Archive for September 17, 2012

Re-Evaluating the Treatment of Nongonococcal Urethritis: Emphasizing Emerging Pathogens–A Randomized Clinical Trial

Clin Infect Dis  Jan. 2011 V.52 N.2 P.163-170

J. R. Schwebke1, A. Rompalo2, S. Taylor3, A. C. Seña4, D. H. Martin3, L. M. Lopez5, S. Lensing6, and J. Y. Lee6

1University of Alabama at Birmingham, Birmingham

2Johns Hopkins University, Baltimore, Maryland

3Louisiana State University Medical Center, Baton Rouge

4University of North Carolina at Chapel Hill, Chapel Hill

5Family Health International, Research Triangle Park, North Carolina

6University of Arkansas for Medical Sciences, Little Rock

Correspondence: Jane R. Schwebke, MD, University of Alabama at Birmingham, 703 19th St South ZRB 239 Birmingham, AL 35294-0007 (schwebke@uab.edu).

Background

Nongonococcal urethritis (NGU) is a common chlamydia-associated syndrome in men; however, Trichomonas vaginalis and Mycoplasma genitalium are associated with its etiology and should be considered in approaches to therapy. We sought to determine whether the addition of tinidazole, an anti-trichomonal agent, to the treatment regimen would result in higher cure rates than those achieved with treatment with doxycycline or azithromycin alone. A secondary aim was to compare the efficacy of doxycycline therapy and with that of azithromycin therapy.

Methods

Randomized, controlled, double-blinded phase IIB trial of men with NGU. Participants were randomized to receive doxycycline plus or minus tinidazole or azithromycin plus or minus tinidazole and were observed for up to 45 days.

Results

The prevalences of Chlamydia trachomatis, M. genitalium, and T. vaginalis were 43%, 31%, and 13%, respectively. No pathogens were identified in 29% of participants. Clinical cure rates at the first follow-up visit were 74.5% (111 of 149 patients) for doxycycline-containing regimens and 68.6% (107 of 156 patients) for azithromycin-containing regimens. By the final visit, cure rates were 49% (73 of 149 patients) for doxycycline-containing regimens and 43.6% (68 of 156 patients) for azithromycin-containing regimens. There were no significant differences in clinical response rates among the treatment arms. However, the chlamydia clearance rate was 94.8% (55 of 58 patients) for the doxycycline arm and 77.4% (41 of 53 patients) for the azithromycin arm (P = .011), and the M. genitalium clearance rate was 30.8% (12 of 39 patients) for the doxycycline arm and 66.7% (30 of 45 patients) for the azithromycin arm (P = .002).

Conclusions

Addition of tinidazole to the treatment regimen did not result in higher cure rates but effectively eradicated trichomonas. Clinical cure rates were not significantly different between patients treated with doxycycline and those treated with azithromycin; however, doxycycline had significantly better efficacy against Chlamydia, whereas azithromycin was superior to doxycycline for the treatment of M. genitalium.

PDF

http://cid.oxfordjournals.org/content/52/2/163.full.pdf+html

September 17, 2012 at 9:58 am

Telavancin versus Vancomycin for Hospital-Acquired Pneumonia due to Gram-positive Pathogens

Clin Infect Dis Jan. 2011 V.52 N.1 P.31-40

Ethan Rubinstein1, Tahaniyat Lalani2,3, G. Ralph Corey2,3, Zeina A. Kanafani11, Esteban C. Nannini12, Marcelo G. Rocha15, Galia Rahav16, Michael S. Niederman4,5, Marin H. Kollef6, Andrew F. Shorr7, Patrick C. Lee8, Arnold L. Lentnek9, Carlos M. Luna13, Jean-Yves Fagon17, Antoni Torres18, Michael M. Kitta, Fredric C. Genter10, Steven L. Barriere10, H. David Friedlanda, Martin E. Stryjewski2,14, and for the ATTAIN Study Groupb

1Section of Infectious Diseases Department of Internal Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

2Department of Medicine, Duke Clinical Research Institute

3Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina

4Winthrop-University Hospital, Mineola

5State University of New York at Stony Brook, Stony Brook, New York

6Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, Missouri

7Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC

8Baystate Medical Center, Springfield, Massachusetts

9Wellstar Infectious Disease, Marietta, Georgia

10Theravance Inc., South San Francisco, California

11American University of Beirut Medical Center, Beirut, Lebanon

12Department of Infectious Diseases, School of Medicine, Universidad Nacional de Rosario, Rosario

13Department of Internal Medicine, Pulmonary Diseases Division, Hospital de Clínicas, Universidad de Buenos Aires

14Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina

15Intensive Care Unit, Pavilhão Pereira Filho, Irmandade da Santa Casa, Porto Alegre, Brazil

16Division of Infectious Diseases Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel

17Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France

18Division of Pulmonary Medicine, Clinic Institute of Thorax, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades Respiratorias, Barcelona, Spain

Background

Telavancin is a lipoglycopeptide bactericidal against gram-positive pathogens.

Methods

Two methodologically identical, double-blind studies (0015 and 0019) were conducted involving patients with hospital-acquired pneumonia (HAP) due to gram-positive pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA). Patients were randomized 1:1 to telavancin (10 mg/kg every 24 h) or vancomycin (1 g every 12 h) for 7–21 days. The primary end point was clinical response at follow-up/test-of-cure visit.

Results

A total of 1503 patients were randomized and received study medication (the all-treated population). In the pooled all-treated population, cure rates with telavancin versus vancomycin were 58.9% versus 59.5% (95% confidence interval [CI] for the difference, –5.6% to 4.3%). In the pooled clinically evaluable population (n = 654), cure rates were 82.4% with telavancin and 80.7% with vancomycin (95% CI for the difference, –4.3% to 7.7%). Treatment with telavancin achieved higher cure rates in patients with monomicrobial S. aureus infection and comparable cure rates in patients with MRSA infection; in patients with mixed gram-positive/gram-negative infections, cure rates were higher in the vancomycin group. Incidence and types of adverse events were comparable between the treatment groups. Mortality rates for telavancin-treated versus vancomycin-treated patients were 21.5% versus 16.6% (95% CI for the difference, –0.7% to 10.6%) for study 0015 and 18.5% versus 20.6% (95% CI for the difference, –7.8% to 3.5%) for study 0019. Increases in serum creatinine level were more common in the telavancin group (16% vs 10%).

Conclusions

The primary end point of the studies was met, indicating that telavancin is noninferior to vancomycin on the basis of clinical response in the treatment of HAP due to gram-positive pathogens.

PDF

http://cid.oxfordjournals.org/content/52/1/31.full.pdf+html

 

Correspondence

On A Different Level: Telavancin Versus Vancomycin for HospitalAcquired Pneumonia

http://cid.oxfordjournals.org/content/52/11/1390.full.pdf+html

 

September 17, 2012 at 9:55 am

A 49-year-old woman with a persistent cough.

Cleve Clin J Med. 2011 Aug  V.78 N.8  P.521-8.

Doleh TY, Rehm SJ, Isaacson JH.

Source

Department of Internal Medicine, Cleveland, OH 44195, USA.

Two weeks ago, she was seen in the outpatient clinic for a nonproductive cough, rhinorrhea, sneezing, and a sore throat. At that time, she described coughing spells that were occasionally accompanied by posttussive chest pain and vomiting. The cough was worse at night and was occasionally associated with wheezing. She reported no fevers, chills, rigors, night sweats, or dyspnea. She said she has tried over-the-counter cough suppressants, antihistamines, and decongestants, but they provided no relief. Since she had a history of well-controlled asthma, she was diagnosed with an asthma exacerbation and was given prednisone 20 mg to take orally every day for 5 days, to be followed by an inhaled corticosteroid until her symptoms resolved….

PDF

http://www.ccjm.org/content/78/8/521.full.pdf+html

September 17, 2012 at 9:52 am


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