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Berlin Brandenburg

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  • 1
    Language: English
    In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 01 March 2012, Vol.54(5), pp.617-20
    Keywords: Tomography, X-Ray Computed ; Angiography -- Methods ; Hematologic Neoplasms -- Complications ; Lung Diseases, Fungal -- Complications ; Pulmonary Artery -- Diagnostic Imaging
    ISSN: 10584838
    E-ISSN: 1537-6591
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  • 2
    Language: English
    In: Clinical Infectious Diseases, June 1, 2005, Vol.40(11), p.1635(3)
    Keywords: Saccharomyces Cerevisiae -- Diagnosis ; Saccharomyces Cerevisiae -- Drug Therapy ; Probiotics -- Health Aspects ; Probiotics -- Research
    ISSN: 1058-4838
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  • 3
    In: Journal of Antimicrobial Chemotherapy, 2011, Vol. 66(suppl1), pp.i25-i35
    Description: Randomized controlled trials (RCTs) provide the most reliable estimates of the effects of treatments. However, not all treatments are compared in available RCTs, making comparison of treatments problematic. Mixed treatment comparisons (MTCs) can provide estimates of the comparative effects of treatments across a range of available therapeutic options. MTCs use networks of available direct comparisons to estimate differences in treatments that have not been estimated in trials via a common comparator. We conducted a systematic review and MTCs of comparative RCTs in haematological patients of anti-mould active agents used for the empirical treatment of febrile neutropenia (Analysis 1), and pre-emptive therapy (Analysis 2) of invasive mould diseases. In addition, we summarized the evidence available associated with the use of directed treatment strategies (Analysis 3). For empirical therapy, caspofungin proved superior to amphotericin B, liposomal amphotericin B, amphotericin B lipid complex and voriconazole in the outcome of survival, but no agents showed superiority for treatment response. There was no evidence of a difference between pre-emptive and empirical strategies on mortality outcomes. For directed therapy, voriconazole was superior to amphotericin B for overall survival, and both voriconazole and liposomal amphotericin B were superior to amphotericin B and amphotericin B colloidal dispersion on the outcome of response. While limited to some degree by the availability of RCTs, the MTCs reported here provide the best available evidence of relative therapeutic success for different available treatment strategies.
    Keywords: Invasive Fungal Disease ; Randomized Controlled Trials ; Empirical Therapy ; Pre - Emptive Therapy
    ISSN: 0305-7453
    E-ISSN: 1460-2091
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  • 4
    In: Journal of Antimicrobial Chemotherapy, 2017, Vol. 72(suppl1), pp.i48-i58
    Description: Recently, several randomized studies have been published that will shape treatment decisions in the prevention and management of invasive mould infections. Liposomal amphotericin B is an option for empirical or targeted treatment of invasive aspergillosis or mucormycosis, but for prophylaxis therapy, the triazole class now predominates. The triazole voriconazole is currently regarded as a drug of choice for the treatment of proven or probable invasive aspergillosis, and has shown significantly higher response rates than amphotericin B deoxycholate in this setting, with fewer severe drug-related adverse events. Isavuconazole, the newest triazole agent, offers the advantages of once-daily dosing, a wider spectrum of antifungal activity than voriconazole, predictable pharmacokinetics and fewer CYP enzyme-mediated drug interactions. A recent large randomized clinical trial showed mortality to be similar under isavuconazole or voriconazole in patients with invasive mould disease, with fewer drug-related adverse events in isavuconazole-treated patients. Another study has indicated that isavuconazole is also effective in mucormycosis infections but patient numbers were small and confirmation is awaited. Experimental studies combining different drug classes with antimould activity have been promising, but the clinical database is limited. A large randomized trial of combination therapy compared voriconazole plus the echinocandin anidulafungin versus voriconazole monotherapy in patients with invasive aspergillosis. Results showed the overall response rate to be similar, but combination therapy improved survival for the subpopulation of patients in whom the diagnosis was confirmed by serum and/or bronchoalveolar lavage fluid galactomannan positivity. This active field of research is likely to continue evolving rapidly in the coming years.
    Keywords: Antibiotic Prophylaxis -- Methods ; Antifungal Agents -- Therapeutic Use ; Aspergillosis -- Drug Therapy ; Invasive Fungal Infections -- Drug Therapy ; Mucormycosis -- Drug Therapy;
    ISSN: 0305-7453
    E-ISSN: 1460-2091
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  • 5
    In: Annals of the New York Academy of Sciences, December 2012, Vol.12721(1), pp.23-30
    Description: Severe prolonged neutropenia, allogeneic hematopoietic stem cell or solid‐organ transplantation, corticosteroids or other T cell suppressive agents, and other severe immunosuppressive factors have for many years been considered to predispose patients to invasive aspergillosis. Other conditions such as impaired innate immunity, diabetes, renal impairment, progression of the underlying malignancy, prior respiratory disease, and nosocomial or environmental exposure to fungal spores or climatic factors have recently been considered additional risk factors of invasive aspergillosis. The multiplicity of risk factors as well as the obvious synergy between them renders risk stratification difficult. An international, large‐scale, multicenter, epidemiological study is necessary to develop a risk score.
    Keywords: Invasive Aspergillosis ; Leukemia ; Neutropenia ; Hematopoietic Stem Cell Transplantation ; Risk Factors
    ISSN: 0077-8923
    E-ISSN: 1749-6632
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  • 6
    In: Journal of Antimicrobial Chemotherapy, 2011, Vol. 66(suppl1), pp.i5-i14
    Description: Invasive fungal diseases are important causes of morbidity and mortality in immunocompromised patients. Patients with haematological malignancies and solid cancers, as well as those with allogeneic haematopoietic stem cell and solid organ transplants, are at high risk of developing such an infection. Many fungi can cause invasive disease, with Aspergillus spp. and Candida spp. being the prevalent fungal pathogens infecting susceptible patients. During the past few years, rare moulds (for example Zygomycetes and Fusarium spp.) have come into focus as the cause of devastating clinical disease. This review aims to analyse environmental factors and parameters related to impairment of the immune system that are thought to favour the onset of invasive mould infections. Some moulds are quite common among all categories of patients, while others appear to be limited to a given subset of patients, such as allogeneic haematopoietic stem cell or solid organ transplant recipients. In addition to an exploration of factors that predispose patients to the acquisition of an invasive mould infection, prognostic factors that help to predict the eventual outcome of these infections are identified.
    Keywords: Moulds ; Immune System ; Environment ; Risk Factors ; Prognostic Factors
    ISSN: 0305-7453
    E-ISSN: 1460-2091
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  • 7
    In: Expert Review of Clinical Pharmacology, November 2011, Vol.4(6), p.743-750
    Description: Methotrexate is an antifolate agent used in the treatment of various cancers and some autoimmune diseases. In oncology, methotrexate is frequently administered at a high dose (〉1 g/m 2 ) and comes with various procedures to reduce the occurrence of toxicity and particularly to ensure optimal renal elimination. Drug–drug interactions involving methotrexate are the origin of severe side effects owing to delayed elimination of the antifolate and, more rarely, of decreased efficacy in relation to suboptimal exposure. Most of these interactions are driven by membrane drug transporters whose activity/expression can be inhibited by the interacting medication. In the last 10 years, research on drug transporters has permitted retrospective identification of the molecular mechanisms underlying drug–drug interactions with methotrexate. This article summarizes reported drug–drug interactions involving methotrexate in clinical oncology with reference to the role of drug transporters that control the disposition of the antifolate agent.
    Keywords: drug–drug interaction ; drug transporter ; methotrexate ; oncology ; pharmacokinetics
    ISSN: 1751-2433
    E-ISSN: 1751-2441
    Source: Future Science Group
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  • 8
    Language: English
    In: The Journal of infectious diseases, 01 November 2010, Vol.202(9), pp.1454-62
    Description: Monitoring treatment response in invasive aspergillosis is challenging, because an immunocompromised host may not exhibit reliable symptoms and clinical signs. Cytokines play a pivotal role in mediating host immune response to infection; therefore, the profiling of biomarkers may be an appropriate surrogate for disease status. We studied, in a cohort of 119 patients with invasive aspergillosis who were recruited in a multicenter clinical trial, serum interleukin (IL)-6, IL‐8, IL‐10, interferon‐γ, and C‐reactive protein (CRP) trends over the first 4 weeks of therapy and correlated these trends to clinical outcome parameters. Circulating IL‐6 and CRP levels were high at initiation of therapy and generally showed a downward trend with antifungal treatment. However, subjects with adverse outcomes exhibited a distinct lack of decline in IL‐6 and CRP levels at week 1, compared with responders (P = .02, for both IL‐6 and CRP). Nonresponders also had significantly elevated IL‐8 levels (P = .001). High initial IL‐8 and persistently elevated IL‐6, IL‐8, and CRP levels after initiation of treatment may be early predictors of adverse outcome in invasive aspergillosis. Cytokine and CRP profiles could be used for early identification of patients with a poor response to antifungal treatment who may benefit from more‐aggressive antimicrobial regimens.
    Keywords: Aspergillosis -- Diagnosis ; C-Reactive Protein -- Analysis ; Cytokines -- Blood
    ISSN: 00221899
    E-ISSN: 1537-6613
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  • 9
    In: Journal of Antimicrobial Chemotherapy, 2013, Vol. 68(suppl3), pp.iii5-iii16
    Description: Invasive fungal disease (IFD), predominantly aspergillosis, is associated with significant morbidity and mortality in immunocompromised patients, especially those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. There has been a great deal of scientific debate as to the effectiveness of antifungal prophylaxis in preventing infection in different patient groups and in which patients it is an appropriate management option. Deciding on an appropriate prophylaxis regimen for IFD is challenging as the incidence varies among different patient groups, due to the varied nature of their underlying haematological disease, and in different regions and centres. Attempts have been made to define risk factors and include them in treatment protocols. Impaired immune status of the patient, especially neutropenia, is a key risk factor for IFD and can sometimes be related to specific polymorphisms of genes controlling innate immunity. Risk factors also vary according to the type of fungal pathogen. Consequently, prophylaxis needs to be tailored to individual patient groups. Furthermore, the choice of antifungal agent for prophylaxis depends on the potential for drug–drug interactions with the patients' concomitant medications. Additional challenges are optimal timing of antifungal prophylaxis, when to change from prophylaxis to antifungal treatment and how to prevent recurrence of IFD. This article considers the use of antifungal prophylaxis for patients at risk of IFD in daily clinical practice, with clinical profiles that may be distinct from those covered by guidelines, and aims to provide practical advice for treatment of these patient groups.
    Keywords: Prophylaxis ; Aspergillosis ; Candidiasis ; Haematological Malignancy ; Immunocompromised Hosts
    ISSN: 0305-7453
    E-ISSN: 1460-2091
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  • 10
    Language: English
    In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 15 March 2008, Vol.46(6), pp.886-9
    Keywords: Chemoprevention ; Antifungal Agents -- Therapeutic Use ; Aspergillosis -- Prevention & Control ; Candidiasis -- Prevention & Control ; Leukemia -- Complications ; Beta-Glucans -- Blood
    ISSN: 10584838
    E-ISSN: 1537-6591
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