ANTIBIOTIC RESISTANCE
Research focuses on revitalizing vancomycin
Although vancomycin is still widely used to treat serious infections, bacteria have become increasingly resistant to it. Looking for new approaches to treating antibiotic-resistant bacteria, Australian researchers are revitalizing vancomycin. "We did this by modifying vancomycin's membrane-binding properties to selectively bind to bacterial membranes rather than those of human cells, creating a series of supercharged vancomycin derivatives called vancapticins," explains Dr. Mark Blaskovich. This new, improved vancomycin has the potential to treat methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci, according to Dr. Blaskovich. Because new drug development is costly and time-consuming, he and his colleagues believe that reengineering old antibiotics may be a better way to create drugs that can combat antibiotic resistance. "Drug development is normally focused on improving binding to a biological target, and rarely focuses on assessing membrane-binding properties," says Dr. Blaskovich. "This approach worked with the vancapticins, and the question now is whether it can be used to revitalize other antibiotics that have lost effectiveness against resistant bacteria."
Source: Supercharged antibiotics could turn the tide against superbugs. University of Queensland. News release. January 4, 2018.
POSTOP PAIN
Prescribing guidelines reduce opioid overuse
Overprescribing opioid analgesics is implicated in the current opioid epidemic, as is diversion of unused prescription opioids stored in households. One hospital sought to reduce these risks by developing evidence-based prescribing guidelines based on surveys of 170 patients who'd undergone elective laparoscopic cholecystectomy. Within 12 months of the procedure, they were queried about the number of opioid pills they used during their recovery, their use of nonopioid analgesics, and their level of pain during the first week after surgery. Their responses formed the basis for the new guidelines.
To determine how effective the guidelines were, researchers then tracked 200 new patients undergoing the same procedure. They found that under the guidelines, patients were prescribed substantially lower dosages-75 mg on average compared with 250 mg previously. Yet patients didn't report more pain and were no more likely to ask for prescription refills. In the year since the new guidelines took effect, the hospital reduced prescriptions by an estimated 15,000 pills. The researchers concluded that physicians typically prescribe more opioids than patients need and can safely reduce the amount while still managing pain effectively.
The researchers suggest that healthcare providers and nurses use some simple talking points when educating patients about postoperative pain management:
* Encourage patients to use lower-strength, nonopioid analgesics first.
* Warn them about addiction risks.
* Inform them that they'll still have some pain, even with the prescribed dose of an opioid.
* Tell them how to safely store opioids to prevent theft or diversion and how to dispose of unused pills.
Sources: Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg. [e-pub December 6, 2017]. Luthra S. Stopping opioid addiction at one key source: the hospital. Kaiser Health News. December 6, 2017.
HIV INFECTION
Ingenious slow-release capsule under investigation
Treatment for HIV infection requires patients to take multiple drugs. Because of the complexity of treatment, up to 30% of patients fail to adhere to prescribed therapy. To meet this challenge, researchers are developing a slow-release capsule that stays in the stomach for a week while releasing up to 6 antiretroviral medications. When swallowed, the capsule unfolds into a star-shaped structure that prevents it from passing through the pylorus into the duodenum but allows food to leave the stomach normally. Each of its six arms is designed to hold a medication, which diffuses out slowly over time.
In preclinical trials, researchers studied delivery of the antiretroviral medications dolutegravir, rilpivirine, and cabotegravir indicated for HIV prevention in noninfected patients and for viral suppression in HIV-infected patients. An analysis of the data indicated that the slow-release system could not only reduce therapeutic failures, but also prevent thousands of new HIV infections: Conversion from daily to weekly drug administration could improve the efficacy of preexposure HIV prevention strategies by up to 20%. Researchers are now gearing up to initiate clinical trials.
Sources: Kirtane AR, Abouzid O, Minahan D, et al. Development of an oral once-weekly drug delivery system for HIV antiretroviral therapy. Nat Commun. 2018;9(1):2. Slow-release pill developed to deliver HIV therapeutics. Brigham and Women's Hospital. News release. January 9, 2018.
PEDIATRICS
Certain cold remedies will be off-limits to kids
Because the risks outweigh the benefits, the FDA is requiring pharmaceutical companies to make safety changes to labeling for prescription opioid cough and cold medications containing codeine or hydrocodone. After the changes are made, these products will be indicated only for adults age 18 and older, not children of any age. The new labeling will also contain updated warnings about the risks of misuse, abuse, addiction, overdose, and death, associated with exposure to codeine or hydrocodone.
The FDA encourages clinicians to talk with parents about nonopioid treatment options for cold symptoms. Also teach them to read labels on over-the-counter cough and cold products because nonprescription remedies sold in some states may contain codeine.
Source: FDA acts to protect kids from serious risks of opioid ingredients contained in some prescription cough and cold products by revising labeling to limit pediatric use. Food & Drug Administration. News release. January 11, 2018.
GIAPREZA APPROVED
New treatment for severe hypotension in critically ill
The FDA has approved Giapreza (angiotensin II) injection for I.V. infusion. A vasoconstrictor, Giapreza is indicated to treat hypotension in adults with refractory septic or other distributive shock. FDA approval was based on a Priority Review, which the FDA may grant after determining that a drug would significantly improve the safety or effectiveness of preventing, diagnosing, or treating a serious condition.
In a clinical trial of 321 patients with shock and critically low BP, significantly more patients responded to treatment with Giapreza compared with those treated with placebo. Most patients (97%) were also being treated with other vasopressors, such as norepinephrine, vasopressin, phenylephrine, epinephrine, or dopamine.
Patients treated with Giapreza are at risk for venous and arterial thrombotic and thromboembolic events and should receive concurrent venous thromboembolism prophylaxis.
Sources: FDA approves drug to treat dangerously low blood pressure. Food & Drug Administration. News release. December 21, 2017. Giapreza (angiotensin II) Injection, for intravenous infusion. Prescribing information. http://lajollapharmaceutical.com/wp-content/uploads/2017/12/Final-Approved-Label.