ABSTRACT
Title
Antimicrobials for GI Infections: Current and Future Options
Authors
F. Scaglione
Department of Pharmacology, Chemotherapy and Toxicology, Faculty of Medicine, University of Milan
Department of Pharmacology, Chemotherapy and Toxicology, Faculty of Medicine, University of Milan
Abstract
Gastrointestinal (GI) disease, including dysentery, is one of the most important cause of morbidity and mortality in developing country but is still problematic in developed countr also.Treatment goals remain unchanged over the last several decades: avoid dehydration, reducethe severity and duration of symptoms, and prevent the interruption of planned activities . All persons should maintain hydration. Infants and young children, the elderly and those with chronic medical conditions for whom dehydration could have adverse health consequences,should consider drinking oral rehydration solutions. Healthy adolescents and adults can usuallymaintain hydration with potable fluids and then slow advancement of the diet.
Symptomatic measures such as bismuth subsalicylate and loperamide are generally reserved for mild-to-moderate illness, with antibiotics given for moderate-to-severe diseases. The choice of antibiotic and duration oftreatment have been clarified in recent years. Currently, the drugs of choice for diarrhoea therapy are rifaximin , fluoroquinolones (either levofloxacin or ciprofloxacin) and azithromycin.
A major public health problem is the increasing frequency of quinolone-resistance among Campylobacter strains as well as Salmonella on a worldwide basis.
Clostridium difficileinfection (CDI) associated with consumption of antibiotics is an other increasing problem in developed countries. Currently, only vancomycin or metronidazole are recommended for treatment and many patients suffer from relapse on infection. Hence, there is a need for new treatment options.
One agent, fidaxomicin, has undergone Phase III clinical trials which show it to be a promising new agent for the treatment of CDI with a low rate of relapse. Nitazoxanide is licensed for the treatment of parasitic intestinal infections but is not licensed for CDI. However, in small scale clinical trials it has been shown to have activity comparable to that of vancomycin and metronidazole. The other agents are all at early stages of development and clinical trials to evaluate their therapeutic potential for CDI have not yet been undertaken.
1 )D. R. Hill and N. J. Beeching , Travelers’ diarrhea
Current Opinion in Infectious Diseases 2010, 23:481–487
2) Shah D, Dang MD, Hasbun R, Koo HL, Jiang ZD, DuPont HL, Garey KW.Clostridium difficile infection: update on emerging antibiotic treatment options and antibiotic resistance
Expert Rev Anti Infect Ther. 2010 May;8(5):555-64.
3) Koo HL, DuPont HL. Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases.Curr Opin Gastroenterol. 2010 Jan;26(1):17-25.
Symptomatic measures such as bismuth subsalicylate and loperamide are generally reserved for mild-to-moderate illness, with antibiotics given for moderate-to-severe diseases. The choice of antibiotic and duration oftreatment have been clarified in recent years. Currently, the drugs of choice for diarrhoea therapy are rifaximin , fluoroquinolones (either levofloxacin or ciprofloxacin) and azithromycin.
A major public health problem is the increasing frequency of quinolone-resistance among Campylobacter strains as well as Salmonella on a worldwide basis.
Clostridium difficileinfection (CDI) associated with consumption of antibiotics is an other increasing problem in developed countries. Currently, only vancomycin or metronidazole are recommended for treatment and many patients suffer from relapse on infection. Hence, there is a need for new treatment options.
One agent, fidaxomicin, has undergone Phase III clinical trials which show it to be a promising new agent for the treatment of CDI with a low rate of relapse. Nitazoxanide is licensed for the treatment of parasitic intestinal infections but is not licensed for CDI. However, in small scale clinical trials it has been shown to have activity comparable to that of vancomycin and metronidazole. The other agents are all at early stages of development and clinical trials to evaluate their therapeutic potential for CDI have not yet been undertaken.
1 )D. R. Hill and N. J. Beeching , Travelers’ diarrhea
Current Opinion in Infectious Diseases 2010, 23:481–487
2) Shah D, Dang MD, Hasbun R, Koo HL, Jiang ZD, DuPont HL, Garey KW.Clostridium difficile infection: update on emerging antibiotic treatment options and antibiotic resistance
Expert Rev Anti Infect Ther. 2010 May;8(5):555-64.
3) Koo HL, DuPont HL. Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases.Curr Opin Gastroenterol. 2010 Jan;26(1):17-25.