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Prolonged antibiotics infusion

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https://www.readbyqxmd.com/read/30012756/murepavadin-a-novel-antipseudomonal-antibiotic-pharmacokinetics-tolerability-and-safety-in-subjects-with-mild-moderate-and-severe-renal-function-impairment
#1
Glenn E Dale, Atef Halabi, M Petersen-Sylla, Achim Wach, Christian Zwingelstein
This open-label, non-randomized, single-dose, Phase I study evaluated the pharmacokinetics and safety of murepavadin, a novel peptide antibiotic for the treatment of serious Pseudomonas aeruginosa infections. The study was conducted in 32 subjects of either sex in 4 groups (in up to 8 per group) with mild (group A), moderate (group B), severe (group C) renal function impairment or with normal renal function (group D). The degree of renal impairment of the subjects was classified at screening according to the estimated creatinine clearance (CLCr ) according to the Cockcroft-Gault equation...
July 16, 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/30005302/emergence-of-antimicrobial-resistance-to-piperacillin-tazobactam-or-meropenem-in-the-icu-intermittent-versus-continuous-infusion-a-retrospective-cohort-study
#2
Sofie A M Dhaese, Magalie De Kezel, Maxime Callant, Jerina Boelens, Liesbet De Bus, Pieter Depuydt, Jan J De Waele
BACKGROUND: Prolonged infusion of beta-lactam antibiotics is broadly recognized as a strategy to optimize antibiotic therapy by achieving a higher percentage of time that concentrations remain above the minimal inhibitory concentration (% fT>MIC ), i.e. the pharmacokinetic/pharmacodynamic (PK/PD) index. However, %fT>MIC may not be the PK/PD index of choice for inhibition of resistance emergence and it is therefore unsure what impact prolonged infusion of beta-lactam antibiotics may have on the emergence of resistance...
July 4, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29998951/-preclinical-and-clinical-properties-of-bezlotoxumab-zinplava-%C3%A2-25-mg-ml-concentrate-for-solution-for-infusion-novel-therapeutic-agent-for-clostridium-difficile-infection
#3
Kiyoshi Kinoshita
Clostridium difficile (C. difficile), an enterobacteria, flourishes and produces potent toxins, toxin A (TcdA) and toxin B (TcdB), after the disruption of the normal colonic microbiota by antibiotic therapy. C. difficile infection (CDI) may induce life-threatening complications such as fulminant colitis through damage of the intestinal wall by the toxins, therefore the prevention of CDI recurrence is the most important in CDI treatment. Bezlotoxumab is a human monoclonal antibody that neutralizes the activity of TcdB directly...
2018: Nihon Yakurigaku Zasshi. Folia Pharmacologica Japonica
https://www.readbyqxmd.com/read/29777282/ambulatory-intravenous-inotropic-support-and-or-levosimendan-in-pediatric-and-congenital-heart-failure-safety-survival-improvement-or-transplantation
#4
Sotiria C Apostolopoulou, George A Vagenakis, Alexandros Tsoutsinos, Felicia Kakava, Spyridon Rammos
End-stage heart failure (HF) frequently needs continuous inotropic support in hospital and has high morbidity and mortality in absence of heart transplantation. This study reports outcome, efficacy, and safety of continuous ambulatory inotropes (AI) and/or periodic levosimendan (LS) infusions in pediatric HF patients. The study included 27 patients, median age 9.4 (0.1-26.1) years, with severe HF (6 myocarditis, 13 dilated cardiomyopathy, 2 restrictive cardiomyopathy, 6 repaired congenital heart disease). Dobutamine and milrinone AI were administered in 21 patients through a permanent central catheter for median duration 1...
May 18, 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29766208/-adequate-anti-infective-treatment-importance-of-individual-dosing-and-application
#5
A Brinkmann, A C Röhr, A Köberer, T Fuchs, W A Krüger, C König, D Richter, M A Weigand, O R Frey
Sepsis-induced changes in pharmacokinetic parameters are a well-known problem in intensive care medicine. Dosing of antibiotics in this setting is therefore challenging. Alterations to the substance-specific kinetics of anti-infective substances have an effect on the distribution and excretion processes in the body. Increased clearance and an increased distribution volume (Vd ) and particularly compromized organ function with reduced antibiotic elimination are often encountered in patients with sepsis. Renal replacement treatment, which is frequently used in intensive care medicine, represents a substantial intervention in this system...
June 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29746711/a-monte-carlo-simulation-approach-for-beta-lactam-dosing-in-critically-ill-patients-receiving-prolonged-intermittent-renal-replacement-therapy
#6
Soo Min Jang, Katherine N Gharibian, Susan J Lewis, William H Fissell, Ashita J Tolwani, Bruce A Mueller
Cefepime, ceftazidime, and piperacillin/tazobactam are commonly used beta-lactam antibiotics in the critical care setting. For critically ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic data are available to inform clinicians on the dosing of these agents. Monte Carlo simulations (MCS) can be used to guide drug dosing when pharmacokinetic trials are not feasible. For each antibiotic, MCS using previously published pharmacokinetic data derived from critically ill patients was used to evaluate multiple dosing regimens in 4 different prolonged intermittent renal replacement therapy effluent rates and prolonged intermittent renal replacement therapy duration combinations (4 L/h × 10 hours or 5 L/h × 8 hours in hemodialysis and hemofiltration modes)...
May 10, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29534630/antibiotic-use-in-the-intensive-care-unit-optimization-and-de-escalation
#7
Maureen Campion, Gail Scully
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29507062/population-pharmacokinetics-of-piperacillin-in-sepsis-patients-should-alternative-dosing-strategies-be-considered
#8
Maria Goul Andersen, Anders Thorsted, Merete Storgaard, Anders N Kristoffersson, Lena E Friberg, Kristina Öbrink-Hansen
Sufficient antibiotic dosing in septic patients is essential for reducing mortality. Piperacillin-tazobactam is often used for empirical treatment, but due to the pharmacokinetic (PK) variability seen in septic patients, optimal dosing may be a challenge. We determined the PK profile for piperacillin given at 4 g every 8 h in 22 septic patients admitted to a medical ward. Piperacillin concentrations were compared to the clinical breakpoint MIC for Pseudomonas aeruginosa (16 mg/liter), and the following PK/pharmacodynamic (PD) targets were evaluated: the percentage of the dosing interval that the free drug concentration is maintained above the MIC ( fT MIC ) of 50% and 100%...
May 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29390512/venous-thromboembolism-related-to-cytomegalovirus-infection-a-case-report-and-literature-review
#9
REVIEW
Amar H Kelkar, Kavitha S Jacob, Eman B Yousif, John J Farrell
RATIONALE: Herein, we present a case of seemingly unprovoked portal vein thrombosis (PVT) occurring in the context of an acute cytomegalovirus (CMV) infection and prolonged debilitating fatigue. PATIENT CONCERNS: A 46-year-old male airline pilot presented with a 2 week history of abdominal pain, nausea, vomiting, watery diarrhea, and daily recurrent fevers. This was in the context of progressive, debilitating fatigue for 3 months forcing the patient to leave his job...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29383395/bacterial-sepsis-diagnostics-and-calculated-antibiotic-therapy
#10
REVIEW
D C Richter, A Heininger, T Brenner, M Hochreiter, M Bernhard, J Briegel, S Dubler, B Grabein, A Hecker, W A Kruger, K Mayer, M W Pletz, D Storzinger, N Pinder, T Hoppe-Tichy, S Weiterer, S Zimmermann, A Brinkmann, M A Weigand, C Lichtenstern
The mortality of patients with sepsis and septic shock is still unacceptably high. An effective calculated antibiotic treatment within 1 h of recognition of sepsis is an important target of sepsis treatment. Delays lead to an increase in mortality; therefore, structured treatment concepts form a rational foundation, taking relevant diagnostic and treatment steps into consideration. In addition to the assumed infection and individual risks of each patient, local resistance patterns and specific problem pathogens must be taken into account during the selection of anti-infective treatment...
January 30, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29324478/site-of-entry-and-surgical-timing-in-infective-endocarditis
#11
Francesco Bovenzi, Lucia Borelli, Lauro Cortigiani
No abstract text is available yet for this article.
February 2018: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/29317824/selection-of-piperacillin-tazobactam-infusion-mode-guided-by-sofa-score-in-cancer-patients-with-hospital-acquired-pneumonia-a-randomized-controlled-study
#12
Yang Lyu, Yang Yang, Xin Li, Min Peng, Xin He, Peng Zhang, Shangwen Dong, Wanhua Wang, Donghao Wang
Background: This study aimed to select piperacillin/tazobactam (TZP) infusion mode guided by Sequential Organ Failure Assessment (SOFA) score in cancer patients with hospital-acquired pneumonia (HAP) postoperation. Patients and methods: A total of 120 cancer patients with postoperative HAP were divided into two groups: improved administration group (L group) and conventional treatment group (Con group). The Con group received traditional infusion of TZP and the L group received it as prolonged infusion...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29310404/extracorporeal-membrane-oxygenation-combined-with-continuous-renal-replacement-therapy-in-cutaneous-burn-and-inhalation-injury-caused-by-hydrofluoric-acid-and-nitric-acid
#13
Qinhua Pu, Jinxian Qian, Weiyi Tao, Aixiang Yang, Jian Wu, Yaodong Wang
RATIONALE: Hydrofluoric acid (HF) is a highly corrosive agent and can cause corrosive burns. HF can penetrate deeply into tissues through intact skin and the lipid barrier, leading to painful liquefactive necrosis, and inducing hypocalcemia and hypomagnesemia. In this study, we hypothesize that continuous renal replacement therapy (CRRT) may be beneficial in addressing hemodynamic instability in cases of HF poisoning. PATIENT CONCERNS: A 25-year-old man fell into an electroplating pool containing 10% HF and 50% nitric acid...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29290748/therapeutic-drug-monitoring-of-prolonged-infusion-aztreonam-for-multi-drug-resistant-pseudomonas-aeruginosa-a-case-report
#14
Jeffrey J Cies, Richard J LaCoursiere, Wayne S Moore, Arun Chopra
Aztreonam, a broad-spectrum monobactam, is typically reserved for multidrug resistant (MDR) infections. Pharmacokinetic (PK) data to guide dosing in children, however, are limited to healthy volunteers or nonintensive care unit (ICU) patients. Impaired antibiotic delivery into tissue remains a major concern and may explain the high morbidity and mortality associated with MDR infections. Therefore, evaluating the PK changes in pediatric ICU patients is necessary to elucidate the most appropriate antimicrobial regimen...
November 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/29225790/update-on-ventilator-associated-pneumonia
#15
REVIEW
Jean-Francois Timsit, Wafa Esaied, Mathilde Neuville, Lila Bouadma, Bruno Mourvllier
Ventilator-associated pneumonia (VAP) is the most frequent life-threatening nosocomial infection in intensive care units. The diagnostic is difficult because radiological and clinical signs are inaccurate and could be associated with various respiratory diseases. The concept of infection-related ventilator-associated complication has been proposed as a surrogate of VAP to be used as a benchmark indicator of quality of care. Indeed, bundles of prevention measures are effective in decreasing the VAP rate. In case of VAP suspicion, respiratory secretions must be collected for bacteriological secretions before any new antimicrobials...
2017: F1000Research
https://www.readbyqxmd.com/read/29191263/persistent-and-severe-hypoglycemia-associated-with-trimethoprim-sulfamethoxazole-in-a-frail-diabetic-man-on-polypharmacy-a-case-report-and-literature-review
#16
REVIEW
Raffaella Rossio, Sara Arcudi, Flora Peyvandi, Stefania Piconi
OBJECTIVE: Trimethoprim-sulfamethoxazole (co-trimoxazole) is a commonly used broad-spectrum antibiotic, but it can be associated with potentially serious adverse effects, often not recognized by clinicians. This is a relevant problem in elderly patients, who are particularly susceptible to adverse drug reactions. Moreover, multiple medications taken by older people increase the risk for adverse drug reactions and drug-drug interactions. CASE REPORT: We report the case of an 85-year-old man with diabetes mellitus who attended the emergency room with severe hypoglycemia that persisted despite multiple intravenous bolus doses and continuous infusion of glucose...
February 2018: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29116995/prolonged-infusion-piperacillin-tazobactam-decreases-mortality-and-improves-outcomes-in-severely-ill-patients-results-of-a-systematic-review-and-meta-analysis
#17
Nathaniel J Rhodes, Jiajun Liu, J Nicholas O'Donnell, Joel M Dulhunty, Mohd H Abdul-Aziz, Patsy Y Berko, Barbara Nadler, Jeffery Lipman, Jason A Roberts
OBJECTIVE: Piperacillin-tazobactam is a commonly used antibiotic in critically ill patients; however, controversy exists as to whether mortality in serious infections can be decreased through administration by prolonged infusion compared with intermittent infusion. The purpose of this systematic review and meta-analysis was to describe the impact of prolonged infusion piperacillin-tazobactam schemes on clinical endpoints in severely ill patients. DESIGN: We conducted a systematic literature review and meta-analysis searching MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library from inception to April 1, 2017, for studies...
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29102324/prolonged-versus-short-term-intravenous-infusion-of-antipseudomonal-%C3%AE-lactams-for-patients-with-sepsis-a-systematic-review-and-meta-analysis-of-randomised-trials
#18
Konstantinos Z Vardakas, Georgios L Voulgaris, Athanasios Maliaros, George Samonis, Matthew E Falagas
BACKGROUND: The findings of randomised controlled trials (RCT), observational studies, and meta-analyses vary regarding the effectiveness of prolonged β-lactam infusion. We aimed to identify the effectiveness of prolonged versus short-term infusion of antipseudomonal β-lactams in patients with sepsis. METHODS: We did a systematic review and meta-analysis to compare prolonged versus short-term intravenous infusion of antipseudomonal β-lactams in patients with sepsis...
January 2018: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28980026/-bacterial-sepsis-diagnostics-and-calculated-antibiotic-therapy
#19
REVIEW
D C Richter, A Heininger, T Brenner, M Hochreiter, M Bernhard, J Briegel, S Dubler, B Grabein, A Hecker, W A Krüger, K Mayer, M W Pletz, D Störzinger, N Pinder, T Hoppe-Tichy, S Weiterer, S Zimmermann, A Brinkmann, M A Weigand, Christoph Lichtenstern
The mortality of patients with sepsis and septic shock is still unacceptably high. An effective antibiotic treatment within 1 h of recognition of sepsis is an important target of sepsis treatment. Delays lead to an increase in mortality; therefore, structured treatment concepts form a rational foundation, taking relevant diagnostic and treatment steps into consideration. In addition to the assumed focus and individual risks of each patient, local resistance patterns and specific problem pathogens must be taken into account for selection of anti-infection treatment...
October 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28869666/comprehensive-guidance-for-antibiotic-dosing-in-obese-adults
#20
REVIEW
Lina Meng, Emily Mui, Marisa K Holubar, Stan C Deresinski
Physiologic alterations seen in obesity commonly impact the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. In the last 10 years, additional antimicrobial PK/PD and clinical data encompassing prolonged infusion strategies and examination of critically ill populations have emerged to inform antimicrobial dosing in obesity...
November 2017: Pharmacotherapy
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