Gentile I, Giuliano S, Corcione S
… +11 more, De Rosa FG, Falcone M, Giacobbe DR, Maraolo AE, Mastroianni CM, Oliva A, Pascale R, Tascini C, Tiseo G, Viale P, Bassetti M
INTRODUCTION: Community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) are major global health challenges, with high morbidity and mortality rates. The increasing prevalence of multidrug-resistant (MDR) b...INTRODUCTION: Community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) are major global health challenges, with high morbidity and mortality rates. The increasing prevalence of multidrug-resistant (MDR) bacteria may diminish the effectiveness of standard empirical antibiotics, highlighting the need for broader-spectrum agents that target also MDR organisms. AREAS COVERED: This review summarizes findings from a PubMed search on the use of ceftobiprole in CAP and HAP. It highlights key features of ceftobiprole, including its mechanism of action and broad spectrum of activity against multiple MDR pathogens. Clinical data from randomized controlled trials and real-world studies underscore its non-inferiority to standard treatments, with favorable safety profile and high clinical cure rates even in challenging cases. EXPERT OPINION: Ceftobiprole represents a valid option for the patients with CAP and HAP. Its main advantages include its broad spectrum of activity, making it a valuable therapeutic choice for treating polymicrobial infections, and its favorable safety profile, which makes it a good candidate in elderly patients with multiple comorbidities and polypharmacy. Caution is advised in patients at high risk of ESBL-producing organisms or MDR infections, where combination therapy is recommended. Moreover, therapeutic drug monitoring is recommended to improve outcomes, particularly in complex clinical conditions.
INTRODUCTION: Fungal infections constitute a significant global health threat, with an estimated incidence of 6.5 million invasive fungal infections and 2.5 million associated deaths each year. New antifungal agents are...INTRODUCTION: Fungal infections constitute a significant global health threat, with an estimated incidence of 6.5 million invasive fungal infections and 2.5 million associated deaths each year. New antifungal agents are being developed to address the challenges of fungal infections management, driven by the evolving fungal epidemiology, the emergence of antifungal resistance, and the limitations of existing treatments. AREA COVERED: This review provides a thorough overview of the latest developments in novel antifungal agents, highlighting pivotal evidence obtained from clinical trials. EXPERT OPINION: New antifungal agents hold promising future for difficult-to-treat fungal infections, providing for improved bioavailability, pharmacokinetic properties, adverse events and drug interactions, as well as, spectrum of activity. However, further data is needed before incorporating these agents in everyday clinical practice for the management of invasive fungal infections.
BACKGROUND: Tegoprazan (TPZ), a potassium-competitive acid blocker with potent gastric acid-suppressing activity, may be a potential agent for treating infection. The study aimed to evaluate the efficacy of TPZ-based th...BACKGROUND: Tegoprazan (TPZ), a potassium-competitive acid blocker with potent gastric acid-suppressing activity, may be a potential agent for treating infection. The study aimed to evaluate the efficacy of TPZ-based therapy for eradication compared with proton pump inhibitor (PPI)-based therapy. RESEARCH DESIGN AND METHODS: A comprehensive literature search was conducted up to August 2024 using PubMed, Embase, and the Cochrane Library to investigate the beneficial effects of TPZ-based therapy for eradication. Studies that evaluated the eradication rates between the TPZ- and PPI-based therapies were included. The authors conducted a meta-analysis to calculate the eradication rate and pooled risk ratio (RR) with a 95% confidence interval. RESULTS: Seven studies involving 3200 patients were included. eradication rates did not differ significantly between the TPZ- and PPI-based therapies based on the intention-to-treat (77.3% vs. 76.4%, = 0.68; pooled RR = 1.01 [0.97-1.05]) and per-protocol (84.3% vs. 84.2%, = 0.69; pooled RR = 1.01 [0.98-1.04]) analyses. Additionally, no significant difference was observed in the adverse drug events between TPZ- and PPI-based therapies (27.2% vs. 30.8%, = 0.26; pooled RR = 0.91 [0.76-1.08]). CONCLUSIONS: eradication and adverse drug event rates with TPZ- and PPI-based treatments were similar.
INTRODUCTION: Lower respiratory infections have a huge impact on global health, especially in older individuals, immunocompromised people, and those with chronic comorbidities. The COVID-19 pandemic highlights the import...INTRODUCTION: Lower respiratory infections have a huge impact on global health, especially in older individuals, immunocompromised people, and those with chronic comorbidities. The COVID-19 pandemic highlights the importance of vaccination. However, there are lower rates of vaccination in the adult population that are commonly due to a missed opportunity to vaccinate. Vaccination offers the best strategy to prevent hospitalization, complications, and death caused by lower respiratory infections. AREAS COVERED: In this review, the authors provide an overview of the vaccines for lower respiratory infections in the adult population. The review highlights the available data about the impact of vaccines on preventing respiratory infections, focusing on the pneumococcal vaccine, influenza vaccine, COVID-19 vaccines, and respiratory syncytial virus (RSV) vaccines. The authors discuss the currently available scientific evidence on the role of vaccines against respiratory infections. Finally, the authors review the current recommendations for vaccines in the adult population. EXPERT OPINION: Scientific evidence on the effectiveness of vaccines against respiratory infections is important. An efficient implementation of adult immunization strategies will provide an opportunity to decrease the global burden of lower respiratory infections. Recognizing the existing vaccines and their recommendations for the adult population is essential to achieve a high vaccination rate in the population.
BACKGROUND: Nursing home (NH) residents are frequently treated with antibiotics for urinary tract infections (UTIs), often due to overdiagnosis. The aim of this study was to evaluate the proportion of potentially unneces...BACKGROUND: Nursing home (NH) residents are frequently treated with antibiotics for urinary tract infections (UTIs), often due to overdiagnosis. The aim of this study was to evaluate the proportion of potentially unnecessary antibiotic use for suspected UTIs in NHs across eight European countries. RESEARCH DESIGN AND METHODS: Over a three-month period (February to April 2024), NH professionals recorded information on all antibiotic treatments for UTIs using a specific registration chart. Based on medical literature and the expertise of the project consortium members, the authors developed and endorsed by consensus a simplified algorithm to assess unnecessary antibiotic use in residents without indwelling catheters. RESULTS: The study, conducted across 110 NHs, included 2773 antibiotic-treated infections. Of these, 1158 (41.8%) were treated for UTIs. Among 975 UTI cases without catheters, 54.1% may have been unnecessarily treated. Over one-third involved nonspecific symptoms including poor general condition and changes in urine appearance, while specific urinary symptoms, such as incontinence (21.3%) and dysuria (20.8%), were less common. A trend toward greater, potentially unnecessary antibiotic use was observed when urine dipsticks were performed. CONCLUSIONS: The findings reveal potentially unnecessary antibiotic use. Further algorithm validation is needed to enhance diagnostic criteria, reduce overuse, and improve UTI management in NHs.
Bonifaz A, García-Sotelo RS, Lumbán-Ramirez F
… +5 more, Vázquez-González D, Inclán-Reyes JI, Sierra-Garduño ME, Araiza J, Chandler D
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39760435
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INTRODUCTION: Mycetoma is a chronic granulomatous infection, common throughout tropical regions, and is considered a neglected disease that mostly affects impoverished populations. Mycetoma is divided into eumycetoma, ca...INTRODUCTION: Mycetoma is a chronic granulomatous infection, common throughout tropical regions, and is considered a neglected disease that mostly affects impoverished populations. Mycetoma is divided into eumycetoma, caused by fungi, and actinomycetoma, caused by filamentous bacteria. Clinical presentation is distinctive, and making the diagnosis is usually not difficult; however, access to safe and effective treatments is a major challenge. There is not a single best treatment, with the choice of treatment depending on etiology, severity and extent of disease, and patient comorbidities. AREAS COVERED: The following topics regarding actinomycetoma are discussed. I) Background information on actinomycetoma, and etiology. II) Differences between actinomycetoma caused by , and cutaneous nocardiosis. III) Review of the treatment options for actinomycetoma, caused by three species - , , and . IV) Experience using linezolid in the treatment of mycetoma caused by spp. and . EXPERT OPINION: Multiple treatment regimens for actinomycetoma were discussed according to the causative agent. Experience in using linezolid in combined therapy for actinomycetoma caused by in which conventional treatment options failed was also presented. The first case report of treatment with linezolid for mycetoma caused by is presented in this article.
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39754518
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INTRODUCTION: There is a rise in the emergence of multidrug resistant fungal pathogens worldwide, including in Africa. METHOD: This systematic review summarized the published data on the mechanisms and epidemiology of an...INTRODUCTION: There is a rise in the emergence of multidrug resistant fungal pathogens worldwide, including in Africa. METHOD: This systematic review summarized the published data on the mechanisms and epidemiology of antifungal resistance in species in Africa between 2000 and early 2024. RESULT: Seventeen reports from seven African countries were analyzed but due to the paucity of data, the prevalence of antifungal resistant isolates in Africa could not be estimated. However, a total of 1376 (out of 2812) resistant isolates were documented with South Africa reporting the most. was the most reported species with multidrug and pandrug resistant strains documented in South Africa. Generally, azoles but not posaconazole or isavuconazole, resistance was reported. Fluconazole resistant isolates harbored Erg11 Y132F, VF125LA and K177A/R/N335S/E343D substitutions, gain of function mutations or efflux pump protein over expression. Resistance to members of the echinocandin family was also reported and Fks1 S639P substitution was observed. CONCLUSION: The data highlight that the increasing species resistance to cell wall and cell membrane active antifungals is a cause for serious concern in Africa. There is need to increase antifungal research capacity and mount epidemiological surveillance to determine the true scale of the problem. PROSPERO REGISTRATION NUMBER: CRD42024550231.
Tonutti A, Polverini D, De Nicola S
… +6 more, Ceribelli A, Soleri M, De Santis M, Aghemo A, Selmi C, Pugliese N
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39749733
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INTRODUCTION: Hepatitis C virus (HCV) infection represents a significant global health burden, particularly due to its extrahepatic immune-mediated manifestations, such as mixed cryoglobulinemia, associated vasculitis (C...INTRODUCTION: Hepatitis C virus (HCV) infection represents a significant global health burden, particularly due to its extrahepatic immune-mediated manifestations, such as mixed cryoglobulinemia, associated vasculitis (CryoVas), and non-Hodgkin B-cell lymphoma (B-NHL), which pose significant challenges. The advent of direct-acting antiviral (DAA) has changed the therapeutic landscape for HCV-related complications. AREAS COVERED: This review explores the evolving epidemiology and management of HCV extrahepatic manifestation and lymphoproliferative disorders in the era of DAAs. It examines the efficacy of DAAs in controlling CryoVas and their complex role in HCV-related B-cell lymphoma. The literature search included studies on the immunological dynamics between HCV, CryoVas, and lymphoma, focusing on the impact of sustained virological response (SVR) on immune dysregulation, relapse risk, refractory disease, and patient stratification based on risk profiles. EXPERT OPINION: DAAs have significantly improved the management of HCV-related CryoVas and autoimmune manifestations, but remain a challenge in refractory cases and the risk of lymphoma. Future strategies should focus on refining risk stratification and integrating new therapeutic approaches to better address immune dysregulation and associated complications.
INTRODUCTION: Infectious disease treatments are transitioning from a one-size-fits-all approach to a more tailored approach. The increasing adoption of therapeutic drug monitoring (TDM) of antimicrobials is a clear examp...INTRODUCTION: Infectious disease treatments are transitioning from a one-size-fits-all approach to a more tailored approach. The increasing adoption of therapeutic drug monitoring (TDM) of antimicrobials is a clear example of this trend. Routine antimicrobial TDM in critically ill patients should be mandatory. Unfortunately, nowadays, only expert centers can provide it. Given the crucial nature of the first hours/days for achieving a favorable clinical outcome, empirical antibiotic therapy with an adequate choice of drug, dose and administration modalities is fundamental. AREAS COVERED: We outline common scenarios encountered in clinical practice, such as in edematous patients, hypoalbuminemia, patients with liver and renal diseases, patients under renal replacement therapy or extracorporeal membrane oxygenation (ECMO), over or under-weight patients, in old adults and cases of infections caused by relatively high minimum inhibitory concentration (MIC) pathogens. Various clinical situations were analyzed with the help of the available literature (PubMed/MEDLINE/Google Scholar and books written by experts in pharmacology and infectious diseases). EXPERT OPINION: In these different scenarios, we reported common examples of optimizing drug utilization to maximize therapeutic outcomes, reduce incorrect prescriptions and limit the emergence of antimicrobial resistance.
Shabil M, Bushi G, Apostolopoulos V
… +15 more, Alrahbeni T, Al-Mugheed K, Khatib MN, Gaidhane S, Zahiruddin QS, Kukreti N, Rustagi S, Alhashem YN, Alotaibi J, Kaabi NAA, Sulaiman T, Alturaifi HR, Khamis F, Rabaan AA, Satapathy P
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39745180
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INTRODUCTION: Dengue fever is a significant health concern globally, especially in tropical regions. Identifying reliable markers for severe dengue, such as hypoalbuminemia, is crucial for early diagnosis and treatment....INTRODUCTION: Dengue fever is a significant health concern globally, especially in tropical regions. Identifying reliable markers for severe dengue, such as hypoalbuminemia, is crucial for early diagnosis and treatment. METHODS: This review systematically explores the association between hypoalbuminemia and severe dengue. We searched databases including PubMed, Embase, Scopus, Cochrane, and Web of Science until 28 December 2023, focusing on studies that reported albumin levels in dengue patients. Our selection criteria aimed at observational studies, from which data extraction and quality assessment were performed using Nested- Knowledge and the Newcastle-Ottawa Scale. RESULTS: A meta-analysis of 17 studies involving 974 severe and 18,496 non-severe dengue patients identified a standardized mean difference (SMD) in albumin levels of -1.625 g/dL (95% CI: -3.618 to -0.369). Subgroup analysis indicated more pronounced hypoalbuminemia in pediatric patients, with a pooled SMD of -1.08 g/dL (95% CI: -1.71 to -0.45). Our analysis demonstrated the link between hypoalbuminemia and severe dengue, indicating a significant pooled relative risk of 2.286, within 95% CI 1.308 to 3.996. CONCLUSIONS: The study confirms hypoalbuminemia as a significant predictor of severe dengue. Recognizing hypoalbuminemia in dengue patients can aid clinicians in forecasting the severity, potentially improving patient outcomes through targeted therapeutic strategies.
Katsarou A, Tzikopoulou M, Papadopoulos D
… +2 more, Palioura S, Falagas ME
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39727178
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INTRODUCTION: Tedizolid is a novel antibiotic of the class of oxazolidinones. This review evaluates the published literature on the optic and peripheral neuropathy associated with short and prolonged administration of te...INTRODUCTION: Tedizolid is a novel antibiotic of the class of oxazolidinones. This review evaluates the published literature on the optic and peripheral neuropathy associated with short and prolonged administration of tedizolid. AREAS COVERED: A review of published data from 4 databases was conducted, regarding the development of optic and peripheral neuropathy in patients who received tedizolid for short or prolonged duration. A total of 1,212 records were screened; 33 were included in this review. No peripheral or optic neuropathy cases were reported in 6 randomized controlled trials that studied tedizolid use for a short course. In contrast, 2 cases with optic neuropathy (1 not supported by objective findings) in 87 patients of the prospective studies were identified. Additionally, in a total of 277 patients who participated in the 6 retrospective studies, 9 adverse events related to optic or peripheral neuropathy and 1 case with foot drop in 22 patients of the relevant cases reports were recorded. EXPERT OPINION: The available data suggests that the safety profile of tedizolid is favorable, especially when given for a short time. However, more clinical studies are needed regarding its long-term use, given that the neurotoxicity induced by oxazolidinones may be time and dose-dependent.
Srivastava S, Jayaswal N, Kumar S
… +9 more, Rao GSNK, Budha RR, Mohanty A, Mehta R, Apostolopoulos V, Sah S, Bonilla-Aldana DK, Ulloque-Badaracco R, Rodriguez-Morales AJ
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39688174
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INTRODUCTION: The emergence of the H3N2 influenza virus in 1968 marked a significant event as it crossed the species barrier. This shift led to a pandemic, resulting in the deaths of one million people globally and highl...INTRODUCTION: The emergence of the H3N2 influenza virus in 1968 marked a significant event as it crossed the species barrier. This shift led to a pandemic, resulting in the deaths of one million people globally and highlighting the virus's severe impact on older individuals due to antigenic drift. AREA COVERED: This review comprehensively examines the virological characteristics, evolutionary trends, and global epidemiology of the Influenza A (H3N2) virus. It delves into vaccination strategies, antiviral interventions, and emerging diagnostic approaches. The impact of antigenic variation on vaccine design and effectiveness, seasonal outbreak patterns, and pandemic potential are explored. Additionally, the interplay between viral factors and host immune responses is assessed. Researchers are actively investigating innovative strategies to enhance vaccine efficacy against H3N2 mutations, such as precise antigenic material administration, controlled release patterns, understanding immune system mechanisms, and glycan engineering. EXPERT OPINION: The ongoing mutational dynamics of the H3N2 virus necessitate regular vaccine updates, as advocated by the WHO. Research in the Western Pacific region underscores the need for heightened awareness and effective control strategies. Evaluating antiviral therapies and addressing drug resistance requires multidisciplinary approaches involving researchers, healthcare professionals, and policymakers. This comprehensive understanding of H3N2 is vital for improving public health interventions and preparing for future influenza challenges.
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39670956
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INTRODUCTION: The increase in antibiotic resistance, together with the absence of novel antibiotics, makes mandatory the introduction of novel strategies to optimize the use of existing antibiotics. Among these strategie...INTRODUCTION: The increase in antibiotic resistance, together with the absence of novel antibiotics, makes mandatory the introduction of novel strategies to optimize the use of existing antibiotics. Among these strategies, the use of molecules that increase their activity looks promising. AREAS COVERED: Different categories of adjuvants have been reviewed. Anti-resistance adjuvants increase the activity of antibiotics by inhibiting antibiotic resistance determinants. Anti-virulence approaches focus on the infection process itself; reducing virulence in combination with an antibiotic can improve therapeutic efficacy. Combination of phages with antibiotics can also be useful, since they present different mechanisms of action and targets. Finally, combining antibiotics with adjuvants in the same molecule may serve to improve antibiotics' efficacy and to overcome potential problems of differential pharmacokinetics/pharmacodynamics. EXPERT OPINION: The successful combination of inhibitors of β-lactamases with β-lactams has shown that adjuvants can improve the efficacy of current antibiotics. In this sense, novel anti-resistance adjuvants able to inhibit efflux pumps are still needed, as well as anti-virulence compounds that improve the efficacy of antibiotics by interfering with the infection process. Although adjuvants may present different pharmacodynamics/pharmacokinetics than antibiotics, conjugates containing both compounds can solve this problem. Finally, already approved drugs can be a promising source of antibiotic adjuvants.
INTRODUCTION: Leishmaniasis, including visceral, cutaneous, and mucocutaneous forms, present a major health challenge in tropical regions. Current antileishmanial medications has significant limitations, creating a criti...INTRODUCTION: Leishmaniasis, including visceral, cutaneous, and mucocutaneous forms, present a major health challenge in tropical regions. Current antileishmanial medications has significant limitations, creating a critical need for novel therapies that are safe and cost-effective with a shorter duration of treatment. AREAS COVERED: This review explores the critical aspects of existing antileishmanial therapy and targets for future therapeutic developments. It emphasizes the need for new treatment options due to drug resistance, low success rates, toxicity, and high prices associated with current medications. The different forms of leishmaniasis, their clinical manifestations, the challenges associated with their treatment and emerging treatment options are explored in detail. EXPERT OPINION: The first anti-leishmanial drug pentavalent antimony (Sb) was invented more than 100 years back. Since then, this compound has been used for all forms of leishmaniasis worldwide. For more than 70-80 years after discovery of Sb, no new antileishmanial drugs were developed, reflecting the lack of interest from academia or pharma industry. All three new treatments (Amphotericin-B, paromomycin and miltefosine) which underwent the clinical trials were repurposed drugs. The current pipeline for antileishmanial drugs is empty, with LXE 408 being the only potential drug reaching phase II clinical trial.
Expert Rev Anti Infect Ther
· 2025 Jan · PMID 39644103
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INTRODUCTION: Carbapenem-resistant (CRAB) is a critical priority pathogen posing a substantial threat to our public health due to its virulence and resistance to broad-spectrum antimicrobials. Sulbactam-durlobactam (Xac...INTRODUCTION: Carbapenem-resistant (CRAB) is a critical priority pathogen posing a substantial threat to our public health due to its virulence and resistance to broad-spectrum antimicrobials. Sulbactam-durlobactam (Xacduro) is a newly approved β-lactam-β-lactamase inhibitor combination agent with potent and activity against CRAB. The phase III randomized trial (ATTACK) demonstrated the safety and efficacy of sulbactam-durlobactam in combination with imipenem-cilastatin as background therapy in treating adult patients with hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia caused by CRAB. AREAS COVERED: This review will discuss pharmacology, antimicrobial activity, pharmacokinetics/pharmacodynamics, clinical efficacy, safety, and therapeutic role of sulbactam-durlobactam. To gather relevant information, a literature search was performed using PubMed and Google Scholar electronic databases. Search terms used include sulbactam, sulbactam-durlobactam, ETX2514, complex, CRAB, OXA-24, and OmpA. Additional information was obtained from the sulbactam-durlobactam FDA package insert and infectious diseases conference abstracts. EXPERT OPINION: Sulbactam-durlobactam is a well-tolerated β-lactam-β-lactamase inhibitor combination agent with efficacy against CRAB. Given the limitations of alternative treatment options, sulbactam-durlobactam may also be considered as a treatment option for non-respiratory infections caused by CRAB, however further clinical studies are warranted.
Mahapatra C, Jadhav S, Kumar P
… +3 more, Roy DN, Kumar A, Paul MK
Expert Rev Anti Infect Ther
· 2024 Dec · PMID 39466600
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INTRODUCTION: Mucormycosis, popularly known as the black fungus, has become a worldwide concern in the continuing COVID-19 pandemic, causing increased morbidity and death in immunocompromised people. Due to multi-drug re...INTRODUCTION: Mucormycosis, popularly known as the black fungus, has become a worldwide concern in the continuing COVID-19 pandemic, causing increased morbidity and death in immunocompromised people. Due to multi-drug resistance and the limited number of antifungals, surgical interventions, including the excision of infected tissue, remain a standard treatment option. Surgical treatment usually results in the loss of organs or their function, long-term intensive care, and a significant risk of reinfection during the procedure. A comprehensive approach is needed to treat the disease, and nanomaterials can be a powerful alternative therapeutic approach. AREAS COVERED: We searched PubMed, Scopus, and Google Scholar with the keywords 'emerging role of nanomaterials,' and 'combating COVID-19-related mucormycosis,' and reviewed the related research paper. Antifungal nanomaterials and their delivery can significantly impact the treatment of COVID-19-related fungal infections like mucormycosis. However, the therapeutic options for mucormycosis are limited and drug resistance is also reported. EXPERT OPINION: The current review encompasses a detailed overview of the recent developments in antifungal/antiviral nanomaterials and the properties of these therapeutic nanomaterials that may contribute to formulating an efficient strategy against invasive mucormycosis. Further extensive research is needed to develop nano-based therapeutics for the management of mucormycosis-viral coinfection with a definitive end-point.
Expert Rev Anti Infect Ther
· 2024 Dec · PMID 39466139
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INTRODUCTION: Despite the existence of antivirals that potently and efficiently inhibit the replication of herpes simplex virus 1 and 2 (HSV-1, -2), their ability to establish and maintain, and reactivate from, latency h...INTRODUCTION: Despite the existence of antivirals that potently and efficiently inhibit the replication of herpes simplex virus 1 and 2 (HSV-1, -2), their ability to establish and maintain, and reactivate from, latency has precluded the development of curative therapies. Several groups are exploring the opportunities of targeting epigenetic regulation to permanently silence latent HSV genomes or induce their simultaneous reactivation in the presence of antivirals to flush the latent reservoirs, as has been explored for HIV. AREAS COVERED: This review covers the basic principles of epigenetic regulation with an emphasis on those mechanisms relevant to the regulation of herpes simplex viruses, as well as the current knowledge on the regulation of lytic infections and the establishment and maintenance of, and reactivation from, latency, with an emphasis on epigenetic regulation. The differences with the epigenetic regulation of viral and cellular gene expression are highlighted as are the effects of known epigenetic regulators on herpes simplex viruses. The major limitations of current models to the development of novel antiviral strategies targeting latency are highlighted. EXPERT OPINION: We provide an update on the epigenetic regulation during lytic and latent HSV-1 infection, highlighting the commonalities and differences with cellular gene expression and the potential of epigenetic drugs as antivirals, including the opportunities, challenges, and potential future directions.
Wang T, Wu J, Li J
… +5 more, Zhou P, Li Q, Xu X, Gong Y, Yin X
Expert Rev Anti Infect Ther
· 2024 Dec · PMID 39422303
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BACKGROUND: Irrational use of antibiotics is a major driver of antimicrobial resistance. Self-medication with antibiotics (SMA) may exacerbate antimicrobial resistance in the community without professional diagnosis by p...BACKGROUND: Irrational use of antibiotics is a major driver of antimicrobial resistance. Self-medication with antibiotics (SMA) may exacerbate antimicrobial resistance in the community without professional diagnosis by physicians, due to the complexity of the pharmacological mechanisms. There is still a lack of assessment of the global prevalence of SMA. We have evaluated the global prevalence of SMA and its associated factors, which could provide more reliable data to support global action. METHODS: We searched PubMed, Embase, Web of Science, and EBSCO CINAHL Plus. Quantitative studies were combined using meta-analysis with random-effects models, and qualitative synthesis was performed using interpretive meta-ethnographic methods. RESULTS: A total of 242 studies were included in this study. The pooled prevalence of SMA was 27.7% (95%CI: 24.9%-30.5%). Quantitative studies indicate that high income level, having family members working in the healthcare system, storing antibiotics at home, and purchasing antibiotics without prescriptions were associated with a greater likelihood of SMA. Qualitative findings revealed the following four factors: individual characteristics, healthcare, pharmacy, and social networks. CONCLUSIONS: The prevalence of global SMA among the public remains high level. Multisectoral and community-based interventions are needed to reduce SMA, including targeted health education, improved access to healthcare, and regulation of antibiotics sales in pharmacies. REGISTRATION: PROSPERO (CRD42023402206).
Hsu WH, Shiau BW, Tsai YW
… +5 more, Wu JY, Liu TH, Huang PY, Chuang MH, Lai CC
Expert Rev Anti Infect Ther
· 2024 Dec · PMID 39422246
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OBJECTIVE: To investigate the effectiveness of oral antiviral agents - nirmatrelvir - ritonavir or molnupiravir in non-hospitalized COVID-19 patients aged < 60 years. METHODS: This retrospective cohort study analyzed dat...OBJECTIVE: To investigate the effectiveness of oral antiviral agents - nirmatrelvir - ritonavir or molnupiravir in non-hospitalized COVID-19 patients aged < 60 years. METHODS: This retrospective cohort study analyzed data of patients aged 18-60 years diagnosed with COVID-19 between 1 January 2022, and 30 June 2023. Propensity score matching was used to balance the demographic and clinical characteristics of patients receiving oral antivirals (nirmatrelvir - ritonavir or molnupiravir) and untreated controls. The primary outcome was a composite of all-cause emergency department visits, hospitalizations, or mortality within 30 days. The secondary outcomes included each individual component of the primary composite outcome. RESULTS: Two matched cohorts (antiviral group and control group) comprising 52,585 patients with balanced baseline characteristics were created using propensity score-matching. During follow-up period, the antiviral group demonstrated a lower risk of the primary outcome than the control group (hazard ratio [HR] 0.772, 95% confidence interval [CI] 0.736-0.808, < 0.001). The antiviral group also exhibited a reduced risk of individual secondary outcomes, including emergency department visits (HR 0.780, 95% CI, 0.738-0.825), hospitalization (HR 0.755, 95% CI, 0.715-0.840), and mortality (HR 0.297, 95% CI, 0.147-0.600). CONCLUSION: Oral antiviral agents were associated with lower risks of all-cause emergency department visits, hospitalizations, and mortality in non-hospitalized COVID-19 patients aged < 60 years.