Expert Rev Anti Infect Ther
· 2026 May · PMID 42138976
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INTRODUCTION: Syphilis, caused by subsp. , is a chronic sexually transmitted infection resulting in a broad spectrum of clinical manifestations showing a rising incidence at the global level. A high proportion of syphil...INTRODUCTION: Syphilis, caused by subsp. , is a chronic sexually transmitted infection resulting in a broad spectrum of clinical manifestations showing a rising incidence at the global level. A high proportion of syphilis patients have atypical manifestations that may complicate clinical recognition and lead to diagnostic uncertainty and delays in treatment, thereby increasing the risk of syphilis transmission. AREAS COVERED: We performed bibliographical searches of online databases to provide an overview of the clinical profiles observed in patients with syphilis. We also reviewed published correlations between clinical symptomatology and genotypes of the and syphilis patients. EXPERT OPINION: strains analyzed revealed differences in growth characteristics and clinical isolates showed differences in the epidemiological success of individual allelic profiles. In addition, genetic differences in the clinical isolates were found with respect to syphilis stage at the time of diagnosis, multiple primary lesions and other patient characteristics. Moreover, first examples of human genomic polymorphisms involved in syphilis susceptibility and progress of infection were discovered. These findings suggest that both genetic background of a treponemal strain and a patient contribute to the different clinical outcome of syphilis infection.
Expert Rev Anti Infect Ther
· 2026 May · PMID 42132334
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INTRODUCTION: Nontuberculous mycobacteria (NTM) are increasingly recognized as clinically significant pathogens, particularly in immunocompromised individuals and patients with chronic lung disease. A key determinant of...INTRODUCTION: Nontuberculous mycobacteria (NTM) are increasingly recognized as clinically significant pathogens, particularly in immunocompromised individuals and patients with chronic lung disease. A key determinant of their persistence and pathogenicity is the ability to form biofilms. It is important to distinguish biofilm-associated phenotypic tolerance (persistence) from genetic antimicrobial resistance. Biofilm-related persistence is transient and non-genetic, while genetic resistance involves stable heritable changes. Both mechanisms contribute to treatment failure and prolonged infection. AREAS COVERED: This review addresses the clinical and therapeutic challenges posed by biofilm-associated NTM infections. We discuss conventional multidrug regimens, the limitations imposed by biofilm physiology, and novel interventions under investigation, including enzymatic biofilm disruption, nanoparticle-based drug delivery, and bacteriophage therapy. Understanding these therapeutic paradigms in the context of biofilm biology is essential for improving outcomes in these difficult-to-treat infections.Given the growing clinical relevance of these organisms, this review primarily examines therapeutic strategies for biofilm-associated NTM infections, while also considering epidemiological and diagnostic aspects to contextualize treatment challenges. EXPERT OPINION: Treatment of biofilm-related NTM infections is extremely difficult to cure, and they usually need the implication of a multidisciplinary team for the best management of these infections, while the cure of the patients is, in many cases, impossible.
Expert Rev Anti Infect Ther
· 2026 May · PMID 42112527
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INTRODUCTION: Invasive mold infections (IMIs) remain a leading cause of morbidity and mortality in susceptible pediatric populations. Numerous challenges exist in diagnosis and management, with limited pediatric clinical...INTRODUCTION: Invasive mold infections (IMIs) remain a leading cause of morbidity and mortality in susceptible pediatric populations. Numerous challenges exist in diagnosis and management, with limited pediatric clinical trial data. AREAS COVERED: The pediatric specific epidemiology of IMIs, current diagnostic and management approaches, and recommendations are presented. The potential role of isavuconazole, a newer triazole antifungal, is evaluated. EXPERT OPINION: Treatments for IMIs in pediatric patients include mold-active triazoles, such as voriconazole and posaconazole, and liposomal amphotericin B. Isavuconazole has recently been approved for clinical use and will be a valuable addition to the antifungal armamentarium. Several agents with novel mechanisms of action are under development which show promise for the treatment of rare mold infections. Management principles in pediatric patients include prompt initiation of antifungal therapy, species identification, and susceptibility testing, clinical evaluation of other infection sites, timely source control (e.g. surgery), control of conditions predisposing patients to IMIs, and administration of supportive therapies. The pharmacology, tolerability, and safety of the newer triazole isavuconazole has been established for the treatment of pediatric patients with IMIs with supportive efficacy data. However, further larger-cohort studies are warranted to define its role relative to the existing mold-active triazoles and liposomal amphotericin B.
Expert Rev Anti Infect Ther
· 2026 May · PMID 42108950
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INTRODUCTION: Toxoplasmosis is a widespread protozoan infection that exhibits increased pathogenicity in its congenital form. The diagnosis and management of this condition require high accuracy and rapid intervention th...INTRODUCTION: Toxoplasmosis is a widespread protozoan infection that exhibits increased pathogenicity in its congenital form. The diagnosis and management of this condition require high accuracy and rapid intervention throughout the maternal-fetal and neonatal periods. AREAS COVERED: The aim of this review is to provide an updated overview of screening and diagnostic confirmation strategies for congenital toxoplasmosis, covering prenatal screening, neonatal assessment and long-term follow-up. It also examines therapeutic options for prenatal treatment based on gestational age. EXPERT OPINION: Diagnostic strategies for congenital toxoplasmosis remain highly heterogeneous worldwide, ranging from intensive prenatal screening to a complete absence of systematic testing. When implemented, screening programs promote early diagnosis and treatment, with a positive impact on transmission and disease severity. The recent withdrawal of various key serological tests has forced laboratories to adopt and validate alternative diagnostic algorithms in complex situations. Pyrimethamine-sulfonamide is the cornerstone of treatment, but its toxicity profile remains a major limitation of current management. Cotrimoxazole appears to be a better-tolerated alternative that warrants consideration, although studies are still scarce.
BACKGROUND: Pediatric data on tigecycline for multidrug-resistant infections caused by gram-negative bacteria remain scarce. We described clinical outcomes and tolerability of tigecycline in critically ill children at a...BACKGROUND: Pediatric data on tigecycline for multidrug-resistant infections caused by gram-negative bacteria remain scarce. We described clinical outcomes and tolerability of tigecycline in critically ill children at a single tertiary center. RESEARCH DESIGN AND METHODS: In this retrospective cohort study, 143 pediatric patients receiving tigecycline (1-1.2 mg/kg or 50 mg twice daily) between January 2018 and September 2023 were analyzed. Most patients (72.0%) required intensive care; 66.4% received combination therapy. Primary outcome was clinical success (infection resolution with marker normalization). Logistic regression and Cox modeling assessed success and mortality predictors; Kaplan-Meier curves compared survival. Paired laboratory data assessed tolerability. RESULTS: (72.0%) and (17.5%) predominated; 87% of isolates displayed carbapenem resistance. Clinical success reached 76.9%. Intensive care admission and combination therapy independently predicted failure. Overall infection-related mortality was 28.7%; intensive care admission was the sole independent mortality predictor. Paired laboratory values showed no significant hepatic, pancreatic, or hematological changes; one biliary sludge event was recorded. CONCLUSIONS: Tigecycline, a glycylcycline antimicrobial, was associated with favorable outcomes and acceptable tolerability in children with multidrug-resistant infections. The single-center retrospective design, absence of a control group, and frequent concomitant antibiotic use limit generalizability; prospective trials are needed.
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 42083740
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INTRODUCTION: The global rise of multidrug-resistant (MDR) Gram-negative pathogens challenges therapy, driving development of novel β-lactam/β-lactamase inhibitor (BL/BLI) combinations. Cefepime-based combinations offer...INTRODUCTION: The global rise of multidrug-resistant (MDR) Gram-negative pathogens challenges therapy, driving development of novel β-lactam/β-lactamase inhibitor (BL/BLI) combinations. Cefepime-based combinations offer mechanistically diverse options against a broad range of resistance phenotypes. AREAS COVERED: This review summarizes approved and investigational cefepime-based BL/BLI combinations, including cefepime/enmetazobactam (FEP/EMT), cefepime/taniborbactam (FTB), cefepime/zidebactam (FPZ), and cefepime/nacubactam (FEP/NAC). We discuss microbiological activity, resistance mechanisms, pharmacokinetics/pharmacodynamics, and available clinical evidence. In vitro data show differential activity against ESBL-, AmpC-, and carbapenemase-producing Enterobacterales, as well as difficult-to-treat Pseudomonas aeruginosa, with emerging but limited clinical outcomes. Challenges include incomplete resistance coverage, geographic variability, and limited clinical trials. EXPERT OPINION: Cefepime-based BL/BLI therapy should be pathogen- and mechanism-driven. FEP/EMT is suited for ESBL- and AmpC-producing Enterobacterales, potentially sparing carbapenems and covering OXA producers if susceptible. FTB may target severe carbapenem-resistant Enterobacterales infections resistant to existing BL/BLI agents, considering coverage for metallo-β-lactamases (MBL). FPZ combines β-lactamase inhibition and β-lactam-enhancer activity, retaining activity against XDR Enterobacterales and P. aeruginosa, including cefiderocol- or aztreonam/avibactam (ATM/AVI)-resistant strains. FEP/NAC shows promise against carbapenem- and MBL-producing strains, though clinical data remain limited. Optimal use relies on rapid molecular diagnostics, susceptibility testing, and antimicrobial stewardship to maximize efficacy and limit the emergence of resistance.
Guo Y, Fu J, Wang J
… +8 more, Xing L, Li J, Gao C, Zhao Y, Li Q, Ding Y, Xiao J, Zhao H
Expert Rev Anti Infect Ther
· 2026 May · PMID 42077212
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BACKGROUND: Although the high efficacy and safety of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir/lamivudine (DTG/3TC) in treatment-naïve people living with HIV (PLWH) have been well est...BACKGROUND: Although the high efficacy and safety of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir/lamivudine (DTG/3TC) in treatment-naïve people living with HIV (PLWH) have been well established, their metabolic effects remain a concern. RESEARCH DESIGN AND METHODS: We retrospectively analyzed 499 treatment-naïve PLWH who initiated BIC/FTC/TAF or DTG/3TC at Beijing Ditan Hospital between January 2021 and December 2023 to compare metabolic outcomes over a 48-week follow-up period. RESULTS: Compared to DTG/3TC, the BMI at week 48 was higher in participants receiving BIC/FTC/TAF (24.65 vs. 23.14 kg/m, = 0.023) after propensity score matching, with a greater increase from baseline (+1.10 vs. +0.71 kg/m, = 0.011). PLWH receiving BIC/FTC/TAF exhibited an increase in uric acid over 48 weeks (median change 5 μmol/L vs. -6 μmol/L, adjusted change = 0.034). No significant between-group differences were observed in the changes of lipid, glucose and renal parameters over 48 weeks. Both regimens achieved similar virologic suppression (95.5% vs. 94.5%, = 0.857) and comparable CD4 recovery (+188 vs. +173 cells/μL, = 0.726). CONCLUSION: In this cohort of treatment-naïve PLWH, initiation of BIC/FTC/TAF or DTG/3TC achieved comparable metabolic outcomes, immunologic and virologic after 48 weeks, while BIC/FTC/TAF was associated with significantly increases in BMI.
BACKGROUND: Gepotidacin, a novel oral antibacterial targeting bacterial DNA gyrase and topoisomerase IV, exhibits potent activity against Escherichia coli and Neisseria gonorrhoeae resistant strains. This systematic revi...BACKGROUND: Gepotidacin, a novel oral antibacterial targeting bacterial DNA gyrase and topoisomerase IV, exhibits potent activity against Escherichia coli and Neisseria gonorrhoeae resistant strains. This systematic review and meta-analysis assessed the efficacy and safety of gepotidacin compared with standard-of-care antibiotics in adults and adolescents with uncomplicated urogenital infections. METHODS: Randomized controlled trials comparing gepotidacin with standard antibiotic regimens for uncomplicated urinary tract infections or urogenital gonorrhea were included. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for microbiological success, clinical cure, and serious adverse events (SAEs). Risk of bias and certainty of evidence were assessed using the Cochrane RoB2 tool and GRADE approach, respectively. RESULTS: Three phase 3 trials (EAGLE-1, EAGLE-2, EAGLE-3; = 3,757) were included. Gepotidacin achieved comparable microbiological success (RR = 1.10; 95% CI: 0.96-1.27; = 0.17) and clinical cure rates (RR = 1.04; 95% CI: 0.95-1.13; = 0.39) versus standard antibiotics. SAEs were rare and balanced (RR = 0.98; 95% CI: 0.37-2.58; = 0.96). Overall risk of bias was low. CONCLUSIONS: Gepotidacin demonstrates non-inferior efficacy and comparable safety to standard antibiotics, supporting its role as a promising oral agent against resistant E. coli and N. gonorrhoeae.
INTRODUCTION: Viruses manipulate cellular pathways to support their replication, often leading to inflammatory responses through the arachidonic acid (AA)/cyclooxygenase (COX)/prostaglandin E2 (PGE) axis. Given the poten...INTRODUCTION: Viruses manipulate cellular pathways to support their replication, often leading to inflammatory responses through the arachidonic acid (AA)/cyclooxygenase (COX)/prostaglandin E2 (PGE) axis. Given the potential impact of this pathway on viral pathogenesis and disease severity, defining its role during infection warrants attention. AREAS COVERED: This review examines the roles of COX-2 and its primary metabolite, PGE, in RNA virus infections, highlighting their context-dependent effects on viral replication, pathogenesis, and host immunity. It also covers the therapeutic potential of selective COX-2 inhibitors over these processes. The review is based on articles retrieved during 2000-2025 through a systematic search in PubMed and the web. EXPERT OPINION: Emerging evidence suggests that the AA/COX-2/PGE axis exerts significant, yet context-dependent antiviral effects during RNA virus infections. Critical gaps remain in understanding the tissue-specific effects of this pathway during RNA virus infections, including the contributions of COX-2-derived metabolites and their molecular mechanisms of action. studies and clinical trials are needed to evaluate the therapeutic potential of targeting the AA/COX-2/PGE axis, with available safe COX-2-inhibiting drugs approved for human use that allow such approaches. Knowledge derived from these assays could yield impactful therapeutic applications that significantly improve clinical outcomes in RNA virus infections.
BACKGROUND: Vancomycin is commonly prescribed in hemodialysis (HD) patients, who are highly susceptible to infections. Although HD-specific dosing targets have recently emerged, considerable practice variability persists...BACKGROUND: Vancomycin is commonly prescribed in hemodialysis (HD) patients, who are highly susceptible to infections. Although HD-specific dosing targets have recently emerged, considerable practice variability persists, highlighting the need to standardize vancomycin therapeutic drug monitoring (TDM). RESEARCH DESIGN AND METHODS: This multicenter retrospective study describes local practice of vancomycin dosing and monitoring, measures attainment of vancomycin target concentration range (trough: 15-20 mg/L), and identifies predictors of attainment of TDM target in HD patients. Data was collected from patients on chronic intermittent high-flux HD who received vancomycin in two Canadian health centers from 1 January 2019 to 31 December 2022. RESULTS: 453 treatment courses, corresponding to 261 patients, were analyzed. Target attainment varied in both centers. The median (IQR) target attainment during a treatment course was 16.7% (0-50%) across all courses. Residual diuresis (OR = 0.48, 95% CI [0.28, 0.83]) and shorter treatment duration (OR = 0.91, 95% CI [0.87, 0.97]) were associated with worse target attainment. CONCLUSIONS: This study highlights the high rate of 0% target trough concentration attainment per treatment course in our centers and identifies patients with residual diuresis and/or early stages of treatment (less than 7 days) as populations that may benefit from closer vancomycin TDM.
INTRODUCTION: Intensive care unit-acquired lower respiratory tract infections (ICU-LRTIs), including ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), and hospital-acquired pneumonia (...INTRODUCTION: Intensive care unit-acquired lower respiratory tract infections (ICU-LRTIs), including ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), and hospital-acquired pneumonia (vHAP) requiring invasive ventilation, remain among the most frequent and complex infections in critical care. Their management is challenged by diagnostic uncertainty, overlapping syndromes, and rising antimicrobial resistance. Despite advances in diagnostic and therapeutic tools, empirical broad-spectrum antibiotics remain the cornerstone of treatment, often started without microbiological confirmation. AREAS COVERED: This narrative review examines current approaches to ICU-LRTIs, with a focus on the growing role of bronchoscopy, molecular diagnostics, host biomarkers, and therapeutic drug monitoring (TDM). The need for harmonized definitions, such as ventilator-associated lower respiratory tract infection (VA-LRTI), is discussed to address diagnostic variability. The review also considers combined therapies, including nebulized antibiotics, novel antimicrobials targeting multidrug-resistant pathogens, and real-time TDM to optimize treatment in complex ICU cases. EXPERT OPINION: Management of VA-LRTIs is moving toward precision-guided care. Integrating bronchoscopy, molecular testing, and host-response profiling into routine practice can enable earlier, targeted therapy. Real-time TDM and local resistance surveillance should be standard to optimize antimicrobial use and prevent resistance. A shift from rigid syndromic classifications toward phenotype-driven management is needed to improve patient outcomes.
BACKGROUND: To assess the prevalence, characteristics, dispensing practices, and counseling behavior of non-prescription antibiotic dispensing among Iraqi community pharmacies to inform antimicrobial stewardship (AMS) po...BACKGROUND: To assess the prevalence, characteristics, dispensing practices, and counseling behavior of non-prescription antibiotic dispensing among Iraqi community pharmacies to inform antimicrobial stewardship (AMS) policy. RESEARCH DESIGN AND METHODS: A cross-sectional simulated client study was conducted among 696 pharmacies across five Iraqi provinces. Standardized scenarios of upper respiratory tract infection were used to evaluate dispensing behavior, counseling quality (defined as whether staff provided key counseling components including enquiry about symptoms, allergy status, dosage instructions, and treatment duration), and antibiotic class distribution according to the WHO-AWaRe framework. Data were analyzed using descriptive and multivariable logistic regression. RESULTS: Antibiotics were dispensed without prescription in 80.6% (95%CI:77.6-83.5%) of the visits. Access antibiotics accounted for 60.8% (95%CI:56.9-65.0%) and Watch agents for 39.2% (95%CI:34.9-43.1%), with amoxicillin-(26.4%), amoxicillin-clavulanate-(30.7%), and azithromycin-(25.5%) most common. Counseling was poor; only 15% (95%CI:12.3-18.3%) of the providers asked any clinical question and only 7.7% (95%CI:5.5-9.9%) enquired about allergy history. Non-pharmacist staff (nurses) were significantly more likely to dispense antibiotics without prescription compared with pharmacists (OR = 5.7; 95%CI:3.2-10.1). CONCLUSIONS: Non-prescription antibiotic dispensing and minimal counseling remain widespread in Iraqi pharmacies. Effective AMS in Iraq will require phased, system-level approaches, including strengthened regulatory enforcement, workforce support addressing all pharmacy personnel, and integration of community pharmacies into national AMR strategies.
INTRODUCTION: Dengue has emerged as the most widespread and rapidly increasing vector-borne disease globally and is currently a global public health threat. Geographical, environmental, host and/or vector-specific factor...INTRODUCTION: Dengue has emerged as the most widespread and rapidly increasing vector-borne disease globally and is currently a global public health threat. Geographical, environmental, host and/or vector-specific factors can act as drivers of dengue epidemics globally. AREAS COVERED: The current dengue virus distribution and the geographical expansion of competent spp. vectors are reviewed. Recent advances in vaccine development and novel treatment options under evaluation are highlighted, including novel antivirals and monoclonal antibodies. EXPERT OPINION: Climate change and human-related factors are driving the global expansion of dengue risk, including in temperate regions. While licensed vaccines offer new prevention opportunities, limitations remain, especially for vulnerable populations. Continued research into effective antivirals and innovative vaccines is critical. A multidisciplinary approach integrating vector control, vaccination, and emerging therapies is essential to address the growing dengue burden in a warming world.
Sillen M, Baldewijns S, Vandecruys P
… +1 more, Van Dijck P
Expert Rev Anti Infect Ther
· 2026 Mar · PMID 41979905
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INTRODUCTION: Vulvovaginal candidiasis (VVC) is a highly prevalent fungal vaginal infection with a substantial impact on women's quality of life. Increasing evidence indicates that VVC pathogenesis is driven not only by...INTRODUCTION: Vulvovaginal candidiasis (VVC) is a highly prevalent fungal vaginal infection with a substantial impact on women's quality of life. Increasing evidence indicates that VVC pathogenesis is driven not only by high fungal burden but also by dysregulated host-immune responses, highlighting the need for therapeutic strategies that extend beyond conventional antifungal treatment. AREAS COVERED: In this review, recent advances elucidating the antifungal and immunomodulatory properties of in the context of (recurrent) VVC are critically examined. Evidence from , , , and clinical studies is integrated to assess -mediated attenuation of virulence, modulation of host inflammatory responses, and interactions with the vaginal microbiota. In addition, translational challenges, safety considerations, regulatory constraints, and the therapeutic potential of yeast-based combination strategies are discussed. EXPERT OPINION: treatment will play a role in both the prevention of recurrence/occurrence of infections and the integration into combination regimens, where they can complement antifungal and host-directed therapies rather than function as standalone treatments. Future advances will depend on patient stratification, strain-specific optimization, and the integration of microbial therapies into combination treatment frameworks aimed at restoring and maintaining mucosal homeostasis.
INTRODUCTION: infection (CDI) remains a leading cause of healthcare-associated infectious diarrhea, with a major burden driven by recurrences and severe or even fulminant disease in vulnerable hosts. The therapeutic lan...INTRODUCTION: infection (CDI) remains a leading cause of healthcare-associated infectious diarrhea, with a major burden driven by recurrences and severe or even fulminant disease in vulnerable hosts. The therapeutic landscape has shifted toward fidaxomicin-based antibiotic regimens and microbiota restoration strategies, including standardized microbiota-based products. AREAS COVERED: Recent international guidelines, outcome studies, and pivotal trials focused on difficult-to-treat phenotypes such as refractory or fulminant CDI, multiply recurrent CDI, and CDI in high-risk populations (immunocompromised, inflammatory bowel disease, critical illness) were reviewed. A PubMed search was supplemented by hand-searching additional references, guidelines and regulatory documents. Evidence is summarized for optimized antibiotic regimens, bezlotoxumab, conventional fecal microbiota transplantation (FMT), FDA-approved microbiota-based products, and salvage strategies including intracolonic therapy and surgery. EXPERT OPINION: Advanced CDI management is moving from repeated antibiotic cycling toward individualized recurrence prevention and microbiota restoration strategies. Implementation requires diagnostic stewardship, early recognition of recurrences, clear pathways for microbiota-based therapy access, and multidisciplinary care for fulminant infection. Over the next five years, standardized microbiota therapeutics and better risk tools should shift care toward earlier, more durable recurrence prevention.
Expert Rev Anti Infect Ther
· 2026 Mar · PMID 41919681
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INTRODUCTION: There is currently no unified standard treatment for () infection, and its treatment faces clinical challenges, such as limited drug options and increasing drug resistance. Therefore, reviewing the progres...INTRODUCTION: There is currently no unified standard treatment for () infection, and its treatment faces clinical challenges, such as limited drug options and increasing drug resistance. Therefore, reviewing the progress in its treatment is of significant importance for guiding clinical practice. This article systematically reviews the advances in the treatment of infection. AREAS COVERED: This study systematically reviewed relevant literature by searching four electronic databases, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Wan Fang database, for publications up to 1 January 2026, and summarized the current treatment landscape of infections, including oral antibacterial monotherapy and combination regimens, novel local treatments such as photodynamic therapy, and adjuvant therapies including hyperthermia, surgical interventions, and immunomodulation. EXPERT OPINION: infection can involve the skin and deep tissues, and standardized diagnosis and treatment are pivotal for improving its prognosis. Optimizing antimicrobial regimens and applying novel local therapies hold considerable value, yet critical issues, such as the lack of treatment standards, persist. Future multicenter studies and precision treatment models are needed to establish a new paradigm of precise, diversified, and standardized clinical management.
Suwa UF, Montefusco ELB, de Araújo CPM
… +2 more, Bonates P, Crainey JL
Expert Rev Anti Infect Ther
· 2026 Mar · PMID 41910088
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INTRODUCTION: Mansonellosis, a filarial disease caused by genus parasites, affects hundreds of millions globally and represents a growing public health challenge. Currently, there are no coordinated international manson...INTRODUCTION: Mansonellosis, a filarial disease caused by genus parasites, affects hundreds of millions globally and represents a growing public health challenge. Currently, there are no coordinated international mansonellosis management programs or guidelines, but there is a growing recognition that mansonellosis control interventions do need to be formulated. AREAS COVERED: Between 1 January 2025 and 1 September 2025, the search-terms 'Mansonellosis' and 'Mansonella' were used to identify literature concerning macrofilaricidal and microfilaricidal chemotherapeutic treatment of mansonellosis in the PubMed and Web-of-Science databases. Identified literature revealed susceptibility and regional community-support levels make mass drug administration with ivermectin (MDAi) viable for mansonellosis control in the Americas. Macrofilaricidal test-and-treat programs were found to be more appealing for African mansonellosis control because of sub-optimal and microfilaricidal responses. Shortening treatment times could, however, make curative macrofilaricides the best option in Africa and the Americas. EXPERT OPINION: The susceptibility of to ivermectin and the growing appeal of MDAi for malaria control will present opportunities for synergistic malaria-mansonellosis control programs in the Americas. New short course curative macrofilaricides, which are in development for onchocerciasis and lymphatic filariasis, will likely be useful for mansonellosis treatment and will make the disease much easier to manage.