scholarly journals Rare manifestation of a large stenosing gastrointestinal tumor caused by Mycobacterium tuberculosis in a previously healthy man from Austria

2021 ◽  
Author(s):  
Guangyu Shao ◽  
Bakari Chitechi ◽  
Gamze Demireli ◽  
Karoline Ornig ◽  
Matthias J. Neuböck ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Resistance Testing ◽  
Therapeutic Drug ◽  
High Dose ◽  
Immunocompromised Patients ◽  
Large Tumor ◽  
Tumor Mass ◽  
Healthy Man ◽  
Rare Manifestation

Summary Background Gastrointestinal tuberculosis (TB) is a rare manifestation in low TB-incidence countries such as Austria. It is usually seen in immunocompromised patients or in migrants being more susceptible for extrapulmonary disease manifestations. Case description We report a very rare manifestation of severe gastrointestinal TB in a 49-year-old previously healthy man from Upper Austria. Endoscopy showed a large tumor mass obstructing about 2/3 of the lumen of the cecum. Positron emission tomography/computed tomography scan revealed not only a high metabolic activity in the tumor mass, but also active pulmonary lesions in both upper lung lobes. Bronchial secretion showed acid-fast bacilli in the microscopy and polymerase chain reaction was positive for M. tuberculosis complex. Phenotypic resistance testing showed no resistance for first-line anti-TB drugs. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was initiated. Based on therapeutic drug monitoring, the standard treatment regime was adapted to rifampicin high dose. TB treatment was well tolerated and the patient achieved relapse-free cure one year after the end of treatment. Conclusion Gastrointestinal involvement mimicking an intestinal tumor is a very rare TB manifestation in previously healthy Austrians. However, it should be kept in mind due to increasing migration from countries with higher rates of extrapulmonary TB and due to an increasing number of immunocompromised patients. TB telephone consultations can support medical professionals in the diagnosis and the management of complex TB patients. TB management is currently at a transitional stage from a programmatic to personalized management concept including therapeutic drug monitoring or biomarker-guided treatment duration to achieve relapse-free cure.

scholarly journals Successful and safe long‐term treatment of cerebral aspergillosis with high‐dose voriconazole guided by therapeutic drug monitoring

2018 ◽  
Vol 85 (1) ◽  
pp. 266-269 ◽  
Author(s):  
Pier Giorgio Cojutti ◽  
Maria Merelli ◽  
Lorenzo Allegri ◽  
Giuseppe Damante ◽  
Matteo Bassetti ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Term Treatment ◽  
Therapeutic Drug ◽  
High Dose ◽  
Long Term Treatment

scholarly journals Sensitive and Rapid Quantification of Busulfan in Small Plasma Volumes by Liquid Chromatography–Electrospray Mass Spectrometry

2001 ◽  
Vol 47 (8) ◽  
pp. 1437-1442 ◽  
Author(s):  
Thomas E Mürdter ◽  
Janet Coller ◽  
Alexander Claviez ◽  
Frank Schönberger ◽  
Ute Hofmann ◽  
...  
Keyword(s):  
Liquid Chromatography ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Internal Standard ◽  
Therapeutic Drug ◽  
High Dose ◽  
Selected Ion Monitoring ◽  
Hematopoietic Stem ◽  
Adults And Children ◽  
Liquid Chromatographic

Abstract Background: High-dose busulfan is widely used in conditioning regimens before hematopoietic stem cell transplantation in both adults and children. Large interindividual variability in pharmacokinetics after oral administration has been reported; therefore, therapeutic drug monitoring of busulfan may decrease the incidence of drug-related toxicity (for example, hepatic venoocclusive disease) and may also improve therapeutic efficacy. Methods: Busulfan concentrations were quantified using 200 μL of plasma and liquid–liquid extraction with diethyl ether after the addition of [2H8]busulfan as the internal standard. Separation and detection of busulfan and [2H8]busulfan were achieved with a LUNA C8 column (5 μm; 150 × 2 mm i.d.) at 30 °C, a HP 1100 liquid chromatography system, and a HP 1100 single-quadrupole mass spectrometer. Busulfan and [2H8]busulfan were detected as ammonium adducts in selected-ion monitoring mode at m/z 264.2 and 272.2, respectively. Results: The calibration curve was linear at 5–2000 μg/L busulfan. Intra- and interassay imprecision (CV) and bias were both <11%. The limits of detection and quantification were 2 and 5 μg/L, respectively. Extraction recovery of busulfan was >87%. Analysis of pharmacokinetics in four patients receiving high-dose busulfan indicated that minimum busulfan concentrations before the next dose were 405–603 μg/L, with no interference observed. Conclusions: The new rapid and sensitive liquid chromatographic–mass spectrometric assay is an appropriate method for quantification of busulfan in human plasma, making therapeutic drug monitoring of busulfan faster and easier in clinical practice.

Even high-dose extended infusions may not yield desired concentrations of β-lactams: the value of therapeutic drug monitoring

2015 ◽  
Vol 47 (10) ◽  
pp. 739-742 ◽  
Author(s):  
Menino Osbert Cotta ◽  
Belinda Gowen ◽  
Natasha Truloff ◽  
Evan Bursle ◽  
Brett McWhinney ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
High Dose

Evaluation of Existing Limited Sampling Models for Therapeutic Drug Monitoring of Busulphan in Children and Adults Undergoing SCT.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1150-1150
Author(s):  
Zuzana Hassan ◽  
Marie Sandström ◽  
Moustapha Hassan
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Conditioning Regimen ◽  
Trapezoidal Rule ◽  
Therapeutic Window ◽  
Therapeutic Drug ◽  
High Dose ◽  
Time Interval ◽  
Suitable Model ◽  
Limited Sampling

Abstract Busulphan (Bu) is used in high dose conditioning regimen prior to stem cell transplantation. Bu has a narrow therapeutic window and over- and under-dosing may have a fatal outcome. Bu pharmacokinetics and pharmacodynamics were extensively studied and wide inter- and intra-individual variation was found. Several limited sampling models (LSM) have been developed for Bu administered orally to simplify therapeutic drug monitoring and consequently dose adjustment. The aim of this study was to evaluate the existing LSM in adults and children undergoing conditioning regimen before SCT. Seventy-four patients (62 adults and 12 children) with malignant and non-malignant diseases were analysed. Plasma was sampled at 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 5 and 6 hours after the first dose of Bu. Bu was determined using gas chromatography with electron capture detection. The area under the plasma concentration-time curve (AUC) for time interval 0 to 6 hours was determined using Winnonlin program and trapezoidal rule. Results were compared to the estimated AUCs using LSMs (Vassal 1992, Schuler 1994, Hassan 1996, Chatergoon 1997). The best correlation between the AUCs determined using trapezoidal rule and 3-points model by Schuler was found (R²=0.95 for all patients, R²=0.97 for children and R²=0.94 for adults). In children, a correlation between AUCs determined with trapezoidal rule and following LSMs was found: 2-points LSM by Schuler (R²=0.94), LSM by Hassan (R²=0.94), LSM by Vassal (R²=0.81) and 3 of 5 LSMs by Chatergoon (R²=0.85, 0.88 and 0.87, resp.). AUCs in children determined using Winnonlin showed good correlation with both Schuler’s models, model by Hassan and one of 4-points models by Chatergoon. However, the correlation between the AUCs determined using trapezoidal rule and Winnonlin was good in children (R²=0.98), but not in adults (R²=0.65). Thus, several limited sampling models are suitable for AUC estimation in children, while there is only one suitable model for adults. This conclusion is made with reservation that even the trapezoidal rule may underestimate the real AUC dependent on sampling density.

scholarly journals Therapeutic drug monitoring and use of an adjusted body weight strategy for high-dose voriconazole therapy

2017 ◽  
pp. dkw550
Author(s):  
Patrick G. Richards ◽  
Kimberlyn M. Dang ◽  
Carol A. Kauffman ◽  
Kay Lyn Stalker ◽  
David Sudekum ◽  
...  
Keyword(s):  
Body Weight ◽  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
High Dose

scholarly journals Therapeutic drug monitoring for colistin therapy in severe multi-resistant Acinetobacter intracerebral abscess: A single case study with high-dose colistin and review of literature

2017 ◽  
Vol 5 ◽  
pp. 2050313X1771163 ◽  
Author(s):  
Sascha Tafelski ◽  
Lukas Wagner ◽  
Stefan Angermair ◽  
Maria Deja ◽  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Single Case ◽  
Multidrug Resistant ◽  
Therapeutic Drug ◽  
High Dose ◽  
Intracranial Abscess ◽  
Infection Focus ◽  
Dosing Strategies ◽  
High Doses

Objectives: Intracranial infections due to multidrug- resistant (MDR) gram-negative pathogens are associated with increased morbidity and mortality. As therapeutic options are limited and systemic drug penetration into the infection focus is difficult, intraventricular therapy has been described. Methods: We report on a patient with intracranial abscess caused by MDR Acinetobacter baumannii. Results: He was treated with high doses of intravenous and intraventricular colistin resulting in microbiological clearance and clinical cure. Therapy was controlled by therapeutic drug monitoring (TDM) of serum and liquor colistin levels. About 100 cases with intraventricular or intrathecal colistin are reported in literature but data on TDM are sparse. Conclusions: This is one of the first cases providing data on TDM for locally administered high dose colistin therapy for the treatment of intracranial abscess formations. Based on these findings, increasing the intraventricular application interval paralleled with intravenous colistin could possibly be sufficient to achieve appropriate therapeutic drug levels. Further studies are needed to support alternative dosing strategies in similar cases.

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