ABSTRACT
BACKGROUND: The global push for the use of hydroxychloroquine (HCQ) and chloroquine (CQ) against COVID-19 has resulted in an ongoing discussion about the effectivity and toxicity of these drugs. Recent studies report no effect of (H)CQ on 28-day mortality. We investigated the effect of HCQ and CQ in hospitalized patients on the non-ICU COVID-ward. METHODS: A nationwide, observational cohort study was performed in The Netherlands. Hospitals were given the opportunity to decide independently on the use of three different COVID-19 treatment strategies: HCQ, CQ, or no treatment. We compared the outcomes between these groups. The primary outcomes were 1) death on the COVID-19 ward, and 2) transfer to the intensive care unit (ICU). RESULTS: The analysis included 1064 patients from 14 hospitals: 566 patients received treatment with either HCQ (n = 189) or CQ (n = 377), and 498 patients received no treatment. In a multivariate propensity-matched weighted competing regression analysis, there was no significant effect of (H)CQ on mortality on the COVID ward. However, HCQ was associated with a significantly decreased risk of transfer to the ICU (hazard ratio (HR) = 0.47, 95% CI = 0.27-0.82, p = 0.008) when compared with controls. This effect was not found in the CQ group (HR = 0.80, 95% CI = 0.55-1.15, p = 0.207), and remained significant after competing risk analysis. CONCLUSION: The results of this observational study demonstrate a lack of effect of (H)CQ on non-ICU mortality. However, we show that the use of HCQ - but not CQ - is associated with a 53% reduction in risk of transfer of COVID-19 patients from the regular ward to the ICU. Recent prospective studies have reported on 28-day, all-cause mortality only; therefore, additional prospective data on the early effects of HCQ in preventing transfer to the ICU are still needed.
Subject(s)
Antiviral Agents/therapeutic use , COVID-19 Drug Treatment , Chloroquine/therapeutic use , Hydroxychloroquine/therapeutic use , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Female , Hospitalization , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Netherlands/epidemiology , Patient Admission/statistics & numerical data , Prospective Studies , SARS-CoV-2/drug effects , SARS-CoV-2/physiology , Treatment OutcomeABSTRACT
Within the Dutch Acute HCV in HIV Study, a surveillance system was initiated to estimate the incidence of hepatitis C virus (HCV) infections in 2014. Following the Dutch HIV treatment guidelines, HIV-positive men having sex with men (MSM) in 19 participating centers were screened. Ninety-nine acute HCV infections were reported, which resulted in a mean incidence of 11 per 1000 patient-years of follow-up. Unfortunately, the HCV epidemic among Dutch HIV-positive MSM is not coming to a halt.
Subject(s)
Epidemics , HIV Infections/virology , Hepatitis C/epidemiology , Adult , Coinfection/epidemiology , Coinfection/virology , Hepatitis C/virology , Homosexuality, Male , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Population Surveillance , Risk FactorsABSTRACT
The aim of this non-randomized study was to investigate whether there is any benefit in the extension of antimicrobial treatment in patients with left-sided native valve endocarditis in whom C-reactive protein levels are still elevated after a standard course of therapy. There was no statistically significant difference in outcome between the group of patients in which treatment was extended in comparison to the group in which treatment was ended at the recommended time. It is unlikely that there is much to gain from extending treatment based on elevated C-reactive protein levels alone.
Subject(s)
Anti-Bacterial Agents/administration & dosage , C-Reactive Protein/analysis , Endocarditis, Bacterial/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/analysis , Drug Administration Schedule , Endocarditis, Bacterial/blood , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
In this article we present the path that led to current concepts regarding antimicrobial treatment of endocarditis caused by viridans streptococci highly susceptible to penicillin. Early treatment trials indicate that some patients with subacute endocarditis can be cured with shorter treatment duration than currently advised by international guidelines. Also, high-dose antibiotics, as recommended today, have a predominantly pharmacokinetic and pharmacodynamic rationale that is based mostly on experimental animal studies. Shortening antimicrobial treatment in select patients with endocarditis would be of great benefit. As yet there are no predictors of cure that can be used to individualize treatment duration in patients with bacterial endocarditis.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Endocarditis, Subacute Bacterial/drug therapy , Penicillins/therapeutic use , Streptococcal Infections/drug therapy , Viridans Streptococci/drug effects , Anti-Bacterial Agents/administration & dosage , Endocarditis, Subacute Bacterial/microbiology , Humans , Penicillins/administration & dosage , Streptococcal Infections/microbiology , Treatment Outcome , Viridans Streptococci/isolation & purificationABSTRACT
The Working Party on Antibiotic Policy (Dutch acronym is SWAB) is a Dutch organisation that develops guidelines for in-hospital antimicrobial therapy of bacterial infectious diseases. This present guideline describes the antimicrobial treatment for adult patients with infective endocarditis. The choice and duration of antimicrobial therapy is determined by the infecting micro-organism, sensitivity of this micro-organism for antimicrobial therapy, location of the endocarditis, left-sided or right-sided, and presence of intracardial prosthetic material. In this guideline, the empirical therapy for endocarditis is discussed as well as the therapy for the most frequent causative organisms: streptococci, enterococci, staphylococci and HACEK micro-organisms.
