ABSTRACT
BACKGROUND: Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. OBJECTIVE: A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. METHODS: In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. MAIN OUTCOME MEASURES: Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. CONCLUSION: Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.
Subject(s)
Dermatitis, Seborrheic/drug therapy , Dermatologic Agents/therapeutic use , Facial Dermatoses/drug therapy , HIV Infections/complications , Tacrolimus/analogs & derivatives , Administration, Topical , Adult , Dermatitis, Seborrheic/complications , Dermatologic Agents/administration & dosage , Facial Dermatoses/complications , Female , Humans , Male , Middle Aged , Ointments , Pilot Projects , Recurrence , Tacrolimus/administration & dosage , Tacrolimus/therapeutic use , Treatment OutcomeABSTRACT
A retrospective study of 76 patients was carried out using ritonavir in an antiretroviral regimen combined with two reverse transcriptase inhibitors to treat outpatients from July, 1996, to April, 1998, with the objective of evaluating clinical efficacy and tolerability. Seventy-six percent of the patients had been diagnosed with AIDS, an average number of CD(4) cells = 233.7 cells/mm(3) and viral load = 144, 084 RNA copies/mm(3). The majority of patients (76.3% )were antiretroviral treatment-experienced, 21.4% having taken protease inhibitors. A positive clinical response was found in 86.7% (including an average weight gain of 4.4 kg in 58.5% ), an average CD(4) count increase of 169.5 cells/mm(3) in 83.3% and an average viral load decrease of approximately 2.28 log in 75% of patients. A high percentage of adverse effects (76.3% ) was detected, with most slight or moderate, but they significantly impacted adherence to treatment as 31.6% stopped taking the drug as a result. We conclude that this antiretroviral regimen has good clinical efficacy, but relatively poor tolerability.
Subject(s)
HIV Infections/drug therapy , HIV Protease Inhibitors/administration & dosage , HIV Protease Inhibitors/adverse effects , Reverse Transcriptase Inhibitors/administration & dosage , Reverse Transcriptase Inhibitors/adverse effects , Ritonavir/administration & dosage , Ritonavir/adverse effects , Adult , Aged , CD4-Positive T-Lymphocytes , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Viral LoadABSTRACT
A case-control study was done to evaluate factors associated with nosocomial infections by multiresistant Pseudomonas aeruginosa (MRPA). Results showed that MRPA was associated with the use of immunosuppressive and antimicrobial drugs. Five typing methods indicated that the MRPA infections were due to multiple strains rather than a single strain.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cross Infection/classification , Cross Infection/epidemiology , Drug Resistance, Multiple , Pseudomonas Infections/classification , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/drug effects , APACHE , Adult , Aminoglycosides , Bacteriophage Typing , Brazil/epidemiology , Case-Control Studies , Cross Infection/microbiology , Female , Humans , Infection Control , Male , Middle Aged , Pseudomonas aeruginosa/classification , Pseudomonas aeruginosa/isolation & purificationABSTRACT
Sixty nosocomial infections caused by Pseudomonas aeruginosa and Acinetobacter baumannii resistant to aminoglycosides, cephalosporins, quinolones, penicillins, monobactams, and imipenem were treated with colistin (one patient had two infections that are included as two different cases). The infections were pneumonia (33% of patients), urinary tract infection (20%), primary bloodstream infection (15%), central nervous system infection (8%), peritonitis (7%), catheter-related infection (7%), and otitis media (2%). A good outcome occurred for 35 patients (58%), and three patients died within the first 48 hours of treatment. The poorest results were observed in cases of pneumonia: only five (25%) of 20 had a good outcome. A good outcome occurred for four of five patients with central nervous system infections, although no intrathecal treatment was given. The main adverse effect of treatment was renal failure; 27% of patients with initially normal renal function had renal failure, and renal function worsened in 58% of patients with abnormal baseline creatinine levels. Colistin may be a good therapeutic option for the treatment of severe infections caused by multidrug-resistant P. aeruginosa and A. baumannii.
