Concurrent Antibiotic Therapy in Disseminated Strongyloidiasis

Kow, Chia Siang; Hasan, Syed Shahzad

doi:10.4269/ajtmh.20-1059a

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…In addition, clinicians should be reminded that the use of systemic corticosteroids is not without harm, where it can be associated with hyperglycemia and an increased risk of secondary infections (including bacterial, fungal, and Strongyloides infections), and potential mortality benefits could be negated. 9 , 10 In patients with mild-to-moderate illness, perhaps the use of inhaled budesonide can be encouraged based on the findings from the PRINCIPLE trial 11 and the STOIC trial 12 ( Table 4 ), which demonstrated significantly faster recovery than to usual care among outpatients with COVID-19. Nevertheless, 1600 μg per day of inhaled budesonide is recommended (used in the PRINCIPLE and STOIC trials), but patients in our cohort received up to 2400 μg per day.…”

Section: Discussionmentioning

confidence: 99%

Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan

Mustafa

Kow

Salman

et al. 2022

Exploratory Research in Clinical and Social Pharmacy

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Purpose In Pakistan, a wide range of repurposed drugs are recommended to manage hospitalized patients with COVID-19. Therefore, the current study was conducted to evaluate the pattern of utilization of repurposed drugs and other potential therapeutic options among hospitalized patients with COVID-19 in Pakistan. Methods This retrospective, multicenter, descriptive study enrolled consecutive hospitalized patients with COVID-19 who were admitted between March 1, 2021, and April 30, 2021, from three District Headquarter Hospitals in the Punjab province of Pakistan. We describe patient and clinical characteristics and medications, stratified by COVID-19 severity during hospitalization: mild, moderate, and severe. In addition, an analytical study of drug utilization was conducted. Findings A total of 444 hospitalized patients with COVID-19 were included. Remdesvir, corticosteroids, antibiotics, and antithrombotics were administered to 45.0%, 93.9%, 84.9%, and 60.1% of patients, respectively. Specifically, dexamethasone was the most commonly used corticosteroid among the included patients ( n = 405; 91.2%), irrespective of their clinical severity. Only 60.1% of patients hospitalized with COVID-19 in our cohort received antithrombotic therapy, and the prevalence of use was especially low (27.8%) in patients with mild illness. Of 444 patients records screened, 399 (89.9%) patients had been discharged, and 45 (10.1%) died. Implications We provided an important glimpse into the utilization patterns of several medications of interest for the treatment of COVID-19, which had not been entirely evidence-based, especially concerning systemic corticosteroids and antibiotics.

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Section: Discussionmentioning

confidence: 99%

Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan

Mustafa

Kow

Salman

et al. 2022

Exploratory Research in Clinical and Social Pharmacy

Self Cite

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“…The World Gastroenterology Organisation recommends, especially in critically ill patients, to continue antiparasitic therapy for two weeks after negativization of previously positive samples (stool, urine, respiratory samples) (Farthing et al , 2018). Although controlled trials are lacking, the clinical experience articulates against early discontinuation of antibiotic therapy after introducing antiparasitic treatment (Kow & Hasan, 2020; Lier et al , 2020a, b).…”

Section: Resultsmentioning

confidence: 99%

Strongyloidiasis – diagnostic and therapeutic dilemmas in hyperinfection patients: a case series

et al. 2022

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The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase its significance. The aim of this retrospective descriptive study was to explore disease patterns and discuss clinical dilemmas in patients with S. stercoralis hyperinfection treated at the University Hospital for Infectious Diseases ‘Dr. Fran Mihaljević’ in Zagreb, Croatia, between 2010 and 2021. Five out of 22 (22.7%) immunosuppressed patients treated due to strongyloidiasis developed hyperinfection. All patients were male, median 64 years; four were immunosuppressed by corticosteroids (although ileum resection could have been the trigger in one) and one by rituximab. The diagnosis was established after a median of 1.5 months of symptom duration, accidentally in all patients, by visualizing the parasite in the gastric/duodenal mucosa in four cases, and bronchial aspirate in one. All patients were cachectic, four out of five had severe hypoalbuminemia and all suffered secondary bacterial/fungal infection. Despite combined antibiotic, antifungal and antihelmintic therapy, three out of five of the patients died, after failing to clear living parasites from stool samples. We can conclude that significant delays in diagnosis and lack of clinical suspicion were observed among our patients with the most severe clinical presentations of strongyloidiasis. Although being beyond diagnostic recommendations for strongyloidiasis, an early upper gastrointestinal endoscopy with mucosal sample analysis could expedite diagnosis in severe, immunosuppressed patients. The persistence of viable parasites in the stool despite antihelmintic therapy should be further investigated.

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“…In our patient’s case, antibiotic therapy had been discontinued on hospital day 19 following initiation of ivermectin therapy for disseminated strongyloides infection. 1 The patient had received broad-spectrum antibiotic therapy since day 12, and his blood cultures, which previously grew Gram-positive and Gram-negative bacteria, had cleared by day 14. 2 The decision to discontinue antibiotic therapy on this date was based on clinical improvement leading to extubation, a decrease in white blood cell count, a procalcitonin level in the normal range, and the diagnosis of a nonbacterial infection.…”

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confidence: 99%