Executive Summary: International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the

Clinical Infectious Diseases 1 March 2011 V.52 N.5 P.561-564

Kalpana Gupta1, Thomas M. Hooton2, Kurt G. Naber9, Björn Wullt10, Richard Colgan3, Loren G. Miller4, Gregory J. Moran5, Lindsay E. Nicolle8, Raul Raz11, Anthony J. Schaeffer6, and David E. Soper7

1Department of Medicine, Veterans Affairs Boston Health Care System and Boston University School of Medicine, Boston, Massachusetts

2Department of Medicine, University of Miami Miller School of Medicine, University of Miami, Miami  Florida

3Department of Family and Community Medicine, University of Maryland, Baltimore,  Maryland

4Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance

5Department of Emergency Medicine and Division of Infectious Diseases Olive View-UCLA Medical Center, Slymar, California

6 Deptartment of urology, Northwestern University, Chicago, Illinois

7Departments of Obstetrics and Gynecology and Medicine, Medical University of South Carolina, Charleston, South Carolina

8Department of Internal Medicine and Department of Medical Mirobiology University of Manitoba, Winnipeg, Canada

9Technical University of Munich, Munich, Germany

10Lund University Hospital, Lund, Sweden

11Infectious Diseases Unit, Ha’Emek Medical Center, Afula, and Rappaport Faculty of Medicine, Technion, Haifa, Israel

Abstract

ARTICLEA Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration
with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and
Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases–Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological
abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.

abstract

http://cid.oxfordjournals.org/content/52/5/561.abstract

PDF

http://cid.oxfordjournals.org/content/52/5/561.full.pdf+html

 

No Risk of Myocardial Infarction Associated With Initial Antiretroviral Treatment Containing Abacavir: Short and Long-Term Results from ACTG A5001/ALLRT

Clinical Infectious Diseases 1 April 2011 V.52 N.7 P.929-940

Heather J. Ribaudo1, Constance A. Benson2, Yu Zheng1, Susan L. Koletar3, Ann C. Collier4, Judith J. Lok1, Marlene Smurzynski1, Ronald J. Bosch1, Barbara Bastow5, and Jeffrey T. Schouten4, for the ACTG A5001/ALLRT Protocol Team

1Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

2Division of Infectious Disease, University of California, San   Diego

3Division of Infectious Diseases, Ohio State University, Columbus

4School of Medicine, University of Washington, Seattle

5Social & Scientific Systems, Silver Spring, Maryland

Abstract

Background

Observational and retrospective clinical trial cohorts have reported conflicting results for the association of abacavir use with risk of myocardial infarction (MI), possibly related to issues that may bias estimation of treatment effects, such as time-varying confounders, informative dropout, and cohort loss due to competing events.

Methods

We analyzed data from 5056 individuals initiating randomized antiretroviral treatment (ART) in AIDS Clinical Trials Group studies; 1704 started abacavir therapy. An intent-to-treat analysis adjusted for pretreatment covariates and weighting for informative censoring was used to estimate the hazard ratio (HR) of MIs after initiation of a regimen with or without abacavir.

Results

Through 6 years after ART initiation, 36 MIevents were observed in 17,404 person-years of follow-up. No evidence of an increased hazard of MI in subjects using abacavir versus no abacavir was seen (over a 1-year period: P =.50; HR, 0.7 [95% confidence interval {CI}, 0.2-2.4]); over a 6-year period: P= .24; HR, 0.6 [95% CI, 0.3-1.4]); these results were robust over as-treated and sensitivity analyses. Although the risk of MI decreased over time, there was no evidence to suggest a time-dependent abacavir effect. Classic
cardiovascular disease (CVD) risk factors were the strongest predictors of MI.

Conclusion

We find no evidence to suggest that initial ART containing abacavir increases MI risk over short-term and long-term periods in
this population with relatively low MI risk. Traditional CVD risk factors should be the main focus in assessing CVD risk in individuals with human immunodeficiency virus infection.

abstract

http://cid.oxfordjournals.org/content/52/7/929.abstract

PDF

://cid.oxfordjournals.org/content/52/7/929.full.pdf+html