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- Andersson, Viktoria, et al.
(författare)
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The In vitro Activity of Carbapenems Alone and in Combination with β-lactamase Inhibitors against Difficult-to-treat Mycobacteria; Mycobacterium tuberculosis, Mycobacterium abscessus, and Mycobacterium avium Complex: A Systematic Review
- 2023
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Ingår i: INTERNATIONAL JOURNAL OF MYCOBACTERIOLOGY. - : WOLTERS KLUWER MEDKNOW PUBLICATIONS. - 2212-5531 .- 2212-554X. ; 12:3, s. 211-225
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Forskningsöversikt (refereegranskat)abstract
- Difficult-to-treat mycobacterial infections are increasing globally. There is an urgent need of new treatment alternatives for multidrug-resistant Mycobacterium tuberculosis (MTB), as well as nontuberculous mycobacteria such as the Mycobacterium abscessus complex (MABC) and Mycobacterium avium complex (MAC). Recently, new carbapenems and combinations of carbapenems with beta-lactamase inhibitors have become available, but activity data in vitro against mycobacteria are so far scarce. Therefore, we performed a systematic review collating the minimum inhibitory concentrations (MICs) of carbapenems, with or without a beta-lactamase inhibitors for MTB, MABC, and MAC. The databases PubMed and Web of Science were searched for the relevant articles in English up until September 21, 2022. Screening of studies was performed by two independent reviewers. MIC data by recommended methods with at least five individual MICs were included. Data were reported as MIC range, MIC50, modal MIC, and/or histograms when individual MICs were available. The study protocol was registered at PROSPERO (CRD42021258537). After screening, a total of 75 studies with MIC data for carbapenems with or without beta-lactamase inhibitors were included in the review. For MTB, the oral carbapenem tebipenem combined with the beta-lactamase inhibitor clavulanic acid resulted in the most significant reduction of MICs. For MABC, the addition of avibactam to tebipenem resulted in a 64-fold reduction of modal MIC. Data were insufficient for the analysis of MAC. Carbapenems, and in particular the novel oral compound tebipenem, in combination with clavulanic acid for MTB and avibactam for MABC may be an untapped potential for difficult-to-treat mycobacterial infections.
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- Ridell, Malin, 1942
(författare)
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New options in Tuberculosis Care: Visions for the future are crucial for controlling the disease.
- 2016
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Ingår i: International journal of mycobacteriology. - : Medknow. - 2212-554X .- 2212-5531. ; 5:Suppl 1
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Forskningsöversikt (refereegranskat)abstract
- The current strategies for controlling tuberculosis (TB) are not sufficient. Improved prophylactic and diagnostic tools are imperative, being crucial for decreasing TB incidence and mortality and for preventing outbreaks. Furthermore, new and better drugs are badly needed, particularly considering the increase in cases with multidrug-resistant strains. The current TB vaccine-the Bacillus Calmette-Guérin vaccine-has a preventive impact on disseminated TB in children, but little effect on the most common form of TB, that is, lung TB in adults and young adults. For many years extensive scientific efforts have been made in order to develop new vaccines against TB that are better and more effective than Bacillus Calmette-Guérin. No such vaccine exists, however, to date. During the last few years it has become increasingly clear that TB patients can be infected with more than one strain and that a previous TB infection increases rather than decreases the risk for getting a new one. Mycobacterium tuberculosis organisms are thus not capable of inducing protective immunity to such an extent that a new TB infection is prevented. This phenomenon highlights the problems of developing effective vaccines against TB. A new TB vaccine based on general immunological protection models would in all probability only have a limited capacity to hamper TB incidence and mortality. The question whether or not it is feasible to make a vaccine of sufficient efficacy must therefore be discussed. Prophylaxis is practically always far better than therapy and we all wish we had an effective TB vaccine. However, considering the problems with vaccines, scientific efforts could well focus on developing new therapies rather than new vaccines. New scientific approaches are highly necessary and we need ideas and visions. Some examples of recent projects will hereby be presented. One study concerns the mycobacterial cell envelope and its unique macromolecules as targets for new drugs. Another study concerns new ways of administrating the drugs which could enhance the effects of new as well as of already available drugs. In addition, what can be learnt from cancer therapy-is supporting the patient's own defense by immune modularly methods a possible approach? We also need to look back since ample knowledge on TB has been assembled during many years. Unfortunately some of this valuable knowledge is about to be forgotten, particularly, the experience from the time when TB was an incurable disease.
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