The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Oct 2003
ReviewHow good is the evidence for the recommended empirical antimicrobial treatment of patients hospitalized because of community-acquired pneumonia? A systematic review.
For years, monotherapy with a beta-lactam antibiotic (penicillin, amoxicillin or second-generation cephalosporin) was recommended as empirical therapy for patients with community-acquired pneumonia (CAP). A combination of a beta-lactam and a macrolide antibiotic was only recommended for patients with severe CAP needing intensive care treatment or when atypical pathogens, i.e. Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae, were strongly suspected. However, new guidelines recommend a combination of a beta-lactam antibiotic plus a macrolide or monotherapy with a fluoroquinolone for all patients hospitalized with CAP. We evaluated whether treatment with a beta-lactam plus macrolide or quinolone monotherapy is truly superior to beta-lactam treatment alone. ⋯ A randomized controlled trial is warranted to circumvent the methodological flaws in the designs of the currently available studies. Since the addition of macrolides or treatment with fluoroquinolones may lead to enhanced antibiotic resistance, increased side effects and healthcare-related costs, such a fundamental change in the treatment of CAP should be based on valid data.
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J. Antimicrob. Chemother. · Jun 2003
ReviewAntibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review.
A systematic review of studies that investigated the association of antibiotics with hospital-acquired Clostridium difficile-associated diarrhoea (CDAD) was undertaken to summarize the strength of the evidence for this relationship. The results from the studies identified were considered after critically reviewing the design and conduct of each study. ⋯ Two studies of reasonable quality suggested an association between clindamycin, cephalosporins, penicillins and CDAD. Well-designed studies grounded in epidemiological principles are needed to identify true risk factors for CDAD and to provide reliable estimates of the strength of association.
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J. Antimicrob. Chemother. · Feb 2002
Review Comparative StudyLiposomal amphotericin B versus conventional amphotericin B in the empirical treatment of persistently febrile neutropenic patients.
Liposomal amphotercin B was compared with conventional amphotericin B for empirical antifungal therapy in febrile neutropenic patients in a randomized, double-blind, multicentre trial. Using a composite end-point, the two drugs were equivalent in overall efficacy. However, the liposomal amphotericin B treatment group had fewer proven fungal infections, fewer infusion-related side effects and less nephrotoxicity. ⋯ Therefore, the drug acquisition costs and the risk of nephrotoxicity are important factors in determining the cost-effectiveness of liposomal amphotericin B as empirical therapy in persistently febrile neutropenic patients. In a recent randomized double-blind study comparing liposomal amphotericin B at 3 or 5 mg/kg/day with amphotericin B lipid complex (ABLC) 5 mg/kg/day as empirical antifungal treatment in patients with febrile neutropenia, liposomal amphotericin B was associated with less toxicity than ABLC, both in terms of infusion-related reactions and nephrotoxicity. The incidence of study drug discontinuation due to toxicity was: liposomal amphotericin B 3 mg/kg/day, 14%; liposomal amphotericin B 5 mg/kg/day, 15%; and ABLC, 42% (P < 0.001).
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J. Antimicrob. Chemother. · Feb 2001
ReviewHerpes zoster--predicting and minimizing the impact of post-herpetic neuralgia.
Herpes zoster results from reactivation of latent varicella-zoster virus in the dorsal root ganglia and is frequently associated with severe pain. Most patients suffer acute pain during the rash phase, and in many, prodromal pain or discomfort also precedes the rash. The pain of herpes zoster gradually resolves with time, but may persist after the acute disease as post-herpetic neuralgia for weeks, months or even years. ⋯ Early treatment with oral antivirals has been shown to accelerate the resolution of postherpetic neuralgia, with therapeutic effects particularly evident in the over-50 age group, where pain generally persists for longer. Progressively increasing life expectancy of the population translates to increasing numbers of cases of herpes zoster. The socio-economic gains associated with active management, including use of oral antivirals where indicated, to speed resolution of pain and post-herpetic neuralgia, readily justify additional cost.