusses key updates, including use of oral antibiotics, shorter treatment durations, and novel approaches like phage therapy, as well as common clinical dilemmas, such as the role of rifampin.
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Evaluating the use of Uromune® autovaccine in recurrent urinary tract infections: a pilot unicenter retrospective study in Reus, Spain
Authors: Simona Iftimie1
Abstract
Background Urinary tract infections (UTIs) are a significant global health issue, especially among women, with growing concerns related to antibiotic resistance and adverse effects. The Uromune®, a sublingual, heat-inactivated, polybacterial vaccine, represents a promising therapeutic alternative by enhancing immune responses against uropathogens. Methods This pilot retrospective study, conducted at Hospital Universitari de Sant Joan de Reus from January 2018 to August 2022, assessed the association between Uromune® administration and changes in recurrent UTIs. Patients received personalized autovaccines administered as two sublingual puffs daily for three months. Clinical, microbiological, and demographic data were analyzed to assess treatment outcomes and identify recurrenceassociated factors. Results Forty-nine patients (mean age, 61 years, and 59.2% women) were included in the study. Uromune® treatment decreased UTI episodes from 3.73±0.97 the year before to 0.98±1.36 (p