Successful use of fidaxomicin in recurrent Clostridium difficile infection in a child.
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چکیده
report of maraviroc plasma concentrations when the drug is given as 150 mg once daily with lopinavir/ ritonavir. It is noteworthy that the current recommended minimum effective values of the trough concentration (50 ng/mL) and average concentration (100 ng/mL) were derived from a sub-study of the MOTIVATE trial, 3 where patients were administered 150 mg of maraviroc once daily or twice daily: these cutoff values are most likely applicable to multi-experienced subjects. A subsequent analysis of the MERIT trial, in fact, showed lower pharmacological requirements in treatment-naive patients. All patients in our study were treatment naive and showed average concentrations .75 ng/mL for near maximal virological efficacy according to exposure–response analysis of the MERIT study. Furthermore , the post hoc analysis of the MOTIVATE trial did not confirm the relationship between the efficacy and plasma concentration of maraviroc administered with protease inhibitors, further supporting the evaluation of maraviroc at reduced dosing when associated with the latter. Interestingly, maraviroc exposure in our patients is comparable to the PK of the same dose in association with atazanavir/ritonavir (AUC 4330 ng/mL. h and C ave 180 ng/mL) 4 and darunavir/ritonavir (C trough 43 ng/mL). 6 Moreover, lopinavir and ritonavir exposure did not seem to be affected by the coadministration of maraviroc, as all PK parameters were comparable to what was previously reported. 9 In conclusion, our study suggests that once-daily 150 mg dosing of maraviroc appears to be pharmacologically adequate in association with lopinavir/ritonavir in treatment-naive subjects. The potential impact in terms of regimen simplification and cost savings, coupled with the promising immunovirological results of the VEMAN study, deserves further clinical evaluation.
منابع مشابه
Fidaxomicin is a Superior Treatment to Vancomycin for Recurrent Clostridium Difficile Infection
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Fidaxomicin for Clostridium difficile Infection.
To the Editor: In their randomized study comparing fidaxomicin with vancomycin for Clostridium difficile infection, Louie et al. (Feb. 3 issue)1 found that substantially fewer patients in the fidaxomicin group had recurrences of C. difficile infection within 4 weeks after the conclusion of treatment. We recently reported on an observational study involving U.S. veterans in which the recurrence ...
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Abstract Background Clostridium difficile infection (CDI) recurs in nearly one-third of patients who develop an initial infection. Recurrent CDI (RCDI) is associated with considerable morbidity, mortality, and cost. Treatment for RCDI has not been not well examined. Methods A systematic review. Results Sixty-four articles were identified evaluating eight different treatment approaches: metronid...
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The use of fecal microbiota transplantation in recurrent Clostridium difficile infection and coexistent inflammatory bowel disease remains unclear. A 61-year-old man with ulcerative pancolitis was diagnosed with a third recurrence of Clostridium difficile infection, previously treated with metronidazole, vancomycin and fidaxomicin. Fecal microbiota transplantation of an unrelated healthy donor ...
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عنوان ژورنال:
- The Journal of antimicrobial chemotherapy
دوره 68 7 شماره
صفحات -
تاریخ انتشار 2013