INTRODUCTION: Although different novel beta-lactam/beta-lactamase inhibitor combinations (BL/BLIc) were recently licensed, resistance occurrence have been reported up to 15% of Gram-negative pathogens. For this reason, n...INTRODUCTION: Although different novel beta-lactam/beta-lactamase inhibitor combinations (BL/BLIc) were recently licensed, resistance occurrence have been reported up to 15% of Gram-negative pathogens. For this reason, novel BL/BLIc of tomorrow will be released for managing difficult-to-treat resistance (DTR) Gram-negative infections. AREAS COVERED: This review provides a critical reappraisal of current issues for improving the proper clinical use of the novel BL/BLIc of tomorrow. A literature search was performed on PubMed-MEDLINE (until December 2024) for retrieving available studies on cefepime-enmetazobactam, sulbactam-durlobactam, and cefepime-taniborbactam. Four different main areas were discussed according to available evidence: 1) translating findings coming from the randomized clinical trials into the real-world clinical practice; 2) defining the optimal joint pharmacokinetic/pharmacodynamic (PK/PD) target; 3) identifying proper dosing schedules in patients with renal dysfunction; 4) attributing proper relevance to the epithelial lining fluid (ELF) penetration rate in defining optimal dosing schedule for treating pneumonia. EXPERT OPINION: Overall, old habits die hard and issues retrieved with licensed beta-lactams emerged also with novel BL/BLIc of tomorrow, potentially affecting their efficacy when used in real-world practice. Adopting appropriate corrective measures for overcoming these issues might increase the likelihood of preserving their efficacy in the future by minimizing the propensity risk of resistance development.
Maraolo AE, Gatti M, Principe L
… +4 more, Marino A, Pipitone G, De Pascale G, Ceccarelli G
Expert Rev Anti Infect Ther
· 2025 Jun · PMID 40165471
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INTRODUCTION: Bloodstream infections (BSIs) caused by are common worldwide, representing one of the most relevant issues in clinical infectious diseases practice. In particular, BSIs by methicillin-resistant (MRSA-BSI)...INTRODUCTION: Bloodstream infections (BSIs) caused by are common worldwide, representing one of the most relevant issues in clinical infectious diseases practice. In particular, BSIs by methicillin-resistant (MRSA-BSI) are still today a challenge since mortality burden remains elevated although decades of research. AREAS COVERED: The following topics regarding MRSA-BSI were reviewed and discussed by resorting to best available evidence retrieved from PubMed/MEDLINE up to October 2024: i) epidemiology; ii) microbiology; iii) classification, with a focus on complicated and not complicated forms; iv) the structured approach to the patient; v) pharmacokinetics and pharmacodynamics of the main antimicrobial options; vi) controversies regarding the best therapeutic approach. EXPERT OPINION: Despite ongoing efforts to better stratify and manage MRSA-BSI, there is no universally accepted classification system accurately distinguishing between uncomplicated/low risk and complicated/high risk forms. Biomarkers such as interleukin(IL)-10 hold promise in order to enable a more precise stratification, premise for an appropriate treatment plan. There is a theoretical rationale for implementing a combination therapy including a beta-lactam agent upfront, especially for patients considered at higher risk of unfavorable outcomes, but further data are necessary, and the same applies to newer adjuvants. Novel microbiological techniques may help in guiding antimicrobial duration.
Expert Rev Anti Infect Ther
· 2025 Jun · PMID 40163819
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INTRODUCTION: Although febrile neutropenia (FN) remains a major cause of morbidity and mortality in patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients, the increasing prevalen...INTRODUCTION: Although febrile neutropenia (FN) remains a major cause of morbidity and mortality in patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients, the increasing prevalence of antimicrobial resistance necessitates a reassessment of antibiotic prophylaxis and treatment strategies. AREAS COVERED: This review explores the prophylactic and therapeutic use of antibiotics in FN management, with a particular focus on patients with hematologic malignancies - particularly acute leukemia - and HSCT recipients. EXPERT OPINION: Challenges in FN management, including antibiotic prophylaxis and treatment optimization, remain due to the complexity of the condition. Pathogens with emerging antibacterial resistance cause significant concern in the management of patients. Particularly due to selection potential of resistant Gram-negative bacteria (GNB), fluoroquinolones (FQs) have become less attractive agents for prophylaxis. Whereas, emerging data may help to revitalize long-abandoned aminoglycoside containing combination therapies particularly in high-risk patients with presumed sepsis. With only a few agents available for highly resistant bacteria alternative treatment strategies including pharmacokinetic/pharmacodynamic (PK/PD) concerning antibiotic applications may be warranted. Carefully designed, randomized, controlled trials providing large scale data which then can be analyzed with emerging artificial intelligence (AI) technologies are needed. The results from such trials may allow a better, data-driven approaches for management of FN.
BACKGROUND: To evaluate the efficacy of a new D-mannose dietary supplement containing D-mannose, Propolis-Quercetin, Bacillus Coagulans, Hyaluronic Acid and Chondroitin Sulfate with fosfomycin in reducing rUTI episodes a...BACKGROUND: To evaluate the efficacy of a new D-mannose dietary supplement containing D-mannose, Propolis-Quercetin, Bacillus Coagulans, Hyaluronic Acid and Chondroitin Sulfate with fosfomycin in reducing rUTI episodes and improving quality of life. RESEARCH DESIGN AND METHODS: Single-blind, randomized controlled trial conducted at tertiary-care hospital in Italy. Women aged 21-65 with a history of rUTIs were randomized into three groups: fosfomycin, the dietary supplement, and a combination of both treatments. Primary outcome was frequency of rUTI episodes per month. RESULTS: Combination therapy demonstrated greatest reduction in rUTI episodes per month at 12 months compared to fosfomycin or supplement monotherapy (0.23 ± 0.37 vs 0.58 ± 0.67 and 1.12 ± 0.96 for fosfomycin and supplement monotherapy respectively; < 0.05) and to supplement monotherapy at 6 months (0.69 ± 1.03 vs 1.43 ± 1.33; < 0.05), with significant improvement of ICIQ-FLUTS domains compared to other groups at 12 months ( < 0.05). Combination therapy had lower number of women matching rUTI criteria (55.32% vs 76.47% and 84%; < 0.05) and symptoms remission at 12 months (89.36% vs 56.86% and 20%; < 0.001). CONCLUSIONS: Combining fosfomycin and an integrated D-mannose supplement for managing rUTIs offers a potential reduction in antibiotic reliance. Further large-scale studies are recommended to confirm these findings. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT06659016).
Flisiak R, Rzymski P, Flisiak-Jackiewicz M
… +2 more, Brzdęk M, Zarębska-Michaluk D
Expert Rev Anti Infect Ther
· 2025 Jun · PMID 40156354
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INTRODUCTION: Non-adherence to any therapy may be related to skipping drug doses, discontinuation of therapy, or loss of follow-up. It leads to the ineffectiveness of treatment, which is associated with obvious individua...INTRODUCTION: Non-adherence to any therapy may be related to skipping drug doses, discontinuation of therapy, or loss of follow-up. It leads to the ineffectiveness of treatment, which is associated with obvious individual health losses, significant social and financial costs, and, in the case of infectious diseases, epidemiological consequences resulting from the possibility of further spread of infection. AREAS COVERED: This review article analyses the causes and effects of non-adherence to treatment in patients infected with the hepatitis C virus (HCV). It also presents strategies to reduce the risk of non-adherence, which can be implemented by simplifying the treatment process, improving the flow of information between the doctor and the patient, as well as improving patients' knowledge about hepatitis C infection, and facilitating the understanding of the risks associated with non-adherence. EXPERT OPINION: Since the treatment of HCV infections is highly effective in almost all patients who complete medication, no new drugs are to be expected in the coming years. Therefore, the primary attention in the global elimination of HCV will be focused on screening programs, improving the availability of drugs, and reducing the risk of non-adherence.
Iroh Tam PY, Bekker A, Bielicki JA
… +13 more, Bolaji O, Chimhini G, Dangor Z, Fitzgerald F, Govender N, Holgate S, Kali GT, Okomo U, Okwor T, Rodrigues C, Velaphi S, Whitelaw A, Dramowski A
Expert Rev Anti Infect Ther
· 2025 May · PMID 40139980
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INTRODUCTION: Traditional microbiological diagnostics face challenges in pathogen identification speed and antimicrobial resistance (AMR) evaluation. Artificial intelligence (AI) offers transformative solutions, necessit...INTRODUCTION: Traditional microbiological diagnostics face challenges in pathogen identification speed and antimicrobial resistance (AMR) evaluation. Artificial intelligence (AI) offers transformative solutions, necessitating a comprehensive review of its applications, advancements, and integration challenges in clinical microbiology. AREAS COVERED: This review examines AI-driven methodologies, including machine learning (ML), deep learning (DL), and convolutional neural networks (CNNs), for enhancing pathogen detection, AMR prediction, and diagnostic imaging. Applications in virology (e.g. COVID-19 RT-PCR optimization), parasitology (e.g. malaria detection), and bacteriology (e.g. automated colony counting) are analyzed. A literature search was conducted using PubMed, Scopus, and Web of Science (2018-2024), prioritizing peer-reviewed studies on AI's diagnostic accuracy, workflow efficiency, and clinical validation. EXPERT OPINION: AI significantly improves diagnostic precision and operational efficiency but requires robust validation to address data heterogeneity, model interpretability, and ethical concerns. Future success hinges on interdisciplinary collaboration to develop standardized, equitable AI tools tailored for global healthcare settings. Advancing explainable AI and federated learning frameworks will be critical for bridging current implementation gaps and maximizing AI's potential in combating infectious diseases.
Expert Rev Anti Infect Ther
· 2025 May · PMID 40125988
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BACKGROUND: To analyze bacterial profiles, antibiotic resistance, and urosepsis risk factors in urine culture-positive (UC+) patients post-endoscopic lithotripsy. RESEARCH DESIGN AND METHOD: Retrospectively, 806 UC+ pati...BACKGROUND: To analyze bacterial profiles, antibiotic resistance, and urosepsis risk factors in urine culture-positive (UC+) patients post-endoscopic lithotripsy. RESEARCH DESIGN AND METHOD: Retrospectively, 806 UC+ patients (2016.3-2021.3) were stratified into urosepsis/non-urosepsis groups per Sepsis-3 criteria. RESULTS: Among 845 isolates (56 species), dominated (46.8%), followed by (8.8%). Gram-negative bacteria exhibited high resistance to ampicillin, cefazolin, and cefuroxime. Multivariate analysis identified preoperative multidrug-resistant (MDR) bacteriuria (OR = 2.15), staghorn calculi (OR = 2.23), days of preoperative antibiotics use <3 (OR = 1.87), absence of nephrostomy (OR = 2.30), and postoperative WBC > 9.8 × 10/L (OR = 2.69) as independent sepsis predictors. A nomogram incorporating these factors achieved robust predictive accuracy. Preoperative antibiotic use for ≥3 days was inversely correlated with the risk of urinary sepsis as the duration of antibiotic administration increased. CONCLUSIONS: Urosepsis incidence was 13.1% post-lithotripsy. Early risk stratification, targeted infection control, and antibiotic stewardship guided by urine susceptibility testing are critical for prevention.
Carbonell-Estrany X, Simões EAF, Bont L
… +30 more, Manzoni P, Zar HJ, Greenough A, Ramilo O, Stein R, Law B, Mejias A, Sanchez Luna M, Checchia PA, Krilov L, Lanari M, Dagan R, Fauroux B, Resch B, Heikkinen T, Domachowske JB, Wildenbeest JG, Martinon-Torres F, Thwaites R, Cetinkaya M, Alharbi AS, Rodriguez-Martinez CE, Noyola DE, Kassim A, Kusuda S, Kang JM, Rodgers-Gray B, Platonova A, Jah F, Paes B
Expert Rev Anti Infect Ther
· 2025 Jun · PMID 40111069
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INTRODUCTION: Respiratory syncytial virus (RSV) causes significant morbidity and mortality in young children. For 25 years, palivizumab has been the only effective pharmaceutical RSV preventive. AREAS COVERED: We summari...INTRODUCTION: Respiratory syncytial virus (RSV) causes significant morbidity and mortality in young children. For 25 years, palivizumab has been the only effective pharmaceutical RSV preventive. AREAS COVERED: We summarize the development and a quarter-century of real-world evidence with palivizumab. We highlight its positive impact on the burden of RSV in high-risk children. Based on lessons learnt from its implementation, we suggest strategies for effective and equitable deployment of newer RSV preventives. EXPERT OPINION: Following failure of the formalin-inactivated RSV vaccine in 1967, RSV intravenous immunoglobulin was approved in 1996 after three decades' research. Subsequently, palivizumab emerged as the most effective and safe RSV preventive, demonstrated by the IMpact trial, and was licensed in 1998 in the United States. Over the last 25 years, the benefits of palivizumab have been firmly established through a wealth of evidence, predominantly from high-income countries (HICs). To achieve a global impact with the newer RSV preventives, evidenced-based universal guidelines must be developed and endorsed by regulatory authorities and relevant scientific societies. Independent economic evaluations should incorporate all RSV-associated healthcare costs, reduction of long-term respiratory sequelae, and standardized outcomes. Most importantly, equity in product availability and implementation, particularly in low- and middle-income countries (LMICs) is essential.
Saleem Z, Mekonnen BA, Orubu ES
… +42 more, Islam MA, Nguyen TTP, Ubaka CM, Buma D, Thuy NDT, Sant Y, Sono TM, Bochenek T, Kalungia AC, Abdullah S, Miljković N, Yeika E, Niba LL, Akafity G, Sefah IA, Opanga SA, Kitutu FE, Khuluza F, Zaranyika T, Parajuli A, Darweesh O, Islam S, Kumar S, Nabayiga H, Jairoun AA, Chigome A, Ogunleye O, Fadare J, Massele A, Cook A, Jelić AG, Godói IPD, Phillip A, Meyer JC, Funiciello E, Lorenzetti G, Kurdi A, Haseeb A, Moore CE, Campbell SM, Godman B, Sharland M
Expert Rev Anti Infect Ther
· 2026 Jun · PMID 40110804
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INTRODUCTION: Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antim...INTRODUCTION: Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries. AREAS COVERED: This narrative review analyzes publications from 2018 to 2024 regarding access, availability, and use of appropriate antibiotics. EXPERT OPINION: There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impact on their use, resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps affects sustainable development goals to provide routine access to safe, effective, and appropriate antibiotics. CONCLUSIONS: There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.
Chakrabarti A, Oladele R, Hermsen E
… +3 more, Novis de Figueiredo ML, Muñoz P, Johnson M
Expert Rev Anti Infect Ther
· 2025 Aug · PMID 40074556
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INTRODUCTION: Despite the crucial importance of effective AFS in resource-limited settings, such settings remain comparatively underserved and underrepresented in terms of resource-setting-specific guidance and research....INTRODUCTION: Despite the crucial importance of effective AFS in resource-limited settings, such settings remain comparatively underserved and underrepresented in terms of resource-setting-specific guidance and research. Further practical contextualization and application of current AFS best practices is thus necessary. AREAS COVERED: A panel of leading experts from diverse countries (India, Nigeria, Spain, and the US) was brought together to provide recommendations for practical and effective implementation of AFS in resource-limited settings. We have adapted and contextualized the Centers for Disease Control and Prevention's (CDC) seven core elements and the Mycoses Study Group Education and Research Consortium's (MSGERC) recommendations for facilities in resource-limited settings through a resource-stratified approach. Where relevant to facilities based on their context and respective resources across multiple dimensions, facilities may choose to prioritize certain recommendations that may be more immediately actionable before implementing others. EXPERT OPINION: We recommend future studies to examine the efficacy, cost-effectiveness, and practicality of our recommendations in resource-limited settings to enable them to effectively prioritize, channel or gradually increase resource capacity at hand. AFS interventions should be integrated within a larger systemic framework (e.g. city, state, national, regional, international) with collaboration among institutional leadership, ID specialists, healthcare workers, public, policymakers, and pharmaceutical industry.
Sobrino B, Luque S, Velasco-Arnaiz E
… +2 more, Lovatti González R, Del Pozo JL
Expert Rev Anti Infect Ther
· 2025 May · PMID 40065481
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INTRODUCTION: This review considers special populations as those patients for whom Gram-positive infections are particularly challenging to treat. We examine the potential benefits of dalbavancin in these patients. AREAS...INTRODUCTION: This review considers special populations as those patients for whom Gram-positive infections are particularly challenging to treat. We examine the potential benefits of dalbavancin in these patients. AREAS COVERED: We focus on patients with renal impairment, hepatic failure or obesity, and, also, pediatric patients, elderly patients and socially vulnerable individuals. Five independent experts conducted exhaustive literature searches on PubMed. Papers were selected for inclusion according to their relevance to the topic. For each special population, we outline the most significant characteristics for infection management, describing the challenges of the most frequent Gram-positive infections, and reviewing the potential role of dalbavancin. EXPERT OPINION: Dalbavancin may be a valid alternative to overcome the difficulties of infection management in these populations. We hope our insights will prove useful for patient-centered care. A long half-life, evidence-based efficacy and good safety profile make dalbavancin an adequate option, particularly for patients for whom oral treatment or continued IV access may be challenging, or those for whom hospital stay is more impactful. [Figure: see text].
Miselli F, Boncompagni A, Cuoghi Costantini R
… +10 more, Zini T, Bedetti L, Buttera M, Corso L, Creti R, Guidotti I, Rossi C, Spaggiari E, Lugli L, Berardi A
Expert Rev Anti Infect Ther
· 2025 May · PMID 40057829
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INTRODUCTION: Group-B Streptococcus(GBS) infections may rarely recur after antibiotic treatment. We aimed to fill existing gaps on epidemiology, clinical features, and outcomes of GBS recurrences. METHODS: A systematic s...INTRODUCTION: Group-B Streptococcus(GBS) infections may rarely recur after antibiotic treatment. We aimed to fill existing gaps on epidemiology, clinical features, and outcomes of GBS recurrences. METHODS: A systematic search of PubMed and Embase was conducted, covering the period until 1 July 2024. The demographics, clinical characteristics, treatment, and outcomes of infants withGBS recurrence were analyzed. Recurrence was defined as > 1 episode of invasiveGBS infection (positive blood and/or cerebrospinal fluid culture), occurring after the completion of treatment for the initial episode. RESULTS: Among the 213 recurrences, 146 reported individual data and were included in the analysis. GBS recurrences developed shortly after the completion of antibiotic treatment for the initial infection (median = 10 days 95%CI 6.0-18.8). Most infants were preterm (63.5%) and had received an adequately long course of antibiotics for the initial infection (median = 13 days, 95%CI 10-14). Serotype III waspredominant. Breast milk yielded GBS in most samples cultured (41/62, 66%); 5/15 (33%) infants who discontinued breastfeeding after recurrence had further GBS recurrence. Case fatalities were 3.7%. CONCLUSIONS: Preterm birth is closely associated with GBS recurrences. Adequately long courses of antibiotics or withdrawal of breast milk may not be useful measures to prevent recurrences.
Matera MG, Capristo C, de Novellis V
… +1 more, Cazzola M
Expert Rev Anti Infect Ther
· 2025 May · PMID 40051224
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INTRODUCTION: Pertussis, a respiratory disease caused primarily by , is undergoing a resurgence despite decades of high rates of vaccination. The prevention of pertussis in infants presents several challenges, including...INTRODUCTION: Pertussis, a respiratory disease caused primarily by , is undergoing a resurgence despite decades of high rates of vaccination. The prevention of pertussis in infants presents several challenges, including the waning immunity of the acellular pertussis (aP) vaccine, the limited protection afforded to newborns before they complete the vaccine series, and the existence of gaps in maternal vaccination. Furthermore, the unwillingness or refusal of a considerable number of individuals, including some healthcare workers, to receive vaccinations represents another significant challenge. AREAS COVERED: This narrative review provides an updated overview of the ongoing challenge of preventing pertussis in infants and discusses some possible solutions. EXPERT OPINION: The ongoing challenge of preventing pertussis in infants is multifaceted. To address these challenging issues, a multi-pronged approach is required. This approach should be designed to address various barriers and increase uptake. It should include measures to strengthen maternal vaccination programs, ensure timely infant vaccinations, improve public education, and continue research into more effective vaccines with longer-lasting immunity.
Fornari V, Accardo G, Lupia T
… +2 more, De Rosa FG, Corcione S
Expert Rev Anti Infect Ther
· 2025 May · PMID 40016121
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INTRODUCTION: Antibiotics were originally developed to treat acute bacterial infections, and research studies focus their efforts on safety and efficacy in the short term; however, prolonged course of antibiotics has bee...INTRODUCTION: Antibiotics were originally developed to treat acute bacterial infections, and research studies focus their efforts on safety and efficacy in the short term; however, prolonged course of antibiotics has been documented in multiple clinical settings. The aim of this narrative review is to provide a new perspective on SAT and to discuss new therapeuticpossibilities. AREAS COVERED: We discuss new clinical scenarios in which SAT could be considered. We provided a broad discussion about long-acting agents and new or repurposed oral agents as well as the use of OPAT with elastomeric pumps and an overview of the pipeline of new antifungals. Limitations of SAT are presented in this review and especially patients' adherence issues, possible spread of MDROs, possible rising of the incidence of infections, drug-to-drug interactions and drug-related problems, cost-effectiveness evaluation issues. EXPERT OPINION: Many research gaps are evident and further studies are needed. Above all, the efficacy and safety of SAT in the different clinical scenarios. Discovery of new molecules against MDROs and ongoing research on PK/PD variables as well as a better understanding of the relationship between SAT and the emergence of resistance could improve SAT usage and reduce the impact of DRPs.
Expert Rev Anti Infect Ther
· 2025 May · PMID 40011051
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INTRODUCTION: Aztreonam is a monobactam antibiotic approved in 1986 to treat infections caused by aerobic Gram-negative bacteria, but, together with cephalosporins, lost clinical utility due to the emergence of extended-...INTRODUCTION: Aztreonam is a monobactam antibiotic approved in 1986 to treat infections caused by aerobic Gram-negative bacteria, but, together with cephalosporins, lost clinical utility due to the emergence of extended-spectrum β-lactamases (ESBLs) and novel (serine) carbapenemases. Avibactam was the first in a novel non-β-lactam β-lactamase inhibitor class to effectively inhibit these enzymes. It has been approved in combination with ceftazidime to treat Gram-negative infections caused by bacteria that produce AmpC, ESBLs and serine carbapenemases, and with aztreonam to treat patients infected with metallo-β-lactamase-producing enteric bacteria. Combinations of avibactam with ceftazidime and/or aztreonam have been used successfully to treat enteric pathogens producing multiple classes of β-lactamases. AREAS COVERED: Development of aztreonam, avibactam, and avibactam combinations are placed into a historical perspective, based on both preclinical and clinical data. A search of MEDLINE (Ovid) was used to identify relevant literature. EXPERT OPINION: Avibactam combined with ceftazidime and aztreonam in either dual or triple combinations provides the opportunity to treat previously untreatable Gram-negative infections that produce multiple β-lactamases. Aztreonam combinations should be particularly attractive, due to stability to metallo-β-lactamase hydrolysis and its safety advantage in treating penicillin-allergic patients. Other inhibitor combinations in development may challenge these combinations.
Expert Rev Anti Infect Ther
· 2025 Jun · PMID 40007187
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INTRODUCTION: The success in the coronavirus infectious disease 2019 (COVID-19) pandemic containment largely originated from vaccine- and infection-elicited immunity, with severe acute respiratory syndrome coronavirus 2...INTRODUCTION: The success in the coronavirus infectious disease 2019 (COVID-19) pandemic containment largely originated from vaccine- and infection-elicited immunity, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection only marginally mitigated by the availability of antiviral drugs. The current lack of effective antiviral prophylactic and therapeutic agents in immunocompromised patients highlights the need for a radical change in the design of both drug manufacturing and clinical trials. AREAS COVERED: In this review, the authors summarize their suggestions for manufacturers, by reviewing classes of small molecule antivirals and passive immunotherapies and highlighting their limitations and unexploited potential. EXPERT OPINION: Molecular and serological testing of patients can improve appropriateness. Efficacy of antivirals can be improved by combining different therapeutic classes while preserving economical sustainability. Respiratory delivery should be better investigated in clinical trials.
Guo J, Cai X, Wang S
… +15 more, Wen H, Ren J, Zhou M, Li X, Yan X, Tian S, Zhang F, Liu Y, Zhang W, Shao Y, Cao J, Liu X, Hou K, Wei D, Lin G
Expert Rev Anti Infect Ther
· 2025 Jun · PMID 39994071
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BACKGROUND: High-dose (HD) tigecycline is often required for severe multidrug-resistant gram-negative infections in liver failure patients, despite package recommendations to halve the dose for those with severe liver im...BACKGROUND: High-dose (HD) tigecycline is often required for severe multidrug-resistant gram-negative infections in liver failure patients, despite package recommendations to halve the dose for those with severe liver impairment. This study evaluated the efficacy and safety of different tigecycline doses in this population. RESEARCH DESIGN AND METHODS: A retrospective cohort of 192 patients with Child-Pugh grade C liver failure was divided into label-dose (LD), standard-dose (SD), and HD groups. Primary and secondary outcomes included microbial eradication, mortality, and adverse effects. RESULTS: The SD group achieved higher microbial eradication than LD, with comparable efficacy to HD but fewer adverse events, such as fibrinogen requirements. High-dose treatment increased mortality risk (Hazard Ratio: 1.85, = 0.062). Optimal microbial eradication and minimized adverse effects occurred with the SD group at 7 days of treatment. CONCLUSIONS: Standard-dose tigecycline offers a balanced approach to microbial eradication and safety, making it preferable in liver failure patients.
INTRODUCTION: The diagnosis and management of abdominal tuberculosis, i.e Gastrointestinal Tuberculosis (GITB) and tuberculous peritonitis (TBP) is challenging. Abdominal tuberculosis, presenting usually with abdominal p...INTRODUCTION: The diagnosis and management of abdominal tuberculosis, i.e Gastrointestinal Tuberculosis (GITB) and tuberculous peritonitis (TBP) is challenging. Abdominal tuberculosis, presenting usually with abdominal pain, intestinal obstruction, and constitutional symptoms, is typically a paucibacillary condition. The diagnosis hinges on a correct interpretation of clinical, radiological, histological, biochemical, and microbiological findings as also appropriately assessing response to therapy. AREAS COVERED: The authors review potential missteps that could occur in managing GITB and TBP sourced from published literature and clinical experience. These include avoiding excess use of tests with limited accuracy, understanding limitations of ascitic adenosine deaminase (ADA) and granulomas, avoiding empirical antitubercular therapy (ATT) where possible but also understanding that microbiological tests may not always be positive, and finally not to bank solely on subjective clinical responses but to use objective markers in assessing response to therapy. In addition, diagnosis of predisposing immunosuppressed states, attention to nutrition, appropriate management of sequelae with endoscopic dilatation/surgery, and early surgery when indicated are some of the additional issues discussed. EXPERT OPINION: In future, a more secure diagnosis banking on the use of better microbiological tools, multiparameter-based models, artificial intelligence-based approaches, and use of advances in -omics-based approaches can improve diagnosis and avoid some missteps.
INTRODUCTION: Nontreponemal tests (NTT) constitute a significant method in syphilis detection, playing a crucial role in screening, diagnosing, and monitoring disease activity. However, recent discussions have cast doubt...INTRODUCTION: Nontreponemal tests (NTT) constitute a significant method in syphilis detection, playing a crucial role in screening, diagnosing, and monitoring disease activity. However, recent discussions have cast doubt on the traditional belief that NTT are suitable for evaluating treatment efficacy, as inconsistencies between NTT results and syphilis treatment outcomes have been observed with some frequency. AREAS COVERED: We have delineated the current status of serological methods for evaluating the therapeutic efficacy of syphilis treatment and summarized and discussed the exploration of biomarkers for syphilis therapy. A literature search was conducted in PubMed over all available dates for relevant published papers and conference abstracts with the search terms, 'Syphilis,' 'Treponema pallidum,' 'Serofast,' 'Treatment efficacy evaluation,' 'Nontreponemal,' 'RPR,' 'TRUST,' 'VDRL,' 'Neurosyphilis,' 'Pregnant syphilis,' 'Congenital syphilis,' 'Reinfection,' 'Cardiolipin,' 'Serology.' EXPERT OPINION: Currently, the assessment of treatment efficacy through serological methods is limited to the use of the NTT. Therefore, it is imperative for clinicians to gain a deeper understanding of the significance and limitations of the NTT, as well as a focus on exploring more potential indicators for evaluating treatment efficacy.