Expert Review of Anti-infective Therapy最新文献

{"title":"Predicting the limit to ceftriaxone's use in gonorrhea treatment: impending resistance and logistical challenges.","authors":"Susannah F Vanderpool, Nardine Karam, Margaret R Hammerschlag","doi":"10.1080/14787210.2025.2499471","DOIUrl":"10.1080/14787210.2025.2499471","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing prevalence of antimicrobial resistance in Neisseria gonorrhoeae threatens the efficacy of ceftriaxone, the last widely effective treatment for gonorrhea. Resistance mechanisms challenge the adequacy of current dosing strategies and minimum inhibitory concentration (MIC) thresholds, with treatment failures documented at MICs as low as 0.125 mcg/mL. Limited clinical and pharmacodynamic data complicate efforts to define optimal dosing and resistance breakpoints.</p><p><strong>Areas covered: </strong>This review examines the evolution of ceftriaxone dosing recommendations in response to resistance trends, explores the genetic and pharmacokinetic factors driving reduced susceptibility, and critically evaluates the CDC's MIC 'alert value' of 0.125 mcg/mL. Surveillance data are analyzed alongside pharmacokinetic/pharmacodynamic (PK/PD) models, including Monte Carlo simulations and hollow fiber infection models (HFIM). Practical challenges, including injection site tolerability, lidocaine safety, and dosing limits for intramuscular administration, are reviewed.</p><p><strong>Expert opinion: </strong>Current PK/PD data and IV tolerability studies support ceftriaxone dose escalation up to 3.5 g IM as a feasible outpatient limit for strains with MICs up to 0.5 mcg/mL. However, the MIC at which even high-dose regimens fail remains unknown. Urgent priorities include validating higher doses through clinical pharmacokinetic and outcomes studies, refining MIC thresholds by anatomical site, and evaluating novel agents for reliable pharyngeal eradication.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"343-350"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Febrile neutropenia management in high-risk neutropenic patients: a narrative review on antibiotic prophylaxis and empirical treatment.","authors":"Cemre Boşnak, Murat Akova","doi":"10.1080/14787210.2025.2487149","DOIUrl":"10.1080/14787210.2025.2487149","url":null,"abstract":"<p><strong>Introduction: </strong>Although febrile neutropenia (FN) remains a major cause of morbidity and mortality in patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients, the increasing prevalence of antimicrobial resistance necessitates a reassessment of antibiotic prophylaxis and treatment strategies.</p><p><strong>Areas covered: </strong>This review explores the prophylactic and therapeutic use of antibiotics in FN management, with a particular focus on patients with hematologic malignancies - particularly acute leukemia - and HSCT recipients.</p><p><strong>Expert opinion: </strong>Challenges in FN management, including antibiotic prophylaxis and treatment optimization, remain due to the complexity of the condition. Pathogens with emerging antibacterial resistance cause significant concern in the management of patients. Particularly due to selection potential of resistant Gram-negative bacteria (GNB), fluoroquinolones (FQs) have become less attractive agents for prophylaxis. Whereas, emerging data may help to revitalize long-abandoned aminoglycoside containing combination therapies particularly in high-risk patients with presumed sepsis. With only a few agents available for highly resistant bacteria alternative treatment strategies including pharmacokinetic/pharmacodynamic (PK/PD) concerning antibiotic applications may be warranted. Carefully designed, randomized, controlled trials providing large scale data which then can be analyzed with emerging artificial intelligence (AI) technologies are needed. The results from such trials may allow a better, data-driven approaches for management of FN.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"327-341"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can probiotics replace antibiotics? Not yet, says the evidence.","authors":"Jan Łukasik, Hania Szajewska","doi":"10.1080/14787210.2025.2499485","DOIUrl":"10.1080/14787210.2025.2499485","url":null,"abstract":"","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"323-326"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-five years of palivizumab: a global historic review of its impact on the burden of respiratory syncytial virus disease in children.","authors":"Xavier Carbonell-Estrany, Eric A F Simões, Louis Bont, Paolo Manzoni, Heather J Zar, Anne Greenough, Octavio Ramilo, Renato Stein, Barbara Law, Asuncion Mejias, Manuel Sanchez Luna, Paul A Checchia, Leonard Krilov, Marcello Lanari, Ron Dagan, Brigitte Fauroux, Bernhard Resch, Terho Heikkinen, Joseph B Domachowske, Joanne G Wildenbeest, Federico Martinon-Torres, Richard Thwaites, Merih Cetinkaya, Adel S Alharbi, Carlos E Rodriguez-Martinez, Daniel E Noyola, Asiah Kassim, Satoshi Kusuda, Ji-Man Kang, Barry Rodgers-Gray, Anna Platonova, Fungwe Jah, Bosco Paes","doi":"10.1080/14787210.2025.2481908","DOIUrl":"10.1080/14787210.2025.2481908","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory syncytial virus (RSV) causes significant morbidity and mortality in young children. For 25 years, palivizumab has been the only effective pharmaceutical RSV preventive.</p><p><strong>Areas covered: </strong>We summarize the development and a quarter-century of real-world evidence with palivizumab. We highlight its positive impact on the burden of RSV in high-risk children. Based on lessons learnt from its implementation, we suggest strategies for effective and equitable deployment of newer RSV preventives.</p><p><strong>Expert opinion: </strong>Following failure of the formalin-inactivated RSV vaccine in 1967, RSV intravenous immunoglobulin was approved in 1996 after three decades' research. Subsequently, palivizumab emerged as the most effective and safe RSV preventive, demonstrated by the IMpact trial, and was licensed in 1998 in the United States. Over the last 25 years, the benefits of palivizumab have been firmly established through a wealth of evidence, predominantly from high-income countries (HICs). To achieve a global impact with the newer RSV preventives, evidenced-based universal guidelines must be developed and endorsed by regulatory authorities and relevant scientific societies. Independent economic evaluations should incorporate all RSV-associated healthcare costs, reduction of long-term respiratory sequelae, and standardized outcomes. Most importantly, equity in product availability and implementation, particularly in low- and middle-income countries (LMICs) is essential.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"359-378"},"PeriodicalIF":4.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating the role of molnupiravir in COVID-19 treatment.","authors":"Chia Siang Kow, Dinesh Sangarran Ramachandram, Syed Shahzad Hasan, Kaeshaelya Thiruchelvam","doi":"10.1080/14787210.2025.2511955","DOIUrl":"https://doi.org/10.1080/14787210.2025.2511955","url":null,"abstract":"","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: the earliest observation of <i>bla</i>_NDM was in Israel.","authors":"Louis-Patrick Haraoui","doi":"10.1080/14787210.2025.2510284","DOIUrl":"10.1080/14787210.2025.2510284","url":null,"abstract":"","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"1-2"},"PeriodicalIF":4.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doxycycline post-exposure prophylaxis as prevention of STIs - the golden bullet?","authors":"Manik Kohli, Thomas Elliott-Walker, John Saunders, Helen Fifer","doi":"10.1080/14787210.2025.2510278","DOIUrl":"10.1080/14787210.2025.2510278","url":null,"abstract":"<p><strong>Introduction: </strong>Doxycycline post-exposure prophylaxis ('doxyPEP') is an emerging strategy to prevent bacterial sexually transmitted infections (STIs). Users take 200 mg of doxycycline up to 72 hours after condomless sex, and data from randomized controlled trials and real-world implementation have shown doxyPEP to be effective in preventing syphilis, chlamydia, and to a lesser extent gonorrhea, in gay, bisexual, and other men-who-have-sex-with-men (GBMSM) and transgender women.</p><p><strong>Areas covered: </strong>We discuss the potential benefits, risks, and important considerations for doxyPEP implementation, drawing on published literature and our own perspectives.</p><p><strong>Expert opinion: </strong>Is doxyPEP the golden bullet? DoxyPEP provides significant benefits through STI prevention and holistic improvements in sexual health and wellbeing. Concerns over emergent antimicrobial resistance need to be weighed against STI-related morbidity and contextualized within society's overuse of antibiotics. Inequities in the doxyPEP evidence-base and implementation will undermine its ability to end the syphilis epidemic and reduce chlamydia associated morbidity in cisgender women. Moreover, contexts in which doxyPEP proves effective for gonorrhea prevention initially are unlikely to see a long-lasting impact. Rather than a golden bullet, doxyPEP is a bridge to the next set of STI prevention tools.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"1-13"},"PeriodicalIF":4.2,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-drug resistant tuberculosis: where should we be with optimal treatment?","authors":"Emanuele Pontali, Rosella Centis, Lia D'Ambrosio, Denise Rossato Silva, Daria Podlekareva, Giovanni Battista Migliori","doi":"10.1080/14787210.2025.2506777","DOIUrl":"10.1080/14787210.2025.2506777","url":null,"abstract":"","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"1-4"},"PeriodicalIF":4.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of potential combination therapies with ceftriaxone as a treatment for gonorrhoea.","authors":"Izumo Kanesaka, Fabian Yuh Shiong Kong, Thibaut Vanbaelen, Sheeba Santhini Manoharan-Basil, Chris Kenyon","doi":"10.1080/14787210.2025.2505559","DOIUrl":"10.1080/14787210.2025.2505559","url":null,"abstract":"<p><strong>Introduction: </strong>Ceftriaxone is the last available single dose therapy for gonorrhea that effectively treats infections at all sites. Over a quarter of isolates are now resistant to ceftriaxone in some countries. The introduction of carefully chosen combination therapy with ceftriaxone could retard the emergence of ceftriaxone resistance.</p><p><strong>Areas covered: </strong>This review summarizes the findings of a PubMed search on the use of partner antimicrobial that could be used with ceftriaxone to prevent the emergence and spread of ceftriaxone resistance. We review 16 antimicrobials that could be partnered with ceftriaxone in terms of pharmacokinetic and pharmacodynamic compatibilities, activity against ceftriaxone resistant isolates and probability of antimicrobial resistance emerging.</p><p><strong>Expert opinion: </strong>Of these 16 antimicrobials, we reject antimicrobials such as fosfomycin due to poor clinical efficacy and tigecycline due to its considerably longer half-life which would likely select for tetracycline resistance. The most promising agents for combination with ceftriaxone are zoliflodacin, delafloxacin, sitafloxacin, eravacycline and possibly gepotidacin and gentamicin. Clinical studies should be conducted to evaluate the efficacy of these combinations on the eradication of N. gonorrhoeae and their impact on AMR in N. gonorrhoeae and other bacterial species.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":4.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and clinical management of <i>Candida auris</i> infections in immunocompromised patients.","authors":"Brunella Posteraro, Terenzio Cosio, Riccardo Torelli, Elena De Carolis, Carlotta Magrì, Patrizia Posteraro, Giulia De Angelis, Maurizio Sanguinetti","doi":"10.1080/14787210.2025.2505567","DOIUrl":"10.1080/14787210.2025.2505567","url":null,"abstract":"<p><strong>Introduction: </strong><i>Candida</i> (<i>Candidozyma</i>) <i>auris</i> is an emerging fungal pathogen that poses a significant threat to immunocompromised patients. Its high mortality rates, resistance to multiple antifungal classes, and ability to spread rapidly in healthcare settings underscore the need for timely and accurate diagnosis to guide effective clinical management.</p><p><strong>Areas covered: </strong>This special report provides an updated overview of <i>C.</i> <i>auris</i> infections in immunocompromised hosts. It discusses current phenotypic and molecular diagnostic tools, antifungal susceptibility testing methods, and infection control strategies. Emerging therapies, including investigational antifungals and combination regimens, are also examined in light of evolving resistance patterns and clinical challenges.</p><p><strong>Expert opinion: </strong>Despite notable advances in diagnostics and treatment, major obstacles remain in the clinical management of <i>C.</i> <i>auris</i>, particularly in vulnerable populations. Barriers to guideline implementation, lack of standardized screening protocols, and limited access to novel antifungal agents continue to hinder effective response. Future efforts should focus on expanding diagnostic capacity, developing innovative therapies, and implementing targeted surveillance strategies to reduce the global burden of <i>C.</i> <i>auris</i>.</p>","PeriodicalId":12213,"journal":{"name":"Expert Review of Anti-infective Therapy","volume":" ","pages":"1-10"},"PeriodicalIF":4.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}