geoffrey modest medical blogs

  A recent article found that the combination of lopinavir with an azole antifungal (itraconazole) may effectively treat multidrug-resistant Candida  species, including C. auris, which has recently come to light as a huge potential problem (see  candida auris lopinavir plus azole works  antimicagentchemo2020  in dropbox, or  DOI:  10.1128/AAC.00684-20 )     Details:   -- this is basically a laboratory study, so I will not go into lots of detail   -- they assessed fluconazole chemosensitization    by 1,547 FDA approved drugs and clinical molecules against azole-resistant  C. aureus     Results:   --lopinavir exhibited potent synergistic interactions with azole drugs, especially with itraconazole but also with fluconazole and  voriconazole   (lopinavir's combination with itraconazole  worked on all C. auris clades, fluconazole only on clade 1, and  voriconazole worked only on clades 1 ...

  A new study found that adding ribavirin plus interferon beta-1b to lopinavir/ritonavir   over just taking lopinavir/ritonavir alone  significantly decreased SARS-CoV-2 viral loads and hospital stays  in patients with early/mild Covid-19 ( see  covid early triple therapy helps lancet2020  in dropbox, or doi.org/10.1016/S0140-6736(20)31042-4)   Details: --127 patients in Hong Kong were randomized to a 14-day combo of lopinavir 400mg/ritonavir 100mg bid    (41 patients) vs that plus ribavirin 400mg bid and 3 doses of 8 million international units of interferon beta-1b (86 patients)      --the interferon beta-1b was only used if patients were within 7 days of symptom onset, for fear of its proinflammatory effects --all patients had to have NEWS2 score of at least 1 (see below) and symptom duration of <14 days --median age 54, 54% male --40% had underlying diseases: hypertension 32%, hyperlipidemia 27%, diabetes 15%, ...

A open-label randomized controlled trial in Wuhan, China showed no significant benefit for lopinavir/ritonavir in hospitalized patients with severe COVID-19 infection ( see  covid lopinavir not help nejm2020 in dropbox, or DOI: 10.1056/NEJMoa2001282 ) Details: --199 patients with laboratory confirmed SARS-CoV-2 infection and documented pneumonia, an oxygen saturation of <94% on room air or a ratio of the partial pressure of oxygen/fraction of inspired oxygen of <300 mmHg, randomized to lopinavir/ritonavir 400mg/100mg twice daily for 14 days vs standard care -- mean age 58, male 60%, fever 92%, respiratory rate>24 in 19%, white count normal 70%/low 10%/high 20%, lymphocytosis 37% -- diabetes 12%, cerebrovascular disease 7%, cancer 3% -- not requiring oxygen supplement 14%/requiring it 70%/requiring high flow or noninvasive mechanical ventilation 16%, <12 days from symptom onset 45%, mean viral load 10,000 per mL, days from illness to randomizatio...