scholarly journals Erratum to: Plasma concentrations resulting from continuous infusion of meropenem in a community-based outpatient program: A case series

2021 ◽  
Keyword(s):  
Continuous Infusion ◽  
Plasma Concentrations ◽  
Case Series ◽  
Community Based ◽  
Outpatient Program

Plasma concentrations resulting from continuous infusion of meropenem in a community-based outpatient program: A case series

2020 ◽  
Vol 77 (24) ◽  
pp. 2074-2080
Author(s):  
Amy Legg ◽  
Melanie Halford ◽  
Kate McCarthy
Keyword(s):  
Continuous Infusion ◽  
Drug Exposure ◽  
Plasma Concentrations ◽  
Case Series ◽  
Infectious Complications ◽  
Antimicrobial Treatment ◽  
Therapeutic Drug ◽  
Community Based ◽  
Drug Concentrations ◽  
Tertiary Center

Abstract Purpose Traditionally meropenem has been considered too unstable in solution for continuous infusion. However, in the era of increasing antimicrobial resistance, use of meropenem is becoming more frequently required, and the ability to facilitate its administration via community-based programs would be beneficial. There are some reassuring data about meropenem stability in solution, but data about actual drug exposure in patients and subsequent clinical outcomes are lacking. Summary Here we present a case series of 4 patients at a single tertiary center who received meropenem via continuous infusion coordinated through an outpatient parenteral antimicrobial treatment (OPAT) program. We provide plasma drug concentrations achieved and report on the patients’ clinical progress. All patients achieved drug concentrations of at least 2 times the minimum inhibitory concentration (MIC) while receiving meropenem via continuous infusion and had resolution of their infectious complications. No adverse effects of meropenem continuous infusion were noted. Conclusion Meropenem continuous infusion along with therapeutic drug monitoring was used successfully in a community-based program. Due to interpatient pharmacokinetic variability, we consider meropenem concentration monitoring compulsory during continuous-infusion meropenem therapy.

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

2021 ◽  
Vol 41 (3) ◽  
pp. 261-272
Author(s):  
Chau Wei Ling ◽  
Kamal Sud ◽  
Connie Van ◽  
Syed Tabish Razi Zaidi ◽  
Rahul P. Patel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Case Reports ◽  
Plasma Concentrations ◽  
Case Series ◽  
Therapeutic Drug ◽  
Pharmacokinetic Studies ◽  
Pharmacokinetic Data ◽  
Automated Peritoneal Dialysis ◽  
Final Study ◽  
Drug Plasma

The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.

Bleeding with Tirofiban During Percutaneous Coronary Intervention

2021 ◽  
Vol 15 (10) ◽  
pp. 2833-2834
Author(s):  
Muhammad Waqas ◽  
Muhammad Shahzad Azeem ◽  
Muhammad Qasim Khan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Continuous Infusion ◽  
Case Series ◽  
Coronary Intervention ◽  
Male Gender ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Modern Era ◽  
Current Guidelines

Objective: To determine the frequency of bleeding with Tirofiban during percutaneous coronary intervention Methodology: In this case series (Descriptive) at Mayo Hospital, Cardiology Deptt. Lahore during the year 2018 and 2019, we enrolled a total of 385 cases of either gender with acute coronary syndrome(ACS) and undergoing percutaneous coronary intervention(PCI)were included. Preloading with aspirin 300 mg and clopidogrel 600 mg was done. Intravenous Tirofiban was given keeping in mind the current guidelines. Tirofiban was given as I/V bolus of 0.25 mcg/kg over 5 minutes during/before the start of PCI. It was followed by a continuous infusion of 0.125 mcg/kg/min for up to eighteen hours. Bleeding during and within 24 hours of percutaneous coronary intervention was noted according to BARC bleeding type Results: Mean age was 50.750± 5.63years. Male gender was dominant i.e. 85.7% as compare to 14.3% females. Bleeding was observed in 3.9% patients Conclusion: In acute coronary syndrome patients undergoing PCI, Tirofiban use was associated with bleeding. In the modern era of PCI, the judicious use of Tirofiban is safe. Keywords: Percutaneous coronary intervention, Tirofiban, Bleeding, Acute coronary syndrome

Indomethacin Stimulates Basal Glucose Production in Humans without Changes in Concentrations of Glucoregulatory Hormones

1993 ◽  
Vol 85 (6) ◽  
pp. 679-685 ◽  
Author(s):  
E. P. M. Corssmit ◽  
J. A. Romijn ◽  
E. Endert ◽  
H. P. Sauerwein
Keyword(s):  
Continuous Infusion ◽  
Control Experiment ◽  
Hepatic Glucose Production ◽  
Plasma Concentrations ◽  
Glucose Production ◽  
C Peptide ◽  
Hepatic Glucose ◽  
Glucoregulatory Hormones

1. To investigate whether indomethacin affects basal glucose production, we measured hepatic glucose production in six healthy postabsorptive subjects on two occasions: once after administration of indomethacin (150 mg orally) and once after administration of placebo. 2. Glucose production was measured by primed, continuous infusion of [3-3H]-glucose. 3. Indomethacin administration resulted in an increase in glucose production from 10.9 (SEM 0.3) μmol min−1 kg−1 to a maximum of 16.5 (SEM 1.6) μmol min−1 kg−1 (P <0.05) within ∼1 h, whereas in the control experiment glucose production declined gradually (P <0.01) (P <0.05 indomethacin versus control). There were no differences in plasma concentrations of insulin, C-peptide and counter-regulatory hormones between the two experiments. 4. Since indomethacin administration resulted in an increase in glucose production in the absence of any changes in concentrations of glucoregulatory hormones, we conclude that indomethacin stimulates hepatic glucose production through other mechanisms.

scholarly journals Population Pharmacokinetics of Meropenem in Plasma and Subcutis from Patients on Extracorporeal Membrane Oxygenation Treatment

2018 ◽  
Vol 62 (5) ◽  
Author(s):  
Pelle Hanberg ◽  
Kristina Öbrink-Hansen ◽  
Anders Thorsted ◽  
Mats Bue ◽  
Mikkel Tøttrup ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Continuous Infusion ◽  
Prospective Observational Study ◽  
Plasma Concentrations ◽  
Content Type ◽  
Membrane Oxygenation ◽  
Population Pk ◽  
Dosing Regimens ◽  
Subcutaneous Adipose ◽  
Ecmo Treatment

ABSTRACTThe objectives of this study were to describe meropenem pharmacokinetics (PK) in plasma and/or subcutaneous adipose tissue (SCT) in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) treatment and to develop a population PK model to simulate alternative dosing regimens and modes of administration. We conducted a prospective observational study. Ten patients on ECMO treatment received meropenem (1 or 2 g) intravenously over 5 min every 8 h. Serial SCT concentrations were determined using microdialysis and compared with plasma concentrations. A population PK model of SCT and plasma data was developed using NONMEM. Time above clinical breakpoint MIC forPseudomonas aeruginosa(8 mg/liter) was predicted for each patient. The following targets were evaluated: time for which the free (unbound) concentration is maintained above the MIC of at least 40% (40%fT>MIC), 100%fT>MIC, and 100%fT>4×MIC. For all dosing regimens simulated in both plasma and SCT, 40%fT>MIC was attained. However, prolonged meropenem infusion would be needed for 100%fT>MIC and 100%fT>4×MIC to be obtained. Meropenem plasma and SCT concentrations were associated with estimated creatinine clearance (eCLCr). Simulations showed that in patients with increased eCLCr, dose increment or continuous infusion may be needed to obtain therapeutic meropenem concentrations. In conclusion, our results show that using traditional targets of 40%fT>MIC for standard meropenem dosing of 1 g intravenously every 8 h is likely to provide sufficient meropenem concentration to treat the problematic pathogenP. aeruginosafor patients receiving ECMO treatment. However, for patients with an increased eCLCr, or if more aggressive targets, like 100%fT>MIC or 100%fT>4×MIC, are adopted, incremental dosing or continuous infusion may be needed.

Concurrent Paclitaxel and Radiation in the Treatment of Locally Advanced Head and Neck Cancer

2001 ◽  
Vol 19 (3) ◽  
pp. 800-811 ◽  
Author(s):  
John B. Sunwoo ◽  
Laurie L. Herscher ◽  
Glenn S. Kroog ◽  
Giovana R. Thomas ◽  
Frank G. Ondrey ◽  
...  
Keyword(s):  
Head And Neck ◽  
Continuous Infusion ◽  
Locally Advanced ◽  
Plasma Concentrations ◽  
Disease Free Survival ◽  
Complete Response ◽  
Survival Duration ◽  
Advanced Head ◽  
Skin Reactions ◽  
Standard Format

PURPOSE: To determine the feasibility of an organ preservation regimen consisting of infusional paclitaxel administered concurrently with radiotherapy to patients with locally advanced head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: Thirty-three previously untreated patients with stage III or IV tumors were enrolled onto the study. Paclitaxel was administered as a 120-hour continuous infusion every 3 weeks during the course of radiation therapy. Sixteen patients received a paclitaxel dose of 105 mg/m2, and 17 patients received 120 mg/m2. Radiation was delivered in a standard format at 1.8 Gy/d to a total dose of 70.2 to 72 Gy. RESULTS: Three months after therapy, a 76% complete response (CR) at the primary site and a 70% overall CR was achieved. At 36 months, locoregional control was 55.7%, overall survival was 57.8%, and disease-free survival was 51.1%. The median survival duration for all 33 patients was greater than 50 months at the time of this report. Local toxicities including mucositis, dysphagia, and skin reactions were severe but tolerable. All patients retained functional speech, and all but four patients were swallowing food 3 months after treatment. Steady-state plasma concentrations for paclitaxel were not achieved during a 120-hour infusion, suggesting a nonlinear process. Tumor volume quantified by pretreatment computerized tomography imaging was associated with likelihood of response and survival. CONCLUSION: Paclitaxel administered as a 120-hour continuous infusion in combination with radiotherapy is a feasible and promising treatment for patients with advanced HNSCC.

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