The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Feb 2015
ReviewStemming the tide of drug-resistant Neisseria gonorrhoeae: the need for an individualized approach to treatment.
Drug-resistant Neisseria gonorrhoeae poses a significant public health challenge. In recent years, gonococci resistant to first- and second-line antibiotics have spread worldwide and new strains have developed that are increasingly resistant to third-generation cephalosporins, which are currently our last line of available treatments. Given the timeline required to develop new drugs or an effective vaccine for N. gonorrhoeae, a top priority is to use the drugs that are available as effectively as possible. ⋯ Clearly, methods are needed that provide patient-specific drug susceptibility information in a time frame that would allow clinicians to prescribe individualized treatment regimens for gonorrhoea. Fortunately, in recent years, there have been a number of advances in the development of rapid methods for characterizing both the genotype and the drug resistance phenotype of N. gonorrhoeae strains. Here, we review these advances and propose additional studies that would help facilitate a transition towards an individualized treatment approach for gonorrhoea.
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J. Antimicrob. Chemother. · Nov 2014
ReviewThe World Health Assembly resolution on antimicrobial resistance.
Antimicrobial resistance is a global problem that can only be tackled successfully through strengthened international partnerships. A concerted political, scientific and media campaign has garnered support for the recent World Health Assembly resolution on antimicrobial resistance, mandating the WHO to develop a global action plan. ⋯ Key themes are communication, prevention of infection, using knowledge to guide action, sustainability and optimizing the use of antimicrobial medicines and diagnostic devices. Implementation of the global action plan will require member states to make a commitment to developing national action plans and strengthening capacity, building on collaborations between the WHO, the World Organisation for Animal Health, the World Bank, Codex Alimentarius and the Transatlantic Task Force on Antimicrobial Resistance.
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J. Antimicrob. Chemother. · Sep 2014
ReviewBedaquiline: a review of human pharmacokinetics and drug-drug interactions.
Bedaquiline has recently been approved for the treatment of pulmonary multidrug-resistant tuberculosis (TB) as part of combination therapy in adults. It is metabolized primarily by the cytochrome P450 isoenzyme 3A4 (CYP3A4) to a less-active N-monodesmethyl metabolite. ⋯ Potential interactions have been assessed between bedaquiline and first- and second-line anti-TB drugs (rifampicin, rifapentine, isoniazid, pyrazinamide, ethambutol, kanamycin, ofloxacin and cycloserine), commonly used antiretroviral agents (lopinavir/ritonavir, nevirapine and efavirenz) and a potent CYP3A inhibitor (ketoconazole). This review summarizes the pharmacokinetic profile of bedaquiline as well as the results of the drug-drug interaction studies.
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J. Antimicrob. Chemother. · Sep 2014
ReviewViruses versus bacteria-novel approaches to phage therapy as a tool against multidrug-resistant pathogens.
Bacteriophage therapy (the application of phages to treat bacterial infections) has a tradition dating back almost a century, but interest in phage therapy slowed down in the West when antibiotics were discovered. With the emerging threat of infections caused by multidrug-resistant bacteria and scarce prospects of newly introduced antibiotics in the future, phages are currently being reconsidered as alternative therapeutics. Conventional phage therapy uses lytic bacteriophages for treatment and recent human clinical trials have revealed encouraging results. ⋯ The use of enzymes derived from phages, such as endolysin, as therapeutic agents has been efficient in the elimination of Gram-positive pathogens. This review presents novel strategies for phage-related therapies and describes our current knowledge of natural bacteriophages within the human microbiome. Our aim is to provide an overview of the high number of different methodological concepts, thereby encouraging further research on this topic, with the ultimate goal of using phages as therapeutic or preventative medicines in daily clinical practice.
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J. Antimicrob. Chemother. · Jun 2014
Review Meta Analysisβ-Lactam/macrolide dual therapy versus β-lactam monotherapy for the treatment of community-acquired pneumonia in adults: a systematic review and meta-analysis.
Several studies have compared the clinical effect of β-lactam/macrolide (BLM) dual therapy versus β-lactam (BL) monotherapy in community-acquired pneumonia (CAP) patients. However, the results remain controversial. Thus, we did this meta-analysis to determine which treatment was more effective. ⋯ In comparison with BL monotherapy, BLM dual therapy might reduce mortality risk in patients with CAP. Because this finding is based on observational studies, randomized controlled trials are required to demonstrate the usefulness of BLM dual therapy in the treatment of CAP.