Posts filed under ‘Antivirales no HIV’

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.

Clinical Infectious Diseases March 2019 V.68  N.6 e1–e47

Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM Jr, Fry AM, et al.

These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic.

This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza.

It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza.

The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.




March 20, 2019 at 3:42 pm

Effectiveness of the ribavirin in treatment of hantavirus infections in the Americas and Eurasia: a meta-analysis

Virus disease. September 2014 V.25 N.3 P. 385–389

Marcos L. Moreli,corresponding author Ariany C. Marques-Silva, Vagner A. Pimentel, and Vivaldo G. da Costa

Virology Laboratory, Federal University of Goiás, Jataí, Brazil

Marcos L. Moreli, Email: rb.gfu.iataj@ileromlm

Hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) are transmitted to humans through infection with the old- and new-world hantaviruses, respectively.

Together these diseases affect tens of thousands of people every year, and no specific treatment is available.

To investigate whether ribavirin treatment for hantaviruses infections decreases disease severity, we conducted a meta-analysis involving human and animal studies.

After defining the research protocol and criteria for inclusion/exclusion, we identified seven studies. We found that in groups with HPS who were treated with ribavirin, there was no significant reduction in mortality (RR 0.99, 95 % CI 0.60–1.61, I2 = 0 %).

On the other hand, for animal group with HPS-like disease, there was significant increase in survival (RR 0.05, 95 % CI 0.01–0.34, I2 = 0 %).

For animal group infected with the old-world hantaviruses, treated with ribavirin, there was a statistically significant increase in survival (RR 0.56, 95 % CI 0.42–0.76, I2 = 64 %).

Similarly, for humans with HFRS treated, there was increase in survival (RR 0.28, 95 % CI 0.08–1), although only a study exist.

Our meta-analysis provides data that should be interpreted with caution, partly due to the limited number of studies available.

Additionally, the results of the application of ribavirin in the population with HPS could not be determined, particularly in patients in the end stage of this disease.


January 12, 2019 at 12:17 pm

Infections in patients affected by rheumatologic diseases associated to glucocorticoid use or tumor necrosis factor-alpha inhibitors.

Rev Chilena Infectol. April 2014 V.31 N.2 P.181-95.

[Article in Spanish]

Fica A.


A great diversity of infectious agents can affect patients that use steroids at immunosuppressive doses or tumor necrosis factor alpha (TNF-alpha) antagonists.

The list of participating microorganisms is more restricted in the case of anti TNF-alpha blockers.

Overlapping agents include intracellular bacteria, Mycobacterium tuberculosis, geographic fungal agents that have the ability to establish granulamotous infections, herpes zoster, and reactivation of chronic hepatitis B virus infection.

An important conceptual issue for these infections is the existence of a threshold prednisone daily dose for the emergence of opportunistic infections but higher levels of immunosuppression and cofactors are required in the case of Pneumocystis jiroveci and cytomegalovirus infections.

In order to prevent these threats, a detailed medical evaluation is needed before prescription to detect potential risks and manage them properly.

Prevention rules must be prescribed in every case, that include common sense behaviors, vaccines, and in selected cases, chemoprophylaxis for latent tuberculosis (TB) infection, P. jiroveci pneumonia (PCP) or other specific requirements.

Latent TB infection is probable and requires chemoprophylaxis in the case of remote or recent exposure to a patient with lung TB, a positive tuberculin or interferon-gamma release assay result or residual lung scars in a chest x-ray exam.

PCP prevention is suggested when the patient reaches a daily dose of prednisone of 30 mg but might be needed at lower doses in case of other concomitant immunosuppressive drugs or when lymphopenia arises shortly after prednisone initiation.



November 19, 2018 at 11:12 am

2017 GUIA ARGENTINA PARA USO de ANTIBIOTICOS en el 1er Nivel Asistencial – MSN 181 pags.

Guía de medicamentos esenciales para el PNA – Antimicrobianos 1ra edición – Ciudad Autónoma de Buenos Aires : Ministerio de Salud de la Nación. Cobertura Universal de Salud. Medicamentos, 2017

“Guía de Medicamentos Esenciales en el PNA – Grupo Antimicrobianos” describe las características farmacológicas y clínicas más relevantes de los Medicamentos Esenciales utilizados en el manejo de las enfermedades infecciosas prevalentes en el primer nivel de atención.

La misma se agrupa a su vez en: antibióticos, antimicóticos, antivirales, antiparasitarios y fármacos para el tratamiento de la Tuberculosis.


November 3, 2018 at 5:44 pm

Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the U.K. Clinical Research Practice Datalink.

Br J Dermatol. December 2016 V.175 N.6 P.1183-1194.

doi: 10.1111/bjd.14815.

Matthews A1, Turkson M1, Forbes H1, Langan SM1, Smeeth L1, Bhaskaran K1.



Statins are commonly prescribed worldwide and recent evidence suggests that they may increase the risk of herpes zoster (HZ).


To quantify the effect of statin exposure on the risk of HZ in the U.K.


A matched case-control study was conducted using data from U.K. primary care and hospital records. Patients > 18 years with an incident diagnosis of HZ were matched to up to four controls for age, sex and general practice. Patients were included in the statin exposure group if they had ever used a statin, and the daily dosage of the most recent statin prescription and the time since the most recent statin prescription were also recorded. The primary outcome was an incident diagnosis of HZ. Odds ratios (ORs) were estimated from conditional logistic regression and adjusted for potential confounders.


A total of 144 959 incident cases of HZ were matched to 549 336 controls. Adjusted analysis suggested strong evidence for an increase in the risk of HZ related to statin exposure (OR 1·13, 95% confidence interval 1·11-1·15). There was also an increased risk when dosages were increased for patients who were currently or had recently been receiving statin treatment (Ptrend < 0·001), and we found an attenuation of the increased risk of HZ in previous statin users as the time since last statin exposure increased (Ptrend < 0·001).


These findings are consistent with the hypothesis that statin therapy leads to an increase in the risk of HZ.


August 24, 2018 at 4:09 pm

Herpes zoster is associated with prior statin use: a population-based case-control study.

PLoS One. October 24, 2014 V.9 N.10 P.:e111268.

doi: 10.1371/journal.pone.0111268.

Chung SD1, Tsai MC2, Liu SP3, Lin HC4, Kang JH5.



This study investigated the association between statin use and herpes zoster (HZ) occurrence in a population-based case-control study.


Study subjects were retrieved from the Taiwan Longitudinal Health Insurance Database 2000. This study included 47,359 cases with HZ and 142,077 controls. We performed conditional logistic regression analyses to calculate the odds ratio (OR) to present the association between HZ and having previously been prescribed statin.


We found that 13.0% of the sampled subjects had used statins, at 15.5% and 12.1% for cases and controls, respectively (p<0.001). A conditional logistic regression analysis suggested that the adjusted OR of being a statin user before the index date for cases was 1.28 (95% confidence interval (CI): 1.24∼1.32) compared to controls. Subjects aged 18∼44 years had the highest adjusted OR for prior statin use among cases compared to controls (OR: 1.69; 95% CI: 1.45∼1.92). Furthermore, we found that the ORs of being a regular and irregular statin user before the index date for cases were 1.32 (95% CI: 1.27∼1.38) and 1.23 (95% CI: 1.181.29), respectively, compared to controls.


We concluded that prior statin use was associated with HZ occurrence.


August 24, 2018 at 4:07 pm

Impact of postherpetic neuralgia: A six year population-based analysis on people aged 50 years or older

Journal of Infection August 2018 V.76 N.8 P.131–136

Cintia Muñoz-Quiles, Mónica López-Lacort, Alejandro Orrico-Sánchez, Javier Díez-Domingo


  • This population-based study shows that 15.7% of HZ cases develop PHN.
  • Incidence rate of PHN was 1.19/1000 persons (≥50)-year and it was double in women.
  • The adjusted risk of developing PHN increased sharply with age and comorbidities.
  • About 32% of people will develop a HZ between ages 50–90 years.
  • About 7% of people will develop PHN between ages 50–90 years.


To estimate the incidence and burden of postherpetic neuralgia (PHN) and to investigate risk factors for PHN in the Valencia Region of Spain.


Data were extracted from population and healthcare databases from the Valencia Region (2009–2014). Herpes zoster (HZ) and PHN were defined using ICD-9 codes and drug prescriptions in people aged ≥50 years. The risk of HZ patients for developing PHN and potential risk factors (diabetes mellitus, COPD and heart failure) were investigated. A survival analysis was developed to estimate the cumulative hazard of developing HZ and PHN between ages 50–90 years.


From a total of 2,289,485 subjects, 87,086 cases of HZ were registered, 13,658 (15.7%) of whom developed PHN. PHN risk was higher in women and increased sharply with age and comorbidities as diabetes mellitus, COPD and heart failure. The cumulative risk of developing HZ between ages 50–90 years was 31.7% (95% CI: 31.3-32.1) and 6.9 (95% CI: 6.7–7.1) for PHN.


PHN risk was higher in women and increased with age and comorbidities. At least 32% and 7% of people will develop HZ and PHN, respectively, between ages 50–90 years. These results should be considered for vaccine policy implementation.



July 28, 2018 at 7:32 pm

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