Management of Multiple Drug-Resistant Infections (Infectious Disease) - Hardcover

Hardcover

ISBN 10: 1588292304 ISBN 13: 9781588292308

Publisher: Humana, 2004

Synopsis

A comprehensive and cutting-edge review of how practicing physicians can best treat multiple drug resistance in bacterial, viral, protozoal, and helminthic infections. The authors focus on the major hospital and community-acquired pathogens, including S. aureus, S. pneumoniae, Enterococcus, Acinetobacter, and M. tuberculosis, and on the management of such common problems as multiple drug-resistant urinary tract infections and gonorrhea. Among the resistant tropical organisms covered are Salmonella typhi, malaria, and Burkholderia pseudomalei. Resistance to such important antiviral classes as antiretrovirals and anticytomegalovirals is also discussed, as are those measures necessary to prevent the spread of infections patients.

About this title

From the Back Cover

Multiple drug resistance to antimicrobials is a growing problem that limits the effective lifetime of nearly all drugs developed against microorganisms. In Management of Multiple Drug-Resistant Infections, prominent clinicians and leading microbiologists describe how practicing physicians can best treat bacterial, viral, protozoal, and helminthic infections when there is significant resistance to antibiotics. The authors focus on the major hospital and community-acquired pathogens, including S. aureus, S. pneumoniae, Enterococcus, Acinetobacter, and M. tuberculosis, and on the management of such common problems as multiple drug-resistant urinary tract infections and gonorrhea. Among the resistant tropical organisms covered are Salmonella typhi, malaria, and Burkholderia pseudomalei. Resistance to such important antiviral classes as antiretrovirals and anticytomegaloviral agents is also discussed, as are those measures necessary to prevent the spread of infections among patients. When national or international treatment guidelines cannot be established, clinical trial data, in vitro susceptibility data, and epidemiologic and pharmacological evidence are cited to help make treatment decisions. Wherever possible, the question of drug resistance is set in the context of its biology and epidemiology.
Comprehensive and practice-oriented, Management of Multiple Drug-Resistant Infections offers physicians and clinical microbiologists treating infectious disease patients not only a critically evaluated guide to the immense literature of the field, but also an up-to-date practical survey of today's gold-standard therapeutic strategies.

Reviews

It is now well accepted that many pharmaceutical companies have given up on the development of antibacterial compounds. Among the reasons for this exodus is that many safe and effective antimicrobial agents already exist to treat the vast majority of infections. As a result, new opportunities for profitable anti-infective agents, if they exist, lie in the treatment of resistant bacteria. Multidrug-resistant, and therefore difficult-to-treat, infections continue to occur and are clearly increasing in some areas. But difficulties can arise in enrolling patients with such infections in clinical trials in order to derive reliable information on the efficacy of specific agents. Therefore, many pharmaceutical companies are limiting their development efforts to the perceived safe havens of hypertension, dyslipidemia, and depression. Similar challenges face researchers who are attempting to compile defensible and "evidence-based" recommendations regarding the efficacy of existing regimens against resistant microorganisms. Case reports and small, uncontrolled retrospective studies form the bulk of the literature on these subjects, and randomized, controlled studies are virtually nonexistent. Moreover, the wide variety of known resistance mechanisms further complicates attempts to generalize. Nevertheless, the problem of multidrug resistance is very real, and developing a comprehensive manual on the treatment of multidrug-resistant infections has considerable appeal. Management of Multiple Drug-Resistant Infections, edited by Stephen H. Gillespie, attempts to address this need. Gillespie has engaged a large number of authors (primarily from his native United Kingdom) to address a variety of topics concerning multidrug-resistant infections. The book has five sections that deal with gram-positive bacteria, gram-negative bacteria, mycobacteria, fungal and parasitic infections, and viral infections. In general, these divisions are logical. However, the choices of topics within these areas raise some questions. For example, it is not clear that resistant Streptococcus pneumoniae deserves 3 chapters (out of a total of 21), especially since a very lucid chapter on the relationship between the minimal inhibitory concentration of drugs with respect to S. pneumoniae and treatment efficacy is followed by a chapter -- mainly anecdotal -- on the bacteria's role in central nervous system infection and a polemic on the "mutant-prevention concentration." The section on gram-positive bacteria ends with an excellent chapter on evidence for the need to control the spread of methicillin-resistant Staphylococcus aureus (MRSA). However, a discussion on treating MRSA infections is ignored in favor of chapters on treating glycopeptide-resistant staphylococci and (non-Enterococcus faecium) gram-positive infections -- issues of interest to microbiologists and researchers but not a major concern for the practicing physician. The section on gram-negative bacteria includes useful chapters on acinetobacter, management of resistant urinary tract infections, and resistance in salmonella species. However, it is disappointing that there are no chapters devoted to resistant Pseudomonas aeruginosa or extended-spectrum (beta)-lactamase-producing klebsiella infections, which are important and growing problems for clinicians around the world. A chapter on melioidosis is well written and interesting and will serve as a useful reminder about these infections for those who encounter them only rarely. In the remainder of the book, highlights include excellent chapters on the management of multidrug-resistant malaria and drug-resistant infections caused by the human immunodeficiency virus. Less appropriate for this book (although nicely written) are chapters on praziquantel resistance in schistosomiasis and cytomegalovirus resistance, since, as the authors acknowledge, such resistance does not cause major problems in the clinical setting. Quibbles over chapter choices aside, however, this is a useful and informative book. The chapters are generally concise, clear, and well written. The references are extensive and quite up to date, and the perspectives offered by the various authors are often thought provoking. It is probably not possible at this point in time to produce a comprehensive and authoritative book on treating multidrug-resistant infections. Good data on treatments of choice are simply not available. Despite these challenges, Gillespie has made an honest attempt to compile a diverse array of useful information and opinions on the subject. The result is a book that will be an enjoyable and useful reference for physicians and microbiologists who are interested in developing a better grasp of this complex and rapidly changing field. Louis B. Rice, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Edition details

• Publisher: Humana
• Publication date: 2004
• Language: English
• ISBN 10: 1588292304
• ISBN 13: 9781588292308
• Binding: Hardcover
• Number of pages: 415
• Editor: Gillespie Stephen H.