[Therapeutic options in chronic HBV infection]. / Scelte terapeutiche nell'infezione cronica HBV.

A durable suppression of viral replication in chronic HBV infection decreases the risk of liver disease progression. Treatment is recommended for patients in the immune-active phases of chronic HBV infection (HBeAg positive or HBeAg negative patients with serum HBV-DNA and elevated ALT). Licensed HBV therapies include interferon (sIFN, pegylated-IFN alfa-2a) and nucleoside/nucleotide analogues (lamivudine, adefovir, entecavir) allowing for two different treatment strategies: a finite treatment course of IFN that provides sustained off-treatment response in about one third of patients, or an indefinite treatment with nucleoside/nucleotide analogues that provides a therapy maintained response. IFN has the advantage of a defined treatment duration and of lacking resistance selection; disadvantages are the subcutaneous route of administration and poor tolerability. Nucleoside/nucleotide analogues are orally administered and well tolerated; their drawback is the risk of developing antiviral resistance which increases with duration of treatment. A finite course of IFN should be tried as first-line therapy; a long-term treatment with nucleoside/nucleotide analogues should be used for patients not responding or intolerant to interferon.

Clinical case of seroconversion for syphilis following a needlestick injury: why not take a prophylaxis?

A 47-year-old woman was pricked accidentally with a needle previously used for a neurosyphilitic man. At day 0 she had no positive laboratory results for the infection, while the source, at day 1, had TPHA positive, but no post-exposure prophylaxis (PEP) against syphilis was prescribed. The subject missed the day 30 follow-up, and underwent our visit at day 90, when she showed no clinical signs, but she seroconverted (VDRL = positive 1/2; TPHA = positive 1/320; FTA-Abs IgG and IgM = present). She started antibiotic therapy, and currently her serological status is VDRL = positive 1/2, TPHA = positive 1/160, FTA-Abs IgM = negative.

[Early and timely therapy: when to interrupt antibiotic therapy in nosocomial acquired pneumonia?]. / Terapia precoce e tempestiva: quando interrompere la terapia antibiotica nella polmonite nosocomiale?

Nosocomial pneumonia is the second most frequent nosocomial infection and represents the leading cause of death due to hospital acquired infections. In recent years, evidence has accumulated that initial inappropriate antibiotic treatment is an important and independent mortality risk factor for patients with nosocomial pneumonia. On this point, several authors have found that delaying the administration of appropriate antibacterial treatment is associated with an excess in hospital mortality. In this scenario, various strategies have been proposed, such as de-escalation therapy, that attempt to balance the need to provide appropriate initial treatment with limiting the emergence of antibacterial resistance. Another relevant point is the duration of antibiotic therapy: international guidelines suggest that it should be based upon the clinical response, with a standard duration of 14-21 days, but several authors have shown that a shorter course could lead to the same clinical results, and significantly reduce both antimicrobial consumption and the emergence of resistant pathogens. The present review deals with the clinical importance of early, shorter antibiotic therapy.