Effects of New Penicillin Susceptibility Breakpoints for Streptococcus pneumoniae — United States, 2006–2007

MMWR December 19, 2008 / 57(50);1353-1355

Full Text

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5750a2.htm?s_cid=mm5750a2_e

PDF

http://www.cdc.gov/mmwr/PDF/wk/mm5750.pdf

Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America

Clinical Infectious Diseases 1 January 2009 V.48 N.1 p.1-12

IDSA REPORT

Helen W. Boucher,¹ George H. Talbot,² John S. Bradley,^3,4 John E. Edwards, Jr,^5,6,7 David Gilbert,⁸ Louis B. Rice,^9,10 Michael Scheld,¹¹ Brad Spellberg,^5,6,7 and John Bartlett¹²

¹Division of Geographic Medicine and Infectious Diseases, Tufts University and Tufts Medical Center, Boston, Massachusetts; ²Talbot Advisors, Wayne, Pennsylvania; ³Division of Infectious Diseases, Rady Children’s Hospital San Diego, and ⁴University of California at San Diego, San Diego, ⁵Division of Infectious Diseases, Harbor–University of California at Los Angeles (UCLA) Medical Center, and ⁶Los Angeles Biomedical Research Institute, Torrance, and ⁷The David Geffen School of Medicine at UCLA, Los Angeles, California; ⁸Division of Infectious Diseases, Providence Portland Medical Center and Oregon Health Sciences University, Portland; ⁹Medical Service, Louis Stokes Cleveland Veterans Administration Medical Center, and ¹⁰Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; ¹¹Department of Medicine, University of Virginia School of Medicine, Charlottesville; and ¹²Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

The Infectious Diseases Society of America (IDSA) continues to view with concern the lean pipeline for novel therapeutics to treat drug-resistant infections, especially those caused by gram-negative pathogens. Infections now occur that are resistant to all current antibacterial options. Although the IDSA is encouraged by the prospect of success for some agents currently in preclinical development, there is an urgent, immediate need for new agents with activity against these panresistant organisms. There is no evidence that this need will be met in the foreseeable future. Furthermore, we remain concerned that the infrastructure for discovering and developing new antibacterials continues to stagnate, thereby risking the future pipeline of antibacterial drugs. The IDSA proposed solutions in its 2004 policy report, “Bad Bugs, No Drugs: As Antibiotic R&D Stagnates, a Public Health Crisis Brews,” and recently issued a “Call to Action” to provide an update on the scope of the problem and the proposed solutions. A primary objective of these periodic reports is to encourage a community and legislative response to establish greater financial parity between the antimicrobial development and the development of other drugs. Although recent actions of the Food and Drug Administration and the 110th US Congress present a glimmer of hope, significant uncertainly remains. Now, more than ever, it is essential to create a robust and sustainable antibacterial research and development infrastructure—one that can respond to current antibacterial resistance now and anticipate evolving resistance. This challenge requires that industry, academia, the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, the US Department of Defense, and the new Biomedical Advanced Research and Development Authority at the Department of Health and Human Services work productively together. This report provides an update on potentially effective antibacterial drugs in the late-stage development pipeline, in the hope of encouraging such collaborative action.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/595011

Treatment of Syphilis, 1998: Nonpregnant Adults

Clinical Infectious Disease 1 Jan 1999 V.28 N.S1 S21-S28

Michael H. Augenbraun – Robert Rolfs

From the Department of Medicine and Department of Preventive Medicine and Community Health, SUNY Health Science Center at Brooklyn, Brooklyn, New York; and the Office of Public Health Data, Utah Department of Public Health, Salt Lake City, Utah

Questions regarding the appropriate therapy for syphilis remain, despite the many years during which this infection has been subjected to intense scientific scrutiny. In an effort to provide guidance for the development of the 1998 sexually transmitted disease (STD) treatment guidelines of the Centers for Disease Control and Prevention (CDC), these questions were outlined and an effort to answer them was made. Articles relating to syphilis treatment published after the previous revision of the CDC STD treatment guidelines (in 1993) and by the end of 1996 were identified with use of MEDLINE. Abstracts from relevant scientific meetings held during that time were also examined. Reference was also made to older literature, and expert opinion was sought. Conclusions were reached and recommendations were made on the basis of published evidence wherever possible.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/514724

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/514724

Primary Syphilis

N Engl J of Medicine 1 Dec. 1994 V.331 N.22 p.1492

Images in Clinical Medicine

Primary Syphilis

abstract

http://content.nejm.org/cgi/content/extract/331/22/1492

Full Text

http://content.nejm.org/cgi/content/full/331/22/1492

The Response of Symptomatic Neurosyphilis to High-Dose Intravenous Penicillin G in Patients with Human Immunodeficiency Virus Infection

N Engl J of Medicine 1 Dec. 1994 V.331 N.22 p.1469-1473

Steven M. Gordon, Molly E. Eaton, Rob George, Sandra Larsen, Sheila A. Lukehart, Jane Kuypers, Christina M. Marra, and Sumner Thompson

Department of Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta (S.M.G., M.E.E., S.T.); the Sexually Transmitted Disease Laboratory, Center of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (R.G., S.L.); and the Departments of Medicine (S.A.L., C.M.M.) and Pathology (J.K.), University of Washington, Seattle.

Background Infection with the human immunodeficiency virus (HIV) may affect both the natural course of syphilis and the response to treatment. We examined the response to treatment with high-dose penicillin G in HIV-infected patients with symptomatic neurosyphilis.

Methods Neurosyphilis was defined by reactivity in serum treponemal tests for syphilis, neurologic manifestations consistent with neurosyphilis, and a positive Venereal Disease Research Laboratory (VDRL) test on cerebrospinal fluid. We identified 11 HIV-infected patients with symptomatic neurosyphilis; 5 had been treated previously for early syphilis with penicillin G benzathine. Patients were treated with 18 million to 24 million units of penicillin G per day administered intravenously for 10 days. Cerebrospinal fluid was examined approximately 6 and 24 weeks after treatment, when the polymerase chain reaction and rabbit inoculation were used to detect Treponema pallidum.

Results In four of the seven patients studied 24 weeks after treatment, the serum titers on rapid plasma reagin (RPR) testing decreased by at least two doubling dilutions, and four patients had reductions in the cerebrospinal fluid titers on VDRL testing or reverted to nonreactive results. In two patients there was no normalization or improvement in serum titers on RPR testing or cerebrospinal fluid titers on VDRL testing, cell counts, or protein concentrations. One patient relapsed with meningovascular syphilis six months after therapy. T. pallidum was detected by the polymerase chain reaction in cerebrospinal fluid from 3 of 10 patients before treatment, but in none of the 10 post-treatment specimens.

Conclusions In patients with early syphilis who are also infected with HIV, therapy with penicillin G benzathine may fail, and neurosyphilis may develop. The regimen of high-dose penicillin recommended for neurosyphilis is not consistently effective in patients infected with HIV.

abstract

http://content.nejm.org/cgi/content/abstract/331/22/1469

Full Text

http://content.nejm.org/cgi/content/full/331/22/1469

Editorial

Neurosyphilis in HIV-Infected Persons

abstract

http://content.nejm.org/cgi/content/extract/331/22/1516

Full Text

http://content.nejm.org/cgi/content/full/331/22/1516