Novel "High-dose Quad" Salvage Therapy Approach for Helicobacter pylori Infection: A Case Report.

Purpose: This case report outlines the successful eradication of chronic Helicobacter pylori (H. pylori) infection using a novel, "high-dose quad" salvage therapy approach. Gastroenterologists may consider using this approach for patients who have previously failed first- and second-line treatment regimens, as recommended by the American College of Gastroenterology (ACG). Summary: H. pylori infection is associated with multiple chronic gastrointestinal diseases, and patients who test positive for H. pylori should undergo treatment until eradication is achieved. Unfortunately, increasing antibiotic resistance to clarithromycin, metronidazole, and levofloxacin makes eradication of H. pylori challenging. This case describes an 84-year-old American woman with chronic H. pylori gastritis who failed two first-line treatment regimens (bismuth quadruple therapy and concomitant therapy), but responded to a novel, "high-dose quad" salvage regimen consisting of high-dose levofloxacin, amoxicillin, metronidazole, and high-dose acid suppression. Conclusion: This is the first time the "high-dose quad" regimen has been reviewed in the literature and is not FDA approved, but may be considered as an alternative salvage therapy in certain patients, based on the efficacy and safety observed in this case.

Case Report of Hepatitis C Treatment Success in Male With Decompensated Cirrhosis and Polysubstance Abuse: The Important Role of the Pharmacist in Active Care Coordination.

This is a case report of a man with decompensated cirrhosis and polysubstance abuse that was cured of chronic hepatitis C virus (HCV) infection through pharmacist active care coordination. The patient was prescribed Epclusa (sofosbuvir 400 mg/velpatasvir 100 mg) 1 tablet by mouth daily for 24 weeks, but finished his course 18 days late due to poor compliance and treatment interruptions. The active role of the clinical pharmacist in the hepatology clinic facilitated the patient's ongoing engagement in care, leading to treatment success.

Cross-border antibiotic resistance patterns in trauma patients.

BACKGROUND: Antibiotic resistance is a growing problem worldwide, with differences in regional resistance patterns driven by variance in antibiotic stewardship. Hospitals along the United States-Mexico border increasingly identify resistance, raising concern for transfer of drug-resistant organisms across the border. METHODS: This retrospective review evaluated trauma admissions between March 2011 and August 2015. Patients were included if cultures were obtained during the first 3 days of hospitalization to limit analysis of hospital-acquired bacteria. A matched Mexico and US cohort subanalysis was later compared to eliminate bias in time from injury to culture. RESULTS: Among 115 Mexico and 1,149 US patients, Mexico patients were younger (mean 44.3 vs 60.4 years), had a higher median injury severity score (21 vs 10), and longer hospital durations of stay (mean 11.6 vs 5.5 days). These differences resolved in the matched analysis. Infections were more common in Mexico than US patients in the matched cohort, and resistant infections including resistant gram-negative infections were more common in Mexico patients in both the matched and overall cohorts. The only resistant organism identified in matched US patients was methicillin-resistant Staphylococcus aureus. Extended-spectrum ß-lactamase Klebsiella was found only in patients from Mexico. Additional risk factors for resistance in the matched cohorts included injury in Mexico, ≥2 days from injury to admission, and tracheostomy placement in Mexico. CONCLUSION: Antibiotic resistance is more common in patients initially treated in Mexico healthcare facilities than those treated exclusively in the United States and may require alternative empiric treatment. Global initiatives to improve antibiotic stewardship will be critical to limit the continued rise in drug-resistant infections.

Phase I Clinical Trial Results of Auranofin, a Novel Antiparasitic Agent.

Under an NIH priority to identify new drugs to treat class B parasitic agents, we performed high-throughput screens, which identified the activity of auranofin (Ridaura) against Entamoeba histolytica and Giardia intestinalis, major causes of water- and foodborne outbreaks. Auranofin, an orally administered, gold (Au)-containing compound that was approved by the FDA in 1985 for treatment of rheumatoid arthritis, was effective in vitro and in vivo against E. histolytica and both metronidazole-sensitive and -resistant strains of Giardia We now report the results of an NIH-sponsored phase I trial to characterize the pharmacokinetics (PK) and safety of auranofin in healthy volunteers using modern techniques to measure gold levels. Subjects received orally 6 mg (p.o.) of auranofin daily, the recommended dose for rheumatoid arthritis, for 7 days and were followed for 126 days. Treatment-associated adverse events were reported by 47% of the subjects, but all were mild and resolved without treatment. The mean gold maximum concentration in plasma (Cmax) at day 7 was 0.312 µg/ml and the half-life (t1/2) 35 days, so steady-state blood levels would not be reached in short-term therapy. The highest concentration of gold, 13 µM (auranofin equivalent), or more than 25× the 50% inhibitory concentration (IC50) for E. histolytica and 4× that for Giardia, was in feces at 7 days. Modeling of higher doses (9 and 21 mg/day) was performed for systemic parasitic infections, and plasma gold levels of 0.4 to 1.0 µg/ml were reached after 14 days of treatment at 21 mg/day. This phase I trial supports the idea of the safety of auranofin and provides important PK data to support its potential use as a broad-spectrum antiparasitic drug. (This study has been registered at ClinicalTrials.gov under identifier NCT02089048.).