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Clinical Therapeutics Mar 2002The mainstays of treatment for nosocomial fungal infections have been amphotericin B and azole derivatives. Caspofungin acetate is a new echinocandin antifungal agent... (Review)
Review
BACKGROUND
The mainstays of treatment for nosocomial fungal infections have been amphotericin B and azole derivatives. Caspofungin acetate is a new echinocandin antifungal agent with a mechanism of action that targets a structural component of the fungal cell wall.
OBJECTIVE
This article describes the pharmacologic properties and potential clinical usefulness of caspofungin.
METHODS
Relevant information was identified through searches of MEDLINE (1966-September 2001). Iowa Drug Information Service (1966-September 2001), and International Pharmaceutical Abstracts (1970-September 2001), as well as meeting abstracts of the Infectious Diseases Society of America and the Interscience Conference on Antimicrobial Agents and Chemotherapy (1996-2001), using the terms caspofungin, MK-0991, pneumocandin, echinocandin, candin, and beta-(1,3)-glucan inhibitor.
RESULTS
In vitro, caspofungin exhibits antifungal activity against an array of clinically important yeasts and molds, including Candida and Aspergillus spp. The proposed susceptibility breakpoint for caspofungin against Candida spp, the most common cause of nosocomial fungal infections, is a minimum inhibitory concentration of < or =1 microg/mL. In humans, caspofungin has a volume of distribution of 9.67 L, is extensively bound to albumin (97%), has a plasma elimination half-life of 9 to 11 hours, and is metabolized to inactive metabolites in the liver. Dose adjustment based on age, sex, race, or renal function does not appear to be necessary, although patients with moderate hepatic insufficiency (Child-Pugh score 7-9) should receive a lower maintenance dose. The results of clinical trials, although somewhat preliminary, suggest that caspofungin is effective in the treatment of esophageal and oropharyngeal candidiasis and invasive aspergillosis. When combined with other antifungal agents, caspofungin produces a synergistic or additive effect against a variety of clinically important fungi. The most commonly reported adverse events with caspofungin have included fever, infusion-related reactions, headache, nausea, elevations in liver transaminase levels, and histamine-type reactions. The recommended dosage in adults is 70 mg IV on day 1 followed by 50 mg/d, with the duration of treatment depending on the severity of the patient's underlying condition and the clinical response.
CONCLUSION
Although additional studies are needed, caspofungin appears to be a promising agent for the treatment of patients with difficult-to-treat or life-threatening fungal infections.
Topics: Aged; Animals; Anti-Bacterial Agents; Antifungal Agents; Caspofungin; Clinical Trials as Topic; Drug Interactions; Drug Resistance, Microbial; Echinocandins; Fungi; Humans; Lipopeptides; Mycoses; Peptides; Peptides, Cyclic
PubMed: 11952021
DOI: 10.1016/s0149-2918(02)85039-1 -
Journal of Paediatrics and Child Health May 2023To assess whether febrile neonates from the community received their first dose of intravenous antibiotics within 1 h from time of arrival, as per the regional...
AIM
To assess whether febrile neonates from the community received their first dose of intravenous antibiotics within 1 h from time of arrival, as per the regional paediatric sepsis pathway, at a tertiary combined adult/child emergency department in New Zealand.
METHOD
Retrospective data were collected from January 2018 to December 2019 with 28 patients included.
RESULTS
Mean time to first antibiotic dose for all neonates and those with serious bacterial infection was 3 h 20 min and 2 h 53 min respectively. No case used the paediatric sepsis pathway. A pathogen was identified in 19/28 (67%) neonates and 16/28 (57%) had clinical signs of shock.
CONCLUSION
This study adds to Australasian data on community neonatal sepsis. Antibiotic administration was delayed for neonates with serious bacterial infection, clinical signs of shock and raised lactate. The reasons for delay are examined, with a number of potential areas for improvement identified.
Topics: Infant, Newborn; Adult; Humans; Child; Anti-Bacterial Agents; Retrospective Studies; Fever; Sepsis; Bacterial Infections
PubMed: 36999339
DOI: 10.1111/jpc.16375 -
Current Clinical Pharmacology Sep 2006Chronobiology studies the phenomenon of rhythmicity in living organisms. Circadian rhythms are genetically determined and are regulated by external synchronizers (i.e.... (Review)
Review
Chronobiology studies the phenomenon of rhythmicity in living organisms. Circadian rhythms are genetically determined and are regulated by external synchronizers (i.e. light/day cycle). Several biological processes involved in the pharmacokinetics and pharmacodynamics of drugs are subject to circadian variations. Chronopharmacology studies how biological rhythms impact on drug pharmacokinetic (chronokinetics), pharmacodynamics (chronoesthesy) and toxicity and determines whether time of day administration modifies drug's pharmacological characteristics. Chronotherapy applies chronopharmacological studies to clinical treatments, determining the best biological time for its dosing, i.e. when beneficial effects are maximal and incidence and/or intensity of related side-effects and toxicity are minimal. Significant variations in the pharmacokinetics and toxicity of antibiotics (aminoglycosides, beta-lactams and fluoroquinolones) related to administration time are well known. The aims of this review are to discuss, briefly, the currently accepted model of the circadian system that substantiates endogenous rhythmicity and to provide an update on the knowledge of circadian rhythms applied to drugs used as medicines, with a special mention to the possible impact on antimicrobial treatments. It is concluded that the dosing time of an antimicrobial agent might be clinically relevant in some treatments, thus, clinicians should be aware that the dosing time might affect the clinical response of a drug.
Topics: Anti-Bacterial Agents; Circadian Rhythm; Humans; Kidney
PubMed: 18666751
DOI: 10.2174/157488406778249299 -
Expert Review of Anti-infective Therapy Jun 2005Pharmacokinetic/pharmacodynamic modeling has become an extremely important tool in evaluating and optimizing anti-infective therapy. By systematically linking the... (Review)
Review
Pharmacokinetic/pharmacodynamic modeling has become an extremely important tool in evaluating and optimizing anti-infective therapy. By systematically linking the pharmacokinetic and pharmacodynamic properties of the anti-infective agent, it is possible to make educated decisions about the correct drug to be used, correct dosing regimen and to estimate the probability of success with the selected dose regimen. This article gives an overview of the current pharmacokinetic/pharmacodynamic approaches for anti-infective agents and discusses their use in optimizing drug therapy.
Topics: Anti-Bacterial Agents; Area Under Curve; Dose-Response Relationship, Drug; Microbial Sensitivity Tests; Models, Biological; Monte Carlo Method
PubMed: 15954853
DOI: 10.1586/14787210.3.3.361 -
The Medical Clinics of North America Nov 1987Combinations of antimicrobial agents are most often used to provide empiric broad spectrum coverage. Other potential reasons for combination therapy include treatment of... (Review)
Review
Combinations of antimicrobial agents are most often used to provide empiric broad spectrum coverage. Other potential reasons for combination therapy include treatment of polymicrobial infections, to enhance killing or inhibition (synergism), to reduce the potential for developing resistance, and less commonly to allow reduction in the dose of a toxic agent. However, combination regimens are often used unnecessarily and can result in increased side effects, costs, and other undesirable effects.
Topics: Anti-Bacterial Agents; Bacterial Infections; Drug Antagonism; Drug Synergism; Drug Therapy, Combination; Humans
PubMed: 3320612
DOI: 10.1016/s0025-7125(16)30798-2 -
Archives of Internal Medicine Jul 1997Although several new antibiotics have recently become available, in several clinical instances conventional antibiotics may be equally efficacious at a considerably... (Review)
Review
Although several new antibiotics have recently become available, in several clinical instances conventional antibiotics may be equally efficacious at a considerably lower cost. In today's era of cost containment, it is particularly relevant to revisit older, inexpensive antibiotics to reexplore their role in the face of the emergence of resistant microorganisms and competition from newer agents. Doxycycline is one such antibiotic. It is an inexpensive, broad-spectrum antimicrobial agent that remains the drug of first choice for several infections. In addition, it can be used for a variety of other indications. Adverse effects are infrequent and relatively minor. While interactions occur with several medications, none of these interactions has significant adverse consequences.
Topics: Animals; Anti-Bacterial Agents; Doxycycline; Drug Interactions; Humans
PubMed: 9224219
DOI: No ID Found -
Brazilian Journal of Biology = Revista... 2023Staphylococcus aureus (S. aureus) is a pathogenic bacteria that causes a variety of potentially fatal infections. The emergence of antibiotic-resistant strains of S.... (Review)
Review
Staphylococcus aureus (S. aureus) is a pathogenic bacteria that causes a variety of potentially fatal infections. The emergence of antibiotic-resistant strains of S. aureus has made treatment even more difficult. In recent years, nanoparticles have been used as an alternative therapeutic agent for S. aureus infections. Among various methods for the synthesis of nanoparticles, the method utilizing plant extracts from different parts of a plant, such as root, stem, leaf, flower, seeds, etc. is gaining widespread usage. Phytochemicals present in plant extract are an inexpensive, eco-friendly, natural material that act as reducing and stabilization agent for the nanoparticle synthesis. The utilization of plant-fabricated nanoparticles against S. aureus is currently in trend. The current review discusses recent findings in the therapeutic application of phytofabricated metal-based nanoparticles against Staphylococcus aureus.
Topics: Staphylococcus aureus; Metal Nanoparticles; Staphylococcal Infections; Plant Leaves; Anti-Bacterial Agents; Plant Extracts; Microbial Sensitivity Tests
PubMed: 36888798
DOI: 10.1590/1519-6984.268052 -
The Journal of Antibiotics Jun 2021An anti-mannheimiosis agent, aldsulfin, was isolated from a culture broth of the fungus Lasiodiplodia pseudotheobromae FKI-4499, together with a known compound,...
An anti-mannheimiosis agent, aldsulfin, was isolated from a culture broth of the fungus Lasiodiplodia pseudotheobromae FKI-4499, together with a known compound, lasiodipline C, using bioassay-guided fractionation. Spectroscopic analysis of aldsulfin, using NMR, mass spectrometry, and CD analyses revealed it to be an epithiodiketopiperazine with an unstable and unusual hemithioaminal moiety. Aldsulfin showed antibacterial activity against Mannheimia haemolytica and Pasteurella multocida.
Topics: Anti-Bacterial Agents; Ascomycota; Culture Media; Diketopiperazines; Drug Evaluation, Preclinical; Fermentation; Magnetic Resonance Spectroscopy; Mannheimia haemolytica; Microbial Sensitivity Tests; Molecular Structure; Pasteurella multocida
PubMed: 33654250
DOI: 10.1038/s41429-021-00411-8 -
Minocycline as a prospective therapeutic agent for cancer and non-cancer diseases: a scoping review.Naunyn-Schmiedeberg's Archives of... May 2024Minocycline is an FDA-approved secondary-generation tetracycline antibiotic. It is a synthetic antibiotic having many biological effects, such as antioxidant,... (Review)
Review
Minocycline is an FDA-approved secondary-generation tetracycline antibiotic. It is a synthetic antibiotic having many biological effects, such as antioxidant, anti-inflammatory, anti-cancer, and neuroprotective functions. This study discusses the pharmacological mechanisms of preventive and therapeutic effects of minocycline. Specifically, it provides a comprehensive overview of the molecular pathways by which minocycline acts on the different cancers, including ovarian, breast, glioma, colorectal, liver, pancreatic, lung, prostate, melanoma, head and neck, leukemia, and non-cancer diseases such as Alzheimer's disease, Parkinson, schizophrenia, multiple sclerosis, Huntington, polycystic ovary syndrome, and coronavirus disease 19. Minocycline may be a potential medication for these disorders due to its strong blood-brain barrier penetrance. It is also widely accepted as a specific medication, has a well-known side-effect characteristic, is reasonably priced, making it appropriate for continuous use in managing diseases, and has been demonstrated as an oral approach because it is effectively absorbed and accomplished almost all of the body's parts.
Topics: Humans; Minocycline; Neoplasms; Animals; Antineoplastic Agents; Anti-Bacterial Agents; COVID-19 Drug Treatment
PubMed: 37991540
DOI: 10.1007/s00210-023-02839-1 -
Expert Opinion on Pharmacotherapy Mar 2014Despite available treatment options for methicillin-resistant Staphylococcus aureus (MRSA), the morbidity and mortality attributed to the diverse infection... (Review)
Review
INTRODUCTION
Despite available treatment options for methicillin-resistant Staphylococcus aureus (MRSA), the morbidity and mortality attributed to the diverse infection manifestations of this pathogen remain high. More anti-MRSA agents are needed as options for treatment of these infections. Ideally, these new agents would be rapidly bactericidal for bloodstream clearance in septic patients, have few toxicities, be active against MRSA in biofilms, be easy to administer, and have oral bioavailability.
AREAS COVERED
This review focuses on MRSA agents in Phase III trials or antibiotics currently in the market, which are being studied for new indications. For each agent, the antimicrobial potency against MRSA, pharmacokinetic and pharmacodynamic considerations and approved and potential new indications are presented. The role of novel combination therapies is also introduced.
EXPERT OPINION
The new lipoglycopeptides oritavancin, telavancin and dalbavancin have the potential to make a large impact on the treatment of MRSA due to unique pharmacokinetic/pharmacodynamic properties and proposed dosing regimens. Other new agents (omadacycline and tedizolid) as well as revisited older agents (fosfomycin and fusidic acid) appear promising but require further study for their potential role. Combination therapy may improve outcomes in patients with high MRSA infection burden or when patient or pathogen factors predict a worse outcome with monotherapy.
Topics: Anti-Bacterial Agents; Clinical Trials, Phase III as Topic; Drug Therapy, Combination; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections
PubMed: 24437531
DOI: 10.1517/14656566.2014.876991