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Carol J Baker - One of the best experts on this subject based on the ideXlab platform.
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fluconazole prophylaxis in extremely low birth weight neonates reduces invasive Candidiasis mortality rates without emergence of fluconazole resistant candida species
Pediatrics, 2008Co-Authors: Mary C Healy, Elena Zaccaria, Judith R Campbell, Carol J BakerAbstract:OBJECTIVE. We evaluated the impact of fluconazole prophylaxis for extremely low birth weight infants on invasive Candidiasis incidence, invasive Candidiasis-related mortality rates, and fluconazole susceptibility of Candida isolates. METHODS. Extremely low birth weight infants RESULTS. Twenty-two infants had invasive Candidiasis (all candidemia) during fluconazole prophylaxis; before fluconazole prophylaxis, there were 19 cases (candidemia: 17 cases; meningitis: 2 cases). Invasive Candidiasis incidence in NICU infants decreased from 0.6% (19 of 3012 infants) before fluconazole prophylaxis to 0.3% (22 of 6393 infants) in 2002–2006 and that in extremely low birth weight infants decreased 3.6-fold. No Candida-attributable deaths occurred during 2002–2006 fluconazole prophylaxis, compared with 4 (21%) before fluconazole prophylaxis. The onset of invasive Candidiasis was later during 2002–2006 (23.5 vs 12 days), but risk factors were similar. The invasive Candidiasis species distribution remained stable. Of 409 infants who received fluconazole prophylaxis, 119 (29%) received 42 days. Shorter fluconazole prophylaxis duration was related to intravenous access no longer being necessary in 242 cases (59%), noninvasive Candidiasis-related death in 29 (7%), hospital transfer in 8 (2%), invasive Candidiasis diagnosis in 8 (2%), and transient increase in serum transaminase levels in 4 (1%). One hundred twenty-seven infants (31%) who received fluconazole prophylaxis developed cholestasis during hospitalization, two thirds of whom had other predisposing conditions. On multivariate logistic regression necrotizing enterocolitis and increasing days of total parenteral nutrition, but not increasing number of doses on days of fluconazole, were significantly associated with the development of cholestasis. CONCLUSION. During 4 years of fluconazole prophylaxis, the incidence of invasive Candidiasis and invasive Candidiasis-associated mortality rates in extremely low birth weight infants were reduced significantly, without the emergence of fluconazole-resistant Candida species.
Daniel K. Benjamin - One of the best experts on this subject based on the ideXlab platform.
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changes in the incidence of Candidiasis in neonatal intensive care units
Pediatrics, 2014Co-Authors: Sofia Aliaga, Daniel K. Benjamin, Thomas J. Walsh, Reese H Clark, Matthew M Laughon, William W Hope, David A Kaufman, Antonio Arrieta, Brian P SmithAbstract:OBJECTIVE: Neonatal invasive Candidiasis is associated with significant morbidity and mortality. We describe the association between invasive Candidiasis and changes in use of antifungal prophylaxis, empirical antifungal therapy, and broad-spectrum antibacterial antibiotics over time. METHODS: We examined data from 709 325 infants at 322 NICUs managed by the Pediatrix Medical Group from 1997 to 2010. We determined the cumulative incidence of invasive Candidiasis and use of antifungal prophylaxis, broad-spectrum antibacterial antibiotics, and empirical antifungal therapy by year. RESULTS: We identified 2063 (0.3%) infants with 2101 episodes of invasive Candidiasis. Over the study period, the annual incidence of invasive Candidiasis decreased from 3.6 episodes per 1000 patients to 1.4 episodes per 1000 patients among all infants, from 24.2 to 11.6 episodes per 1000 patients among infants with a birth weight of 750–999 g, and from 82.7 to 23.8 episodes per 1000 patients among infants with a birth weight CONCLUSIONS: The incidence of invasive Candidiasis in the NICU decreased over the 14-year study period. Increased use of fluconazole prophylaxis and empirical antifungal therapy, along with decreased use of broad-spectrum antibacterial antibiotics, may have contributed to this observation.
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the association of third generation cephalosporin use and invasive Candidiasis in extremely low birth weight infants
Pediatrics, 2006Co-Authors: Michael C Cotten, Scott A Mcdonald, Barbara J Stoll, Ronald N Goldberg, Kenneth Poole, Daniel K. BenjaminAbstract:OBJECTIVES. Previous studies have shown that incidence of invasive Candidiasis varies substantially among centers, and previous use of broad-spectrum antibiotics is a risk factor for Candidiasis in extremely low birth-weight infants. Differences in center practices, such as antibiotic strategies and the effects of these strategies on center incidence of Candidiasis, are not reflected in assessments of an individual9s risk of Candidiasis. We evaluated the relationship between empirical antibiotic practices for extremely low birth-weight infants and center incidence of Candidiasis. METHODS. We studied a cohort of extremely low birth-weight infants who survived ≥72 hours and were admitted to 1 of 12 tertiary centers between 1998 and 2001. Multivariable logistic regression was used to validate previous broad-spectrum antibiotics use as a risk factor for subsequent Candidiasis in individual infants. We calculated correlation coefficients to assess the relationship between center incidence of Candidiasis with antibiotic practice patterns. RESULTS. There were 3702 infants from 12 centers included, and 284 (7.7%) developed invasive Candidiasis. Broad-spectrum antibiotics use was associated with Candidiasis for individual infants. Center Candidiasis incidence ranged from 2.4% to 20.4%. Center incidence of Candidiasis was correlated with average broad-spectrum antibiotics use per infant and average use of broad-spectrum antibiotics with negative cultures per infant. CONCLUSIONS. Center incidences of invasive Candidiasis differ substantially, and antibiotic practice differences are possible contributors to center variation in Candidiasis risk.
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Disseminated Candida tropicalis in a patient with chronic mucocutaneous Candidiasis.
Southern Medical Journal, 2004Co-Authors: Terry C. Dixon, William J. Steinbach, Daniel K. Benjamin, Larry W. Williams, Laurie MyersAbstract:Chronic mucocutaneous Candidiasis is a heterogeneous group of immunodeficiencies associated with persistent candidal infections. Patients with chronic mucocutaneous Candidiasis are rarely associated with systemic infections caused by other fungi, but almost never by Candida. The authors report a case of a 16-year-old with chronic mucocutaneous Candidiasis who developed a fungemia with Candida tropicalis.
Jose A. Vazquez - One of the best experts on this subject based on the ideXlab platform.
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a phase 2 open label study of the safety and efficacy of intravenous anidulafungin as a treatment for azole refractory mucosal Candidiasis
Journal of Acquired Immune Deficiency Syndromes, 2008Co-Authors: Jose A. Vazquez, Annette C Reboli, Jennifer Schranz, Kay Clark, Beth P Goldstein, Carl J FichtenbaumAbstract:Background: Azole-refractory mucosal Candidiasis is a debilitating disease frequently seen in patients who are immunosuppressed as a result of HIV, malignancy, posttransplant immunosuppressive therapy, persistent neutropenia, steroid use, or diabetes. Anidulafungin has potent activity against a broad spectrum of Candida species, including strains resistant to azoles and amphotericin B. We performed an open-label, noncomparative study to examine efficacy and safety of anidulafungin in patients with azole-refractory oropharyngeal and esophageal Candidiasis. Methods: Patients enrolled met diagnostic criteria for azole-refractory mucosal Candidiasis. They received intravenous anidulafungin 100 mg on day 1 followed by daily 50-mg doses on day 2 through day 14 or for a maximum of 21 days. Primary efficacy variables were clinical response (for oropharyngeal Candidiasis) and endoscopic and clinical response (for esophageal Candidiasis) at the end of therapy. Results: Nineteen patients were enrolled; 89% had advanced HIV infection. Clinical success was observed in 95% of patients at end of therapy, and endoscopic success was observed in 92% of patients with esophageal Candidiasis. At follow-up, clinical success was maintained in 47% of patients. The most common adverse event, experienced by 4 patients, was nausea and/or vomiting. Conclusions: Anidulafungin was well tolerated and efficacious in the treatment of patients with azole-refractory esophageal and oropharyngeal Candidiasis.
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Anidulafungin: a new echinocandin with a novel profile.
Clinical therapeutics, 2005Co-Authors: Jose A. VazquezAbstract:Abstract Background: Until recently, available treatment for serious fungal infections comprised amphotericin B and azoles, which have limitations. Renal toxicity is a major concern with amphotericin B, while drug-drug interactions, hepatotoxicity, and skin rashes are the primary concerns with the azole medications. The development of the echinocandins, including caspofungin, has helped to fill the need for more efficacious antifungals that are useful across different patient populations and have a good safety profile. Anidulafungin is an echinocandin being developed to treat mucosal and invasive fungal infections. Objective: The aim of this report was to describe the pharmacodynamic and pharmacokinetic (PK) properties of anidulafungin. Methods: Data were identified using MEDLINE and National Library of Medicine Gateway searches for English-language literature (key words: anidulafungin, esophageal Candidiasis, echinocandin, caspofungin, ravuconazole, voriconazole, posaconazole, micafungin , and fluconazole ; years: 1996–2004), and from meeting abstracts of the American Society for Blood and Marrow Transplantation (Arlington Heights, Illinois), European Congress of Clinical Microbiology and Infectious Diseases (Basel, Switzerland), International Conference on Antimicrobial Agents and Chemotherapy (Washington, DC), and Infectious Diseases Society of America (Arlington, Virginia). Results: Anidulafungin has potent in vitro activity against Aspergillus and Candida spp, including those resistant to either fluconazole or amphotericin B. Results of several clinical trials imply that anidulafungin is effective in treating esophageal Candidiasis (EC), candidemia, and invasive Candidiasis (IC). In a Phase III, randomized, blinded clinical trial evaluating anidulafungin (50 mg/d) versus fluconazole (100 mg/d) for the treatment of EC, 97.2% and 98.9% of patients who received anidulafungin and fluconazole, respectively, showed evidence of cure or improvement (treatment difference, −1.6%; 95% CI, −4.1 to 0.8). In a Phase II study of candidasis and candidemia, anidulafungin showed success rates of 72%, 85%, and 83% in patients receiving the drug at dosages of 50, 75, or 100 mg/d, respectively. Studies evaluating the concomitant use of anidulafungin and either amphotericin, voriconazole, or cyclosporine did not show clinically significant drug-drug interactions or altered adverse-event (AE) profiles ( P P Conclusions: Anidulafungin may offer a new option to treat serious fungal infections, such as EC, azole-refractory EC, candidemia, and IC. In addition, anidulafungin has been associated with no clinically significant drug-drug interactions and few treatment-related AEs. Anidulafungin may offer a new option in the management of serious and difficult-to-treat invasive fungal infections.
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randomized trial of itraconazole oral solution for oropharyngeal Candidiasis in hiv aids patients
The American Journal of Medicine, 1998Co-Authors: John R Graybill, Jose A. Vazquez, Rabih O Darouiche, Robert Morhart, Deborah Greenspan, Carmelita U Tuazon, Joseph L Wheat, John P Carey, Ira Leviton, Ross G HewittAbstract:Abstract Purpose: Oropharyngeal candidasis (thrush) is the most common opportunistic infection in individuals who are positive for the human immunodeficiency virus (HIV) and those who have progressed to AIDS. Itraconazole has a broad in vitro spectrum of activity, including a wide variety of Candida species. Our study determined the relative efficacy of a new oral solution formulation of itraconazole and fluconazole tablets in the treatment of oropharyngeal Candidiasis. Patients and Methods: This was a prospective randomized, third-party–blind, multicenter trial conducted at 12 centers in the United States. One hundred seventy-nine HIV-positive patients with mycologically documented oropharyngeal Candidiasis were treated with itraconazole oral solution 200 mg/day for 7 or 14 days, or fluconazole tablets 100 mg/day for 14 days. Severity of disease was scored clinically before treatment and at clinical evaluations on days 3, 7, 14, 21, 35, and 42. Semiquantitative cultures of mouth washings were also obtained on these days. Results: Both 14-day and 7-day regimens of itraconazole oral solution were equivalent to fluconazole for most efficacy parameters. The clinical response rate was 97% after 14 days of itraconazole and 87% after 14 days of fluconazole. Itraconazole oral solution given for 7 days was also equivalent to fluconazole treatment for 14 days. Approximately one half of patients in all three groups relapsed by 1 month after completion of treatment. There were few adverse reactions to either drug. Conclusion: Itraconazole oral solution is well tolerated and offers an alternative at least as effective as fluconazole in the treatment of oropharyngeal Candidiasis.
Mary C Healy - One of the best experts on this subject based on the ideXlab platform.
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fluconazole prophylaxis in extremely low birth weight neonates reduces invasive Candidiasis mortality rates without emergence of fluconazole resistant candida species
Pediatrics, 2008Co-Authors: Mary C Healy, Elena Zaccaria, Judith R Campbell, Carol J BakerAbstract:OBJECTIVE. We evaluated the impact of fluconazole prophylaxis for extremely low birth weight infants on invasive Candidiasis incidence, invasive Candidiasis-related mortality rates, and fluconazole susceptibility of Candida isolates. METHODS. Extremely low birth weight infants RESULTS. Twenty-two infants had invasive Candidiasis (all candidemia) during fluconazole prophylaxis; before fluconazole prophylaxis, there were 19 cases (candidemia: 17 cases; meningitis: 2 cases). Invasive Candidiasis incidence in NICU infants decreased from 0.6% (19 of 3012 infants) before fluconazole prophylaxis to 0.3% (22 of 6393 infants) in 2002–2006 and that in extremely low birth weight infants decreased 3.6-fold. No Candida-attributable deaths occurred during 2002–2006 fluconazole prophylaxis, compared with 4 (21%) before fluconazole prophylaxis. The onset of invasive Candidiasis was later during 2002–2006 (23.5 vs 12 days), but risk factors were similar. The invasive Candidiasis species distribution remained stable. Of 409 infants who received fluconazole prophylaxis, 119 (29%) received 42 days. Shorter fluconazole prophylaxis duration was related to intravenous access no longer being necessary in 242 cases (59%), noninvasive Candidiasis-related death in 29 (7%), hospital transfer in 8 (2%), invasive Candidiasis diagnosis in 8 (2%), and transient increase in serum transaminase levels in 4 (1%). One hundred twenty-seven infants (31%) who received fluconazole prophylaxis developed cholestasis during hospitalization, two thirds of whom had other predisposing conditions. On multivariate logistic regression necrotizing enterocolitis and increasing days of total parenteral nutrition, but not increasing number of doses on days of fluconazole, were significantly associated with the development of cholestasis. CONCLUSION. During 4 years of fluconazole prophylaxis, the incidence of invasive Candidiasis and invasive Candidiasis-associated mortality rates in extremely low birth weight infants were reduced significantly, without the emergence of fluconazole-resistant Candida species.
Ю. В. Щербакова - One of the best experts on this subject based on the ideXlab platform.
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Optimization of the therapy and prevention of vulvovaginal Candidiasis
Reproductive Endocrinology, 2014Co-Authors: Г. М. Бондаренко, И. Н. Никитенко, Ю. В. ЩербаковаAbstract:The article describes modern views on the problem of vulvovaginal Candidiasis. Study of the ketoconazole (Livarol) effectiveness in the treatment and prevention of vulvovaginal Candidiasis in women of reproductive age was performed. Vaginal suppository Livarol (400 mg) was administered 28 women once a day for 10 days for the treatment of vaginal Candidiasis (study group). Also Vaginal suppository Livarol (400 mg) was administered once a day for 10 days for 20 women without vulvovaginal Candidiasis on the background of antibiotic treatment of sexual transmitted infections to prevent the development of Candidiasis infection (comparison group). The effectiveness of the drug Livarol in the form of vaginal suppositories is demonstrated in treatment and prevention of vulvovaginal Candidiasis. The presence of high-performance component of the drug – ketoconazole and polyethylene oxide bases determine the most widely use of Livarol by women with vulvovaginal Candidiasis.
