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Find video protocols related to scientific articles indexed in Pubmed.
Frequency of the off-label use of monoclonal antibodies in clinical practice: a systematic review of the literature.
Curr Med Res Opin
PUBLISHED: 11-12-2013
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Abstract Background: The monoclonal antibodies represent novel therapeutic options for many clinical entities. This study aimed to study the frequency of the off-label use to total use of different monoclonal antibodies in clinical practice. Methods: This study systematically searched the PubMed and Scopus databases for relevant studies. Results: Fifteen studies were considered eligible for inclusion in this review. Eight of the included studies referred to the off-label use of anti-neoplastic monoclonal antibodies, three referred to immunosuppressive ones, and four to other types of monoclonal antibodies. The most studied anti-neoplastic monoclonal antibody was rituximab; which was prescribed off-label at a frequency varying between 16-75%, mostly for an unapproved diagnosis. Bevacizumab was prescribed off-label for age-related macular degeneration more often than ranibizumab, the approved monoclonal antibody for this condition. Of the immunosuppressive monoclonal antibodies, infliximab was used off-label in an average of 15.4% (range?=?2.8-25%) and adalimumab in 10.5% (range?=?0-15.4% in different years). Conclusion: The frequency of off-label use of different types of monoclonal antibodies varies, but appears to be considerably high for specific monoclonal antibodies or indications. In certain examples, this might reflect implementation into clinical practice of relevant scientific data, albeit not of the strength or quality that suffices for receipt of regulatory approval. In others, it might relate to the sub-optimal effectiveness and considerable toxicity of the conventional therapies. Still, the clinician should bear in mind the potential costs and toxicity that can be associated with off-label use of monoclonal antibodies.
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Antibiotic treatment of infections due to carbapenem-resistant Enterobacteriaceae: systematic evaluation of the available evidence.
Antimicrob. Agents Chemother.
PUBLISHED: 09-30-2013
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Objectives: We sought to evaluate the effectiveness of the antibiotic treatment administered for infections caused by carbapenemase-producing Enterobacteriaceae.Methods: PubMed and Scopus databases were systematically searched. Articles reporting the clinical outcomes of patients infected with carbapenemase-producing Enterobacteriaceae according to the antibiotic treatment administered were eligible.Results: Twenty non-randomized studies comprising 692 patients who received definitive treatment were included. Almost all studies reported on Klebsiella spp. In 8 studies, the majority of infections were bacteremia, while pneumonia and urinary tract infections were the most common infections in 12 studies. In 10 studies, the majority of patients were critically ill. There are methodological issues, including clinical heterogeneity, that preclude the synthesis of the available evidence using statistical analyses including meta-analysis. From the descriptive point of view, among patients who received combination treatment, mortality was up to 50% for tigecycline-gentamicin combination, up to 64% for tigecycline-colistin, and up to 67% for carbapenem-colistin. Among the monotherapy-treated patients, mortality was up to 57% for colistin and up to 80% for tigecycline. Certain regimens were administered to a small number of patients in certain studies. Three studies reporting on 194 critically ill patients with bacteremia showed individually significantly lower mortality in the combination arm compared to the monotherapy arm. In the other studies, no significant difference in mortality was recorded between the compared groups.Conclusion: Combination antibiotic treatment may be considered the optimal option for severely ill patients with severe infections. However, well-designed randomized studies in specific patient populations are needed to further clarify this issue.
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Antimicrobial activity and clinical effectiveness of sisomicin: an evaluation of the literature (1995-2011).
Expert Rev Anti Infect Ther
PUBLISHED: 04-10-2013
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The authors sought to evaluate whether sisomicin has a place in the current therapeutic armamentarium. PubMed and Scopus databases were systematically searched. Ten cohort studies and 11 case reports and case series were included evaluating, in total, 383 Gram-positive and 83 Gram-negative isolates. Sisomicin was active in vitro against 41% of Enterococcus spp., 97% of Staphylococcus spp. and was the most active in vitro (74%) aminoglycoside against Stenotrophomonas maltophilia isolates in one study. Regarding clinical effectiveness, sisomicin topical cream was effective in all 290 patients with pyoderma in one study, while the intravenous formulation of sisomicin was effective as prophylaxis for the development of postoperative pneumonia in 91% of lung surgery patients in another. In conclusion, sisomicin may be useful against certain pathogens; however, clinical data are scarce. Further studies are needed and may shed additional light in this area.
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Trimethoprim/sulfametrole: evaluation of the available clinical and pharmacokinetic/pharmacodynamic evidence.
Int. J. Antimicrob. Agents
PUBLISHED: 04-19-2011
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Emergence of resistance to widely used trimethoprim/sulfamethoxazole (TMP/SMX) as well as common adverse events in human immunodeficiency virus (HIV)-infected patients casts interest on combinations of TMP with other sulfonamides. Sulfametrole (SMT) combined with TMP could provide a choice for difficult-to-treat infections, particularly when administered intravenously. The objective of this review was to evaluate the available clinical and pharmacokinetic/pharmacodynamic (PK/PD) evidence regarding TMP/SMT, particularly in comparison with TMP/SMX. We reviewed the available evidence retrieved from searches in PubMed/Scopus/Google Scholar and by bibliography hand-searching. In total, 46 eligible studies (most published before 1997) were identified, 7 regarding intravenous (i.v.) TMP/SMT, 24 regarding oral TMP/SMT and 15 providing comparative data for TMP/SMT versus TMP/SMX. The antimicrobial activity of TMP/SMT was similar to TMP/SMX for Gram-positive isolates. A greater percentage of Escherichia coli and Proteus spp. isolates were susceptible to TMP/SMT compared with TMP/SMX. PK/PD data suggest a dosage adjustment of i.v. TMP/SMT in patients with seriously impaired renal function. Four randomised controlled trials and 16 non-comparative studies reported good effectiveness/safety outcomes for oral TMP/SMT in genital ulcers (mainly chancroid), respiratory tract infections and urinary tract infections (UTIs). Moreover, i.v. TMP/SMT was effective against Pneumocystis jiroveci infection in HIV-infected patients, severe pneumonia and UTIs. In one study, hypersensitivity reactions occurred in 18/52 (34.6%) of HIV-infected patients; 2/52 (3.8%) developed psychosis. Gastrointestinal adverse events were mild and rare. Excipients in i.v. TMP/SMT formulations might be less toxic compared with i.v. TMP/SMX formulations, particularly for children. In conclusion, despite the scarcity of contemporary evidence, available data suggest that TMP/SMT could be an alternative treatment option to TMP/SMX, even in serious infections, when administered intravenously.
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Knowledge and practices regarding prevention of infections associated with central venous catheters: a survey of intensive care unit medical and nursing staff.
Am J Infect Control
PUBLISHED: 04-15-2011
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Infections associated with central venous catheters (CVCs) are associated with considerable morbidity and mortality.
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?-D-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis.
Clin. Infect. Dis.
PUBLISHED: 03-04-2011
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We aimed to assess the accuracy of measuring serum or plasma (1?3)-?-D-glucan (BDG) for the diagnosis of invasive fungal infections (IFIs) by means of a meta-analysis of relevant studies. We searched in bibliographic databases for relevant cohort or case-control studies. We primarily compared BDG between patients with proven or probable IFIs (excluding Pneumocystis jirovecii infections), according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group or similar criteria, and patients without IFIs (excluding healthy individuals as controls). A total of 2979 patients (594 with proven or probable IFIs), included in 16 studies, were analyzed. The pooled sensitivity of BDG was 76.8% (95% confidence interval [CI], 67.1%-84.3%), and the specificity was 85.3% (95% CI, 79.6%-89.7%). The area under the summary receiver operating characteristic curve was 0.89. Marked statistical heterogeneity was noted. BDG has good diagnostic accuracy for distinguishing proven or probable IFIs from no IFIs. It can be useful in clinical practice, if implemented in the proper setting and interpreted after consideration of its limitations.
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Prulifloxacin: a review focusing on its use beyond respiratory and urinary tract infections.
Int. J. Antimicrob. Agents
PUBLISHED: 02-09-2011
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Prulifloxacin is a fluoroquinolone antibiotic that has been approved in several European countries for the treatment of lower urinary tract infections and exacerbations of chronic bronchitis. In this review, PubMed and Scopus databases were searched for potential uses of prulifloxacin beyond respiratory and urinary tract infections. Nine individual articles (eight randomised controlled trials and one cohort study) were regarded as eligible for inclusion in the review. Three of the studies were double-blinded, whilst six were open-label trials. Three studies referred to the treatment of patients with chronic bacterial prostatitis (CBP), one to prophylaxis of patients undergoing transrectal prostate biopsy, one to prophylaxis of women undergoing surgical abortion, two to patients with travellers diarrhoea, one to diabetic patients with soft tissue infections or osteomyelitis, and one to improving tolerance of Bacillus Calmette-Guérin (BCG) instillations in patients with bladder cancer. Regarding CBP, prulifloxacin was non-inferior to its comparators, with a trend towards better microbiological outcomes at follow-up. Regarding travellers diarrhoea, prulifloxacin resulted in better clinical and microbiological outcomes compared with placebo. Finally, prulifloxacin decreased the adverse events associated with BCG instillations in patients with bladder cancer, without affecting cancer recurrence rates. In summary, prulifloxacin appears to be a promising agent for the treatment of bacterial prostatitis and travellers diarrhoea.
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Once versus multiple daily dosing of aminoglycosides for patients with febrile neutropenia: a systematic review and meta-analysis.
J. Antimicrob. Chemother.
PUBLISHED: 12-03-2010
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Once daily dosing (ODD) of aminoglycosides has become a standard of care for most patient populations. However, the use of ODD of aminoglycosides has not been clarified in febrile neutropenia.
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Fosfomycin versus other antibiotics for the treatment of cystitis: a meta-analysis of randomized controlled trials.
J. Antimicrob. Chemother.
PUBLISHED: 06-29-2010
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Cystitis is a common infection. The alarmingly high resistance rates exhibited by contemporary uropathogens necessitate the re-evaluation of old antibiotics.
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Antiviral treatment for severe EBV infections in apparently immunocompetent patients.
J. Clin. Virol.
PUBLISHED: 06-16-2010
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Infectious mononucleosis usually runs a mild self-limiting course. Complications arise rarely and when so, corticosteroids are the mainstay of their treatment. The role of antivirals in the management of severe EBV infections is debatable.
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Case-control studies reporting on risk factors for emergence of antimicrobial resistance: bias associated with the selection of the control group.
Microb. Drug Resist.
PUBLISHED: 06-07-2010
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The optimal control group for case-control studies examining antibiotics as risk factors for the emergence of antimicrobial resistance is patients selected randomly from the total hospital population, while the selection of patients with a susceptible bacterium is deemed suboptimal. We sought to theoretically elaborate on potential parameters that introduce bias associated with the use of randomly selected control subjects, based on personal experience and data from the literature. In addition, we considered parameters that introduce potential bias associated with the definition of case patients. Parameters that may introduce potential bias associated with the randomly selected control subjects are use of antibiotics in the community (background exposure), availability of an antibiotic in a country, ability to purchase specific antibiotics or health care, the bacterial resistance pattern in the country, in vitro evaluation issues, source of admitting patients (nursing home or community), type of hospital to which patients are admitted (general or disease specific), and ward of hospital to which patients are admitted. Parameters that may introduce potential bias associated with the case definition are multidrug resistance versus resistance to only one antibiotic, resistance phenotype of the microbe, multistep versus one-step development of resistance, appropriateness versus adequacy of antibiotic treatment, antibiotic synergy, details regarding the daily dose and duration of administration of the specific antibiotic, and use of other antibiotics. In conclusion, selection of control subjects from the hospital population is also associated with bias. The most acceptable solutions to evaluate the risk factors for antimicrobial resistance are probably the case-control-control study design and the case-case-control study design.
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Antimicrobial susceptibility of Gram-negative nonurinary bacteria to fosfomycin and other antimicrobials.
Future Microbiol
PUBLISHED: 06-05-2010
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Fosfomycin is an antimicrobial commonly used in uncomplicated urinary tract infections. The microbiological effectiveness of fosfomycin against nonurinary Gram-negative isolates has not been widely investigated. The aim of this study was to evaluate the in vitro activity of fosfomycin against Gram-negative nonurinary isolates in a region of Greece where considerable antimicrobial resistance has been detected.
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Tuberculosis of the oral cavity: a systematic review.
Eur. J. Oral Sci.
PUBLISHED: 05-22-2010
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The recent increase in the incidence of tuberculosis, combined with an emerging global resistance to antituberculous drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in persistent or atypical lesions in the oral cavity. We sought to review the published reports of mycobacterial infection of the oral cavity found in the literature in otherwise uncompromised patients, from 1950 to the present day, and analyzed the documented manifestations. M. tuberculosis infects all parts of the mouth (soft and hard palate, uvula, buccal mucosa, gingivae, lips, tongue, maxilla, and mandible) more often in men than in women, appearing predominantly in the form of ulcerative lesions. It was found as a secondary infection in 58% (54% pulmonary, 4% extrapulmonary) of patients and as a primary infection in 42% of patients. Carcinomas are found to co-exist in the same lesion site in 3% of patients. In approximately 50% of patients, an oral manifestation of TB has led to the diagnosis of a previously unknown systemic infection, which resulted in a timely and effective treatment. The investigation for tuberculosis should therefore be actively pursued in the dental surgery. Diagnostic work-up for systemic involvement and control of healthcare-associated spread is important, while therapeutic options are still considered adequate.
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Effectiveness and safety of neuraminidase inhibitors in reducing influenza complications: a meta-analysis of randomized controlled trials.
J. Antimicrob. Chemother.
PUBLISHED: 05-20-2010
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Several studies suggest that neuraminidase inhibitors (NIs) can reduce the duration of influenza symptoms. However, data regarding their effectiveness in reducing influenza complications are scarce.
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Resistance to polymyxins: Mechanisms, frequency and treatment options.
Drug Resist. Updat.
PUBLISHED: 04-27-2010
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Polymyxins act by binding to lipid A moiety of the bacterial lipopolysaccharide and subsequently disintegrating the bacterial membranes. The most important mechanism of resistance includes modifications of the bacterial outer membrane structure, including lipopolysaccharide. Lipopolysaccharide modification is mostly mediated by PmrA/PmrB and PhoP/PhoQ two-component regulatory systems. These mechanisms exist with some differences in many gram-negative bacterial species. Resistance to polymyxins is generally less than 10%. In specific regions, such as the Mediterranean basin, Korea and Singapore, they tend to be higher. Heteroresistance to polymyxins is associated with exposure to polymyxins and especially suboptimal therapeutic dosage. Polymyxin combination regimens, tigecycline and fosfomycin may be useful options for the treatment of polymyxin-resistant gram-negative infections.
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Evaluation of a direct test for seasonal influenza in outpatients.
Eur. J. Intern. Med.
PUBLISHED: 04-20-2010
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To present our experience regarding the use of a rapid diagnostic test for seasonal influenza A and B.
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Synergy of fosfomycin with other antibiotics for Gram-positive and Gram-negative bacteria.
Eur. J. Clin. Pharmacol.
PUBLISHED: 01-26-2010
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The alarming increase in drug resistance and decreased production of new antibiotics necessitate the evaluation of combinations of existing antibiotics. Fosfomycin shows no cross-resistance to other antibiotic classes. Thus, its combination with other antibiotics may potentially show synergy against resistant bacteria.
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Treatment options for 2009 H1N1 influenza: evaluation of the published evidence.
Int. J. Antimicrob. Agents
PUBLISHED: 01-19-2010
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We evaluated the evidence regarding the effectiveness of various treatment strategies used for 2009 H1N1 influenza by reviewing available relevant studies. In total, 22 studies (15 cohort studies involving >10 patients, 5 cohort studies with < or = 10 patients and 2 case reports) were included. A total of 3020 patients [1068 (35.4%) critically ill, 1722 (57.0%) hospitalised and 230 (7.6%) outpatients, including 909 (30.1%) children] were involved. Notably, 487 (16.1%) were obese [body mass index (BMI) >30)], 362 (12.0%) had asthma or chronic obstructive pulmonary disease and 255 (8.4%) were pregnant. Antiviral treatment was administered to 1622 patients (53.7%), of whom 661 (40.8%) received oseltamivir monotherapy. Corticosteroids were administered in 323 (31.8%) of 1016 patients for whom relevant data were available. Similarly, 633 (85.0%) of 745 patients received antibiotics. Comparative data from the largest included study (involving 1088 patients) indicated that administration of antivirals within 2 days from symptom onset was significantly associated with reduced mortality (P<0.001). In summary, the scarcity of comparative available data hampered the establishment of any firm conclusions regarding the benefit that various treatment strategies may confer to patients with 2009 H1N1 influenza. Studies with a comparative design, as well as randomised studies are needed to clarify further this issue of major importance.
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Chronic bacterial and parasitic infections and cancer: a review.
J Infect Dev Ctries
PUBLISHED: 01-07-2010
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A relatively underestimated facet of infectious diseases is the association of chronic bacterial and parasitic infections with cancer development. Therefore, we sought to evaluate the evidence regarding the association of such infections with the development of malignancy, excluding the overwhelming evidence of the association of Helicobacter pylori and cancer.
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Increasing contribution of China in modern biomedical research. Statistical data from ISI Web of Knowledge.
Med. Sci. Monit.
PUBLISHED: 12-01-2009
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China is one of the most rapidly developing countries with a huge population spreading on a chaotic area. For centuries Chinese medicine was based on tradition, religion and experience. However, the last two decades under the pressure of globalization Chinese medicine is turning gradually to evidence-based medicine, contributing in international biomedical research.
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Attributable mortality of Stenotrophomonas maltophilia infections: a systematic review of the literature.
Future Microbiol
PUBLISHED: 11-10-2009
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Although Stenotrophomonas maltophilia is commonly isolated from clinical specimens, mainly of immunocompromised patients, mortality directly attributable to this organism is controversial. We searched PubMed, Scopus and Cochrane and assessed the available literature regarding mortality attributable to infection with S. maltophilia.
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Susceptibility of urinary tract bacteria to fosfomycin.
Antimicrob. Agents Chemother.
PUBLISHED: 08-17-2009
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We evaluated the in vitro activity of fosfomycin against urinary isolates in a region in Greece that exhibits considerable antimicrobial resistance by evaluating retrospectively relevant susceptibility data retrieved from the microbiological library of the University Hospital of Heraklion, Crete, Greece. We examined 578 urinary isolates. In total, 516 (89.2%) were susceptible to fosfomycin; 415 isolates were gram negative, and 101 isolates were gram positive. Fosfomycin appears to exhibit good levels of in vitro activity against the examined urinary isolates.
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Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients.
Int. J. Antimicrob. Agents
PUBLISHED: 07-28-2009
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It is unclear whether the effectiveness of polymyxins depends on the site of infection, the responsible pathogen, dosage, and monotherapy vs. combination therapy. We investigated colistin therapy in a large, retrospective, single-centre, cohort study. Primary analysis outcomes were infection outcome, survival and nephrotoxicity. Over a 7-year period (October 2000 to October 2007), 258 patients received intravenous (i.v.) colistin for at least 72h for microbiologically documented multidrug-resistant Gram-negative bacterial infections, comprising 170 (65.9%) Acinetobacter baumannii, 68 (26.4%) Pseudomonas aeruginosa, 18 (7.0%) Klebsiella pneumoniae, 1 (0.4%) Stenotrophomonas maltophilia and 1 (0.4%) Enterobacter cloacae. Cure of infection occurred in 79.1% of patients, nephrotoxicity in 10% and hospital survival in 65.1%. In the multivariate analysis, independent predictors of survival were colistin average daily dose [adjusted odds ratio (aOR)=1.22, 95% confidence interval (CI) 1.05-1.42] and cure of infection (aOR=9, 95% CI 3.6-23.1), whilst the proportion of creatinine change (aOR=0.21, 95% CI 0.1-0.45), Acute Physiology and Chronic Health Evaluation (APACHE) II score (aOR=0.89, 95% CI 0.84-0.95) and haematological disease (aOR=0.23, 95% CI 0.08-0.66) were associated with mortality. Effectiveness of colistin was not dependent on the type of pathogen. No independent predictors for nephrotoxicity were observed. The findings of the largest cohort study to date on i.v. colistin show that colistin is a valuable antibiotic with acceptable nephrotoxicity and considerable effectiveness that depends on the daily dosage and infection site.
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Do PubMed and Google searches help medical students and young doctors reach the correct diagnosis? A pilot study.
Eur. J. Intern. Med.
PUBLISHED: 07-23-2009
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In the era of the World Wide Web we sought to examine whether the use of PubMed and Google can help physicians to improve their diagnostic skills.
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Fosfomycin for the treatment of infections caused by Gram-positive cocci with advanced antimicrobial drug resistance: a review of microbiological, animal and clinical studies.
Expert Opin Investig Drugs
PUBLISHED: 06-25-2009
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The advancing antimicrobial drug resistance in Gram-positive cocci complicates the selection of appropriate therapy. The re-evaluation of older antibiotics may prove useful in expanding relevant therapeutic options.
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Linezolid for patients with neutropenia: are bacteriostatic agents appropriate?
Expert Rev Anti Infect Ther
PUBLISHED: 04-30-2009
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A long-held doctrine is that bactericidal antibiotics are required for infections in neutropenic patients. We evaluated the available published evidence regarding the role of linezolid, a bacteriostatic antibiotic, in neutropenic patients with Gram-positive infection. We retrieved two prospective comparative studies (one of them a double-blind, randomized, controlled trial), a prospective cohort study, two retrospective studies and eight case reports that focused on the use of linezolid for Gram-positive bacterial infections in neutropenic patients. Linezolid was administered to 438 neutropenic patients, mainly on a compassionate-use basis, as other antibiotics failed to cure the infection or were associated with significant adverse events. The clinical cure rate ranged between 57 and 87.3% in the intention-to-treat population of the prospective studies. In total, 56 out of 438 (12.7%) neutropenic patients that received linezolid died during therapy. In the only randomized controlled trial that compared linezolid with vancomycin in the treatment of Gram-positive infections in neutropenic patients, mortality was 5.6 versus 7.6%, respectively (p = 0.4). In conclusion, the available evidence suggests that linezolid may be successful in a significant proportion of neutropenic patients with infection, despite the fact that it is a bacteriostatic agent. Such data seem to justify further studies regarding the role of linezolid in this patient population.
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Meta-analyses on the optimization of the duration of antimicrobial treatment for various infections.
Infect. Dis. Clin. North Am.
PUBLISHED: 04-28-2009
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A mainstay of antibiotic treatment is its optimal duration for the management of infections. Many randomized control trials have been conducted on these issues during the last years. The results from these randomized control trials have been analyzed by various meta-analyses. To address the role of meta-analyses that compared a short-duration with a long-duration of the same antibiotic treatment for various infections a search was made in PubMed, Scopus, and Cochrane databases for relevant meta-analyses.
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Fosfomycin for the treatment of infections caused by multidrug-resistant non-fermenting Gram-negative bacilli: a systematic review of microbiological, animal and clinical studies.
Int. J. Antimicrob. Agents
PUBLISHED: 03-09-2009
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The treatment of multidrug-resistant (MDR), extensively drug-resistant or pandrug-resistant non-fermenting Gram-negative bacterial infections constitutes a challenge in an era of few new antibiotic choices. This mandates the re-evaluation of already existing antibiotics such as fosfomycin. We systematically reviewed the literature to assess the clinical and microbiological effectiveness of fosfomycin in the treatment of these infections by searching PubMed, Scopus and the Cochrane Library databases. In 23 microbiological studies identified, 1859 MDR non-fermenting Gram-negative bacterial isolates were examined. The susceptibility rate to fosfomycin of MDR Pseudomonas aeruginosa isolates was >or=90% and 50-90% in 7/19 and 4/19 relevant studies, respectively. Cumulatively, 511/1693 (30.2%) MDR P. aeruginosa isolates were susceptible to fosfomycin. Serotype O12 isolates exhibited greater susceptibility. Only 3/85 (3.5%) MDR Acinetobacter baumannii and 0/31 MDR Burkholderia spp. isolates were susceptible to fosfomycin. Variable criteria of susceptibility were used in the included studies. Fosfomycin was synergistic in combination with a beta-lactam, aminoglycoside or ciprofloxacin in 46/86 (53.5%) MDR P. aeruginosa isolates. One animal study found a good therapeutic effect of the combination fosfomycin/gentamicin against MDR P. aeruginosa endocarditis. In six clinical studies, 33 patients with MDR P. aeruginosa infections (mainly pulmonary exacerbations of cystic fibrosis) received fosfomycin (25/33 in combination with other antibiotics); 91% of the patients clinically improved. In conclusion, fosfomycin could have a role as a therapeutic option against MDR P. aeruginosa infections. Further research is needed to clarify the potential utility of this agent.
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Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials.
J. Infect.
PUBLISHED: 02-04-2009
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Acute uncomplicated cystitis is one of the most common bacterial infections in women and is conventionally treated with antibiotics. However, emergence of resistant uropathogens forces physicians to reconsider the prescription of antibiotics for acute uncomplicated cystitis in non-pregnant young women.
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Systemic colistin use in children without cystic fibrosis: a systematic review of the literature.
Int. J. Antimicrob. Agents
PUBLISHED: 01-24-2009
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The increasing incidence of multidrug-resistant (MDR) Gram-negative infections necessitates the use of neglected antibiotics such as colistin, even in the paediatric field. The objective of this review was to evaluate the available clinical evidence regarding the effectiveness and safety of systemic colistin in children without cystic fibrosis (CF). Relevant articles were identified from PubMed, Cochrane and Scopus databases. Ten case series and fifteen case reports, including a total of 370 children, were eligible for inclusion in this systematic review. Only 17 of the children were included in studies published after 1977. A total of 326 children received colistin for the treatment of infections and 44 for surgical prophylaxis or prophylaxis of infections in burns patients. Regarding the clinical outcome, 271 of 311 children included in the identified cases series were evaluable. From these 271 children, 235 (86.7%) were cured of the infection, 10/271 (3.7%) improved, 6/271 (2.2%) deteriorated and 20/271 (7.4%) died. Fourteen (70%) of the 20 deaths were attributed to the infection. No infection occurred in the 44 reported children with burns or surgical morbidity who received colistin for prophylaxis. Of these 44 children, 9 (20.5%) died; all deaths were attributed to co-morbidity. Nephrotoxicity occurred in 10/355 (2.8%) of the evaluable children in cases series included in this review. Most of the identified relevant case reports focused on treatment complications. The available evidence, mainly from old case series, suggests that systemic colistin is an effective and acceptably safe option for the treatment of children without CF who have MDR Gram-negative infections.
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Inhaled colistin as monotherapy for multidrug-resistant gram (-) nosocomial pneumonia: a case series.
Respir Med
PUBLISHED: 01-03-2009
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Reports of patients with polymyxin-only susceptible gram-negative nosocomial pneumonia treated with inhaled, but without concurrent intravenous, colistin are rare.
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Frequency of the off-label use of antibiotics in clinical practice: a systematic review.
Expert Rev Anti Infect Ther
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Antibiotics constitute a major class among drugs commonly prescribed either empirically or for microbiologically documented infections in clinical practice. In addition, due to medical necessity physicians are forced, at times, to prescribe medications for off-label indications. The authors sought to record the frequency of the off-label use of antibiotics among both adult and pediatric patients. PubMed and Scopus databases were searched to identify relevant studies. A total of 25 studies met the inclusion criteria (725,124,505 prescriptions); 16 were prospective and nine retrospective. Fifteen studies reported on the pediatric population, seven on adults who had received a specific antibiotic, two on adult critical-care patients, and one on the general outpatient population. In the pediatric population, the percentage of off-label prescriptions varied from 1 to 94%. Off-label prescriptions varied from 19 to 43% in adult critical-care patients. Last, one study reporting on general outpatient care showed that 23% of prescriptions were off-label. Antibiotics are frequently prescribed as off-label among patient populations. The wide variation observed in the off-label use of antibiotics among pediatric patients might be attributed to the heterogeneity among the study populations regarding the age of children. Although this unapproved manner of prescribing cannot always be avoided, clinicians should only use unapproved drugs in cases when there are no effective alternatives are available and based on scientific evidence regarding safety and effectiveness.
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Predictors of mortality in patients with infections due to multi-drug resistant Gram negative bacteria: the study, the patient, the bug or the drug?
J. Infect.
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To study the predictors of mortality among patients with multi-drug resistant Gram negative (MDRGN) infections and the role of MDRGN bacteria in the outcome of such patients.
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Impact of vancomycin minimum inhibitory concentration on clinical outcomes of patients with vancomycin-susceptible Staphylococcus aureus infections: a meta-analysis and meta-regression.
Int. J. Antimicrob. Agents
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Although the vancomycin minimum inhibitory concentration (VMIC) susceptibility breakpoint for Staphylococcus aureus was recently lowered to ?2 mg/L, it is argued that isolates in the higher levels of the susceptible range may bear adverse clinical outcomes. Clinical outcomes (all-cause mortality and treatment failure) of patients with S. aureus infections by high-VMIC (conventionally defined as VMIC >1 mg/L but ?2 mg/L) and low-VMIC (VMIC?1 mg/L) isolates were compared by performing a systematic review and meta-analysis. The effect of potential confounders was assessed by univariate meta-regression analyses. In total, 33 studies (6210 patients) were included. Most studies were retrospective (28/33), used the Etest (22/33) and referred to meticillin-resistant S. aureus (MRSA) infections (26/33) and bacteraemia (23/33). Irrespective of VMIC testing method, meticillin resistance and site of infection, the high-VMIC group had higher mortality [relative risk (RR)=1.21 (95% confidence interval 1.03-1.43); 4612 patients] and more treatment failures [RR=1.67 (1.26-2.21); 2049 patients] than the low-VMIC group. The results were not affected by the potential confounders and were reproduced in the subset of patients with MRSA infections [mortality, RR=1.19 (1.02-1.40), 2956 patients; treatment failure, RR=1.69 (1.26-2.25), 1793 patients]. In conclusion, infection by vancomycin-susceptible S. aureus with VMIC>1mg/L appears to be associated with higher mortality than VMIC?1mg/L. Further research is warranted to verify these results and to assess the impact of VMIC on meticillin-susceptible S. aureus infections. Evaluation of alternative antimicrobial agents also appears justified.
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Risk factors for development of Clostridium difficile infection due to BI/NAP1/027 strain: a meta-analysis.
Int. J. Infect. Dis.
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To identify risk factors for the development of Clostridium difficile infection (CDI) due to C. difficile BI/NAP1/027 strain.
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Efficacy and safety of telavancin in clinical trials: a systematic review and meta-analysis.
PLoS ONE
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The epidemiology and antibiotic resistance of Staphylococcus aureus have evolved, underscoring the need for novel antibiotics, particularly against methicillin-resistant S. aureus (MRSA). Telavancin is a bactericidal lipoglycopeptide with potent activity against Gram-positive pathogens.
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Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum ?-lactamases: a systematic review and meta-analysis.
J. Antimicrob. Chemother.
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To study the comparative mortality associated with carbapenems and alternative antibiotics for the treatment of patients with extended-spectrum ?-lactamase (ESBL)-positive Enterobacteriaceae bacteraemia.
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Impact of antibiotic MIC on infection outcome in patients with susceptible Gram-negative bacteria: a systematic review and meta-analysis.
Antimicrob. Agents Chemother.
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The objective of this study was to analyze the impact of MIC values within the susceptible range of antibiotics on the outcomes of patients with Gram-negative infections. The PubMed and Scopus electronic databases were searched. We identified 13 articles (1,469 patients) that studied the impact of antibiotic MICs on the outcomes of infections; ?-lactams were studied in 10 of them. Infections due to Salmonella enterica strains with high fluoroquinolone MICs were associated with more treatment failures than those due to strains with low MICs (relative risk [RR], 5.75; 95% confidence interval [CI], 1.77 to 18.71). Among non-Salmonella enterobacteriaceae, there was no difference in treatment failures depending on the MIC value (RR, 1.18; 95% CI, 0.71 to 1.97); however, a higher all-cause mortality was observed for patients infected with strains with high MICs (RR, 2.03; 95% CI, 1.05 to 3.92). More treatment failures were observed for patients infected with nonfermentative Gram-negative bacilli when strains had high MICs (RR, 5.54; 95% CI, 2.72 to 11.27). The mortality rate for patients with infections with Gram-negative nonfermentative bacilli with high MICs was also higher than for those with low MICs (RR, 2.39; 95% CI, 1.19 to 4.81). The limited available data suggest that there is an association between high MICs, within the susceptible range, and adverse outcomes for patients with Gram-negative infections.
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Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence.
Int. J. Antimicrob. Agents
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The objective of this review was to evaluate the frequency of treatment failure and recurrence of Clostridium difficile infection (CDI) following treatment with vancomycin or metronidazole in recently performed studies (last 10 years). Searches in PubMed and Scopus were performed by two reviewers independently. Data regarding treatment failure and recurrence following metronidazole and vancomycin treatment were extracted and analysed. In total, 39 articles (7005 patients) were selected for inclusion in the systematic review. The reported treatment failure was 22.4% with metronidazole (16 studies) and 14.2% with vancomycin (8 studies). Recurrence of CDI occurred in 27.1% of patients following metronidazole treatment (18 studies) and 24.0% of patients following vancomycin treatment (8 studies). Mean treatment failure and recurrence in the selected studies was 22.3% (24 studies) and 22.1% (37 studies). The reported outcomes depended on the study design (higher in prospective and retrospective cohort studies than in randomised controlled trials), geographic location of the study (higher in North America than in Europe and Asia), funding (higher in studies funded by non-profit organisations than pharmaceutical companies), mean age of the studied population (higher in older patients) and duration of follow-up (higher in studies with follow-up >1 month). In conclusion, infection with C. difficile is associated with 22.4% and 14.2% treatment failure and 27.1% and 24.0% recurrence after treatment with metronidazole and vancomycin, respectively. The variation in the reported outcomes amongst studies depends on the study design, location, funding, age and follow-up period.
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Susceptibility of Gram-negative bacteria to isepamicin: a systematic review.
Expert Rev Anti Infect Ther
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We sought to review the potential role of isepamicin against infections with contemporary Gram-negative bacteria. We searched PubMed and Scopus databases to identify relevant microbiological and clinical studies published between 2000 and 2010, and we retrieved 11 and three studies, respectively. A total of 4901 isolates were examined in the in vitro studies. Isepamicin had higher in vitro activity compared with amikacin in four studies, was as active as amikacin in six studies and in the remaining study both were inactive. Regarding specifically the studies that included multidrug-resistant bacteria, isepamicin appeared superior to amikacin in two studies, as active as amikacin in one study and both did not exhibit activity in one study. In the clinical studies, isepamicin was as active as amikacin for the treatment of 55 children with urinary tract infections. In conclusion, isepamicin might be active in vitro against Gram-negative bacteria with resistance to amikacin and other aminoglycosides.
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Prognostic significance of phosphorylated STAT-1 expression in premenopausal and postmenopausal patients with invasive breast cancer.
Histopathology
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? STAT-1 is the first member of the family of signal transducers and activators of transcription (STATs). In breast cancer experimental models, an apoptotic and antiproliferative effect has been demonstrated. Our aim was to study the role of phosphorylated STAT-1 (pSTAT-1) in invasive breast carcinoma and its prognostic significance in premenopausal and postmenopausal patients.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.