scholarly journals Omalizumab for Severe Asthma: Beyond Allergic Asthma

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
C. C. Loureiro ◽  
L. Amaral ◽  
J. A. Ferreira ◽  
R. Lima ◽  
C. Pardal ◽  
...  
Keyword(s):  
Allergic Asthma ◽  
Severe Asthma ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Allergen Exposure ◽  
Response To Therapy ◽  
Double Blind ◽  
Clinical Signs And Symptoms ◽  
Underlying Mechanisms

Different subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient’s response to therapy and pharmacoeconomical analysis are questions that remain to be answered.

Children With Influenza A Infection: Treatment With Rimantadine

PEDIATRICS ◽  
1987 ◽  
Vol 80 (2) ◽  
pp. 275-282
Author(s):  
Caroline Breese Hall ◽  
Raphael Dolin ◽  
Christine L. Gala ◽  
David M. Markovitz ◽  
Yu Qin Zhang ◽  
...  
Keyword(s):  
Influenza A ◽  
Clinical Signs ◽  
Severity Of Illness ◽  
Signs And Symptoms ◽  
Clinical Isolates ◽  
Double Blind Study ◽  
Double Blind ◽  
Viral Shedding ◽  
Development Of Resistance ◽  
Clinical Signs And Symptoms

Treatment with rimantadine of influenza in children and the potential development of resistance in clinical isolates associated with therapy have not been previously studied. We compared rimantadine to acetaminophen therapy in a controlled, double-blind study of 91 children with influenza-like illness. Of 69 children with proven influenza A/H3N2 infection, 37 received rimantadine and 32 received acetaminophen for five days. Children receiving rimantadine showed significantly greater reduction in fever and improvement in daily scores for symptoms and severity of illness during the first three days. Viral shedding also diminished significantly during the first two days but subsequently increased such that by days 6 and 7 the proportion of children shedding virus, as well as the quantity of virus shed, was significantly greater in the rimantadine group. During the seven-day study, of the 22 children in the rimantadine group with serial isolates tested, ten (45.5%) had resistant isolates compared with two (12.5%) of those with serial isolates in the acetaminophen group (P < .03). Thus, of the total 37 children in the rimantadine group, 27% were found to have resistant isolated compared with 6% in the total group receiving acetaminophen (P < .04). Furthermore, the mean inhibitory concentration of rimantadine increased with time in the rimantadine group (r = .4, P = .002) but not in the acetaminophen group. Rimantadine therapy, thus, appears to be significantly more effective than acetaminophen in ameliorating the clinical signs and symptoms of influenza in children. Treatment with rimantadine was also associated with increased viral shedding after the medication was discontinued and with the development of resistance in the clinical isolates, the significance of which is unknown.

scholarly journals Recurrent Vulvovaginal Candidosis and Cluster Analysis of Clinical Signs and Symptoms: A Laboratory-Based Investigation

2020 ◽  
Vol 6 (3) ◽  
pp. 113
Author(s):  
Aleksandra Ignjatović ◽  
Valentina Arsić-Arsenijević ◽  
Milan Golubović ◽  
Saša Đenić ◽  
Stefan Momčilović ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Clinical Characteristics ◽  
Antifungal Susceptibility ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
In Vitro Susceptibility ◽  
Major Health Problem ◽  
Vulvovaginal Candidosis ◽  
Clinical Signs And Symptoms

Recurrent vulvovaginal candidosis (RVVC) represents a major health problem that significantly affects a patient’s quality of life (QoL). This infection presents with a plethora of clinical manifestation, and this is the first study that carries out a cluster analysis of these signs and symptoms (SS). The goals are to evaluate the distribution of species causing RVVC, their in-vitro susceptibility to antifungals, and the patient’s QoL. Additionally, the clinical characteristics are analyzed using cluster analysis. Prospective analysis of data was performed for women diagnosed with RVVC in the period from January 2016 to December 2019 based on the analysis of data from a single-center’s records. The standard mycological methods and antifungal susceptibility testing were done. Clinical characteristics and QoL were examined by appropriate questions. The cluster analysis was used to identify clusters of SS. A total of 320 women were diagnosed. The dominant species was Candida (C.) albicans. Non-albicans Candida (NAC) yeast was found in 24.4%, and the most common was C. glabrata. Interestingly, Saccharomyces (S.) cerevisiae was detected in 2%. All of the isolated species, except C. parapsilosis and C. kefyr, demonstrated reduced susceptibility to antifungals. We confirmed the emergence of the NAC species and S. cerevisiae with reduced susceptibility to antifungals. Cluster analysis represented by a dendrogram revealed three SS clusters: irritation, uncommon, and discharge, but further studies are needed to examine the relationship between clusters, Candida strains, and outcomes.

scholarly journals Pharmacological Properties of Chalcones: A Review of Preclinical Including Molecular Mechanisms and Clinical Evidence

2021 ◽  
Vol 11 ◽  
Author(s):  
Bahare Salehi ◽  
Cristina Quispe ◽  
Imane Chamkhi ◽  
Nasreddine El Omari ◽  
Abdelaali Balahbib ◽  
...  
Keyword(s):  
Clinical Studies ◽  
Molecular Mechanisms ◽  
Therapeutic Potential ◽  
Biological Activities ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Signs And Symptoms ◽  
Skin Conditions ◽  
Underlying Mechanisms ◽  
Preclinical And Clinical Studies

Chalcones are among the leading bioactive flavonoids with a therapeutic potential implicated to an array of bioactivities investigated by a series of preclinical and clinical studies. In this article, different scientific databases were searched to retrieve studies depicting the biological activities of chalcones and their derivatives. This review comprehensively describes preclinical studies on chalcones and their derivatives describing their immense significance as antidiabetic, anticancer, anti-inflammatory, antimicrobial, antioxidant, antiparasitic, psychoactive, and neuroprotective agents. Besides, clinical trials revealed their use in the treatment of chronic venous insufficiency, skin conditions, and cancer. Bioavailability studies on chalcones and derivatives indicate possible hindrance and improvement in relation to its nutraceutical and pharmaceutical applications. Multifaceted and complex underlying mechanisms of chalcone actions demonstrated their ability to modulate a number of cancer cell lines, to inhibit a number of pathological microorganisms and parasites, and to control a number of signaling molecules and cascades related to disease modification. Clinical studies on chalcones revealed general absence of adverse effects besides reducing the clinical signs and symptoms with decent bioavailability. Further studies are needed to elucidate their structure activity, toxicity concerns, cellular basis of mode of action, and interactions with other molecules.

scholarly journals A scoping review protocol to identify clinical signs, symptoms and biomarkers indicative of biofilm presence in chronic wounds

2021 ◽  
Vol 4 ◽  
pp. 71
Author(s):  
John D. Ivory ◽  
Akke Vellinga ◽  
James O'Gara ◽  
Georgina Gethin
Keyword(s):  
Chronic Wounds ◽  
Evidence Synthesis ◽  
Demographic Data ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Third Party ◽  
Scoping Reviews ◽  
Clinical Signs And Symptoms ◽  
High Level

Introduction: Wound healing is characterised by haemostatic, inflammatory, proliferative and remodelling phases. In the presence of comorbidities such as diabetes, healing can stall and chronic wounds may result. Infection is detrimental to these wounds and associated with poor outcomes. Wounds are contaminated with microbes and debris, and factors such as host resistance, bacterial virulence, species synergy and bioburden determine whether a wound will deteriorate to critically colonised/infected states. Biofilms are sessile microbial communities, exhibiting high-level antibiotic tolerance and resistance to host defences. Biofilm in critically colonised wounds can contribute to delayed healing. Little is known about clinical presentation and diagnosis of wound biofilms. Objective: To identify from the literature clinical signs, symptoms and biomarkers that may indicate biofilm presence in chronic wounds. Methods: This review will be guided by the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR), and the Joanna Briggs Institute Manual for Evidence Synthesis. Studies of any design in any language recruiting adult patients with  venous, diabetic, pressure or mixed arterial-venous ulcers and reporting data on clinical signs/symptoms of biofilm are eligible. Searches of Medline, Embase, CINAHL, Cochrane Central and BASE will be conducted from inception to present. Reference scanning and contact with content experts will be employed. Title/abstract screening and full text selection will be executed by two reviewers independently. Discrepancies will be resolved by discussion between reviewers or through third party intervention. Data will be extracted by a single reviewer and verified by a second. Clinical signs and symptoms data will be presented in terms of study design, setting and participant demographic data. Discussion: Understanding biofilm impact on chronic wounds is inconsistent and based largely on in vitro research. This work will consolidate clinical signs, symptoms and biomarkers of biofilm in chronic wounds reported in the literature.

scholarly journals Use of Lozenges Containing Lactobacillus brevis CD2 in Recurrent Aphthous Stomatitis: A Double-Blind Placebo-Controlled Trial

Ulcers ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Vito Trinchieri ◽  
Stefano Di Carlo ◽  
Maurizio Bossu' ◽  
Antonella Polimeni
Keyword(s):  
Controlled Trial ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Lactobacillus Brevis ◽  
Recurrent Aphthous Stomatitis ◽  
Aphthous Stomatitis ◽  
Rapid Improvement ◽  
Double Blind ◽  
Rapid Healing ◽  
Clinical Signs And Symptoms

Recurrent aphthous stomatitis is a common disorder of the oral cavity, affecting mainly young people. It is characterized by small ulcers which can be very painful and generally heal spontaneously within 7–14 days. There is currently no therapy that can provide rapid healing. This study evaluated the efficacy and rapidity of response of a lozenge containing Lactobacillus brevis CD2. 30 patients were randomized to take 4 lozenges a day of active product or placebo for 7 days. Signs and symptoms as well as laboratory parameters in the saliva were assessed at the start of the study and after 7 days of treatment. The study demonstrated the efficacy and the rapidity of response of the Lactobacillus brevis CD2 lozenges in resolving the clinical signs and symptoms of aphthous stomatitis, with a significantly rapid improvement of pain. This is the first study confirming the efficacy of a probiotic product in this pathology.

scholarly journals Endodontic retreatment due to secondary periapical injury: case report

2020 ◽  
Vol 9 (6) ◽  
pp. 503-506
Author(s):  
Monica Soares de Albuquerque ◽  
Armiliana Soares Nascimento ◽  
Cácio Lopes Mendes ◽  
Leonardo José Rodrigues de Oliveira ◽  
Marília de Lima Soares ◽  
...  
Keyword(s):  
Root Canal ◽  
Clinical Signs ◽  
In Vitro Study ◽  
Signs And Symptoms ◽  
Endodontic Treatment ◽  
Endodontically Treated Teeth ◽  
Clinical Signs And Symptoms ◽  
Endodontic Retreatment

Pulp diseases commonly happens because of the actions of bacteriological factors and show their characteristic signs and symptoms over the time. With pulp necrosis, a degenerative process starts and when there is no early treatment, it is possible to occur periapical lesions as a result of aggression to the pulp. In cases of periapical secondary lesions, clinical signs and symptoms persist and are related to secondary infection due to persistent bacterial contamination, also to operative factors, inadequate obturation or poor coronary restoration. This study aimed to report a case of endodontic retreatment and clinical and radiographic follow-up for 8 years, of chronic periapical abscess case, in which after retreatment, clinical signs and symptoms are no longer observed and bone neoformation is noticed. Descriptors: Periapical Diseases; Endodontics; Periapical Abscess. Referências Alani AH. Endodontic treatment of bilaterally occurring four-rooted maxillary second molars: case report. J Can Dent Assoc. 2003;69(11):733–35. Slowey RR. Radiographic aids in the detection of extra root canals. Oral Surg Oral Med Oral Pathol 1974;37(5):762-72 Bergenholtz G, Malmcrona E, Milthon R. Endodontic treatment and periapical status I. Radiographic evaluation of the frequency of endodontically treated teeth. Tandl€akartidningen. 1973; 65:64–73 (In Swedish, English summary). Buckley M, Spangberg LS. The prevalence and technical quality of endodontic treatment in an American subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(1):92–100. Saunders WP, Saunders EM, Sadiq J, Cruickshank E. Technical standard of root canal treatment in an adult Scottish sub-population. Br Dent J. 1997;182(10):382-86. Segura-Egea JJ, Jimenez-Pinzon A, Poyato-Ferrera M, Velasco-Ortega E, Rios-Santos JV. Periapical status and quality of root fillings and coronal restorations in an adult Spanish population. Int Endod J. 2004;37(8):525-30. Kabak Y, Abbott PV. Prevalence of apical  periodontitis and the quality of endodontic treatment in an adult Belarusian population. Int Endod J. 2005;38(4):238-45. Glickman GN. AAE consensus conference on diagnostic terminology: background and perspectives. J Endod. 2009;35:1619. Gutmann JL, Harrison JW. Surgical endodontics: an online study guide. Blackwell Scientific Publications; 1991. Molven O, Halse A, Grung B. Incomplete healing (scar tissue) after periapical surgery - radiographic findings 8 to 12 years after treatment. J Endod. 1996;22(5):264-68. Macedo, IL Retratamento endodôntico: opção terapêutica do insucesso endodôntico. BJHR. 2018;1(2):421-31. Souza VC et al. Tratamento do insucesso endodôntico. Rev Odontol Bras Central. 2018; 27:44-48. Bender IB, Seltzer S, Soltanoff W. Endodontic success – a reappraisal of criteria. Oral Surg Oral Med Oral Pathol. 1966; 22(6):790–802. Rubinstein R A, Kim S. Long-term follow-up of cases considered healed one year after apical microsurgery. J Endod. 2002; 28(5):378-83. Estrela C et al. Characterization of successful root canal treatment. Braz Dent J. 2014; 25(1):3-11 http://dx.doi.org/10.1590/0103-6440201302356 Kaled GH et al. Retratamento endodôntico: análise comparativa da efetividade da remoção da obturação dos canais radiculares realizada por três métodos. RGO, Rev. gaúch. odontol. (Online). 2011;59(1):103-8. Rossi-Fedele G, Ahmed HMA. Assessment of rootcanal filling removal effectiveness using micro–computedtomography: a systematic review. J Endod. 2017;43(4):520-26 Barbosa SV, Burkhard DH, Spanberg LSV. Cytotoxic effects of gutta-percha solvents. J Endod. 1994; 20(1):6-8. Zakariasen KL, Brayton SM, Collinson DM. Efficient and effective root canal retreatment without chloroform. J Canad Dent Assoc. 1990; 56(6):509-12. Pecora JD, Spano JC, Barbin EL. In vitro study on the softening of gutta-percha cones in endodontic retreatment. Brazilian. Braz Dent Journal. 1993; 4(1): 43-7. Scelza MF et al. Comparative SEM evaluation of three solvents used in endodontic retreatment: an ex vivo study. Journal of Applied Oral Science. 2008; 16(1):24-9. Marques da Silva B et al. Effectiveness of ProTaper, D-RaCe, and Mtwo retreatment files with and without supplementary instruments in the removal of root canal filling material. Int Endod J. 2012; 45(10):927-32 Song M1 et al. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod. 2011;37(11):1516-9. Albuquerque MS et al. Sealing Capacity of Bulk-fill Resin in Endodontically Treated Teeth. The Journal of Contemporary Dental Practice. 2019; 20(3): 311-17 Zancan RF, Vivan RR, Lopes MRM et al. Antimicrobial activity and physicochemical properties of calcium hydroxide pastes used as intracanal medication. J Endod. 2016. 42(12):1822-28. Buttler TK, Crawford JJ. The detoxifying effect of varying concentrations of sodium hypochlorite on endotoxins. J Endod. 1982; 8(2):59-66. Foley DB, Weine FS, Hagen JC, deObarrio JJ. Effectiveness of selected irrigants in the elimination of bacteroides meloninogenicus from the root canal system: an in vitro study. J Endod. 1983; 9(6):236-41. Abou-Ran M, Oglesby SW. The effects of temperature, concentration and tissue type on the solvent ability of sodium hypochlorite. J Endod. 1981; 7(8):376-7. Lee JK et al. Physicochemical Properties of Epoxy Resin-Based and Bioceramic-Based Root Canal Sealers. Bioinorg Chem Appl. 2017; 1-8.  Kandemir DG, Caliskan MK. A prospective Ramdomized  Comparative Study of Cold Lateral Condensation Versus Core/Guta Percha in Teeth with Periapical Lesions. J Endod. 2016; 42(2):206-10 Karaman E, Keskin B, Inan U. Three-year clinical evaluation of class II posterior composite restorations placed with different techniques and flowable composite linings in endodontically treated teeth. Clin Oral Investig. 2017; 21(2):709-16.

scholarly journals A scoping review protocol to identify clinical signs, symptoms and biomarkers indicative of biofilm presence in chronic wounds

2021 ◽  
Vol 4 ◽  
pp. 71
Author(s):  
John D. Ivory ◽  
Akke Vellinga ◽  
James O'Gara ◽  
Georgina Gethin
Keyword(s):  
Chronic Wounds ◽  
Evidence Synthesis ◽  
Demographic Data ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Third Party ◽  
Scoping Reviews ◽  
Clinical Signs And Symptoms ◽  
High Level

Introduction: Wound healing is characterised by haemostatic, inflammatory, proliferative and remodelling phases. In the presence of comorbidities such as diabetes, healing can stall and chronic wounds may result. Infection is detrimental to these wounds and associated with poor outcomes. Wounds are contaminated with microbes and debris, and factors such as host resistance, bacterial virulence, species synergy and bioburden determine whether a wound will deteriorate to critically colonised/infected states. Biofilms are sessile microbial communities, exhibiting high-level antibiotic tolerance and resistance to host defences. Biofilm in critically colonised wounds can contribute to delayed healing. Little is known about clinical presentation and diagnosis of wound biofilms. Objective: To identify from the literature clinical signs, symptoms and biomarkers that may indicate biofilm in chronic wounds. Methods: This review will be guided by the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR), and the Joanna Briggs Institute Manual for Evidence Synthesis. Studies of any design in any language recruiting adult patients with  venous, diabetic, pressure or mixed arterial-venous ulcers and reporting data on clinical signs/symptoms of biofilm are eligible. Searches of Medline, Embase, CINAHL, Cochrane Central, Scopus, Web of Science, Google scholar and BASE will be conducted from inception to present. Reference scanning and contact with content experts will be employed. Title/abstract screening and full text selection will be executed by two reviewers independently. Discrepancies will be resolved by discussion between reviewers or through third party intervention. Data will be extracted by a single reviewer and verified by a second. Clinical signs and symptoms data will be presented in terms of study design, setting and participant demographic data. Discussion: Understanding biofilm impact on chronic wounds is inconsistent and based largely on in vitro research. This work will consolidate clinical signs, symptoms and biomarkers of biofilm in chronic wounds reported in the literature.

scholarly journals Pseudocyesis as a healing mechanism for psychological trauma

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Georgia Nektaria Porfyri ◽  
Anastasia Konsta ◽  
Anthoula Tsolaki ◽  
Ioannis Diakogiannis ◽  
Ioanna Ierodiakonou-Benou
Keyword(s):  
Somatic Symptom ◽  
Present Report ◽  
Clinical Signs ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Psychological Trauma ◽  
Vitro Fertilization ◽  
Clinical Signs And Symptoms ◽  
Patient’S History

Pseudocyesis, a rare condition characterized by clinical signs and symptoms of pregnancy except for the actual existence of a fetus, is a somatic symptom disorder associated with a variety of biological, psychological and social factors. The present report aims to present the case of a 45-year old patient with pseudocyesis from a psychodynamic perspective. According to a psychodynamic perspective and based on patient’s history, pseudocyesis functioned as a mental healing mechanismfor the trauma of long-standing infertility, the trauma of eight unsuccessful and painful in vitro fertilization attempts and above all, the trauma of finally giving birth to a non-healthy child.

scholarly journals Clinical Efficacy and Safety of Benjakul Remedy Extract for Treating Primary Osteoarthritis of Knee Compared with Diclofenac: Double Blind, Randomized Controlled Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
Patamaporn Rachawat ◽  
Piya Pinsornsak ◽  
Puritat Kanokkangsadal ◽  
Arunporn Itharat
Keyword(s):  
Clinical Efficacy ◽  
Safety Issue ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Controlled Study ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Primary Osteoarthritis ◽  
Clinical Signs And Symptoms

Background. The purpose of this study was to investigate the clinical efficacy and safety of Benjakul (BJK) extract for treating primary osteoarthritis (OA) of the knee compared with diclofenac. Methods. A phase 2, double blind, randomized, and controlled study was conducted. The BJK group received 300 mg of BJK extract per day, while another group received 75 mg of diclofenac per day. All patients were followed up at 14 and 28 days. The changing of visual analogue scale (VAS) for pain, 100-meter walking times, the modified Thai WOMAC index scores, and the global assessment were evaluated for efficacy. For safety issue, clinical signs and symptoms, complete physical examination, and renal and liver function were evaluated. Results. 39 and 38 patients for BJK extract group and diclofenac group were evaluated. For efficacy, all patients from both groups reported a decrease in the VAS pain score and 100-meter walking times but only the diclofenac group showed significant reduction of both measurements when compared with day 0. The modified Thai WOMAC scores of both groups were significantly reduced from baseline. However, all efficacy outcomes were not significantly different for both groups. For safety outcomes, the patients from both groups had no severe adverse events reported and only BJK had no toxicity in renal and liver functions. Conclusions. The BJK remedy extract showed equal clinical efficacy in relieving symptoms of OA knee when compared with diclofenac.

Daptomycin Use in Cancer Patients with Neutropenia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2289-2289 ◽  
Author(s):  
Kenneth V.I. Rolston ◽  
Scott A. McConnell ◽  
Jack Brown ◽  
Kenneth C. Lamp
Keyword(s):  
Antibiotic Therapy ◽  
Cancer Patients ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Response To Therapy ◽  
Inadequate Response ◽  
Gram Positive ◽  
History Of ◽  
Clinical Signs And Symptoms ◽  
History Of Cancer

Abstract Infections occurring during neutropenia in cancer patients (pts) frequently involve Gram-positive pathogens and are complicated by antibiotic resistance. Outcomes for infections due to either methicillin-resistant or -susceptible Staphylococcus aureus (MRSA, MSSA) treated with vancomycin are considered suboptimal by many clinicians (Sakoulas G. J Clin Microbiol2004;42:2398–402). New effective agents are needed for treatment. Data were collected retrospectively as part of an ongoing registry (Cubicin Outcomes Registry and Experience; CORE, 2005 and 2006 program years). Data were collected on demographic and microbiologic characteristics; prior, concomitant and follow-up antibiotics; DAP regimen; and clinical data. Outcomes were assessed at the end of DAP therapy by the investigator who, in most cases, was the infectious disease physician involved in the treatment of the patient. The definitions for clinical outcome were: Cure - clinical signs and symptoms resolved (and/or) no additional antibiotic therapy necessary (or) negative culture reported at the end of therapy; Improved - partial resolution of clinical signs and symptoms (and/or) additional antibiotic therapy warranted at the end of therapy; Failure - inadequate response to therapy: worsening or new/recurrent signs and symptoms (or) need for a change in antibiotic therapy (or) positive culture reported at the end of therapy. Pts reported with neutropenia during DAP, a history of cancer, and evaluable for outcome (cure, improved, failure) were analyzed. Eighty-four pts had a history of cancer and had neutropenia during DAP treatment, of these, 72 (86%) were evaluable for DAP outcome. Sixty-five of 72 (90%) pts had either cure (n=40, 56%) or improved (n=25, 35%) as an outcome. Success rates (cure plus improved) stratified by the lowest WBC during DAP were; 29/34 (85%) for < 100 cells/m3, 26/28 (93%) for 100–499 cells/m3, and 10/10 (100%) for 500–1000 cells/m3, P=0.32. The median (range) time to clinical response in those successfully treated (data reported in 47 pts) was 4 days (1–21). Fifty-nine of 72 (82%) had a hematological malignancy. Fifty-eight percent were male, 22% were ≥66 yrs old, 7% had an initial CrCl <30 mL/min, 18% received DAP in an ICU. Eighty-eight percent of pts received antibiotics before DAP, most frequently with vancomycin (83%), cefepime (17%), and linezolid (16%). The most frequent reason for switching to DAP was prior clinical failure / resistance (54%). The major infections being treated with DAP were bacteremia (76%), UTI / pyelonephritis (10%), and uncomplicated skin and skin structure (6%). Seventy-four percent of pts with a WBC < 100 cells/m3 had a bacteremia. The most common Gram-positive pathogens reported were vancomycin-resistant enterococci (52%), coagulase-negative staphylococci (21%), and S. aureus (14%; 7/11, 64% were MRSA). The median (range) initial DAP dose was 6.0 mg/kg (3–7). The median (range) DAP duration of therapy was 13 days (1–86). Nineteen percent of the pts received DAP as an outpatient at some time during their therapy. There were 37 adverse events (AE) reported in 20 (28%) pts; however, only three AEs in 3 pts (4%) were assessed as possibly related to DAP. The data from the registry provide useful information about the clinical characteristics of neutropenic cancer patients treated with DAP for primarily bacteremia. Most of the pts were bacteremic and there was no difference in outcome regardless of the degree of neutropenia. These data require confirmation via prospective clinical trials.

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