This Week in Infectious Disease: Antimicrobial Stewardship and Antiviral Treatment Dynamics

Clinical management of multidrug-resistant infections saw significant scrutiny this week regarding optimal treatment pathways. In the International journal of antimicrobial agents, a network meta-analysis involving 1420 patients with multidrug-resistant Acinetobacter baumannii (MDRAB) pneumonia compared colistin, tigecycline, and sulbactam regimens ^[2].

The study's findings suggest that colistin-based inhalation regimens may be considered a primary choice for MDRAB pneumonia in instances where newer agents are unavailable ^[2].

In a separate study published in the Journal of infection and chemotherapy, researchers conducted a meta-analysis of 975 adults with ESBL-producing Enterobacterales bacteremia ^[4].

The authors reported that cefmetazole or flomoxef was associated with significantly higher 14-day mortality compared to carbapenems (OR...); however, the study notes that selection bias may limit certainty regarding these findings ^[4].

Regarding antiretroviral and antiviral therapies, a meta-analysis in the International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases examined 9 head-to-head RCTs involving 3208 patients ^[3].

The researchers found no significant difference in virological suppression (RR 0.996; 95%...) between long-acting injectable and oral antiretroviral therapies, though they noted that local outcomes may vary based on regional demographics ^[3].

Meanwhile, a Phase 2a randomized, double-blind, 2x2 factorial placebo-controlled trial in the British journal of clinical pharmacology evaluated favipiravir and lopinavir-ritonavir in COVID-19 patients ^[5].

The study reported that co-administration with lopinavir-ritonavir increased favipiravir clearance by twofold, though the authors noted that favipiravir did not demonstrate antiviral activity at the dose used in the trial ^[5].

Finally, research published in The Lancet. Infectious diseases evaluated intervention strategies for trachoma in rural Ethiopian communities ^[1].

A cluster-randomized trial investigated whether adding fly control and hygiene behaviors to azithromycin dosing reduced prevalence; however, the study reported that these stronger SAFE interventions showed no significant advantage over standard single-dose azithromycin for trachoma reduction ^[1].