meropenem and HIV-Infections

The efficacy and toxicity of several drugs now used to treat multidrug-resistant tuberculosis (MDR-TB) have not been fully evaluated. We searched three databases for studies assessing efficacy in MDR-TB or safety during prolonged treatment of any mycobacterial infections, of drugs classified by the World Health Organization as having uncertain efficacy for MDR-TB (group 5). We included 83 out of 4002 studies identified. Evidence was inadequate for meropenem, imipenem and terizidone. For MDR-TB treatment, clarithromycin had no efficacy in two studies (risk difference (RD) -0.13, 95% CI -0.40-0.14) and amoxicillin-clavulanate had no efficacy in two other studies (RD 0.07, 95% CI -0.21-0.35). The largest number of studies described prolonged use for treatment of non-tuberculous mycobacteria. Azithromycin was not associated with excess serious adverse events (SAEs). Clarithromycin was not associated with excess SAEs in eight controlled trials in HIV-infected patients (RD 0.00, 95% CI -0.02-0.02), nor in six uncontrolled studies in HIV-uninfected patients, whereas six uncontrolled studies in HIV-infected patients clarithromycin caused substantial SAEs (proportion 0.20, 95% CI 0.12-0.27). For most group 5 drugs we found inadequate evidence of safety for prolonged use or for efficacy for MDR-TB, although macrolides appeared to be safe in prolonged use.

Topics: Amoxicillin; Antitubercular Agents; Azithromycin; Cilastatin; Clarithromycin; Clavulanic Acid; HIV Infections; Humans; Imipenem; Isoxazoles; Macrolides; Meropenem; Mycobacterium tuberculosis; Oxazolidinones; Randomized Controlled Trials as Topic; Thienamycins; Thioridazine; Treatment Outcome; Tuberculosis, Multidrug-Resistant; World Health Organization

Gram-negative bacillary meningitis remains a rare occurrence, even in patients with human immunodeficiency virus. Current literature only describes anecdotal cases of spontaneous nosocomial Proteus mirabilis meningitis. This report describes the clinical manifestations and management of a patient with healthcare-associated spontaneous Gram-negative bacillary meningitis in a patient with advanced human immunodeficiency virus disease.. A 23-year-old Congolese female was hospitalized in a human immunodeficiency virus specialized center for ongoing weight loss, chronic abdominal pain, and vomiting 9 months after initiation of treatment for tuberculosis meningitis. Hospitalization was complicated by healthcare-associated Gram-negative bacillary meningitis on day 18. Blood and cerebrospinal fluid cultures confirmed Proteus mirabilis. Antibiotic susceptibility testing showed extended spectrum beta-lactamase resistant to common antibiotics, and sensitive to meropenem. Despite initiation of high-dose meropenem by intravenous infusion (2 g every 8 hours), the patient did not improve, and died after 4 days of meropenem treatment. Gram-negative bacillary meningitis remains rare and is associated with an unfavorable prognosis.. This case report highlights the importance of microbiological identification of pathogens in resource-limited settings. As Gram-negative bacillary meningitis does not present with pleocytosis in patients with advanced human immunodeficiency virus, a negative lumbar puncture cannot exclude this diagnosis. Access to clinical bacteriology in resource-limited settings is essential to enable correct antibiotic treatment and avoid overuse of antibiotics to which there is already resistance. It further plays an essential role in public health by identifying antibiotic susceptibilities. Infection prevention and control measures must be reinforced in order to protect patients from such avoidable healthcare-associated infections.

Topics: Adult; Anti-Bacterial Agents; Cross Infection; Female; Gram-Negative Bacteria; HIV; HIV Infections; Humans; Meningitis; Meningitis, Bacterial; Meropenem; Proteus mirabilis; Young Adult

We saw a previously healthy 30-year-old Southeast-Asian sailor with progredient coughing and fever.. We found an atypical pneumonia along with a positive HIV-test. We performed a bronchial lavage and further diagnostics for opportunistic infections. The lab work showed a viral load of 3340 000 copies/ml and a CD4-cell-count of 36/µl.. HIV late presenter in CDC stadium C3 with Pneumocystis jirovecii and CMV pneumonia.. We treated with Meropenem, Moxifloxacin, Cotrimoxazol, Ganciclovir and Genvoya.. Due to a cardio-pulmonal deterioration invasive ventilation was necessary. In the end the patient died of multi organ failure twelve days after admission despite intensive care, hemodialysis and prone positioning.. This case demonstrates the difficulties in the pharmacotherapy and with drug interactions in a HIV late presenter with multi organ failure. Consultation and advice of the hospital pharmacy and the antibiotic stewardship team was vital for treating this patient. In the end cases like the portrayed should be treated in specialized clinics.. Wir sahen einen zuvor gesunden 30-jährigen südostasiatischen Seemann mit progredientem Husten und Fieber.  UNTERSUCHUNGEN:  Wir fanden eine atypische Pneumonie bei positivem HIV-Test. Im Verlauf erfolgten eine Bronchiallavage und weitere Untersuchungen zur Diagnostik etwaiger opportunistischer Infektionen. Das Labor zeigte eine Viruslast von 3340 000 Kopien/ml und eine CD4-Zellzahl von 36/µl.. HIV-„Late Presenter“ im CDC-Stadium C3 mit Pneumocystis jirovecii und CMV-Pneumonie.. Wir therapierten mit Meropenem, Moxifloxacin, Cotrimoxazol, Ganciclovir und Genvoya.. Es kam zu einer fulminanten kardiopulmonalen Verschlechterung, sodass die maschinelle Beatmung notwendig wurde. Letztendlich verstarb der Patient 12 Tage nach Aufnahme, trotz Intensivtherapie mit Dialyse und kinetischer Lagerungstherapie, am Multiorganversagen.. Dieser Fall zeigt die Schwierigkeiten der Pharmakotherapie und der Medikamenten-Interaktionen bei der Behandlung eines HIV-Late Presenter mit Multiorganversagen. Die Beratung durch die Krankenhausapotheke und das Antibiotic Stewardship Team war wesentlich für die Behandlung des Patienten. Letztendlich sollten solche Patienten in spezialisierten Zentren behandelt werden.

Topics: Acquired Immunodeficiency Syndrome; Adult; Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; Ganciclovir; HIV Infections; Humans; Meropenem; Military Personnel; Moxifloxacin; Pneumonia, Pneumocystis

Topics: Adult; Animals; Anti-Bacterial Agents; Antiparasitic Agents; Fatal Outcome; HIV Infections; Humans; Ivermectin; Male; Meropenem; Purpura; Strongyloides stercoralis; Strongyloidiasis

A patient with well-controlled HIV-1 infection presented with fever and rigors, a widespread maculopapular rash, and severe generalised arthralgia. Sepsis of unknown aetiology was diagnosed, and treatment with broad-spectrum antimicrobials commenced. Following initial clinical improvement, a right knee septic arthritis developed. Microscopy and culture of the joint aspirate were negative for organisms but 16S rDNA PCR identified Neisseria meningitidis DNA, subsequently verified as capsular genogroup C, thus confirming a diagnosis of disseminated meningococcal sepsis with secondary septic arthritis.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Arthritis, Infectious; Exanthema; Fever; HIV Infections; Humans; Male; Meningococcal Infections; Meropenem; Middle Aged; Neisseria meningitidis, Serogroup C; Polymerase Chain Reaction; Sepsis; Thienamycins; Treatment Outcome

Topics: Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Darunavir; Female; HIV Infections; HIV Protease Inhibitors; Humans; Levofloxacin; Meropenem; Ophthalmoscopy; Pneumonia, Pneumococcal; Polypharmacy; Retinal Dystrophies; Thienamycins; Young Adult