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Clostridium difficile infection (CDI) is a costly result of antibiotic use, responsible for an estimated 14,000 deaths annually in the USA according to the Centers for Disease Control and Prevention. Annual costs attributable to CDI are in excess of $US 1 billion. This review summarizes appropriate utilization of prevention and treatment methods for CDI that have the potential to reduce the economic and humanistic costs of the disease. Some cost-effective strategies to prevent CDI include screening and isolation of hospital admissions based on C. difficile carriage to reduce transmission in the inpatient setting, and probiotics, which are potentially efficacious in preventing CDI in the appropriate patient population. The most extensively studied agents for treatment of CDI are metronidazole, vancomycin, and fidaxomicin. Most economic comparisons between metronidazole and vancomycin favor vancomycin, especially with the emergence of metronidazole-resistant C. difficile strains. Metronidazole can only be recommended for mild disease. Moderate to severe CDI should be treated with vancomycin, preferably the compounded oral solution, which provides the most cost-effective therapeutic option. Fidaxomicin offers a clinically effective and potentially cost-effective alternative for treating moderate CDI in patients who do not have the NAP1/BI/027 strain of C. difficile. Probiotics and fecal microbiota transplant have variable efficacy and the US FDA does not currently regulate the content; the potential economic advantages of these treatment modalities are currently unknown.

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Objectives: The aim of the study was to assess both the safety and the effectiveness of nitrofurantoin in male veterans treated for urinary tract infections (UTIs) with varying degrees of renal impairment in the outpatient setting. Nitrofurantoin is an important oral option for treating UTIs given increasing resistance to commonly used agents. Nitrofurantoin is currently contraindicated in patients with a creatinine clearance (CrCl) of < 60 ml/min, but the reason for this threshold has not been well documented. Methods: Data were collected through a retrospective chart review from January 2004 to July 2013 of men who had received nitrofurantoin. Bivariate analyses followed by multivariate analyses were performed between patients experiencing clinical cure and those who did not, to determine factors significantly impacting effectiveness. Results: The Gram stain of the organism causing the UTI and CrCl were significant factors impacting effectiveness. For every 1 ml/min increase in CrCl, the odds of clinical cure increased by 1.3%. Patients with Gram-negative UTIs predictably had 80% cure rates with CrCl around 60 ml/min. Patients with Gram-positive UTIs required higher CrCl, nearing 100 ml/min, to establish an 80% cure rate. Adverse effects did not vary with CrCl. Conclusions: The odds of clinical cure varied with CrCl and with the type of organism causing the UTI, while adverse events did not differ based on renal function. A minimum CrCl of 60 ml/min is suggested for men to achieve an 80% cure rate for UTIs with the most common urinary pathogens.

Cutaneous alternariosis is an uncommon fungal infection that most commonly presents in organ transplant patients on immunosuppressive therapy. There are no clinical trials or guidelines to guide treatment of this condition, however itraconazole is the most commonly used antifungal in published cases. Here we report on a case of cutaneous alternariosis in a renal transplant recipient treated with a newer antifungal, posaconazole. A review of published reports of cutaneous alternariosis since 2008 is also discussed.

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Dendrimeric polyorganotellurides are prepared in high yield using propyloxy spacers to connect the organotelluride groups to the core molecules. The polyorganotellurides catalyze the oxidation of thiophenol with hydrogen peroxide to give diphenyl disulfide in homogeneous solutions (5% CH 2 Cl 2 /MeOH or 46% CH 2 Cl 2 /MeOH). The polyorganotellurides with two, three, four, and six catalytic groups show roughly statistical increases for the number of catalytic groups relative to the corresponding monotellurides. Catalysts containing [4-(dimethylamino)-phenyl]telluro groups and n-hexyltelluro groups are oxidized more rapidly by hydrogen peroxide and also show greater catalytic activity than the corresponding catalysts containing phenyltelluro groups. A combination of statistical effects and stereoelectronic effects give a 26-fold increase in catalytic activity from 1-phenoxy-3-(phenyltelluro)propane (23a; ν 0 ) 12 µM min -1 ) to dendrimer 22c with six n-hexyltelluro groups (ν 0 ) 312 µM min -1 ) for the oxidation of 1.0 × 10 -3 M PhSH with 3.75 × 10 -3 M H 2 O 2 in the presence of 1.0 × 10 -5 M catalyst. The rate of appearance of PhSSPh, with a molar extinction coefficient, , of 1.24 × 10 -3 L mol -1 cm -1 at 305 nm, was monitored at 305 nm.While H 2 O 2 is a powerful oxidant thermodynamically, many of the reactions of H 2 O 2 are limited by the kinetics of reaction, as illustrated by the oxidation of halides to the corresponding halogen/hypohalous acid 1 and the oxidation of thiols to disulfides. 2 Nature has developed a variety of peroxidase enzymes to accelerate these reactions of H 2 O 2 and other peroxy compounds, and chemists have designed synthetic catalysts to mimic the peroxidase enzymes. 3 Among these latter catalysts, diorganotellurides have been excellent catalysts for the activation of H 2 O 2 in these particular reactions. 2,4 The diorganotellurides undergo two-electron redox processes at the Te atom during the catalytic cycle, as shown in Scheme 1. 2,4,5 Peroxide oxidation of the diorganotelluride gives the corresponding oxide (or its hydrate), which then acts as an oxidant (kinetically superior to H 2 O 2 ) for a variety of substrates (Sub-H). The diorganotelluride is regenerated in the process to resume the catalytic cycle. The rate-limiting step in the catalytic process is the rate of oxidation of the diorganotelluride. 4a,5b For the diorganotellurides, catalytic activity with H 2 O 2 will be a balance between the rate of oxidation of the Te atom with H 2 O 2 and the rate of reductive elimination to form product and to regenerate catalyst. Traditionally, the molar activity of catalysts has been optimized through structure-activity relationships derived from substituent changes. However, stereoelectronic effects can only go so far with respect to increasing rates of oxidation of the Te atom. We have shown enhanced catalytic activity in dendrimeric 6 diorganotelluride catalysts 7 in which statistical increases in catalytic activity in two-phase systems were noted by (1) Mohammed, A.; Liebhafsky, ...

Mycobacterium szulgai is a non-tuberculous mycobacterium that is an uncommon cause of infection in humans. Risk factors for infection include immunosuppression and pre-existing lung pathology. Herein, we present a case of a 42-year-old male with chronic obstructive pulmonary disease with pulmonary infection caused by M. szulgai that was successfully treated with a regimen of rifampin, isoniazid, pyrazinamide and ethambutol for 2 months, followed by rifampin, isoniazid and azithromycin for an additional 8 months. Symptomatic and radiographic resolutions were achieved.