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Prolonged antibiotics infusion

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https://www.readbyqxmd.com/read/30310294/integrated-pharmacokinetic-pharmacodynamic-modeling-to-evaluate-empiric-carbapenem-therapy-in-bloodstream-infections
#1
Tze-Peng Lim, Reyna Wang, Gang Quan Poh, Tse-Hsien Koh, Thean-Yen Tan, Winnie Lee, Jocelyn Qi-Min Teo, Yiying Cai, Thuan-Tong Tan, Pui Lai Rachel Ee, Andrea L Kwa
Objectives: Treatment for nosocomial bloodstream infections (BSI) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) is challenging. Rising antimicrobial resistance, especially in extended spectrum beta-lactamase production, inadvertently increases empiric carbapenem consumption. Three antipseudomonal carbapenems (imipenem, meropenem [MER], and doripenem [DOR]) are available commercially against MDR GNB in Singapore. The study aims to determine the most optimal empiric carbapenem dosing regimens (CDR) and evaluate their cost-effectiveness for GNB-BSI in the face of increasing MDR GNB...
2018: Infection and Drug Resistance
https://www.readbyqxmd.com/read/30307416/-comparison-of-standard-and-fast-track-rehabilitation-in-patients-with-acute-appendicitis-intermediate-results-of-multicenter-prospective-randomized-trial
#2
A V Sazhin, T V Nechay, S M Titkova, A E Tyagunov, M V Anurov, K Yu Melnikov-Makarchuk, A A Tyagunov, I V Ermakov, N S Glagolev, L S Kurashinova, E A Ivanova, V S Nechay, A V Karpov, A T Mirzoyan, G B Ivakhov, Yu S Balakirev
AIM: To analyze outcomes of fast track rehabilitation in patients with acute appendicitis. MATERIAL AND METHODS: Prospective, randomized multi-center trial including 86 patients was conducted. There were 38 patients in the main group and 48 in the control group. All patients underwent laparoscopic appendectomy under endotracheal anesthesia. Protocol included informing, no premedication, glucose infusion prior to surgery, antibiotics administration, mesoappendix excision, limited deployment of drainage tubes, intraabdominal prolonged anesthesia, minimal pneumoperitoneum, limited irrigation, minimum power monopolar electrocautery, antiemetics, early activation and eating (2 and 6 hours after surgery)...
2018: Khirurgiia
https://www.readbyqxmd.com/read/30250757/a-novel-approach-to-serial-amnioinfusion-in-a-case-of-premature-rupture-of-membranes-near-the-limit-of-viability
#3
Katherine Kohari, Krista Mehlhaff, Audrey Merriam, Sonya Abdel-Razeq, Olga Grechukhina, Daisy Leon-Martinez, Mert Ozan Bahtiyar
Prelabor rupture of the membranes (PROM) near the limit of viability is associated with significant risks for both mother and fetus. Preterm labor, intra-amniotic infection, and placental abruption are the immediate risks to the pregnancy; however, the fetus incurs additional risks related to the sequela of persistent oligohydramnios. Transabdominal intra-amniotic infusions have been studied. Results, suggesting that this intervention may prolong the latency period, and potentially, decrease pulmonary hypoplasia in surviving neonates without evidence of increasing risk of intra-amniotic infection...
July 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30244674/pharmacokinetics-pharmacodynamics-issues-relevant-for-the-clinical-use-of-beta-lactam-antibiotics-in-critically-ill-patients
#4
REVIEW
Rui Pedro Veiga, José-Artur Paiva
Antimicrobials are among the most important and commonly prescribed drugs in the management of critically ill patients and beta-lactams are the most common antibiotic class used. Critically ill patient's pathophysiological factors lead to altered pharmacokinetics and pharmacodynamics of beta-lactams.A comprehensive bibliographic search in PubMed database of all English language articles published from January 2000 to December 2017 was performed, allowing the selection of articles addressing the pharmacokinetics or pharmacodynamics of beta-lactam antibiotics in critically ill patients...
September 24, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/30117081/pharmacodynamic-model-for-%C3%AE-lactam-regimens-used-in-surgical-prophylaxis-model-based-evaluation-of-standard-dosing-regimens
#5
XiangQing Song, MingHui Long
Background Continual evolution of resistance among bacteria against methods of surgical prophylaxis may make currently used beta-lactam regimens inadequate. Objective To re-evaluate beta-lactam regimens in surgical prophylaxis. Setting A pharmacodynamic Monte Carlo simulation (MCS) model based on a number of patients in China. Methods Pharmacodynamic profiling using Monte Carlo simulation up to 4 hours postinfusion was conducted for standard-dose, short-term (0.5 h) and prolonged (2 to 4 h) infusions of ampicillin, cefazolin, cefotaxime, cefoxitin, cefuroxime, ertapenem, and piperacillin/tazobactam in adult patients with normal renal function...
August 16, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/30012756/pharmacokinetics-tolerability-and-safety-of-murepavadin-a-novel-antipseudomonal-antibiotic-in-subjects-with-mild-moderate-or-severe-renal-function-impairment
#6
Glenn E Dale, Atef Halabi, Marc Petersen-Sylla, Achim Wach, Christian Zwingelstein
This open-label, nonrandomized, single-dose, phase 1 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 (up to 8 per group) with mild (group 1), moderate (group 2), and severe (group 3) renal function impairment or with normal renal function (group 4). 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...
September 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
#7
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...
October 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
#8
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
#9
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...
October 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29766208/-adequate-anti-infective-treatment-importance-of-individual-dosing-and-application
#10
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
#11
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)...
October 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29534630/antibiotic-use-in-the-intensive-care-unit-optimization-and-de-escalation
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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