Itraconazole (Sporanox®) in superficial and systemic fungal infections

Itraconazole (Sporanox^®) is a triazole antifungal agent with a broad activity spectrum and favorable pharmacokinetic and safety profiles. Numerous clinical trials have established the efficacy and safety of itraconazole in the treatment of superficial fungal infections. In this field, full exploitation of its pharmacokinetics in keratinized tissues has led to the development of intermittent (pulse) treatment regimens that allow similar efficacy with lower overall drug exposure as well as a reduction in treatment costs. The additional anti-inflammatory action of itraconazole also makes it suitable for application in difficult-to-treat inflammatory skin disorders, such as seborrheic dermatitis. Recently, a new oral liquid formulation and an intravenous formulation have been developed, extending the therapeutic application of itraconazole to systemic fungal infections. Due to its broad activity spectrum and excellent tolerability, itraconazole is a valuable addition to the antifungal armamentarium used for prophylactic and empiric treatment in immunocompromised hosts.     

Antimicrobial stewardship: the aspirin of the 21st Century

The increasing incidence of carbapenem-resistant Klebsiella pneumoniae (CR-KP) fundamentally alters the management of patients at risk to be colonized or infected by such microorganisms. Owing to the limitation in efficacy and potential for toxicity of the alternative agents, many experts recommend using combination therapy instead of monotherapy in CR-KP-infected patients. However, in the absence of well-designed comparative studies, the best combination for each infection type, the continued role for carbapenems in combination therapy and when combination therapy should be started remain open questions. Herein, the authors revise current microbiological and clinical evidences supporting combination therapy for CR-KP infections to address some of these issues.     

PegIFN-α2a for the treatment of chronic hepatitis B and C: a 10-year history

Chronic HBV and HCV are progressive diseases leading to cirrhosis and liver transplantation. Persistent viral eradication or suppression can positively affect the natural course of the infection, by preventing disease progression. Since its introduction more than 30 years ago, IFN-α has represented the foundation of HBV and, lately, anti-HCV treatment. Pegylation of the IFN-α molecule (PegIFN-α2a) has provided improvements in both efficacy and administration schedule, thus becoming part of the standard-of-care regimen for HCV and HBV therapy in the last 10 years. Currently, treatment of finite duration with PegIFN-α2a may achieve a sustained virological response off-treatment and HBsAg seroconversion. PegIFN-α2a will most likely remain the backbone of HCV treatment for the next few years, despite the availability of direct-acting antivirals that are expected to improve cure rates. However, many efforts are concentrated on developing new compounds, with the goal of administrating all oral regimens and eliminating PegIFN from anti-HCV treatment.     

Pseudomonas aeruginosa treatment and transmission reduction

Infections caused by Pseudomonas aeruginosa can be difficult to treat and require a coordinated approach for their management. This involves quickly controlling the source of infection, establishing a correct etiologic diagnosis and administering appropriate empiric antimicrobial therapy. Once antimicrobial therapy has been initiated and susceptibilities are available, therapy should be tailored with optimized antibiotic doses for an appropriate duration in order to sufficiently treat the infection and minimize resistance emergence.     

HAART to heart: highly active antiretroviral therapy and the risk of cardiovascular disease in HIV-infected or exposed children and adults

Infection with HIV is independently associated with an increased risk for clinical heart failure, cardiomyopathies and premature atherosclerosis, including stroke and myocardial infarction in both the pre-HAART and HAART eras. HAART is also associated with clinical cardiovascular concerns. In HIV-infected individuals, HAART may cause adverse lipid profiles and increased risk for cardiovascular events. Its effects on the developing heart remain unclear. Although in utero HAART exposure may improve cardiac function in the first 2 years of life, it may also inhibit myocardial growth. Additional potentially damaging cardiovascular effects of HAART are present, and continuing cardiovascular risk evaluations, screening and follow-up of treated patients is necessary. Here, we review available research in this field and highlight the importance of understanding known complications and their mechanisms.     

Management of severe bacterial infections

Defining the severity of an infection can play a central role for a correct therapeutic choice, avoiding inadequate antimicrobial treatments. Severe bacterial infections are, in fact, characterized by high morbidity and mortality rates so that the appropriateness of therapy can have a profound clinical impact. Indeed, initial inappropriate empirical therapies, and the further need to modify them, substantially increase the mortality risk. Several strategies have been suggested to improve the clinical outcome of patients affected by severe bacterial infections, such as the use of guidelines, use of antibiotics in combination, de-escalation therapy, cycling therapy and the use of infectious disease specialist consultation. A closer collaboration between the medical staff in the wards and infectious disease specialists can possibly bridge the gap between different strategies and individual needs of the patient, thereby improving the decision-making process.     

American Adult Use of Complementary and Alternative Medicine

Editor's Note: In 2004, a study of usage of complementary and alternative medicine among 31,000 American adults revealed that 36% of the population now uses CAM. CAM is defined and usage patterns are described. The survey instrument was developed by the National Center for Complementary and Alternative Medicine and the Center for Disease Control and Prevention National Center for Health Statistics.     

Nonopioid Analgesics for Osteoarthritis: Availability of Topical NSAIDs

ABSTRACT

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topics addressed in this issue are pain-related anxiety, its symptoms, and possible treatment approaches.