Enfermedades infecciosas y microbiología clínica
-
Enferm. Infecc. Microbiol. Clin. · Mar 2011
Review[Drug interactions in critically-ill patients. An important factor in the use of micafungin?].
Currently there are three main drug groups for the prevention and treatment of fungal infections: polyenes (amphotericin B deoxycholate or its lipid formulations), azoles (fluconazole, itraconazole or posaconazole) and echinocandins (caspofungin, micafungin and anidulafungin). However, a major characteristic to be evaluated when choosing an antifungal agent -apart from antifungal spectrum, pharmacokinetics and adverse effects- is the absence of significant drug interactions. Amphotericin B lacks interactions but may cause renal dysfunction, leading to the accumulation of renally metabolized drugs. ⋯ The echinocandin with the highest number of interactions is caspofungin. Micafungin is an echinocandin lacking in relevant interactions and consequently its dosage requires no adjustment in any of its indications. This drug can be used both in adults and in the pediatric population, including neonates.
-
Enferm. Infecc. Microbiol. Clin. · Mar 2011
ReviewUpdate on bacteraemia in oncology and hematology.
The present article is an update of the literature on bacteraemia in onco-hematologic patients. A multidisciplinary group of Spanish physicians with an interest in this field selected the most important papers published recently. ⋯ Important aspects of these studies include the assessment of different strategies in the management of fever in neutropenic patients and the validation of specific scores. Moreover, early identification of patients at risk of bacterial and of multi-drug resistant infections is a topic of increasing interest.
-
Enferm. Infecc. Microbiol. Clin. · Mar 2011
Practice Guideline[National consensus document by GESIDA/National Aids Plan on antiretroviral treatment in adults infected by the human immunodeficiency virus (January 2011 update)].
The update of these adult antiretroviral treatment (cART) recommendations has been carried out by consensus of a panel consisting of members of the Grupo de Estudio de Sida (Gesida, AIDS Study Group) and the Plan Nacional sobre el Sida (PNS, Spanish AIDS Plan) who have reviewed the antiretroviral efficacy and safety advances in clinical trials, cohort and pharmacokinetic studies published in medical journals (PubMed and Embase), or presented in medical scientific meetings. Three levels of evidence were defined according to the data source: randomized studies (level A), cohort or case-control studies (level B), and expert opinion (level C). The decision to recommend, consider or not to recommend antiretroviral treatment (ART) was established by consensus in each situation. ⋯ Therapeutic options are limited after cART failures, but undetectable viral load maybe possible with resistance genotypic studies. Adverse events are a decreasing problem of cART, where the benefits exceed the possible harm. cART in acute HIV infection, in women, pregnancy and prevention of mother to child transmission, and pre- and post-exposure prophylaxis are commented on. Management of hepatitis B or C co-infection is also commented on.
-
Available data on anti-tuberculosis drug research reveal different properties of the agents and provoke speculation about future directions. Higher doses of the rifamycins are promising and are currently being evaluated in regimens of shorter duration that the isoniazid plus rifampin-based, six-to-nine month-course therapy. ⋯ On the other hand, co-administration of moxifloxacin and PA-824 could be active against latent tuberculosis, whereas linezolid, PA-824 and TMC207 are candidates for a rifampin-free regimen in multidrug-resistant and extensively-resistant tuberculosis. Unfortunately, shorter than existent treatment regimens based on the new agents discussed here are likely to take at least another decade to be fully developed and implemented in clinical practice.
-
Enferm. Infecc. Microbiol. Clin. · Mar 2011
Review[Is micafungin useful in the prophylaxis of invasive fungal disease in hematological patients?].
Antifungal prophylaxis is the first option to fight against fungal infection in high-risk hematological patients (remission of induction of acute myeloblastic leukemia/myelodysplastic syndrome, allogeneic hematopoietic stem cell transplantation). Fluconazole prophylaxis is not effective in preventing infection with moulds, mainly invasive aspergillosis, and consequently the triazole currently recommended in high-risk hematological patients is posaconazole. Nevertheless, given that posaconazole can only be administered orally, alternative prophylaxis may be required. ⋯ Higher doses have been evaluated in adults (100 mg/day, 150 mg/day) and in children (3 mg/kg/day) with good efficacy and safety. Because of this agent's spectrum of activity, which includes both Candida and Aspergillus, together with its favorable pharmacokinetic profile regarding to the absence of significant drug interactions, this agent is appropriate in hematopoietic stem cell transplant recipients and in hematological patients following therapeutic protocols with vinca alkaloids. The optimal and most cost-effective dose for prophylaxis, as well as alternative regimens to daily intravenous administration, which would allow the use of this drug beyond conventional hospitalization (day care hospital, domiciliary transplantation therapy), remain to be determined.