Why do echinocandins fail? Identifying Key Predictors to Improve Clinical Outcomes of Candida Bloodstream Infections: a Retrospective Multicentre Cohort Study.

Background: Echinocandins represent first-line therapy for Candida Bloodstream Infections (C-BSIs). Incidence of treatment failure (TF) remains high with unclear risk factors.

Aim: to evaluate predictors of echinocandin TF for C-BSIs.

Proactive Therapeutic Drug MONiToring to Guide Suppressive Antibiotic Therapy with DALBAvaNcin ( > 12 weeks) in Osteoarticular Infections (MONTALBANO).

: Long-term dalbavancin use is increasingly adopted off-label for osteoarticular infections (OAIs), but data on administration timing and long-term effects beyond 12 weeks are scarce. This study evaluated the pharmacological efficacy of proactive therapeutic drug monitoring (TDM) to optimize dalbavancin administration. : This single-center, retrospective study included adult OAI patients treated with doses of dalbavancin from July 2022 to October 2024.

Potential Role of Therapeutic Drug Monitoring in Preventing Antibiotic-Induced Neuropsychiatric Disorders: A Narrative Review.

Background: Neuropsychiatric toxicity is a common adverse effect of antibiotics. Advanced age, renal insufficiency, high drug doses, and prolonged therapy are relevant risk factors, suggesting that this event might be caused due to the accumulation of antibiotics in the central nervous system. In this review, the authors aimed to evaluate the potential role of therapeutic drug monitoring in identifying patients at risk of antibiotic-induced neuropsychiatric toxicity.

Assessment of potential drug-drug interactions in patients with hereditary angioedema from the ITACA cohort: simulations from a real-life dataset considering danazol versus berotralstat.

Background: Danazol is regularly used as a prophylactic treatment in patients with Hereditary angioedema due to C1-inhibitor deficiency (HAE-C1INH). However, this drug is characterized by a risk of drug-drug interactions (DDIs). Berotralstat, the first oral kallikrein inhibitor, has been recently approved for the prevention of HAE attacks.

Effect of body mass index on the timing of therapeutic drug monitoring-guided dalbavancin dosing in patients with osteoarticular infections.

Background: Recently, we documented that proactive therapeutic drug monitoring (TDM) allowed the successful individualization of the timing of dalbavancin administration in patients requiring prolonged antibiotic treatment. Here, we aimed to identify variables associated with the timing of TDM-guided dalbavancin dosing in patients who underwent proactive dalbavancin TDM.

Methods: Adult patients who received at least three 1500 mg doses of dalbavancin for osteoarticular infections were included in the study.

Management of polypharmacy and potential drug-drug interactions in people with HIV and cancer: insights from a 4-year multidisciplinary clinic experience.

Background: People with HIV and cancer (PWHC) are often treated with different combinations of antiretroviral and oncology drugs, frequently associated with other co-medications; this significantly increases the risk of potential drug-drug interactions (DDIs).

Research Design And Methods: A prospective observational study has been carried out from May 2020 to May 2024 to describe the management of therapies in PWHC in an outpatient clinic.

Results: 140 PWHC treated with 42 different antiretroviral and 59 oncology regimens were enrolled, resulting in the identification of 410 DDIs.

Appropriateness of loading dose and TDM in patients treated with teicoplanin: a single-centre observational retrospective cohort study comparing single-daily and thrice-weekly regimens.

Objectives: To assess the appropriateness of teicoplanin loading dose and therapeutic drug monitoring (TDM) in single-daily regimen (SDR) versus thrice-weekly regimen (TWR), and to compare safety and effectiveness.

Methods: This single-centre observational retrospective cohort study included adult patients treated with TDM-based teicoplanin for infections between April 2015 and December 2021. Appropriateness of loading dose and TDM, adverse events (AEs) and clinical outcomes were evaluated.

Adequate posology of antimicrobial therapy in the septic critically ill in continuous veno-venous hemofiltration: a single centre prospective observational study.

Background: Determining the optimal antibiotic (ATB) dosage in septic critically ill patients on continuous renal replacement therapy (CRRT) is still challenging. CRRT further disrupts antibiotic PK, already altered by sepsis-induced fluid shifts, volume of distribution (VD) changes and half-life modifications.

Materials And Methods: Our multi-disciplinary team-comprising an intensivist, nephrologist and clinical pharmacologist-conducted a prospective observational cohort study to evaluate the extent of ATB removal by CRRT and to assess the pharmacokinetic/pharmacodynamic (PK/PD) parameters of the most commonly used antibiotics for treating severe infections.

Non-operative management of uncomplicated appendicitis in children, why not? A meta-analysis of randomized controlled trials.

Background: This study aims to provide a meta-analysis of randomized controlled trials (RCTs) comparing non-operative management (NOM) and operative management (OM) in a pediatric population with uncomplicated acute appendicitis.

Methods: A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL from inception to June 2024.

Navigating Uncertainty: Managing Influenza-Associated Invasive Pulmonary Aspergillosis in an Intensive Care Unit.

We present a challenging case of a patient admitted to an intensive care unit with influenza-associated pulmonary aspergillosis (IAPA). The clinical course was characterised by refractory fungal pneumonia and tracheobronchitis, suspected drug-induced liver injury due to triazole antifungals, and secondary bacterial infections with multidrug-resistant microorganisms, resulting in a fatal outcome despite the optimisation of antifungal treatment through therapeutic drug monitoring. This case underscores the complexity that clinicians face in managing critically ill patients with invasive fungal infections.

The Case of Dolutegravir Plus Darunavir Antiretroviral Regimens: Is It Always Useful to Double the Drug Doses?

Background: Antiretroviral drug combinations affect dolutegravir trough concentrations. Here, the authors focused on dolutegravir plus booster darunavir antiretroviral regimens to investigate the effect of the booster and/or timing of drug administration on dolutegravir and darunavir plasma trough concentrations.

Methods: This retrospective observational study included consecutive people with HIV (PWH) receiving dolutegravir plus booster darunavir antiretroviral regimens for at least 3 months, with at least one assessment of dolutegravir and darunavir plasma trough concentrations.

Mismanagement of SARS-CoV-2 Infection Pre Hospitalisation during the Omicron Era: Antibiotics and Steroids Instead of Early Antivirals.

The aim of this study was to assess the prevalence of inappropriate treatment among hospitalised patients affected by SARS-CoV-2 infection before hospital admission during the Omicron era. This single-centre, retrospective observational study included all the patients hospitalised because of SARS-CoV-2 infection during three periods characterised by the Italian prevalence of an Omicron variant of concern: (1) January-May 2022 (BA.1-BA.

Pilot, open-label, randomized controlled clinical trial evaluating 4 oral hygiene regimens using a manual toothbrush, toothpaste, and mouthwash.

In this prospective pilot study, 84 patients with a history of poor oral hygiene were enrolled in an open-label, interventional, randomized controlled clinical trial. The aim was to provide preliminary clinical data on a new line of oral hygiene products containing a prebiotic and a paraprobiotic based on Lactobacillus plantarum. The recruitment rate and patient satisfaction were analyzed to estimate resources for the future primary study, and descriptive data on rebalancing of the oral microbiota were collected.

Therapeutic drug monitoring of antiretroviral therapy: current progresses and future directions.

Introduction: The treatment of HIV infection has been revolutionized in recent years thanks to the advent of dual antiretroviral regimens, administered orally or as long-acting injectable formulations. Here, we provide an update on the usefulness of therapeutic drug monitoring (TDM) of antiretroviral drugs to optimize the management of people with HIV (PWH) in the current scenario.

Areas Covered: A MEDLINE PubMed search for articles published between January 2014 and January 2024 was completed matching the terms HIV, antiretrovirals and TDM.

Management of the Drug-Drug Interactions Between Valproic Acid and Dolutegravir-A Case Study.

Objective: Preliminary evidence shows that concomitant administration of valproic acid can reduce the exposure to dolutegravir with limited clinical impacts. Here, we describe a male living with HIV who experienced a drastic reduction in dolutegravir trough concentrations a few weeks after starting valproic acid treatment as identified by therapeutic drug monitoring. Concomitantly, pharmacists recommended a supplementation of magnesium to improve insomnia.

Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference-A Case Study.

Background: Carbamazepine (CBZ) is an antiseizure medication known to induce the expression of cytochrome P4503A metabolic enzymes. Here, we describe a man living with HIV who underwent several changes in the daily dose of CBZ, which resulted in different induction effects on darunavir trough concentrations.

Methods: A 59-year-old man with HIV, successfully undergoing maintenance antiretroviral treatment with darunavir/cobicistat once daily (combined with raltegravir), was prescribed CBZ for recurrent trigeminal neuralgia.

Rilpivirine and cabotegravir trough concentrations in people with HIV on long-term treatment with long-acting injectable antiretrovirals.

Objective: Large inter-individual variability in the pharmacokinetics of rilpivirine and cabotegravir has been reported in the first weeks after starting long-acting injectable (LAI) therapy. Here, we assessed the distribution of rilpivirine and cabotegravir trough concentrations in people with HIV (PWH) on long-term LAI treatment.

Methods: Adult PWH treated with LAI for at least 32 weeks with an assessment of drug plasma trough concentrations were considered.