Infections combination therapy

Bacterial bio films develop on a number of living and inert surfaces within the urinary tract, producing chronic intractable urinary tract infections. Combination therapy with fosfomycin and a fluoroquinolone (or a fluoroquinolone and a macrohde) may be the most effective regimen available at present. Nevertheless, management of the local urinary condition and removal of the local... 

Coinfection with HIV is common in patients with HCV given the shared risk factors for transmission. Patients coinfected with these viruses have a more accelerated progression of their HCV disease. Most trials to date have excluded patients with HIV or limited them to patients with stable HTV infection. Combination therapy using ribavirin is considered to be superior however, enhancement of antiretroviral adverse events such as lactic acidosis limits therapy. Concurrent use of ribavirin therapy with didanosine, stavudine, or zidovudine is relatively contraindicated. ... 

Antimicrobial combination therapy is used frequently to treat serious infections. Combination therapy may be used prior to knowing the pathogen or antibiotic susceptibility for the treatment of infections in neutropenic patients and in patients with enterococcal endocarditis or bacteremia, sepsis, or pneumonia caused by P. aeruginosa. In these cases, it is important to know whether the combination will have beneficial (or detrimental) effects on the overall antibacterial activity of the regimen. For example, the combination may result in activity that is... 

Similar to HBV, infections with hepatitis C virus (HCV) have a high rate of progression from an acute to a chronic state that frequently leads to cirrhosis or hepatocellular carcinoma [2]. Monotherapy for HCV infection with IFN-a or combined therapy with ribavirin and IFN-a is associated with initial rates of response as high as 40%. The rates of sustained responses are, however, lower and also depend on the viral genotype. In patients infected with HCV genotype 2 or 3, the response was maximal after 24 weeks of treatment, whereas patients infected with genotype 1 -the most frequent in the USA and Europe - required a minimum treatment course of 48 weeks for an optimal outcome. 

So far, five different protease inhibitors have been approved by the FDA for the treatment of HIV infection [3, 4]. Clinical trials in which protease inhibitors were evaluated in monotherapy demonstrated the potency of this class of inhibitors (decrease in HIV RNA levels, increase in CD4 cell counts). Treatment regimens were subsequently broadened to include reverse transcriptase inhibitors in combination with protease inhibitors. The result of these clinical trials has led to a list of guidelines with recommendations for the optimal treatment options. Prolonged control of the infection with combination therapy (highly active antiretroviral therapy, HAART ) could be shown. 

Condon SM, LaPorte MG, Herbertz T (2005) Allosteric inhibitors of hepatitis C NS5B RNA-dependent RNA polymerase, Curr Med Chem Anti-Infect Agents 4 99-110 Cooper CL, van Heeswijk RP, Gallicano K, Cameron DW (2003) A review of low-dose ritonavir in protease inhibitor combination therapy, Clin Infect Dis 36 1585-1592 Courcambeck J, Bouzidi M, Perbost R, Jouirou B, Amrani N, Cacoub P, Pepe G, Sabatier JM, Halfon P (2006) Resistance of hepatitis C vims to NS3 A protease inhibitors mechanisms... 

Tenofovir in its prodrug form tenofovir, disoproxil fumarate (TDF), is indicated in the treatment of HIV infections (AIDS). It is administered as a single oral dose of 300 mg per day. When combined with emtricitabine and efavirenz, TDF has proven to be more efhcacious than the standard combination therapy of combivir (azidothymidine plus lamivudine) and efavirenz (Gallant et al. 2006) and less prone to cause adverse side effects (Pozniak et al. 2006 De Clercq 2007b). 

It may be possible to increase the utility of our resources to treat influenza virus infection through combinations of antiviral agents with different modes of action (discussed in Cinatl et al. 2007a De Clercq and Neyts 2007). The sialidase inhibitors, for example, may be able to be used in conjunction with the adamantane-based M2 ion channel inhibitors (Govorkova et al. 2004 Ilyushina et al. 2006), with Ribavirin (Smee et al. 2002) or with non-influenza virus specific therapeutics such as anti-inflammatory drugs (Carter 2007). Combination therapy may also reduce the potential of resistance development (Ilyushina et al. 2006). 

Kozlowski A, Charles SA, Harris JM (2001) Development of pegylated interferons for the treatment of chronic hepatitis C. BioDrugs 15 419 29 Krown SE, AeppU D, Balfour HH Jr (1999) Phase II, randomized, open-label, community-based trial to compare the safety and activity of combination therapy with recombinant interferon-alpha2b and zidovudine versus zidovudine alone in patients with asymptomatic to mildly symptomatic HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol 20 245-254 LaFleur DW, NardeUi B, Tsareva T, Mather D, Feng P, Semenuk M, Taylor K, Buergin M, Chinchilla D, Roshke V, Chen G, Ruben SM, Pitha PM, Coleman TA, Moore PA (2001) Interferon-kappa, a novel type I interferon expressed in human keratinocytes. J Biol Chem 276 39765-39771... 

Wolters LM, van Nunen AB, Honkoop P, Vossen AC, Niesters HG, Zondervan PE, de Man RA (2000) Lamivudine-high dose interferon combination therapy for chronic hepatitis B patients co-infected with the hepatitis D virus. J Viral Hepat 7 428 34 Wong DK, Cheung AM, O Rourke K, Naylor CD, Detsky AS, Heathcote J (1993) Effect of alpha-interferon treatment in patients with hepatitis B e antigen-positive chronic hepatitis B. A metaanalysis. Ann Intern Med 119 312-323... 

Brodt HR, Kamps BS et al (1997) Changing incidence of AlDS-defining iUnesses in the era of antiretroviral combination therapy. AIDS 11(14) 1731-1738 Calabrese LH, Proffitt MR et al (1987) Acute infection with the human immunodeficiency virus (HIV) associated with acute brachial neuritis and exanthematous rash. Ann Intern Med 107(6) 849-851... 

Moore RD, Wong WM et al (2000) Incidence of neuropathy in HIV-infected patients on monotherapy versus those on combination therapy with didanosine, stavudine and hydroxyurea. AIDS 14(3) 273-278... 

Treatment is typically initiated based on symptoms, rather than on microscopic evaluation. Since several species can cause tinea infections, the choice of antifungal agent is not always clear. For infections accompanied by inflammation, combination therapy with a topical steroid can be considered. 

Combination therapy may provide improvement in longterm disease-free survival. The combination of fludarabine, cyclophosphamide, and rituximab improves CR rates compared with fludarabine alone (70% versus 20%) but at the expense of increased infections.28,29 Combinations of fludarabine and alemtuzumab are also being investigated, with the hope of improving overall survival.21... 

There is an increasing amount of data regarding combination therapy with newly available triazoles, echinocandins, and polyenes in patients with fungal infections. Given the overall poor prognosis of IA in HCT recipients, many practitioners are treating patients with combination therapy known to be synergistic in vitro in order to maximize the chance of response. 

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