Vancomycin continuous infusion in neonates: dosing optimisation and therapeutic drug monitoring

2012 ◽  
Vol 98 (6) ◽  
pp. 449-453 ◽  
Author(s):  
W. Zhao ◽  
E. Lopez ◽  
V. Biran ◽  
X. Durrmeyer ◽  
M. Fakhoury ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Continuous Infusion ◽  
Drug Monitoring ◽  
Therapeutic Drug

scholarly journals Population Pharmacokinetic Model Development of Tacrolimus in Pediatric and Young Adult Patients Undergoing Hematopoietic Cell Transplantation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jordan T. Brooks ◽  
Ron J. Keizer ◽  
Janel R. Long-Boyle ◽  
Sandhya Kharbanda ◽  
Christopher C. Dvorak ◽  
...  
Keyword(s):  
Young Adult ◽  
Therapeutic Drug Monitoring ◽  
Continuous Infusion ◽  
Drug Monitoring ◽  
Model Building ◽  
Hematopoietic Cell ◽  
Adult Patients ◽  
Therapeutic Drug ◽  
Poppk Model ◽  
Best Fit

Background: With a notably narrow therapeutic window and wide intra- and interindividual pharmacokinetic (PK) variability, initial weight-based dosing along with routine therapeutic drug monitoring of tacrolimus are employed to optimize its clinical utilization. Both supratherapeutic and subtherapeutic tacrolimus concentrations can result in poor outcomes, thus tacrolimus PK variability is particularly important to consider in the pediatric population given the differences in absorption, distribution, metabolism, and excretion among children of various sizes and at different stages of development. The primary goals of the current study were to develop a population PK (PopPK) model for tacrolimus IV continuous infusion in the pediatric and young adult hematopoietic cell transplant (HCT) population and implement the PopPK model in a clinically available Bayesian forecasting tool.Methods: A retrospective chart review was conducted of 111 pediatric and young adult patients who received IV tacrolimus by continuous infusion early in the post-transplant period during HCT from February 2016 to July 2020 at our institution. PopPK model building was performed in NONMEM. The PopPK model building process included identifying structural and random effects models that best fit the data and then identifying which patient-specific covariates (if any) further improved model fit.Results: A total of 1,648 tacrolimus plasma steady-state trough concentrations were included in the PopPK modeling process. A 2-compartment structural model best fit the data. Allometrically-scaled weight was a covariate that improved estimation of both clearance and volume of distribution. Overall, model predictions only showed moderate bias, with minor under-prediction at lower concentrations and minor over-prediction at higher predicted concentrations. The model was implemented in a Bayesian dosing tool and made available at the point-of-care.Discussion: Novel therapeutic drug monitoring strategies for tacrolimus within the pediatric and young adult HCT population are necessary to reduce toxicity and improve efficacy in clinical practice. The model developed presents clinical utility in optimizing the use of tacrolimus by enabling model-guided, individualized dosing of IV, continuous tacrolimus via a Bayesian forecasting platform.

scholarly journals Therapeutic drug monitoring of meropenem and piperacilin administered in continuous infusion. preliminary data

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
M Miralbés Torner ◽  
F Ahmad Diaz ◽  
S Carvalho Brugger ◽  
SM Cano Marron ◽  
JA Schoenenberger ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Continuous Infusion ◽  
Drug Monitoring ◽  
Preliminary Data ◽  
Therapeutic Drug

Use of continuous infusion ceftolozane–tazobactam with therapeutic drug monitoring in a patient with cystic fibrosis

2019 ◽  
Vol 76 (8) ◽  
pp. 501-504 ◽  
Author(s):  
Sarah Elizabeth Davis ◽  
Jared Ham ◽  
Jennifer Hucks ◽  
Alyssa Gould ◽  
Rachel Foster ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Therapeutic Drug Monitoring ◽  
Continuous Infusion ◽  
Renal Clearance ◽  
Drug Monitoring ◽  
Adverse Drug Events ◽  
Pulmonary Function Tests ◽  
Therapeutic Drug ◽  
Augmented Renal Clearance ◽  
Definitive Therapy

Abstract Purpose The safe and effective use of ceftolozane–tazobactam delivered via continuous infusion in a cystic fibrosis (CF) patient with reduced body weight and presumed augmented renal clearance is reported. Summary A 30-year-old woman with CF was admitted for acute pulmonary exacerbations with positive respiratory cultures for Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing Escherichia coli. Susceptibility testing confirmed multidrug resistance, and the patient was transitioned to ceftolozane–tazobactam for definitive therapy. A novel strategy of administering ceftolozane–tazobactam 6 g by continuous i.v. infusion over 24 hours was initiated during hospitalization and continued at discharge for a total of 10 days. Therapeutic drug monitoring over the first 36 hours of the continuous infusion confirmed adequate exposure. The patient had clinical resolution with return to baseline of pulmonary function tests and no noted adverse drug events. Conclusion A continuous infusion regimen of ceftolozane–tazobactam was successfully used in a CF patient with augmented renal clearance.

scholarly journals Therapeutic Drug Monitoring of Continuous Infusion Doripenem in a Pediatric Patient on Continuous Renal Replacement Therapy

2017 ◽  
Vol 22 (1) ◽  
pp. 69-73
Author(s):  
Jeffrey J. Cies ◽  
Wayne S. Moore ◽  
Susan B. Conley ◽  
Paul Shea ◽  
Adela Enache ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Therapeutic Drug Monitoring ◽  
Continuous Renal Replacement Therapy ◽  
Continuous Infusion ◽  
Replacement Therapy ◽  
Drug Monitoring ◽  
Severe Combined Immunodeficiency ◽  
Elevated Serum ◽  
Therapeutic Drug ◽  
Pharmacokinetic Data

An 11-year-old African American male with severe combined immunodeficiency variant, non-cystic fibrosis bronchiectasis, pancreatic insufficiency, chronic mycobacterium avium-intracellulare infection, chronic sinusitis, and malnutrition presented with a 1-week history of fevers. He subsequently developed respiratory decompensation and cefepime was discontinued and doripenem was initiated. Doripenem was the carbapenem used due to a national shortage of meropenem. By day 7 the patient (24.7 kg) had a positive fluid balance of 6925 mL (28% FO), and on days 7 into 8 developed acute kidney injury evidenced by an elevated serum creatinine of 0.68 mg/dL, an increase from the baseline of 0.28 mg/dL. On day 9, the patient was initiated on continuous renal replacement therapy (CRRT) and the doripenem dosing was changed to a continuous infusion of 2.5 mg/kg/hr (60 mg/kg/day). Approximately 12.5 hours after the start of the doripenem a serum concentration was obtained, which was 4.01 mg/L corresponding to a clearance of 10.5 mL/min/kg. The pediatric dosing and pharmacokinetic data available for doripenem suggest a clearance estimate of 4.4 to 4.8 mL/min/kg, and the adult clearance estimate is 2.4 to 3.78 mL/min/kg. The calculated clearance in our patient of 10.5 mL/min/kg is over double the highest clearance estimate in the pediatric literature. This case demonstrates that doripenem clearance is significantly increased with CRRT in comparison with the published pediatric and adult data. An appropriate pharmacodynamic outcome (time that free drug concentration > minimum inhibitory concentration) can be achieved by continuous infusion doripenem with concurrent therapeutic drug monitoring.

Diagnose und Monitoring bei chronisch-entzündlicher Darmerkrankung

2018 ◽  
Vol 75 (5) ◽  
pp. 316-328
Author(s):  
Christian Ansprenger ◽  
Emanuel Burri
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Morbus Crohn ◽  
Therapeutic Drug ◽  
Körperliche Untersuchung

Zusammenfassung. Die Diagnose und auch die Überwachung von chronisch entzündlichen Darmerkrankungen ruht auf mehreren Säulen: Anamnese, körperliche Untersuchung, Laborwerte (im Blut und Stuhl), Endoskopie, Histologie und Bildgebung. Die Diagnose kann nicht anhand eines einzelnen Befundes gestellt werden. In den letzten Jahren hat sich das Therapieziel weg von klinischen Endpunkten hin zu endoskopischen und sogar histologischen Endpunkten entwickelt. Für einige dieser neuen Therapieziele existiert allerdings noch keine allgemein gültige Definition. Regelmässige Endoskopien werden von Patienten schlecht toleriert, weshalb Surrogat-Marker wie Calprotectin untersucht wurden und eine gute Korrelation mit der mukosalen Entzündungsaktivität nachgewiesen werden konnte. Entsprechend zeigte sich bei Morbus Crohn eine Algorithmus-basierte Therapiesteuerung – unter anderem basierend auf Calprotectin – einer konventionellen Therapiesteuerung überlegen. Die Überwachung der medikamentösen Therapie («Therapeutic Drug Monitoring» [TDM]) ist ein zweites Standbein des Monitoring von chronisch entzündlichen Darmerkrankungen. Mit zunehmendem Einsatz vor allem der Biologika-Therapien wurden sowohl reaktives TDM (in Patienten mit klinischem Rezidiv) als auch proaktives TDM (in Patienten in Remission / stabiler Erkrankung) untersucht und haben (teilweise) Eingang in aktuelle Richtlinien gefunden. Zukünftige Studien werden die vorgeschlagenen Therapieziele besser definieren und den Nutzen der medikamentösen Therapieüberwachung auf den Krankheitsverlauf weiter untersuchen müssen.

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