Pharmacokinetic and Pharmacodynamic Issues in the Treatment of Bacterial Infectious Diseases

This review outlines some of the many factors a clinician must consider when selecting an antimicrobial dosing regimen for the treatment of infection. Integration of the principles of antimicrobial pharmacology and the pharmacokinetic parameters of an individual patient provides the most comprehensive assessment of the interactions between pathogen, host, and antibiotic. For each class of agent, appreciation of the different approaches to maximize microbial killing will allow for optimal clinical efficacy and reduction in risk of development of resistance while avoiding excessive exposure and minimizing risk of toxicity. Disease states with special considerations for antimicrobial use are reviewed, as are situations in which pathophysiologic changes may alter the pharmacokinetic handling of antimicrobial agents.     

Efficacy of Probiotics in Prevention and Treatment of Infectious Diseases

Deaths from infectious diseases and deep concerns about increases in microbial resistance make it necessary for scientists to develop innovative therapeutic solutions and complementary therapies. Growing evidence is available on the therapeutic effects of probiotics. There are also documents about the beneficial effects of probiotics, but it is difficult to draw a definitive conclusion regarding the results of these studies because of the small sample size, the limitations of the study methods, and the use of different strains of probiotic bacteria. This review study summarizes the articles available on the scientific and electronic databases Embase, Medline, and Scopus until the end of 2017, including case studies describing beneficial microbes as tools for improving the process of controlling infectious diseases. Until the development of novel vaccines or other approaches occurs, the use of probiotics seems to be a logical way to attempt to control certain infectious diseases.     

Pharmacogenomics of HIV Therapy: Summary of a Workshop Sponsored by the National Institute of Allergy and Infectious Diseases

Abstract

Approximately 1 million people in the United States and over 30 million worldwide are living with human immunodefi ciency virus type 1 (HIV-1). While mortality from untreated infection approaches 100%, survival improves markedly with use of contemporary antiretroviral therapies (ART). In the United States, 25 drugs are approved for treating HIV-1, and increasing numbers are available in resource-limited countries.Safe and effective ART is a cornerstone in the global struggle against the acquired immunodefi ciency syndrome. Variable responses to ART are due at least in part to human genetic variants that affect drug metabolism, drug disposition, and off-site drug targets. Defi ning effects of human genetic variants on HIV treatment toxicity,effi cacy, and pharmacokinetics has far-reaching implications. In 2010, the National Institute of Allergy and Infectious Diseases sponsored a workshop entitled, Pharmacogenomics– A Path Towards Personalized HIV Care. This article summarizes workshop objectives, presentations, discussions, and recommendations derived from this meeting.     

Diagnosis of Infectious Diseases: a Cytopathologist’s Perspective

This review explores the role of the cytopathology laboratory in the detection and presumptive identification of microorganisms. Sample procurement by exfoliation, abrasion, and aspiration techniques, as well as a variety of cytopreparatory and staining methods, is reviewed. Emphasis is placed on the utility of fine-needle aspiration as a rapid, safe, and cost-effective diagnositic procedure. The role of rapid interpretation and specimen triage is also discussed. Cytomorphologic features and staining characteristics are presented for a spectrum of microorganisms potentially encountered in the cytopathology laboratory. Pitfalls in diagnosis and the usefulness of special stains and ancillary techniques are also evaluated. The importance of communication, collaboration, and clinical correlation is stressed.