scholarly journals Updated Management Guidelines for Clostridioides difficile in Paediatrics

Pathogens ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 291
Author(s):  
Margherita Gnocchi ◽  
Martina Gagliardi ◽  
Pierpacifico Gismondi ◽  
Federica Gaiani ◽  
Gian Luigi de’ Angelis ◽  
...  
Keyword(s):  
Low Cost ◽  
Bowel Perforation ◽  
High Sensitivity ◽  
Initial Response ◽  
Future Perspective ◽  
First Line ◽  
Diagnostic Laboratory ◽  
First Line Therapy ◽  
Clostridioides Difficile ◽  
Multiple Recurrences

Clostridioides difficile, formerly known as Clostridium difficile, causes infections (CDI) varying from self-limited diarrhoea to severe conditions, including toxic megacolon and bowel perforation. For this reason, a prompt diagnosis is fundamental to early treatment and the prevention of transmission. The aim of this article is to review diagnostic laboratory methods that are now available to detect C. difficile and to discuss the most recent recommendations on CDI treatment in children. Currently, there is no consensus on the best method for detecting C. difficile. Indeed, none of the available diagnostics possess at the same time high sensitivity and specificity, low cost and rapid turnaround times. Appropriate therapy is targeted according to age, severity and recurrence of the episode of infection, and the recent availability of new antibiotics opens new opportunities. De-escalation of antibiotics that are directly associated with CDI remains a priority and the cautious use of probiotics is recommended. Vancomycin represents the first-line therapy for CDI, although in children metronidazole can still be used as a first-line drug. Fidaxomicin is a new treatment option with equivalent initial response rates as vancomycin but lower relapse rates of CDI. Faecal microbiota transplantation should be considered for patients with multiple recurrences of CDI. Monoclonal antibodies and vaccines seem to represent a future perspective against CDI. However, only further studies will permit us to understand whether these new approaches could be effective in therapy and prevention of CDI in paediatric populations.

scholarly journals Comparative study of laparoscopic ovarian drilling and medical treatment in polycystic ovarian disease

2019 ◽  
Vol 8 (8) ◽  
pp. 3291
Author(s):  
Hema Verma ◽  
Prachi Srivastava
Keyword(s):  
Medical Treatment ◽  
Low Cost ◽  
First Line ◽  
Polycystic Ovarian Disease ◽  
Ovarian Disease ◽  
First Line Therapy ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Hospital Stays ◽  
Effect Of Treatment

Background: To evaluate the result after medical treatment and laparoscopic ovarian drilling in PCOS patients and to compare the results of these two methods.Methods: In this prospective study 50 women with polycystic ovarian disease, were divided into two group,25 women received medical treatment and 25 women received surgical (laparoscopic ovarian drilling) treatment. Effect of treatment on ovulation, menstruation, fertility and androgen level was determined 3 month after therapy.Results: There was significant increase in ovulation and fertility, decrease in androgen levels and decrease in LH/FSH in individual groups when compared with pretreatment levels but difference between groups A and B was not statistically significant for these parameters.Conclusions: Medical treatment and laparoscopic ovarian drilling are equally effective in treating the women of polycystic ovarian disease. Result of both the treatment are similar in this study. However medical treatment should be the first line therapy, it has significant benefit for use in OPD, low cost, no hospital stays and convenience to the patient.

scholarly journals Glycopeptide Hypersensitivity and Adverse Reactions

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 70
Author(s):  
Vanthida Huang ◽  
Nicola A. Clayton ◽  
Kimberly H. Welker
Keyword(s):  
Immunoglobulin E ◽  
Immunoglobulin A ◽  
Infusion Reaction ◽  
Cross Reactivity ◽  
First Line ◽  
First Line Therapy ◽  
Clostridioides Difficile ◽  
Immune Mediated ◽  
Bullous Dermatosis ◽  
Ige Mediated

Glycopeptides, such as vancomycin and teicoplanin, are primarily used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, such as cellulitis, endocarditis, meningitis, pneumonia, and septicemia, and are some of the most commonly prescribed parenteral antimicrobials. Parenteral glycopeptides are first-line therapy for severe MRSA infections; however, oral vancomycin is used as a first-line treatment of Clostridioides difficile infections. Also, we currently have the longer-acting lipoglycopeptides, such as dalbavancin, oritavancin, and telavancin to our armamentarium for the treatment of MRSA infections. Lastly, vancomycin is often used as an alternative treatment for patients with β-lactam hypersensitivity. Common adverse effects associated with glycopeptide use include nephrotoxicity, ototoxicity, and Redman Syndrome (RMS). The RMS is often mistaken for a true allergy; however, it is a histamine-related infusion reaction rather than a true immunoglobulin E (IgE)-mediated allergic reaction. Although hypersensitivity to glycopeptides is rare, both immune-mediated and delayed reactions have been reported in the literature. We describe the various types of glycopeptide hypersensitivity reactions associated with glycopeptides and lipoglycopeptides, including IgE-mediated reactions, RMS, and linear immunoglobulin A bullous dermatosis, as well as describe cross-reactivity with other glycopeptides.

The efficacy and safety of first-line and salvage therapies with bevacizumab combination chemotherapy regimens in metastatic colorectal cancer: A retrospective ASMO experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14705-e14705
Author(s):  
Ramazan Yildiz ◽  
Suleyman Buyukberber ◽  
Dogan Koca ◽  
Lokman Koral ◽  
Aydin Ciltas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Median Survival ◽  
Combination Chemotherapy ◽  
Salvage Therapy ◽  
Median Overall Survival ◽  
Bowel Perforation ◽  
First Line ◽  
First Line Therapy

e14705 Background: The addition of bevacizumab to chemotherapy significantly shows survival advantage in metastatic colorectal cancer (mCRC), but with limited data about irinotecan combination in salvage therapy. Efficacy and toxicity of bevacizumab combination regimens were assessed in first-line and salvage therapies. Methods: Total of 1011 (659 in first-line and 352 in salvage) patients were retrospectively evaluated. Results: In first-line therapy, the ORR was 36.4%. Median PFS was 7 months for FOLFIRI, 6 months for IFL and 6 months for other chemotherapy regimens with a median overall PFS of 7 months. Median survival was 29 months for FOLFIRI, 28 months for IFL and 21 months for others with a median overall survival of 28 months. In salvage therapy, the ORR was 25.2%. Median PFS was 7 months for FOLFIRI, 7 months for IFL and 6 months for others with a median overall PFS of 7 months. Median survival was 19 months for FOLFIRI, 13 months for IFL and 21 months for others with a median overall survival of 19 months. The main toxicities in first-line and salvage therapy were neutropenia, febrile neutropenia, nausea and vomiting, diarrhea, mucositis, bleeding, hypertension, thromboembolism, fistulization and bowel perforation. Conclusions: Bevacizumab combination chemotherapy regimens are effective with a tolerable safety profile in mCRC patients in first-line and salvage therapy.

Current Status and Challenges in Rotigotine Delivery

2020 ◽  
Vol 26 (19) ◽  
pp. 2222-2232 ◽  
Author(s):  
Shadab Md ◽  
Shahid Karim ◽  
Sanggetha R. Saker ◽  
Ooi A. Gie ◽  
Lim C. Hooi ◽  
...  
Keyword(s):  
Transdermal Delivery ◽  
Extended Release ◽  
Current Status ◽  
Future Perspective ◽  
Dopamine Antagonists ◽  
Restless Leg Syndrome ◽  
First Line ◽  
Continuous Administration ◽  
First Line Therapy ◽  
The Central Nervous System

Rotigotine is a non-ergoline, high lipophilic dopamine agonist. It is indicated as the first-line therapy for Parkinson's disease (PD) and Restless Leg Syndrome (RLS). However, the precise mechanism of rotigotine is yet to be known. Rotigotine has similar safety and tolerability to the other oral non-ergolinic dopamine antagonists in clinical trials, which include nausea, dizziness and somnolence. Neupro® was the first marketed transdermal patch formulation having rotigotine. The transdermal delivery system is advantageous as it enables continuous administration of the drug, thus providing steady-state plasma drug concentration for 24-hours. Intranasal administration of rotigotine allows the drug to bypass the blood-brain barrier enabling it to reach the central nervous system within minutes. Rotigotine can also be formulated as an extended-release microsphere for injection. Some challenges remain in other routes of rotigotine administration such as oral, parenteral and pulmonary, whereby resolving these challenges will be beneficial to patients as they are less invasive and comfortable in terms of administration. This review compiles recent work on rotigotine delivery, challenges and its future perspective.

The choice of first-line therapy in advanced Hodgkin lymphoma: Retrospective comparison of ABVD and escalated BEACOPP regimen

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8063-8063
Author(s):  
W. Jurczak ◽  
D. Krochmalczyk ◽  
A. Giza ◽  
J. Węgrzyn ◽  
M. Sobocinski ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Stage ◽  
Poor Response ◽  
Initial Response ◽  
Response Assessment ◽  
Poor Responders ◽  
Treatment Intensification ◽  
First Line ◽  
First Line Therapy ◽  
Study Results

8063 Background: HD patients with high risk have a relatively poor prognosis with less than 50% 5-year overall survival (OS) if treated with ABVD regimen. Methods: Therapy results of all 105 patients with advanced HL (CS IIBX -IV) treated from diagnosis at our Department in the last decade, are presented. The choice of initial 3 cycles between ABVD and escalated BEACOPP was done at the patients preferal and physician's adivice. Further 3 chemotherapy cycles depended on initial response assessment: poorly responding ABVD treated patients were offered therapy escalation. Patients with a good response (over 80% regression) after the first 3 cycles were later treated with ABVD. EFS and OS were primary endpoints of the study. Results: We divided patients into 2 treatment groups, depending on the first 3 cycles (escalated BEACOPP n = 57 or ABVD n = 48). Poor response resulting in therapy intensification was not considered as an event defined only as a relapse or progression during therapy. There was a statistically insignificant imbalance between the risk factor distribution with less favorable prognosis in patients treated with esc BEACOPP: 38 % of pts in IV th clinical stage (as compared to 31% in ABVD group), 3,08 EORTC risk factors (as compared to 2,64 in ABVD group) and 2,19 according to German Hodgkin Study Group (1.93 respectively). Increased toxicity of esc BEACOPP regimen was due to grade 3/4 cytopaenia (present in all patients) resulting in more infection episodes (according to WHO scale stage 3 - 16 pts , stage 4 - 8 pts; in ABVD group, 2 and 1 pt respectively). There were no treatment related mortalities. In esc BEACOPP projected 5 y OS was 96% and EFS 89% , which is comparable to GHSG results. 5 y OS and EFS in ABVD group are 87% and 66% respectively. The difference in EFS is statistically significant (p< 0.05). Conclusions: In our study we checked the feasibility of esc BEACOPP regimen in high risk HD pts. The results show the importance of the intensity of the first line approach. In the poor responders after the initial 3 cycles, even early treatment intensification, didn’t improve the outcome. De-escalation of therapy after the first 3 cycles, in good responders, didn’t make OS and EFS inferior to GHSG results in which they recommend 6 cycles of esc BEACOPP therapy. No significant financial relationships to disclose.

A Randomized Trial of Daily Prednisone versus Pulsed Dexamethasone in Treatment-Naïve Adult Patients with Immune Thrombocytopenia: EIS 2002 Study

2016 ◽  
Vol 136 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Johannes Matschke ◽  
Hannes Müller-Beissenhirtz ◽  
Jürgen Novotny ◽  
Ilona Vester ◽  
Bernd Hertenstein ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Oral Prednisone ◽  
Initial Response ◽  
Good Alternative ◽  
Multicenter Trial ◽  
Infectious Complications ◽  
First Line ◽  
First Line Therapy ◽  
Daily Prednisone

Oral prednisone is considered the standard first-line therapy of adult immune thrombocytopenia, but its long-term efficacy is limited. We performed a prospective, randomized, multicenter trial comparing daily prednisone (1-2 mg/kg/day for 2-4 weeks with subsequent dose reduction) with six 3-week cycles of pulsed dexamethasone (0.6 mg/kg/day, days 1-4). The primary endpoint was remission duration. Of 26 patients enrolled, 22 were evaluable for response. Nine were treated with prednisone and 13 with dexamethasone. The median follow-up was 46 months. The initial response rate (PLT ≥50 × 109/l) was 100% in both groups. Long-term remissions were significantly more frequent with pulsed dexamethasone than with daily prednisone (12 months posttreatment: 77 vs. 22%; p = 0.027). The side effects were similar, but patients on dexamethasone suffered significantly more often from insomnia, while patients on prednisone tended to have more infectious complications. Although the cumulative cortisol equivalent dose was comparable during the first 4 weeks of therapy, it was significantly higher in the dexamethasone arm than in the prednisone arm during the ensuing treatment period. We conclude that repeated cycles of pulsed dexamethasone are a good alternative to daily prednisone as a first-line treatment of immune thrombocytopenia. The duration and intensity of glucocorticoid therapy are important determinants of treatment outcome.

1904: Outcomes of Large Renal Calculi (>2-Cm) Treated with ESWL as First Line Therapy

2004 ◽  
Vol 171 (4S) ◽  
pp. 503-503
Author(s):  
Richard Vanlangendock ◽  
Ramakrishna Venkatesh ◽  
Jamil Rehman ◽  
Chandra P. Sundaram ◽  
Jaime Landman
Keyword(s):  
Renal Calculi ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

Is digoxin still justifiable as single first-line therapy in fetal SVT associated with fetal hydrops?

2008 ◽  
Vol 68 (S 01) ◽  
Author(s):  
DJ Kersten ◽  
J McDougall ◽  
C Schuller ◽  
JP Pfammatter ◽  
L Raio ◽  
...  
Keyword(s):  
First Line ◽  
Fetal Hydrops ◽  
First Line Therapy ◽  
Line Therapy
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