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1.
Vaccine ; 33(12): 1499-505, 2015 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-25444784

RESUMO

Since 2006, the vaccine, ZOSTAVAX(®), has been licensed to prevent herpes zoster. Only limited clinical follow-up data are available to evaluate duration of protection, an important consideration when developing HZ vaccination policy recommendations. Four Poisson regression models were developed based on an integrated analysis of data from the Shingles Prevention Study and its Short Term Persistence extension to estimate the effects of years-since-vaccination and chronological-age on vaccine efficacy among people ≥60 years old. The models included number of HZ cases parsed into categories by chronological-age and time-since-vaccination as the dependent variable with different explanatory variables in each model. In all models, the interaction between vaccine-group and chronological-age was statistically significant indicating that vaccine efficacy decreases with the expected effects of advancing age but the interaction between vaccine-group and time-since-vaccination was not statistically significant indicating that much of the reduction in vaccine efficacy over time-since-vaccination can be explained by increasing age.


Assuntos
Vacina contra Herpes Zoster/imunologia , Herpes Zoster/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Análise de Regressão , Fatores de Tempo , Vacinação , Potência de Vacina
2.
J Infect Dis ; 208(9): 1375-85, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-23908479

RESUMO

BACKGROUND: Safety and immunogenicity of heat-treated zoster vaccine (ZVHT) were assessed in immunocompromised adults. METHODS: In a randomized, double-blind, placebo-controlled, multicenter study, 4 doses ZVHT or placebo were administered approximately 30 days apart to adults with either solid tumor malignancy (STM); hematologic malignancy (HM); human immunodeficiency virus (HIV) with CD4(+) ≤200; autologous hematopoietic stem-cell transplant (HCT) or allogeneic-HCT recipients. Varicella-zoster virus (VZV) T-cell responses by interferon-γ enzyme-linked immunospot (IFN-γ ELISPOT) and VZV antibody concentrations by glycoprotein enzyme-linked immunosorbent assay (gpELISA) were measured at baseline and approximately 28 days after each dose. RESULTS: No safety signals were found in any group. IFN-γ ELISPOT geometric mean fold rises (GMFR) after dose 4 in STM, HM, HIV, and autologous-HCT patients were 3.00 (P < .0001), 2.23 (P = .004), 1.76 (P = .026), and 9.01 (P = NA), respectively. Similarly, antibody GMFR were 2.35 (P < .0001), 1.28 (P = .003), 1.37 (P = .017), and 0.90 (P = NA), respectively. T-cell and antibody responses were poor after 4 doses of ZVHT in allogeneic-HCT patients. CONCLUSION: ZVHT was generally safe and immunogenic through 28 days post-dose 4 in adults with STM, HM, and HIV. Autologous-HCT but not allogeneic-HCT patients had a rise in T-cell response; antibody responses were not increased in either HCT population. Study identification. V212-002 Clinical Trials Registration. NCT00535236.


Assuntos
Infecções por HIV/imunologia , Vacina contra Herpes Zoster/efeitos adversos , Herpes Zoster/prevenção & controle , Hospedeiro Imunocomprometido , Neoplasias/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Transplante de Células-Tronco Hematopoéticas , Vacina contra Herpes Zoster/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Resultado do Tratamento , Vacinação , Vacinas Atenuadas/efeitos adversos , Vacinas Atenuadas/imunologia , Adulto Jovem
3.
J Infect Dis ; 208(9): 1386-90, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-23908486

RESUMO

Prevaccination and 6-week postvaccination samples from the immunogenicity substudy (n = 2269) of the zoster vaccine (ZV) efficacy trial (N = 22 439) in 50-59-year-old subjects were examined for varicella-zoster virus-specific antibody responses to vaccination. The varicella-zoster virus geometric mean titer (GMT) and geometric mean fold rise were higher in ZV recipients than in placebo recipients (GMT, 660.0 vs 293.1 glycoprotein enzyme-linked immunosorbent assay units/mL [P < .001], respectively; geometric mean fold rise, 2.31 vs 1.00 [P < .025]). In each group there was a strong inverse correlation between postvaccination GMT and risk of subsequent herpes zoster. Although these data provide strong evidence that relates ZV-induced antibody and the risk of herpes zoster, a protective threshold was not determined. Clinical Trials Registration. NCT00534248.


Assuntos
Anticorpos Antivirais/sangue , Vacina contra Herpes Zoster/imunologia , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3/imunologia , Método Duplo-Cego , Feminino , Herpes Zoster/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Vacinação
4.
J Infect Dis ; 208(4): 559-63, 2013 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-23633406

RESUMO

BACKGROUND: After completion of the Shingles Prevention Study (SPS; Department of Veterans Affairs Cooperative Studies Program Number 403), SPS participants who had initially received placebo were offered investigational zoster vaccine without charge. This provided an opportunity to determine the relative safety of zoster vaccine in older adults following documented herpes zoster (HZ). METHODS: A total of 13 681 SPS placebo recipients who elected to receive zoster vaccine were followed for serious adverse events (SAE) for 28 days after vaccination. In contrast to the SPS, a prior episode of HZ was not a contraindication to receiving zoster vaccine. The SPS placebo recipients who received zoster vaccine included 420 who had developed documented HZ during the SPS. RESULTS: The mean interval between the onset of HZ and the receipt of zoster vaccine in the 420 recipients with prior HZ was 3.61 years (median interval, 3.77 years [range, 3-85 months]); the interval was <5 years for approximately 80% of recipients. The proportion of vaccinated SPS placebo recipients with prior HZ who developed ≥ 1 SAE (0.95%) was not significantly different from that of vaccinated SPS placebo recipients with no prior history of HZ (0.66%), and the distribution of SAEs in the 2 groups was comparable. CONCLUSIONS: These results demonstrate that the general safety of zoster vaccine in older persons is not altered by a recent history of documented HZ, supporting the safety aspect of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommendation to administer zoster vaccine to all persons ≥ 60 years of age with no contraindications, regardless of a prior history of HZ.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Vacina contra Herpes Zoster/administração & dosagem , Vacina contra Herpes Zoster/efeitos adversos , Herpes Zoster/imunologia , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
N Engl J Med ; 367(11): 1020-4, 2012 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-22913660

RESUMO

BACKGROUND: In January 2012, on the basis of an initial report from a dermatologist, we began to investigate an outbreak of tattoo-associated Mycobacterium chelonae skin and soft-tissue infections in Rochester, New York. The main goals were to identify the extent, cause, and form of transmission of the outbreak and to prevent further cases of infection. METHODS: We analyzed data from structured interviews with the patients, histopathological testing of skin-biopsy specimens, acid-fast bacilli smears, and microbial cultures and antimicrobial susceptibility testing. We also performed DNA sequencing, pulsed-field gel electrophoresis (PFGE), cultures of the ink and ingredients used in the preparation and packaging of the ink, assessment of source water and faucets at tattoo parlors, and investigation of the ink manufacturer. RESULTS: Between October and December 2011, a persistent, raised, erythematous rash in the tattoo area developed in 19 persons (13 men and 6 women) within 3 weeks after they received a tattoo from a single artist who used premixed gray ink; the highest occurrence of tattooing and rash onset was in November (accounting for 15 and 12 patients, respectively). The average age of the patients was 35 years (range, 18 to 48). Skin-biopsy specimens, obtained from 17 patients, showed abnormalities in all 17, with M. chelonae isolated from 14 and confirmed by means of DNA sequencing. PFGE analysis showed indistinguishable patterns in 11 clinical isolates and one of three unopened bottles of premixed ink. Eighteen of the 19 patients were treated with appropriate antibiotics, and their condition improved. CONCLUSIONS: The premixed ink was the common source of infection in this outbreak. These findings led to a recall by the manufacturer.


Assuntos
Cosméticos/efeitos adversos , Surtos de Doenças , Tinta , Infecções por Mycobacterium não Tuberculosas/etiologia , Mycobacterium chelonae/isolamento & purificação , Tatuagem/efeitos adversos , Feminino , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Mycobacterium chelonae/genética , New York/epidemiologia , Análise de Sequência de DNA , Pele/microbiologia , Pele/patologia
6.
Clin Infect Dis ; 54(7): 922-8, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22291101

RESUMO

BACKGROUND: Herpes zoster (HZ) adversely affects individuals aged 50-59, but vaccine efficacy has not been assessed in this population. This study was designed to determine the efficacy, safety, and tolerability of zoster vaccine for preventing HZ in persons aged 50-59 years. METHODS: This was a randomized, double-blind, placebo-controlled study of 22 439 subjects aged 50-59 years conducted in North America and Europe. Subjects were given 1 dose of licensed zoster vaccine (ZV) (Zostavax; Merck) and followed for occurrence of HZ for ≥1 year (mean, 1.3 years) postvaccination until accrual of ≥96 confirmed HZ cases (as determined by testing lesions swabs for varicella zoster virus DNA by polymerase chain reaction). Subjects were followed for all adverse events (AEs) from day 1 to day 42 postvaccination and for serious AEs (SAEs) through day 182 postvaccination. RESULTS: The ZV reduced the incidence of HZ (30 cases in vaccine group, 1.99/1000 person-years vs 99 cases in placebo group, 6.57/1000 person-years). Vaccine efficacy for preventing HZ was 69.8% (95% confidence interval, 54.1-80.6). AEs were reported by 72.8% of subjects in the ZV group and 41.5% in the placebo group, with the difference primarily due to higher rates of injection-site AEs and headache. The proportion of subjects reporting SAEs occurring within 42 days postvaccination (ZV, 0.6%; placebo, 0.5%) and 182 days postvaccination (ZV, 2.1%; placebo, 1.9%) was similar between groups. CONCLUSIONS: In subjects aged 50-59 years, the ZV significantly reduced the incidence of HZ and was well tolerated. CLINICAL TRIALS REGISTRATION: NCT00534248.


Assuntos
Vacina contra Herpes Zoster/efeitos adversos , Vacina contra Herpes Zoster/imunologia , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Método Duplo-Cego , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Vacina contra Herpes Zoster/administração & dosagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Placebos/administração & dosagem
7.
Vaccine ; 30(9): 1729-36, 2012 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-22192849

RESUMO

Merck V710 is a novel vaccine that contains the highly conserved Staphylococcus aureus iron surface determinant B (IsdB) protein. V710 has induced positive immune responses in healthy subjects. The purpose of the two studies described herein was to evaluate the immunogenicity and safety of two different formulations of V710. Both studies were randomized, controlled, double-blind, parallel-group trials. Study 1 compared liquid, aluminum-adjuvanted V710 (30 µg) with liquid, non-adjuvanted V710 (30 µg) in a 1:1 ratio in 64 healthy adults (18-70 years). Study 2 compared non-adjuvanted lyophilized V710 (60 µg) with saline placebo in a 4:1 ratio in 51 healthy adults (18-80 years). Blood was collected at screening and up to Day 360 postvaccination in Study 1, and at screening and up to Day 84 postvaccination in Study 2. Sera were analyzed for IsdB-specific antibodies using a total IgG assay. The primary endpoints in Study 1 were the proportion of patients with a positive immune response (≥2-fold rise in IsdB-specific IgG antibody level) the geometric mean concentration (GMC), and the geometric mean-fold rise (GMFR), all from baseline at Day 14. The primary endpoint in Study 2 was the GMFR in IsdB-specific IgG antibody concentration from baseline at Day 14. In Study 1, 84.4% responded in the adjuvanted V710 group, and 71.9% in the non-adjuvanted V710 group. The GMC was 115.4 µg/mL in the adjuvanted group and 99.1 µg/mL in the nonadjuvanted group. The GMFR in antibody concentration in the group receiving aluminum-adjuvanted V710 was 4.5 and the GMFR in the group receiving non-adjuvanted V710 was 4.0. In Study 2, the GMFR in antibody concentration in the V710 group was 5.3, and 80.5% had a positive immune response. None responded in the placebo group. Positive immune response was seen in the active treatment groups over the full duration of each study. There were no serious adverse experiences (AE) in either study, and no patients discontinued due to an AE. There were no clinically meaningful differences in AEs between groups in either study. In conclusion, V710, both with and without aluminum adjuvant, and in both liquid and lyophilized formulations, was immunogenic within 14 days of vaccination. All treatments showed similar safety profiles.


Assuntos
Proteínas de Transporte de Cátions/imunologia , Infecções Estafilocócicas/prevenção & controle , Vacinas Antiestafilocócicas/imunologia , Adjuvantes Imunológicos/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/imunologia , Método Duplo-Cego , Determinação de Ponto Final , Feminino , Liofilização , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Vacinas Antiestafilocócicas/administração & dosagem , Vacinas Antiestafilocócicas/efeitos adversos , Adulto Jovem
8.
Clin Infect Dis ; 51(3): 295-303, 2010 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-20578829

RESUMO

BACKGROUND: Patients with candidemia frequently have a central venous catheter (CVC) in place, and its early removal is considered the standard of care. METHODS: We performed a subgroup analysis of 2 phase III, multicenter, double-blind, randomized, controlled trials of candidemia to examine the effects of early CVC removal (within 24 or 48 h after treatment initiation) on the outcomes of 842 patients with candidemia. Inclusion criteria were candidemia, age >16 years, CVC at diagnosis, and receipt of 1 dose of the study drug. Six outcomes were evaluated: treatment success, rates of persistent and recurrent candidemia, time to mycological eradication, and survival at 28 and 42 days. Univariate and multivariate analyses were performed, controlling for potential confounders. RESULTS: In univariate analysis, early CVC removal did not improve time to mycological eradication or rates of persistent or recurrent candidemia but was associated with better treatment success and survival. These benefits were lost in multivariate analysis, which failed to show any beneficial effect of early CVC removal on all 6 outcomes and identified Acute Physiology and Chronic Health Evaluation II score, older age, and persistent neutropenia as the most significant variables. Our findings were consistent across all outcomes and time points (removal within 24 or 48 h and survival at 28 and 42 days). The median time to eradication of candidemia was similar between the 2 study groups. CONCLUSIONS: In this cohort of 842 adults with candidemia followed up prospectively, early CVC removal was not associated with any clinical benefit. These findings suggest an evidence-based re-evaluation of current treatment recommendations.


Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/terapia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/terapia , Fungemia/tratamento farmacológico , Fungemia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Sangue/microbiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
9.
Clin Infect Dis ; 48(12): 1676-84, 2009 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-19419331

RESUMO

BACKGROUND: The standard caspofungin treatment regimen (50 mg/day after a 70-mg dose on day 1) is effective and well tolerated for the treatment of invasive candidiasis, but experience with higher doses of caspofungin is limited. We evaluated the safety and efficacy of caspofungin at 3 times the standard dosing regimen. METHODS: Patients with proven invasive candidiasis were randomized to receive a standard or high-dose (150 mg/day) caspofungin treatment regimen. Safety was assessed in all patients as treated. Efficacy was assessed as a secondary objective in a full-analysis-set population. A favorable overall response was defined as symptom resolution and microbiological clearance at the end of caspofungin therapy. RESULTS: A total of 204 patients were included in the safety analysis (104 received the standard regimen, and 100 received the high-dose regimen), and 197 were included in the efficacy analysis (102 and 95 in the standard and high-dose treatment groups, respectively). Patient demographic characteristics, neutropenia status (6.7% and 8.0% had neutropenia, respectively), and Acute Physiology and Chronic Health Evaluation II scores (mean, 16.5 and 17, respectively) were similar between treatment groups. Significant drug-related adverse events occurred in 1.9% of patients receiving the standard regimen and 3.0% of patients receiving the high-dose regimen (difference, 1.1%; 95% confidence interval, -4.1% to 6.8%). The most-common drug-related adverse events in the standard and high-dose treatment groups were phlebitis (3.8% and 2.0%, respectively), increased alkaline phosphatase level (6.9% and 2.0%, respectively), and increased aspartate transaminase level (4.0% and 2.0%, respectively). Overall, 71.6% of patients who received the standard regimen and 77.9% of patients who received the high-dose regimen had favorable overall responses (difference, 6.3%; 95% confidence interval, -5.9% to 18.4%; not statistically significant). Mortality at 8 weeks after therapy was similar between groups. CONCLUSIONS: Both caspofungin dosing regimens were effective and well tolerated in patients with invasive candidiasis. No safety concerns were found for caspofungin at a dosage of 150 mg/day.


Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Equinocandinas/administração & dosagem , Equinocandinas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Antifúngicos/efeitos adversos , Aspartato Aminotransferases/sangue , Caspofungina , Método Duplo-Cego , Equinocandinas/efeitos adversos , Feminino , Humanos , Lipopeptídeos , Masculino , Pessoa de Meia-Idade , Flebite/induzido quimicamente , Resultado do Tratamento , Adulto Jovem
10.
Pain ; 142(3): 209-217, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19195785

RESUMO

Although acute pain in patients with herpes zoster can be severe and has a substantial impact on health-related quality of life, there have been no randomized clinical trials of oral medications specifically for its ongoing treatment. A randomized clinical trial was conducted in which 87 subjects >or=50 years of age with herpes zoster within 6 calendar days of rash onset and with worst pain in the past 24h >or=3 on a 0-10 rating scale initiated 7 days of treatment with famciclovir in combination with 28 days of treatment with either controlled-release (CR) oxycodone, gabapentin, or placebo. Subjects were evaluated for adverse effects of treatment, acute pain, and health-related quality of life. The results showed that CR-oxycodone and gabapentin were generally safe and were associated with adverse events that reflect well-known effects of these medications. Discontinuing participation in the trial, primarily associated with constipation, occurred more frequently in subjects randomized to CR-oxycodone (27.6%) compared with placebo (6.9%). Treatment with CR-oxycodone reduced the mean worst pain over days 1-8 (p=0.01) and days 1-14 (p=0.02) relative to placebo but not throughout the entire 28-day treatment period as pain resolved in most subjects. Gabapentin did not provide significantly greater pain relief than placebo, although the data for the first week were consistent with a modest benefit. By demonstrating that CR-oxycodone is safe, generally adequately tolerated, and appears to have efficacy for relieving acute pain, the results of this clinical trial provide a foundation for evidence-based treatment for acute pain in herpes zoster.


Assuntos
Aminas/uso terapêutico , Ensaios Clínicos como Assunto/tendências , Ácidos Cicloexanocarboxílicos/uso terapêutico , Preparações de Ação Retardada/administração & dosagem , Medicina Baseada em Evidências/tendências , Herpes Zoster/tratamento farmacológico , Oxicodona/administração & dosagem , Dor/tratamento farmacológico , Ácido gama-Aminobutírico/uso terapêutico , Doença Aguda , Idoso , Analgésicos Opioides/administração & dosagem , Feminino , Gabapentina , Herpes Zoster/epidemiologia , Humanos , Masculino , New York/epidemiologia , Dor/epidemiologia , Efeito Placebo , Texas/epidemiologia , Resultado do Tratamento
11.
J Am Acad Dermatol ; 57(6 Suppl): S143-7, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18021866

RESUMO

Herpes zoster disease and its most common complication, postherpetic neuralgia, are associated with significant morbidity in the elderly. The zoster vaccine boosts cell-mediated immunity to varicella-zoster virus, the virus that causes both varicella and herpes zoster. This vaccine has demonstrated the ability to reduce the zoster-related burden of illness and the incidence of both zoster and postherpetic neuralgia in a randomized, controlled trial conducted in individuals aged 60 years and older, an age group at increased risk of herpes zoster. Widespread use of this vaccine could prevent as many as a quarter of a million cases of zoster disease each year. The design and outcomes of the Shingles Prevention Study, which examined the efficacy and safety of the vaccine, and the rationale for widespread immunization against varicella-zoster virus, are presented here.


Assuntos
Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Neuralgia Pós-Herpética/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Efeitos Psicossociais da Doença , Herpes Zoster/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/epidemiologia
12.
Clin Infect Dis ; 45(7): 883-93, 2007 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-17806055

RESUMO

BACKGROUND: Invasive candidiasis is an important cause of morbidity and mortality among patients with health care-associated infection. The echinocandins have potent fungicidal activity against most Candida species, but there are few data comparing the safety and efficacy of echinocandins in the treatment of invasive candidiasis. METHODS: This was an international, randomized, double-blind trial comparing micafungin (100 mg daily) and micafungin (150 mg daily) with a standard dosage of caspofungin (70 mg followed by 50 mg daily) in adults with candidemia and other forms of invasive candidiasis. The primary end point was treatment success, defined as clinical and mycological success at the end of blinded intravenous therapy. RESULTS: A total of 595 patients were randomized to one the treatment groups and received at least 1 dose of study drug. In the modified intent-to-treat population, 191 patients were assigned to the micafungin 100 mg group, 199 to the micafungin 150 mg group, and 188 to the caspofungin group. Demographic characteristics and underlying disorders were comparable across the groups. Approximately 85% of patients had candidemia; the remainder had noncandidemic invasive candidiasis. At the end of blinded intravenous therapy, treatment was considered successful for 76.4% of patients in the micafungin 100 mg group, 71.4% in the micafungin 150 mg group, and 72.3% in the caspofungin group. The median time to culture negativity was 2 days in the micafungin 100 mg group and the caspofungin group, compared with 3 days in the micafungin 150 mg groups. There were no significant differences in mortality, relapsing and emergent infections, or adverse events between the study arms. CONCLUSIONS: Dosages of micafungin 100 mg daily and 150 mg daily were noninferior to a standard dosage of caspofungin for the treatment of candidemia and other forms of invasive candidiasis.


Assuntos
Antifúngicos/administração & dosagem , Candidíase/tratamento farmacológico , Fungemia/tratamento farmacológico , Lipoproteínas/administração & dosagem , Peptídeos Cíclicos/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Caspofungina , Relação Dose-Resposta a Droga , Método Duplo-Cego , Equinocandinas , Feminino , Humanos , Lipopeptídeos , Masculino , Micafungina , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Clin Infect Dis ; 44 Suppl 1: S1-26, 2007 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-17143845

RESUMO

The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.


Assuntos
Antivirais/uso terapêutico , Herpes Zoster/tratamento farmacológico , 2-Aminopurina/análogos & derivados , 2-Aminopurina/uso terapêutico , Aciclovir/análogos & derivados , Aciclovir/uso terapêutico , Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Bromodesoxiuridina/análogos & derivados , Bromodesoxiuridina/uso terapêutico , Famciclovir , Herpes Zoster/complicações , Herpes Zoster/epidemiologia , Herpes Zoster/fisiopatologia , Herpesvirus Humano 3/patogenicidade , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Valaciclovir , Valina/análogos & derivados , Valina/uso terapêutico
14.
Clin Infect Dis ; 40(10): e87-9, 2005 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-15844057

RESUMO

Legionella pneumophila is an important cause of community-acquired and nosocomial pneumonia. We describe an immunocompromised patient with severe pneumonia from whom Legionella species were isolated from sputum samples by culture for 30 days, despite administration of treatment with appropriate antimicrobial agents. However, clear improvement in the patient's respiratory condition was evident, and he subsequently recovered completely.


Assuntos
Hospedeiro Imunocomprometido , Doença dos Legionários/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Humanos , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/microbiologia , Masculino , Pneumonia/microbiologia , Escarro/microbiologia , Fatores de Tempo
15.
Antiviral Res ; 63(3): 191-6, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15451187

RESUMO

Development of a readily available challenge model of human respiratory syncytial virus (RSV) infection would be a useful tool for evaluation of antiviral agents and vaccine candidates. Accordingly, we evaluated a new challenge pool of RSV A2 virus, provided by the National Institutes of Allergy and Infectious Diseases. Healthy adults subjects were inoculated intranasally with various dilutions of the pool, and virus shedding, clinical symptoms, and immune response were studied. In a preliminary study of 36 randomly selected volunteers, stratified by serum neutralization titer both higher inoculum dose (4.7 log(10) TCID(50) virus) and lower antibody titer (<==10.36 log(2)), were associated with infection. In a second confirmatory study 12 of 13 (92%) subjects selected for low serum neutralizing activity shed virus after challenge with the high inoculum of virus. Mean peak virus shedding was 2.2 log(10) TCID(50)/mL nasal wash with a mean duration of 4 days. None of the subjects developed signs or symptoms of lower airway disease, although respiratory symptom scores and nasal mucus weight were temporally correlated with virus shedding. Prescreening for low levels of neutralizing antibody may allow selection of subjects with relatively higher susceptibility to experimental infections. This model provides a safe and efficient mechanism for proof-of-concept studies of anti-viral agents and RSV vaccines, as well as for investigation of immune responses to infection.


Assuntos
Infecções por Vírus Respiratório Sincicial/imunologia , Vírus Sincicial Respiratório Humano/imunologia , Vacinas Virais/imunologia , Administração Intranasal , Adolescente , Adulto , Anticorpos Antivirais/sangue , Técnicas de Cultura de Células , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Vírus Respiratório Sincicial/epidemiologia
16.
Philadelphia; Lippincott Williams & Wilkinson; 5 ed; 2003. vii,1202 p. ilus, tab, graf.
Monografia em Inglês | Coleciona SUS | ID: biblio-926938
17.
Rio de Janeiro; MEDSI; 2 ed; 1995. 633 p. tab.
Monografia em Português | Sec. Munic. Saúde SP, AHM-Acervo, TATUAPE-Acervo, HSPM-Acervo | ID: sms-3583
18.
Rio de Janeiro; Medsi; 1995. 633 p.
Monografia em Português | Coleciona SUS | ID: biblio-929353
19.
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