Posts filed under ‘GUIDELINES’

IDSA GUIDELINE – Official American Thoracic Society – Centers for Disease Control and Prevention – Infectious Diseases Society of America Clinical Practice Guidelines – Treatment of Drug-Susceptible Tuberculosis

Clinical Infectious Diseases October 1, 2016 V.63 N.7 e147-e195

Payam Nahid1, Susan E. Dorman2, Narges Alipanah1, Pennan M. Barry3, Jan L. Brozek4, Adithya Cattamanchi1, Lelia H. Chaisson1, Richard E. Chaisson2, Charles L. Daley5, Malgosia Grzemska6, Julie M. Higashi7, Christine S. Ho8, Philip C. Hopewell1, Salmaan A. Keshavjee9, Christian Lienhardt6, Richard Menzies10, Cynthia Merrifield1, Masahiro Narita12, Rick O’Brien13, Charles A. Peloquin14, Ann Raftery1, Jussi Saukkonen15, H. Simon Schaaf16, Giovanni Sotgiu17, Jeffrey R. Starke18, Giovanni Battista Migliori11, and Andrew Vernon8

1University of California, San Francisco

2Johns Hopkins University, Baltimore, Maryland

3California Department of Public Health, Richmond

4McMaster University, Hamilton, Ontario, Canada

5National Jewish Health, Denver, Colorado

6World Health Organization, Geneva, Switzerland

7Tuberculosis Control Section, San Francisco Department of Public Health, California

8Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

9Harvard Medical School, Boston, Massachusetts

10McGill University, Montreal, Quebec, Canada

11WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy

12Tuberculosis Control Program, Seattle and King County Public Health, and University of Washington, Seattle

13Ethics Advisory Group, International Union Against TB and Lung Disease, Paris, France

14University of Florida, Gainesville

15Boston University, Massachusetts

16Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa

17University of Sassari, Italy

18Baylor College of Medicine, Houston, Texas

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.


September 21, 2016 at 4:52 pm

IDSA GUIDELINE – 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

Clinical Infectious Diseases September 15, 2016 V.63 N.6 e112-e146

John N. Galgiani, Neil M. Ampel, Janis E. Blair, Antonino Catanzaro, Francesca Geertsma, Susan E. Hoover, Royce H. Johnson, Shimon Kusne, Jeffrey Lisse, Joel D. MacDonald, Shari L. Meyerson, Patricia B. Raksin, John Siever, David A. Stevens, Rebecca Sunenshine, and Nicholas Theodore

1Valley Fever Center for Excellence

2Division of Infectious Diseases, University of Arizona, Tucson

3Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona

4Division of Pulmonary and Critical Care, University of California, San Diego

5Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California

6Division of Sanford Health, Sioux Falls, South Dakota

7David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California

8Department of Rheumatology, University of Arizona, Tucson

9Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City

10Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine

11Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois

12Arizona Pulmonary Specialists, Ltd, Phoenix

13Division of Infectious Diseases, Stanford University School of Medicine, California

14Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention

15Maricopa County Department of Public Health

16Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.


Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.


September 21, 2016 at 4:50 pm

Review article: novel therapies for hepatitis B virus cure – advances and perspectives.

Aliment Pharmacol Ther. 2016 Aug V.44 N.3 P.213-22.

Lin CL1,2, Kao JH3,4,5,6.

Author information

1Department of Gastroenterology, Renai branch, Taipei City Hospital, Taipei, Taiwan.

2Department of Psychology, National Chengchi University, Taipei, Taiwan.

3Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

5Hepatitis Research Center, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan.

6Department of Medical Research, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan.



Current anti-viral therapies, interferon and nucleos(t)ide analogues, have been proven to reduce the progression of chronic hepatitis B (CHB). However, covalently closed circular DNA (cccDNA) of hepatitis B virus (HBV)  persists, resulting in viral relapse after the discontinuation of treatment.



To discuss and review novel therapies for chronic hepatitis B infection.



Recent published studies which searched from PubMed were comprehensive reviewed. The key words include chronic hepatitis B, hepatitis B virus cure, covalently closed circular DNA, direct acting anti-virals and host targeting agents.



Several novel agents through viral and host targets approaches are under investigations towards functional cure of HBV. On the one hand, direct acting anti-virals targeting virus itself, such as HBV new polymerase inhibitor,  entry inhibitor, engineered site-specific nucleases and RNA interference, could inhibit amplification of cccDNA as well as intrahepatic HBV infection and eliminate or silence cccDNA transcription. Inhibitors of HBV nucleocapsid assembly suppress capsid formation and prevent synthesis of HBV DNA. On the other hand, host targeting agents (HTA) include lymphotoxin-β receptor agonist, toll-like receptor agonist, immune checkpoint inhibitors and adenovirus-based therapeutic vaccine. Through enhancing innate and adaptive immune responses, these agents could induce noncytolytic destruction of cccDNA or attack HBV-infected hepatocytes.



With these promising approaches, we hope to reach global hepatitis B virus control in the middle of this century.



September 10, 2016 at 10:30 am

Clinical approach to fever of unknown origin in children.

J Microbiol Immunol Infect. 2015 Oct 9.

Chien YL1, Huang FL2, Huang CM2, Chen PY3.

Author information

1Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, Lin Shin Medical Corporation Lin Shin Hospital, Taichung, Taiwan.

2Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.

3Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address:



Fever of unknown origin (FUO) can be caused by many clinical conditions and remains a diagnostic challenge in clinical practice. The etiology of FUO varies markedly among different age groups, geographic areas, and seasons. A four-stage investigative protocol for FUO is widely applied in clinical practice. The aim of this study was to evaluate the usefulness of this four-stage protocol for identifying the etiology of FUO in children.


We enrolled children younger than 18 years of age who were admitted to the Taichung Veterans General Hospital during the period from January 2006 to December 2014 with FUO persisting for more than 3 weeks. The four-stage FUO investigative guideline was used to evaluate the etiology of fever in all patients enrolled in the study.


The etiology of FUO was identified in 79 (84.9%) of the 93 patients enrolled in the study. The most common cause of FUO was infectious disease (37.6%), followed by malignancy (17.2%), miscellaneous disease (16.1%), and collagen vascular disease (14.0%). With respect to the four-stage survey of FUO, 36 of the 79 patients (45.6%) were identified in Stage 3, 28 patients (35.4%) in Stage 2, 13 patients (16.5%) in Stage 4, and only two patients (2.5%) in Stage 1.


A well-designed systemic review of the epidemiological information, medical history, physical examination, laboratory analysis, and adequate invasive procedures provide adequate data to identify the most common causes of FUO in children.


September 8, 2016 at 4:55 pm

Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

Clinical Infectious Diseases September 15, 2016 V.63 N.5 P. 575-582


Andre C. Kalil, Mark L. Metersky, Michael Klompas, John Muscedere, Daniel A. Sweeney, Lucy B. Palmer, Lena M. Napolitano, Naomi P. O’Grady, John G. Bartlett, Jordi Carratalà, Ali A. El Solh, Santiago Ewig, Paul D. Fey, Thomas M. File, Jr, Marcos I. Restrepo, Jason A. Roberts, Grant W. Waterer, Peggy Cruse, Shandra L. Knight, and Jan L. Brozek

1Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha

2Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington

3Brigham and Women’s Hospital and Harvard Medical School

4Harvard Pilgrim Health Care Institute, Boston, Massachusetts

5Department of Medicine, Critical Care Program, Queens University, Kingston, Ontario, Canada

6Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego

7Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook

8Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Michigan, Ann Arbor

9Department of Critical Care Medicine, National Institutes of Health, Bethesda

10Johns Hopkins University School of Medicine, Baltimore, Maryland

11Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona, Spain

12Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York

13Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany

14Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha

15Summa Health System, Akron, Ohio

16Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio

17Burns, Trauma and Critical Care Research Centre, The University of Queensland

18Royal Brisbane and Women’s Hospital, Queensland

19School of Medicine and Pharmacology, University of Western Australia, Perth, Australia

20Library and Knowledge Services, National Jewish Health, Denver, Colorado

21Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.


These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel’s recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.



August 22, 2016 at 9:09 am

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).

World J Emerg Surg. 2016 Jul 15;11:33.

Sartelli M, Weber DG, Ruppé E, Bassetti M, Wright BJ, Ansaloni L, Catena F, Coccolini F, Abu-Zidan FM, Coimbra R, Moore EE, Moore FA, Maier RV, De Waele JJ, Kirkpatrick AW, Griffiths EA, Eckmann C, Brink AJ, Mazuski JE, May AK, Sawyer RG, Mertz D, Montravers P, Kumar A, Roberts JA, Vincent JL, Watkins RR, Lowman W, Spellberg B, Abbott IJ, Adesunkanmi AK, Al-Dahir S, Al-Hasan MN, Agresta F, Althani AA, Ansari S, Ansumana R, Augustin G, Bala M, Balogh ZJ, Baraket O, Bhangu A, Beltrán MA, Bernhard M, Biffl WL, Boermeester MA, Brecher SM, Cherry-Bukowiec JR, Buyne OR, Cainzos MA, Cairns KA, Camacho-Ortiz A, Chandy SJ, Che Jusoh A, Chichom-Mefire A, Colijn C, Corcione F, Cui Y, Curcio D, Delibegovic S, Demetrashvili Z, De Simone B, Dhingra S, Diaz JJ, Di Carlo I, Dillip A, Di Saverio S, Doyle MP, Dorj G, Dogjani A, Dupont H, Eachempati SR, Enani MA, Egiev VN, Elmangory MM, Ferrada P, Fitchett JR, Fraga GP, Guessennd N, Giamarellou H, Ghnnam W, Gkiokas G, Goldberg SR, Gomes CA, Gomi H, Guzmán-Blanco M, Haque M, Hansen S, Hecker A, Heizmann WR, Herzog T, Hodonou AM, Hong SK, Kafka-Ritsch R, Kaplan LJ, Kapoor G, Karamarkovic A, Kees MG, Kenig J, Kiguba R, Kim PK, Kluger Y, Khokha V, Koike K, Kok KY, Kong V, Knox MC, Inaba K, Isik A, Iskandar K, Ivatury RR, Labbate M, Labricciosa FM, Laterre PF, Latifi R, Lee JG, Lee YR, Leone M, Leppaniemi A, Li Y, Liang SY, Loho T, Maegele M, Malama S, Marei HE, Martin-Loeches I, Marwah S, Massele A, McFarlane M, Melo RB, Negoi I, Nicolau DP, Nord CE, Ofori-Asenso R, Omari AH, Ordonez CA, Ouadii M, Pereira Júnior GA, Piazza D, Pupelis G, Rawson TM, Rems M, Rizoli S, Rocha C, Sakakhushev B, Sanchez-Garcia M, Sato N, Segovia Lohse HA, Sganga G, Siribumrungwong B, Shelat VG, Soreide K, Soto R, Talving P, Tilsed JV, Timsit JF, Trueba G, Trung NT, Ulrych J, van Goor H, Vereczkei A, Vohra RS, Wani I, Uhl W, Xiao Y, Yuan KC, Zachariah SK, Zahar JR, Zakrison TL, Corcione A, Melotti RM, Viscoli C, Viale P.


Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy.

Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance.

The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally.

The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs.

The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections).

The authors hope that AGORA, involving many of the world’s leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.


August 17, 2016 at 3:19 pm

Review of the guidelines for complicated skin and soft tissue infections and intra-abdominal infections–are they applicable today?

Clin Microbiol Infect. 2008 Dec;14 Suppl 6:9-18.

Caínzos M1.

Author information

1Hospital Clínico Universitario, Medical School, Santiago de Compostela, Spain.


Difficult-to-treat infections in surgical patients, such as serious skin and soft tissue infections (SSTIs) and complicated intra-abdominal infections (cIAIs), are the cause of significant morbidity and mortality, and carry an economic burden. These surgical site infections are typically polymicrobial infections caused by a plethora of pathogens, which include difficult-to-treat organisms and multiresistant Gram-positive and Gram-negative strains. Optimal management of SSTIs and cIAIs must take into account the presence of resistant pathogens, and depends on the administration of appropriate antimicrobial therapy (i.e. the correct spectrum, route and dose in a timely fashion for a sufficient duration as well as the timely implementation of source control measures). Treatment recommendations from the Infectious Diseases Society of America and the Surgical Infection Society are available for guidance in the management of both of these infections, yet the increased global prevalence of multidrug-resistant pathogens has complicated the antibiotic selection process. Several pathogens of concern include methicillin-resistant Staphylococcus aureus, responsible for problematic postoperative infections, especially in patients with SSTIs, extended-spectrum beta-lactamase-producing Gram-negative bacteria, including CTX-M-type-producing Escherichia coli strains, and multidrug-resistant strains of Bacteroides fragilis. New empirical regimens, taking advantage of potent broad-spectrum antibiotic options, may be needed for the treatment of certain high-risk patients with surgical site infections.



August 10, 2016 at 8:34 am

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