Folliculitis Treatment, Causes, Symptoms, Risk Factors and More

Novel Oral Antibiotic Effective Against Uncomplicated UTIs

Gepotidacin -- a first-in-class oral antibiotic -- appeared effective and safe for the treatment of uncomplicated urinary tract infections (UTIs) in a pair of large, phase III non-inferiority studies.

In the two trials -- EAGLE-2 and EAGLE-3 -- the therapy was shown to be noninferior to nitrofurantoin, an antibiotic commonly used as a first-line therapy for patients with uncomplicated UTIs, reported Florian Wagenlehner, MD, of the Justus Liebig University in Giessen, Germany, and colleagues.

In EAGLE-2, 50.6% of the 320 patients assigned to gepotidacin and 47.0% of the 287 patients assigned to nitrofurantoin had therapeutic success (adjusted difference 4.3%, 95% CI -3.6 to 12.1).

In EAGLE-3, 58.5% of the 277 patients assigned to gepotidacin and 43.6% of the 264 patients assigned to nitrofurantoin had therapeutic success (adjusted difference 14.6%, 95% CI 6.4-22.8), thus meeting superiority as well as noninferiority criteria.

Both studies were stopped early for efficacy.

"Gepotidacin, therefore, represents a potential new treatment option for uncomplicated urinary tract infections, and addresses an important unmet need for oral agents that are effective against uropathogens resistant to currently available treatments," the researchers wrote in The Lancet.

Drug developer GSK plans to begin regulatory filings for gepotidacin in the second half of this year, according to a company spokesperson, who added that the therapy "could be the first in a new class of oral antibiotics for uncomplicated UTI in over 20 years," if approved.

In prespecified subgroup analyses, gepotidacin demonstrated efficacy against Escherichia coli -- the most likely culprit in uncomplicated UTIs.

Across the two trials, overall therapeutic success for E. Coli was 51.1% and 59.8% for gepotidacin and 45.9% and 44.0% for nitrofurantoin.

Gepotidacin also demonstrated efficacy against drug-resistant phenotypes of E. Coli as well as less common uropathogens.

"Because of the increasing worldwide prevalence of antimicrobial resistance, these findings suggest that gepotidacin has potential as a new oral treatment for uncomplicated urinary tract infections caused by common uropathogens resistant to current therapies," the authors observed.

In a commentary accompanying the paper, Ased Ali, MBChB, PhD, of the Mid Yorkshire Teaching NHS Trust in Wakefield, England, and Catriona Anderson, MBChB, of the NHS Primary Care Center in Stoke on Trent, England, said that the prospect of gepotidacin's superiority compared with nitrofurantoin "will probably create much anticipation among clinicians regularly treating patients with uncomplicated urinary tract infections."

"Furthermore," they added, "the shown efficacy against the less common but serious uropathogens such as Proteus mirabilis, which is intrinsically resistant to nitrofurantoin, and Enterococcus faecalis, which is susceptible to a few oral antibiotics, will further enhance the prospects for gepotidacin."

In EAGLE-2 and EAGLE-3, eligible patients were assigned female at birth, non-pregnant, 12 years or older, and weighed 40 kg or more. Eligibility also required two or more symptoms of dysuria, frequency, urgency, or lower abdominal pain along with evidence of urinary nitrite, pyuria, or both.

The mean age of the intent-to-treat population was 52 years in EAGLE-2 and 50 years in EAGLE-3. About 40% of patients had a history of recurrent uncomplicated urinary tract infections.

Therapeutic success was defined as combined clinical success (complete symptom resolution) and microbiological success (reduction of qualifying uropathogens to <103 colony-forming units/mL) without other systemic antimicrobial use.

According to Wagenlehner and colleagues, the studies were among the first to implement "the stringent inclusion criteria and primary endpoint of combined clinical and microbiological response recommended by the FDA and EMA [European Medicines Agency]."

In the safety population, the percentage of patients having at least one treatment-emergent adverse event in the gepotidacin group was 35% in both trials. In the nitrofurantoin groups, 22-25% of patients had at least one treatment-emergent adverse event.

The most common adverse event was diarrhea with gepotidacin and nausea with nitrofurantoin.

In their editorial, Ali and Anderson suggested that when gepotidacin finally enters regular clinical use and as real-world evidence emerges, "signs of emerging resistance should be closely monitored and health economic analysis should be developed to temper clinical excitement regarding a new antibiotic and to better understand the best use of this new agent in clinical practice."

Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.

Disclosures

The studies were funded by GSK.

Wagenlehner disclosed being an advisor to GSK and a principal investigator in a GSK-sponsored study and speaking on behalf of BARRICADE, a research group funded by the German Research Foundation. Several co-authors are employees and shareholders of GSK.

Ali has acted as a consultant for the U.K. National Institute for Health and Care Excellence with regard to UTI study design and is the medical director of Convatec, a medical device company that produces devices for incontinence. Anderson has received speaker fees from Viatris to give a talk on chronic UTIs.

Primary Source

The Lancet

Source Reference: Wagenlehner F, et al "Oral gepotidacin versus nitrofurantoin in patients with uncomplicated urinary tract infection (EAGLE-2 and EAGLE-3): two randomised, controlled, double-blind, double-dummy, phase 3, non-inferiority trials" Lancet 2024; DOI: 10.1016/S0140-6736(23)02196-7.

Secondary Source

The Lancet

Source Reference: Ali ASM, Anderson CS "Gepotidacin, a new first-in-class antibiotic for treating uncomplicated urinary tract infection" Lancet 2024; DOI:10.1016/S0140-6736(23)02697-1.

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Is It Pink Eye Or Allergies?

Conjunctivitis (pink eye) and allergic conjunctivitis (eye allergies) are different health concerns that cause similar symptoms, such as eye discharge, itching, redness, and watery eyes. Pink eye and eye allergies are both types of conjunctivitis, or inflammation of the conjunctiva. The conjunctiva is the outer membrane layer that covers your eyeball and the inside of your eyelids.

How do you know if it's pink eye or allergies? The difference lies in what's causing that inflammation. Pink eye is an infection caused by bacteria or a virus. In contrast, allergens like pet dander and pollen trigger eye allergies.

Pink eye and eye allergies are not the only causes of eyes that look pink or red, but they are among the most common. Read on to learn how to tell the difference between pink eye and eye allergies.

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The common name for bacterial and viral conjunctivitis is pink eye. Bacterial pink eye is less common than viral pink eye and has symptoms that differ from viral pink eye and eye allergies. Symptoms Bacterial pink eye symptoms typically include: Crusty yellow or green discharge from your eyes Eyelids that are stuck together Redness (often is just one eye, though it can appear in both) Viral pink eye often occurs with the common cold. You may have redness and eye discharge that's more watery than crusty. Causes Staphylococcus and streptococcus bacteria are some of the most common causes of bacterial pink eye. For example, the same bacteria that cause strep throat might lead to bacterial pink eye. Those bacteria can spread from hand to eye or through respiratory droplets. You can get viral pink eye the same way you get a cold, such as by touching infected surfaces and then touching your eyes. The same viruses that cause common colds can result in this infection. Diagnosis A healthcare provider can diagnose pink eye by looking at your eyes and swabbing the conjunctiva. They will send the swab sample to a laboratory for analysis. Some analyses can determine what type of bacteria or virus is causing your symptoms. Treatment  A healthcare provider will likely prescribe antibiotic eye drops or ointments to treat bacterial pink eye. Antibiotics will not help treat viral pink eye, but artificial tears, cool compresses, and mild eye steroid drops can ease discomfort. Viral pink eye usually goes away on its own within three weeks, but it can sometimes turn into bacterial superinfection. For example, you can introduce bacteria into your eyes if you keep rubbing them. Bacterial and viral pink eye are contagious. Be diligent about washing your hands if you have it or are around someone who does. You might develop eye allergies if you are allergic to dust mites, mold, pet dander, pollen, or other allergens. The conjunctiva becomes inflamed and swollen when those substances come into contact with your eyes. Symptoms Eye allergies typically cause symptoms like: A gritty feeling in your eyes Burning Itching Light sensitivity Redness Swelling of the eyelids Watery eyes Causes Allergens, including dust mites, mold, pet dander, and pollen, cause eye allergies. Your body overreacts when one of those harmless substances comes into contact with your eye and releases histamine. This chemical causes the blood vessels in the conjunctiva to swell, resulting in itchy, red, and watery eyes. Diagnosis A healthcare provider may look at your eyes for signs of allergic conjunctivitis: "If we look under the eyelid, we may find bumps indicative of allergies, called papillae," Jules Asher Winokur, MD, an ophthalmologist at Northwell Health, told Health. You might require an allergy test to check for what's causing your symptoms. For example, a healthcare provider might advise a skin test if your symptoms do not go away with at-home treatments. They might inject allergens into your skin or tape them onto your skin for 48 hours and then check for a reaction. Treatment  Allergic conjunctivitis is not contagious, and you can usually treat symptoms at home. One of the best ways to reduce symptoms is to stay away from whatever allergens are bothering you. Other ways to treat eye allergies include: Apply a cool compress to your eyes to reduce discomfort. Avoid smoke and secondhand smoke. Take antihistamines, available over the counter as pills, capsules, liquids, and eye drops. Use decongestant, lubricating, or mild eye steroid drops. Make sure you take out contact lenses at the first sign of irritation and redness. Wearing contact lenses increases your risk of infection. Pink eye and eye allergies are both types of conjunctivitis that cause similar symptoms. The difference primarily lies in what's causing those symptoms. A healthcare provider might use different methods to diagnose and treat pink eye and eye allergies, depending on the cause. Here's a look at the similarities and differences between pink eye and eye allergies:   Pink eye Eye allergies Symptoms  Eye discharge (i.E., crusty or watery) and redness Burning, itching, redness, swelling, and watery eyes  Causes  Viruses or bacteria  Allergens (e.G., dust mites, mold, pet dander, and pollen)  Diagnosis Examining the eyes and swabbing the conjunctiva for testing Examining the eyes and performing an allergy test in severe cases Treatment Antibiotics (i.E., eye drops or ointments), artificial tears, cool compresses, and mild eye steroid drops Antihistamines, cool compresses, and eye drops Eye allergies are not contagious, so you cannot spread allergic conjunctivitis. In contrast, the viruses and bacteria that cause pink eye are highly contagious. You can take steps to prevent spreading pink eye, including: Avoid touching your eyes. Change and clean your contact lenses as instructed. Do not share eye makeup, handkerchiefs, and towels. Regularly change your pillowcases. Replace eye makeup if it expires. Wash your hands. Pink eye and eye allergies are types of conjunctivitis that often cause eye discharge, itching, redness, and watery eyes. Viruses and bacteria cause pink eye, while allergens result in eye allergies. A healthcare provider might examine your eyes to diagnose either eye concern. They might recommend antibiotics (if you have a bacterial infection), cool compresses, or eye drops. Eye allergies are not contagious, but you can prevent spreading pink eye by not sharing personal items and washing your hands regularly. Thanks for your feedback! 10 Sources Health.Com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. MedlinePlus. Allergic conjunctivitis. MedlinePlus. Pink eye. Alfonso SA, Fawley JD, Alexa Lu X. Conjunctivitis. Prim Care. 2015;42(3):325-345. Doi:10.1016/j.Pop.2015.05.001 American Academy of Ophthalmology. Conjunctivitis: What is pink eye? Azari AA, Arabi A. Conjunctivitis: A systematic review. J Ophthalmic Vis Res. 2020;15(3):372-395. Doi:10.18502/jovr.V15i3.7456 Pippin MM, Le JK. Bacterial conjunctivitis. In: StatPearls. StatPearls Publishing; 2023. MedlinePlus. Conjunctivitis or pink eye. Solano D, Fu L, Czyz CN. Viral conjunctivitis. In: StatPearls. StatPearls Publishing; 2023. MedlinePlus. Allergy testing - skin. Baab S, Le PH, Kinzer EE. Allergic conjunctivitis. In: StatPearls. StatPearls Publishing; 2023.

AAD Issues Updated Clinical Practice Guidelines For Acne Management

The American Academy of Dermatology (ADD) has issued updated guidelines on the management of acne vulgaris.

The new guidelines include 18 evidence-based recommendations and 5 good practice statements resulting from a systematic review conducted by an expert panel. For patients over the age of 9 years, strong recommendations were made for the use of topical therapies such as benzoyl peroxide and retinoids (eg, adapalene, tretinoin, tazarotene, trifarotene), either as monotherapy or combined. Topical antibiotics were also strongly recommended though not as monotherapy. A strong recommendation was made for fixed-dose topical combination therapies as these agents could help with adherence, and in some cases, may be less expensive than prescribing the individual components separately.

With regard to systemic antibiotics, the panel strongly recommended the use of doxycycline and conditionally recommended minocycline and sarecycline based on the available evidence. In general, oral antibiotics should be used concomitantly with benzoyl peroxide and other topical therapies. Limiting the use of systemic antibiotics to the shortest possible duration helps to reduce the development of antibiotic resistance and antibiotic associated complications.

Additional good clinical practices highlighted in the guidelines include the following:

Intralesional corticosteroid injections may be used as an adjuvant therapy in patients with larger acne papules or nodules.

Consider use in patients at risk for acne scarring and for those who need rapid inflammation and pain improvement.

Risk of local adverse events may be minimized by using a lower concentration and volume of corticosteroid. 

Isotretinoin is recommended for patients with severe acne or for those who have failed other oral and topical therapies.

Patients with psychosocial burden or acne scarring should be considered candidates for isotretinoin.

Monitoring of liver function tests and lipids should be considered in these patients, though complete blood count is not necessary in healthy individuals.

Pregnancy prevention is mandatory for patients of childbearing age.

Based on individual patient factors, conditional recommendations were also made for the use of topical clascoterone, topical salicylic acid, topical azelaic acid, and hormone therapies (eg, combined oral contraceptives, spironolactone).

The full report, which also includes information on physical modalities (eg, acne lesion extraction, chemical peels, laser and light-based devices, microneedle radiofrequency devices, photodynamic therapy), complementary and alternative therapies (eg, vitamins, botanical and plant-derived agents) and diet, is available here.

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