The 2014 Hit Parade: Infectious Disease Stories of the Year

John Bartlett's Annual Review

John G. Bartlett, MD

Disclosures

December 09, 2014

In This Article

New Tests, Vaccines, and Antibiotics

Molecular Diagnostics

The microbiology laboratory has traditionally used culture-based systems with specimens plated on seaweed, as defined by Louis Pasteur in 1850.[13] Recent developments in molecular diagnostics will potentially transform the traditional microbiology lab to look far more like a chemistry lab. The good news is that molecular technology is extremely sensitive, very specific, and fast. The bad news is that it obviously detects any contaminants, does not usually determine sensitivities, and is expensive.

These concerns are likely to be obviated by new methods to detect molecular markers of resistance and the use of semi-quantitative methods to facilitate interpretation (bacterial infections, except group A Streptococcus, nearly always show > 100,000 microbes/mL at the infected site), and the price will go way down with time. At present, molecular microtests are coming fast, but uptake seems slow except for a few, such as polymerase chain reaction for C difficile detection and GeneXpert® (Cepheid; Sunnyvale, California) for tuberculosis.

Vaccines

The hot new vaccine is Prevnar 13® for adults aged > 65 years, according to the 2014 recommendations of CDC's Advisory Committee on Immunization Practices.[14] This decision was based on results of the CAPiTA trial[15] in The Netherlands with 84,496 adults age > 65 years, showing a 45% reduction in pneumococcal pneumonia (P = .007). Other developments in vaccines include the FDA's recent approval of the Neisseria meningitidis type B vaccine. This is of special contemporary interest as a result of recent outbreaks with this strain in colleges and in men who have sex with men in New York City.

The influenza vaccine field is still struggling to create a better vaccine, but recent developments include:

The live virus vaccine (recommended for children aged 2-8 years);

The double-dose product Fluzone® (recommended for adults aged > 65 years);

The recombinant (RIV3) vaccine (recommended for those with an IgE-mediated egg allergy); and

A needleless vaccine, Afluria® (for people with a morbid fear of injections).[16]

The currently recommended flu vaccines are for strain H1N1, which is the same strain that we have used since 2010. The 2014-2015 vaccine is still recommended despite previous vaccination owing to concern about waning immunity.

New Antibiotics

The pipeline for new antibiotics is slow but not dry. Three new anti–methicillin-resistant Staphylococcus aureus drugs were recently FDA approved[17]:

Tedizolid (Sivextro™) is for oral use. Activity is similar to that of linezolid, but it has potential advantages because it is given once daily, is cheaper, and possibly has fewer adverse effects.

Dalbavancin (Dalvance™) is for intravenous use, with a half-life of 6 days! Recommended dosing is 1000 mg given intravenously or intramuscularly, followed by another 500-mg dose on day 8.

Oritavancin (Orbactiv™) is given as a single 1200-mg intravenous dose over 3 hours; it has sustained activity for weeks.

The advantage of the latter two drugs is the ability to administer parenteral therapy with long-lasting activity, permitting early hospital discharge or possibly avoiding hospitalization completely; they are priced on the basis of hospital costs avoided (about $1500 per dose for dalbavancin and about $4000 for oritavancin).

It is great to see new antibiotics being approved, and each of these agents has advantages over currently available agents, but an ongoing concern is the lag in drugs for resistant gram-negative bacilli.

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