LATAM nations demonstrated variable levels of antimicrobial R especially among Enterobacteriaceae (β-lactamase-mediated), PSA and ACB. MRSA (48%), VRE (14%) and multidrug-R SPN were also regional therapeutic challenges.
SUMMARYRecent studies in vitro and in animals have suggested that ribavirin may potentiate the antihepatitis C virus (HCV) activity of interferon-a (IFN-a ) by up-modulating the production of T cell-derived cytokines, such as interleukin (IL)-2 and IFN-g, which play a key role in the cellular immune response against HCV. To study the immune-modulatory mechanisms of ribavirin further, cytokine production by activated T cells and circulating cytokine levels were studied by FACS analysis and ELISA testing in 25 patients with chronic hepatitis C unresponsive to IFN-a , before and after treatment with either ribavirin plus IFN-a or IFN-a alone. After 16 weeks of treatment, both the expression of IFN-g by activated T cells and the blood levels of IFN-g, were significantly reduced with respect to pretreatment values in patients treated with ribavirin and IFN-a but not in those undergoing treatment with IFN-a alone. The expression of IFN-g was significantly lower in patients that gained normal ALT levels with respect to those that did not. No modification of the expression of IL-2, IL-4 and IL-10 was found before and after treatment in either group of patients. In conclusion, the results of this study do not support upmodulation of IFN-g and IL-2 production as the mechanism by which ribavirin potentiates IFN-a anti HCV activity. In addition, our findings suggest that ribavirin may exert an anti-inflammatory effect and may help reducing IFN-g-driven T cell activation and liver damage.
This randomised, open-label, non-inferiority study was designed to demonstrate that a 3-day course of oral azithromycin 1 g once daily was at least as effective as a standard 7-day course of oral amoxicillin-clavulanate 875/125 mg twice daily in the treatment of outpatients with community-acquired pneumonia (Fine class I and II). In total, 267 patients with clinically and radiologically confirmed community-acquired pneumonia were randomly assigned to receive either the azithromycin (n=136) or the amoxicillin-clavulanate (n=131) regimen. At screening, 60/136 (58.8%) and 61/131 (62.9%) respectively had at least one pathogen identified by sputum culture, PCR, or serology. The primary endpoint was the clinical response in the intent-to-treat population at the end of therapy (day 8 to 12). Clinical success rates were 126/136 (92.6%) for azithromycin and 122/131 (93.1%) for amoxicillin-clavulanate (treatment difference: - 0.48%; 95% confidence interval: - 5.66%; 4.69%). Clinical and radiological success rates at follow-up (day 22-26) were consistent with the end of therapy results, no patient reporting clinical relapse. Bacteriological success rates at the end of therapy were 32/35 (91.4%) for azithromycin and 30/33 (90.9%) for amoxicillin-clavulanate (treatment difference: 0.52%; 95% confidence interval - 10.81%; 11.85%). Both treatment regimens were well tolerated: the overall incidence of adverse events was 34/136 (25.0%) for azithromycin and 22/132 (16.7%) for amoxicillin-clavulanate. In both treatment groups, the most commonly reported events were gastrointestinal symptoms. Azithromycin 1g once daily for 3 days is at least as effective as amoxicillin-clavulanate 875/125 mg twice daily for 7 days in the treatment of adult patients with community-acquired pneumonia.
BACKGROUNDHCV-induced chronic hepatitis is a major health problem world-wide because of its propensity to progress to liver cirrhosis and hepatocellular carcinoma. 1±3 Until recently, interferon-a has been the only approved pharmacological treatment for chronic hepatitis C in the United States and Europe. However, many patients do not respond to treatment and roughly two thirds of those who respond will relapse after discontinuing treatment. 4 The combination of interferon-a and ribavirin has been shown to signi®cantly improve the response rate to interferon-a monotherapy, both in relapsers to a previous interferon-a course and in naive patients. 5,6 Yet this combination is associated with signi®cant side-effects and the overall results are unsatisfactory, as sustained responders still represent less than half of the patients. Thus, there is an obvious need for more effective forms of therapy.
SUMMARYBackground: The prognosis of chronic hepatitis depends on the progression of hepatic ®brosis. Aim: To investigate whether the anti®brotic drug colchicine, in combination with interferon-a has a role in the treatment of chronic hepatitis C. Methods: Sixty-®ve HCV±RNA positive patients with chronic hepatitis were randomized to receive interferona, 6 MU t.i.w. for 6 months followed by 3 MU t.i.w. for further 6 months, with or without the adjunct of colchicine, 1 mg o.d., 6 days a week, for 3 years. We report an interim analysis after the ®rst 18 months. Results: Thirty-four patients received interferon-a and 31 received interferon-a and colchicine. The two groups were comparable for baseline data, including HCV±RNA levels, genotypes and histological grading/staging. Drop-outs and side-effects were similar. The proportion
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