Posts filed under ‘Infecciones respiratorias’

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America.

Am J Respir Crit Care Med. October 1, 2019  V.200 N.7  e45-e67.

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al.

Background

This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.

Methods

A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.

Results

The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.

Conclusions

The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

 

Este documento proporciona pautas de práctica clínica basadas en evidencia sobre el manejo de pacientes adultos con NAC.

Métodos

Un panel multidisciplinario realizó revisiones sistemáticas pragmáticas de la investigación relevante y aplicó la metodología de calificación de recomendaciones, evaluación, desarrollo y evaluación para recomendaciones clínicas.

Resultados

El panel abordó 16 áreas específicas para recomendaciones que abarcan preguntas sobre pruebas de diagnóstico, determinación del sitio de atención, selección de terapia ATB empírica inicial y decisiones de manejo posteriores. Aunque algunas recomendaciones permanecen sin cambios con respecto a la guía de 2007, la disponibilidad de resultados de nuevos ensayos terapéuticos e investigaciones epidemiológicas condujo a recomendaciones revisadas para estrategias de tratamiento empírico y decisiones de manejo adicionales.

Conclusiones

El panel formuló y proporcionó la justificación de las recomendaciones sobre estrategias seleccionadas de diagnóstico y tratamiento para pacientes adultos con NAC.

FULL TEXT

https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST#_i6

PDF

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST

November 15, 2019 at 7:59 am

British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together.

BMJ Open Respir Res. May 13, 2015 V.2 N.1 :e000091. doi: 10.1136/bmjresp-2015-000091.

Lim WS1, Smith DL2, Wise MP3, Welham SA4.

Author information

1 Department of Respiratory Medicine , Nottingham City Hospital , Nottingham , UK.

2 Southmead Hospital , North Bristol Lung Centre , Bristol , UK.

3 Department of Adult Critical Care , University Hospital of Wales , Cardiff , UK.

4 British Thoracic Society , London , UK.

Abstract

The British Thoracic Society (BTS) guideline for the management of adults with community acquired pneumonia (CAP) published in 2009 was compared with the 2014 National Institute for Health and Care Excellence (NICE) Pneumonia Guideline. Of the 36 BTS recommendations that overlapped with NICE recommendations, no major differences were found in 31, including those covering key aspects of CAP management: timeliness of diagnosis and treatment, severity assessment and empirical antibiotic choice. Of the five BTS recommendations where major differences with NICE were identified, one related to antibiotic duration in low and moderate severity CAP, two to the timing of review of patients and two to legionella urinary antigen testing.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442154/pdf/bmjresp-2015-000091.pdf

November 13, 2019 at 7:17 am

Mycoplasma pneumoniae outbreak, Southeastern Finland, 2017–2018: molecular epidemiology and laboratory diagnostic lessons

European Journal of Clinical Microbiology & Infectious Diseases October 2019 V.38 N.10 P.1867–1871

This study characterizes a large Mycoplasma pneumoniae outbreak observed in Kymenlaakso in Southeastern Finland during August 2017–January 2018. The first part of the investigation included 327 patients, who sought healthcare consultation at local GPs or hospitals due to clinical symptoms, and were tested for M. pneumoniae antibodies (Patient cohort). The second part of the investigation, conducted approximately 4 weeks after the peak of the outbreak, consisted of school screening of pupils (N = 239) in three different school buildings by PCR on respiratory specimens and questionnaires (Screening cohort). PCR positive respiratory specimens were subsequently utilized for molecular typing. The outbreak peaked in late October 2017. Of the Patient cohort, 9/106 (8.5%) respiratory specimens were PCR positive. In contrast, 3/182 (1.6%) of the Screening cohort were PCR positive. Asymptomatic carriage was observed. Multiple-locus variable-number tandem-repeat analysis (MLVA) identified two distinct MLVA types. All typed M. pneumoniae strains belonged to P1 type 1. No mutations leading to macrolide resistance were observed. In total, 61/327 (19%) of the Patient cohort had a serological indication of recent infection. The IgM test reactivity at the time of a negative PCR test result varied from a completely non-reactive value up to very strong reactivity, highlighting the difficulty in a single specimen serodiagnosis.

FULL TEXT

https://link.springer.com/article/10.1007/s10096-019-03619-7?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_38_10

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03619-7.pdf

November 12, 2019 at 3:47 pm

EDITORIAL – Lefamulin-A New Antibiotic for Community-Acquired Pneumonia.

JAMA September 27, 2019   doi: 10.1001/jama.2019.16215.

Malani PN1,2.

Un arsenal de antibióticos es esencial para la atención al paciente y la salud pública. Sin embargo, en comparación con otras clases de medicamentos, el desarrollo de antibióticos presenta desafíos científicos, regulatorios y económicos únicos.

En particular, los antibióticos proporcionan menos recompensa financiera para las compañías farmacéuticas porque estos medicamentos se usan por un corto período de tiempo y los agentes más nuevos a menudo están restringidos para su uso solo en el contexto de la resistencia a los antimicrobianos.

De hecho, la mayoría de las grandes compañías farmacéuticas han reducido o interrumpido la investigación de antibióticos por completo, dejando la tarea crítica de descubrir nuevos antibióticos a pequeñas empresas con presupuestos y capacidad de investigación limitados.

Por estas y otras razones, el desarrollo y la aprobación de un nuevo antibiótico es una ocurrencia rara y una razón para celebrar.

En este número de JAMA, Alexander et al (1) informan los hallazgos del ensayo Lefamulin Evaluation Against Pneumonia 2 (LEAP 2), un ensayo de fase 3, aleatorizado, sin inferioridad que comparó lefamulina VO por 5 días con moxifloxacina VO por 7 días en el tratamiento de NAC.

En este ensayo de 738 pacientes, el resultado primario de la respuesta clínica temprana a las 96 hs (dentro de un intervalo de 24 hs) después de la 1ra dosis del fármaco del estudio fue del 90.8% en el grupo de lefamulina y del 90.8% en el grupo de moxifloxacina, una diferencia que cumplió el margen de no inferioridad del 10%.

Los pacientes en el grupo de lefamulina informaron una mayor incidencia de efectos adversos emergentes del tratamiento relacionados con el tracto GI (17,9% frente a 7,6% en el grupo de moxifloxacina), principalmente diarrea.

La lefamulina (formulación IV y oral) fue aprobada en agosto 2019 por la FDA para tratar la NAC. Esta aprobación se basó en los datos del estudio LEAP 2 actual, así como en el estudio LEAP 1 publicado anteriormente.(2)

Aunque la lefamulina ofrecerá otra opción VO para tratar la NAC, el espectro de actividad es similar a las FQ. En los últimos años, se ha prestado más atención a los efectos adversos poco comunes pero graves asociados con el uso de FQ, incluida la prolongación de Q-T, la hipoglucemia y la tendinitis y la ruptura del tendón.

El costo probablemente será una barrera para el uso de lefamulina. Un comunicado de prensa del fabricante declaró que el costo de adquisición al por mayor de lefamulina será de u$s 205 por día para el tratamiento IV y de u$s 275 por día para el tratamiento VO (3). Esto es varias veces más que la moxifloxacina o levofloxacina, que son las FQ más comúnmente recetadas para NAC.

La tolerabilidad (especialmente diarrea y vómitos) puede ser otro problema, y merece una estrecha vigilancia posterior a la comercialización. A pesar de estas preocupaciones, la lefamulina es una adición importante al arsenal antibiótico actual, especialmente porque la NAC sigue siendo una de las indicaciones más comunes para el uso de ATB (4,5).

FULL TEXT

https://jamanetwork.com/journals/jama/fullarticle/2752330

November 11, 2019 at 7:57 am

Efficacy and Safety of IV-to-Oral Lefamulin, a Pleuromutilin Antibiotic, for Treatment of Community-Acquired Bacterial Pneumonia: The Phase 3 LEAP 1 Trial.

Clinical Infectious Diseases February 4, 2019  doi: 10.1093/cid/ciz090.

File TM Jr1, Goldberg L2, Das A3, Sweeney C2, Saviski J2, Gelone SP2, Seltzer E4, Paukner S5, Wicha WW5, Talbot GH6, Gasink LB2.

Author information

1 Summa Health, Akron, OH, USA.

2 Nabriva Therapeutics US, Inc., King of Prussia, PA, USA.

3 Das Consulting, Guerneville, CA, USA.

4 Urogen Pharma, New York, NY, USA.

5 Nabriva Therapeutics GmbH, Vienna, Austria.

6 Talbot Advisors LLC, Anna Maria, FL, USA.

Abstract

BACKGROUND:

Lefamulin, a pleuromutilin antibiotic, is active against pathogens commonly causing community-acquired bacterial pneumonia (CABP). The Lefamulin Evaluation Against Pneumonia (LEAP 1) study (NCT02559310) was a global noninferiority trial to evaluate the efficacy and safety of lefamulin for the treatment of CABP.

METHODS:

In this double-blind study, adults with CABP of Pneumonia Outcomes Research Team risk class ≥III were randomized 1:1 to receive lefamulin 150 mg intravenously (IV) q12h or moxifloxacin 400 mg IV q24h. After 6 doses, patients could be switched to oral study drug if prespecified improvement criteria were met. If methicillin-resistant Staphylococcus aureus was suspected, linezolid or placebo was added to moxifloxacin or lefamulin, respectively. The US FDA primary endpoint was early clinical response (ECR) 96±24 hours after the first dose of study drug in the intent-to-treat (ITT) population (noninferiority margin, 12.5%). The EMA co-primary endpoints were investigator assessment of clinical response (IACR) 5-10 days after last dose of study drug in the modified ITT (mITT) and clinically evaluable (CE) populations (noninferiority margin, 10%).

RESULTS:

551 patients were randomized (n=276 lefamulin; n=275 moxifloxacin). Lefamulin was noninferior to moxifloxacin for ECR (87.3% vs 90.2%; difference: -2.9% [95% confidence interval: -8.5, 2.8]) and IACR (mITT, 81.7% vs 84.2%; difference -2.6% [-8.9, 3.9]; CE, 86.9% vs 89.4%; difference -2.5% [-8.4, 3.4]). Rates of study drug discontinuation due to treatment-emergent adverse events were 2.9% for lefamulin and 4.4% for moxifloxacin.

CONCLUSIONS:

Lefamulin was noninferior to moxifloxacin for the primary efficacy endpoints and was generally safe and well tolerated.

FULL TEXT

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz090/5306243

PDF (CLIC DOWNLOAD)

November 11, 2019 at 7:55 am

Diagnosis and Treatment of Adults with Community-acquired Pneumonia

Am J Respir Crit Care Med October 1, 2019 V.200 N.7 P.e45–e67

An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

FULL TEXT

https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST

PDF

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST

November 10, 2019 at 11:36 am

Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials.

Crit Care. 2018;22:191. 

Wirz Y, Meier MA, Bouadma L, et al.

FULL TEXT 

https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2125-7

 

November 10, 2019 at 11:35 am

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