4- Thursday Pharmacotherapy News – 13th May

1 – Exclusion of bacterial co-infection in COVID-19 using baseline inflammatory markers and their response to antibiotics

• COVID-19 is infrequently complicated by bacterial co-infection, but antibiotic prescriptions are common.
• They used community-acquired pneumonia (CAP) as a benchmark to define the processes that occur in bacterial pulmonary infections, testing the hypothesis that baseline inflammatory markers and their response to antibiotic therapy could distinguish bacterial co-infection from COVID-19.
• This study proposes that in COVID-19, absence of both elevated baseline WCC and antibiotic-related decrease in CRP can exclude bacterial co-infection and facilitate antibiotic stewardship efforts.

Source: Oxford Academic

Date: May 2021

2 – Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery

• Prophylactic administration of tranexamic acid has been associated with reduced postpartum blood loss after cesarean delivery in several small trials, but evidence of its benefit in this clinical context remains inconclusive.
• Among women who underwent cesarean delivery and received prophylactic uterotonic agents, tranexamic acid treatment resulted in a significantly lower incidence of calculated estimated blood loss greater than 1000 ml or red-cell transfusion by day 2 than placebo, but it did not result in a lower incidence of hemorrhage-related secondary clinical outcomes.

Source: NEJM

3 – Prophylaxis against covid-19: living systematic review and network meta-analysis

• This study aims to determine and compare the effects of drug prophylaxis on SARS-CoV-2 infection and covid-19.
• Hydroxychloroquine prophylaxis has trivial to no effect on hospital admission and mortality, probably increases adverse effects, and probably does not reduce the risk of SARS-CoV-2 infection.
• Because of serious risk of bias and very serious imprecision, it is highly uncertain whether ivermectin combined with iota-carrageenan and ivermectin alone reduce the risk of SARS-CoV-2 infection

Source: The BMJ

4- Comparative Analysis of Antibodies to SARS-CoV-2 between Asymptomatic and Convalescent Patients

• The SARS-CoV-2 viral pandemic has induced a global health crisis, which requires more in-depth investigation into immunological responses to develop effective treatments and vaccines.
• To understand protective immunity against COVID-19, they screened over 60,000 asymptomatic individuals for IgG antibody positivity against the viral spike protein, and approximately three percent were positive.
• This study shows that healthy individuals can mount robust immune responses against SARS-CoV-2 without symptoms.

Source: ScienceDirect

5 – Cost-effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non–Small Cell Lung Cancer

• Treatment with nivolumab-ipilimumab combination therapy was found to improve overall survival compared with chemotherapy among patients with advanced non–small cell lung cancer
• This study aims to assess whether nivolumab-ipilimumab combination therapy is a cost-effective first-line treatment for patients with advanced NSCLC.
• In this study, first-line treatment with nivolumab-ipilimumab combination therapy was not found to be cost-effective at current prices despite clinical trial data indicating that this regimen increases overall survival among patients with advanced NSCLC.

Source: JAMA Network

6 – Cefazolin versus ceftriaxone as definitive treatment for Klebsiella pneumoniae bacteraemia: a retrospective multicentre study in Singapore

• Ceftriaxone is the preferred treatment for bacteraemia caused by non-MDR (antibiotic-susceptible) Klebsiella pneumoniae. Excessive and widespread ceftriaxone use creates selection pressure for ESBLs.
• In this study, they investigated the outcomes in K. pneumoniae bacteraemia patients treated with IV cefazolin versus IV ceftriaxone as definitive therapy.
• Cefazolin may be a ceftriaxone-sparing alternative treatment for antibiotic-susceptible K. pneumoniae bacteraemia.
• This observation may provide sufficient clinical equipoise for a randomized controlled trial.

Source: Oxford Academic

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