RESUMEN
Very limited labelled indications have been approved for the newer antimicrobials. Data on the clinical uses, efficacy and safety of dalbavancin are scarce, thus here we sought to describe our clinical experience. 16-month observational prospective study was performed. 19 (86%) were used under off-label indications. 10 (46%) for osteoarticular infections, 5 (23%) bloodstream infections and 3 (14%) endocarditis. To highlight, one patient received dalbavancin as long-term suppressive therapy. Most frequent use reasons were promptly hospital discharge, 11 (65%), and the presence of resistant organisms involving limited treatment options, 5 (23%). Successful outcome was observed in >95% of the patients and only 1 (4.5%) adverse event was reported. Further evidence beyond labelled indications is urgently needed. Despite the limitations, dalbavancin appears to be a safe and efficient option for adult patients who have tried and/or failed other therapies due to multidrug-resistant Gram-positive organisms.
Asunto(s)
Antibacterianos/uso terapéutico , Etiquetado de Medicamentos , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Teicoplanina/análogos & derivados , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Etiquetado de Medicamentos/normas , Farmacorresistencia Bacteriana Múltiple/fisiología , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Teicoplanina/farmacología , Teicoplanina/uso terapéuticoRESUMEN
Leishmaniasis is a chronic protozoan disease that is found in diverse geographical areas of the world. Leishmania spp. are endemic in the Mediterranean coasts of southern Europe. Tumour necrosis factor alpha (TNF-α) plays an important role in the defence of the host against infection by Leishmania spp. In this case report we describe Leishmania infection caused by a monoclonal antibody against TNF-α: infliximab. A 51-year-old patient with psoriatic arthritis treated with infliximab, 5 mg/kg every 6 weeks as immunomodulatory treatment and methotrexate 10 mg weekly as a conventional disease-modifying antirheumatic drug, visited his otorhinolaryngologist owing to a lesion in his left nostril. The lesion was diagnosed as cutaneous leishmaniasis so treatment with infliximab was suspended. The patient was then treated with liposomal amphotericin B and showed a total recovery of the lesion; liposomal amphotericin B was maintained at 5 mg/kg monthly.