Effective Treatment of Peritoneal Dialysis-Associated Peritonitis with Cefazolin and Ceftazidime in Children

Objective To evaluate the use of the combination of cefazolin and ceftazidime for initial treatment of peritoneal dialysis (PD)-related peritonitis in pediatric patients. Design Retrospective nonrandomized study. Setting Pediatric dialysis units of the University Medical Center of Utrecht and Nijmegen, The Netherlands. Patients 40 children (median age 5.4 years) who were treated with PD during the study period of 4.5 years. Interventions All 50 episodes of peritonitis that occurred during the study period were evaluated by review of medical records. Patients were given intraperitoneal ceftazidime 500 mg/L dialysis fluid, and cefazolin 500 mg/L as a loading dose, followed by a maintenance dose of ceftazidime 125 mg/L and cefazolin 100 mg/L, intraperitoneally, 4 times daily. Antibiotics were continued for 14 days. Results After identification of the causative microorganism, one of the antibiotics was discontinued in 34 cases, and the antibiotic schedule was adapted in 2 cases. All cases were initially cured within 3 days. In 5 cases (10%), there was a peritonitis with the same organism recurring within 2 weeks after completion of treatment. There were 4 cases of PD-related peritonitis caused by pseudomonas, all of which were cured. Conclusions The antibiotic combination of cefazolin and ceftazidime is effective for the initial therapy of PD-related peritonitis in children. The toxic complications of aminoglycosides are avoided with this combination.

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GAMBARAN PENGGUNAAN TERAPI GEA (GASTROENTERITIS ) PADA PASIEN ANAK DI RSUD BATARA SIANG PANGKEP SULSEL

Jurnal Riset Kefarmasian Indonesia ◽

10.33759/jrki.v3i3.137 ◽

2021 ◽

Vol 3 (3) ◽

pp. 189-198

Author(s):

Dwi Fitrah Wahyuni ◽

Riska Riska

Keyword(s):

Experimental Study ◽

Medical Records ◽

Pediatric Patients ◽

Diarrheal Disease ◽

Evaluation Study ◽

Initial Therapy ◽

Regional Hospital ◽

Inclusion Criteria ◽

South Sulawesi ◽

Appropriate Therapy

GEA (Gastroenteritis) or diarrhea is a disease caused by digestive tract disorders that are infected by bacteria. Treatment of early diarrhea, especially the choice of initial therapy, greatly affects the success of providing appropriate and appropriate therapy. This study aims to determine the rationality of therapy in pediatric patients at Batara Siang Pangkep Regional Hospital, South Sulawesi City. This study is a non-experimental study with a retrospective descriptive evaluation study using patient medical records. The samples that met the inclusion criteria were 65 patients. Acute diarrhea was mostly found in men as many as 38 patients (58%) while for women as many as 27 patients (42%). Characteristics of age 1-3 years (82%). The result showed that there are 3 therapeutic regimen in pediatric patient namely cotrimoxazole,electrolit, and zinc. So from these data meet the standards of management of diarrheal disease in children.

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The Influence of Demographic Factors and Modality on Loss of Residual Renal Function in Incident Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080102100312 ◽

2001 ◽

Vol 21 (3) ◽

pp. 302-305 ◽

Cited By ~ 31

Author(s):

Jean L. Holley ◽

Nabeel Aslam ◽

Judith Bernardini ◽

Linda Fried ◽

Beth Piraino

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Medical Center ◽

Demographic Factors ◽

Residual Renal Function ◽

Nonprotein Nitrogen ◽

University Of Pittsburgh ◽

Test Protein ◽

Rate Of Decline ◽

The University

Objective To determine whether gender, race, diabetes, peritoneal dialysis (PD) modality, and comorbid conditions influence loss of residual renal function (RRF). Design Retrospective study of incident PD patients, using database of prospectively collected demographic, laboratory, and clearance data. Setting Peritoneal Dialysis Registry of the University of Pittsburgh Medical Center. Patients The study included 184 continuous ambulatory PD and automated PD patients who had at least two 24-hour urine collections for glomerular filtration rate (GRF) between April 1991 and March 2000. 836 urine collections were analyzed. Outcome Measures Loss of RRF was defined as the slope of the decline in GFR as measured by the average of creatinine and urea clearances in 24-hour urine collections. Stepwise forward regression was used to identify demographic and laboratory factors associated with loss of GFR. Spearman correlations were used to assess the significance of associations. Results The median rate of decline of renal function was –0.17 mL/minute/month. Gender, race, diabetes, automated PD, peritoneal equilibration test, protein equivalent of nonprotein nitrogen appearance normalized to body surface area, and serum albumin did not predict loss of RRF. Cardiac disease was the only variable affecting decline of RRF ( p = 0.045). Conclusion Modality of PD and patient demographic factors do not contribute to the rate at which RRF is lost in incident PD patients. Additional study of the factors contributing to the decline and maintenance of RRF is needed.

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Intraperitoneal vancomycin for peritoneal dialysis-associated peritonitis in children: Evaluation of loading dose guidelines

Peritoneal Dialysis International ◽

10.1177/0896860820950924 ◽

2020 ◽

pp. 089686082095092

Author(s):

Kathleen Hennessy ◽

Edmund V Capparelli ◽

Gale Romanowski ◽

Lawrence Alejandro ◽

William Murray ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Adverse Effects ◽

Body Surface ◽

First Generation ◽

Pediatric Patients ◽

Generation Cephalosporin ◽

Loading Dose ◽

Population Pk ◽

Dosing Strategies ◽

Dialysate Volume

Background: Current pediatric International Society for Peritoneal Dialysis guidelines for initial treatment of peritoneal dialysis (PD)-associated peritonitis suggest either monotherapy with cefepime or double therapy with first-generation cephalosporin or glycopeptide and ceftazidime or aminoglycoside. When using vancomycin, the intraperitoneal (IP) recommended pediatric loading dosage is 1000 mg/L of dialysate. This is based on adult pharmacokinetic (PK) studies and roughly translates to the adult recommendation where 30 mg/kg in 2 L is approximately 1000 mg/L. However, since the dialysate volume in pediatric patients is normalized to body surface area and not weight, the current recommended dosing can result in high vancomycin exposure in children. Vancomycin can potentially cause adverse effects. We aimed to determine if the IP vancomycin dosing of 1000 mg/L was causing elevated vancomycin levels and to offer possible dosing recommendations based on PK modeling and simulation. Methods: Retrospective review of pediatric patients who had been treated with IP vancomycin for PD-associated peritonitis. Vancomycin levels obtained for clinical monitoring were analyzed using NONMEM to generate population and individual (empiric Bayesian) estimates of vancomycin PK parameters and estimated peak levels. Predicted vancomycin peaks were also simulated from virtual pediatrics patients 3–70 kg following various dosing strategies. Results: Six episodes of peritonitis in three patients were analyzed. In the two episodes treated with 1000 mg/L, the first vancomycin levels (h post) were 95.6 ug/mL (3) and 49 (33) and following 500 mg/L were 33.2 (11), 30.2 (11), 23.6 (24), and 22.1 (11). All patients were cured of their peritonitis without the need for catheter removal. Based on our population PK model, a 1000 mg/L IP vancomycin loading dose will typically result in peak > 50 mg/L in patients weighing <35 kg and >60 mg/L in patients <15 kg. Vancomycin levels will remain above 20 mg/L for over 2 days without additional vancomycin dosing. Conclusion: The data suggest that a loading dose of vancomycin 1000 mg/L leads to higher than desired vancomycin levels and should be lowered. A 500 mg/L loading dosing appears more appropriate and needs further study.

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Response to Initial Griseofulvin Therapy in Pediatric Patients with Tinea Capitis

Annals of Pharmacotherapy ◽

10.1177/106002809703100403 ◽

1997 ◽

Vol 31 (4) ◽

pp. 406-410 ◽

Cited By ~ 25

Author(s):

Susan M Abdel-Rahman ◽

Milap C Nahata ◽

Dwight A Powell

Keyword(s):

Medical Records ◽

Tinea Capitis ◽

Pediatric Patients ◽

Response Rate ◽

Pediatric Population ◽

Signs And Symptoms ◽

Initial Therapy ◽

Additional Treatment ◽

Drug Of Choice ◽

Additional Therapy

Objective To estimate the response rate to initial griseofulvin therapy in pediatric patients with tinea capitis and to determine whether clinical or epidemiologic variables differed between patients responding positively and negatively to therapy. Methods A review of patients' medical records with a confirmed diagnosis of tinea capitis was performed retrospectively over a 2-year period. Patients were included only if a positive dermatophyte culture was obtained and the initial prescription for griseofulvin was filled at our pharmacy. Responders were children not returning to the clinic or returning without signs or symptoms of infection. Nonresponders were those returning within 8 months with signs and symptoms of disease, requiring additional therapy. Results During July 1993-June 1995, 479 positive fungal cultures were confirmed in 474 patients, and 857 prescriptions for griseofulvin were filled for 765 patients at our institution. Of 122 evaluable patients meeting both criteria, 60.7% were classified as responders to initial prescribed therapy. The remaining 39.3% returned to the clinic within 8 months of initial therapy, requiring additional treatment. An additional 10.7% had a recurrence at a later date. There was no correlation between clinical response and dosage, age, race, or gender, although there was a trend toward longer treatment duration among responders. Conclusions It is evident that tinea capitis persists in the urban pediatric population. Our data suggest that griseofulvin, the current drug of choice, may be ineffective in at least one-third of pediatric patients with tinea capitis.

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Tracing diagnosis trajectories over millions of patients reveal an unexpected risk in schizophrenia

Scientific Data ◽

10.1038/s41597-019-0220-5 ◽

2019 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Hyojung Paik ◽

Matthew J. Kan ◽

Nadav Rappoport ◽

Dexter Hadley ◽

Marina Sirota ◽

...

Keyword(s):

San Francisco ◽

Medical Records ◽

Large Scale ◽

Medical Center ◽

Disease Incidence ◽

Muscle Disease ◽

Case Review ◽

Large Scale Analysis ◽

Disease Associations ◽

The University

Abstract The identification of novel disease associations using big-data for patient care has had limited success. In this study, we created a longitudinal disease network of traced readmissions (disease trajectories), merging data from over 10.4 million inpatients through the Healthcare Cost and Utilization Project, which allowed the representation of disease progression mapping over 300 diseases. From these disease trajectories, we discovered an interesting association between schizophrenia and rhabdomyolysis, a rare muscle disease (incidence < 1E-04) (relative risk, 2.21 [1.80–2.71, confidence interval = 0.95], P-value 9.54E-15). We validated this association by using independent electronic medical records from over 830,000 patients at the University of California, San Francisco (UCSF) medical center. A case review of 29 rhabdomyolysis incidents in schizophrenia patients at UCSF demonstrated that 62% are idiopathic, without the use of any drug known to lead to this adverse event, suggesting a warning to physicians to watch for this unexpected risk of schizophrenia. Large-scale analysis of disease trajectories can help physicians understand potential sequential events in their patients.

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Transfusions increase with nationally driven reimbursement changes of erythropoiesis stimulating agents for chemotherapy-induced anemia

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155210382318 ◽

2010 ◽

Vol 17 (4) ◽

pp. 360-365 ◽

Cited By ~ 5

Author(s):

Janny ManYan Yu ◽

Stacy S Shord ◽

Sandra Cuellar

Keyword(s):

Overall Survival ◽

Clinical Practice ◽

Medical Records ◽

Medical Center ◽

Erythropoiesis Stimulating Agents ◽

Response To Chemotherapy ◽

Before And After ◽

Medicaid Beneficiaries ◽

Group 2 ◽

The University

Background. The Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination (NCD) in July 2007, which imposed restrictions on the reimbursement of ESAs for Medicare and Medicaid beneficiaries. Since a majority of our patients are Medicare or Medicaid beneficiaries, we changed our clinical practice regarding the use of erythropoiesis stimulating agents (ESAs) to coincide with the NCD’s reimbursement restriction. Objective. To evaluate the number of transfusions in patients diagnosed with chemotherapy-induced anemia (CIA) receiving ESAs before and after the clinical practice was changed at the University of Illinois Medical Center (UIMC). Methods. The medical records of all adult patients diagnosed with a nonmyeloid malignancy and CIA who received an ESA between July 2006 and June 2008 at the UIMC were evaluated. The patients were divided into two groups: patients in receipt of ESAs BEFORE (group 1) and AFTER (group 2). The number of transfusions, the response rates to chemotherapy and ESAs therapy, and overall survival were compared. Results. Medical records for 110 patients were reviewed. More transfusions were given to patients AFTER we implemented the change in clinical practice (BEFORE 18 transfusions vs. AFTER 52 transfusions, p = 0.004). More patients responded to ESA therapy AFTER we implemented the change (67% vs. 83%, p = NS). The treatment response to chemotherapy and overall survival were similar between the two groups. Conclusion. The primary goal of reducing the number of transfusions in patients with CIA by administering ESAs cannot be met when clinical practice coincides with the NCD.

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Pharmacokinetics of Intraperitoneal Piperacillin/Tazobactam in Patients on Peritoneal Dialysis with and without Pseudomonas Peritonitis

Peritoneal Dialysis International ◽

10.1177/089686080002000211 ◽

2000 ◽

Vol 20 (2) ◽

pp. 227-231 ◽

Cited By ~ 4

Author(s):

Ronit Zaidenstein ◽

Joshua Weissgarten ◽

Victor Dishi ◽

Maya Koren ◽

Stefan Soback ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Intravenous Administration ◽

Maintenance Dose ◽

High Performance ◽

Medical Center ◽

Plasma Concentrations ◽

Loading Dose ◽

Maintenance Period ◽

Therapeutic Implications

Objective The objective of this study was to assess the pharmacokinetics of intraperitoneal (IP) administration of the antibiotic combination piperacillin/tazobactam (PIP/TAZ) to patients on chronic ambulatory peritoneal dialysis (CAPD) with and without pseudomonas peritonitis. Design Open-labeled study. Setting The study was carried out in the CAPD unit of Assaf Harofeh Medical Center, Zerifin, Israel. Patients and Methods Six patients participated in the study, 4 had pseudomonas peritonitis, all were given an IP loading dose of 4 g/0.5 g PIP/TAZ. Twenty-four hours after the initial dose, a maintenance dose of 0.5 g/0.0625 g PIP/TAZ was administered with each dialysate exchange for a period of 1 week. The patients without peritonitis received only the loading dose. High performance liquid chromatography was used to determine the concentrations of PIP/TAZ in plasma obtained at 0, 30, 60, 90, 120, 360, 480, 600, 720, and 1440 minutes after administration. Samples of the dialysate fluid for determination of PIP/TAZ concentration were collected at 6, 10, 14, 24, and 72, 120, and 168 hours. Results After the loading dose, the highest plasma PIP concentration (Cmax) was 51.6 ± 21.25 μg/mL and appeared at 1.5 ± 0.45 hours (tmax). During the maintenance period plasma PIP concentration was 5.2 ± 4.75 μg/mL. Tazobactam was detected in the plasma of 1 patient only. The concentration of TAZ in the dialysate fluid during the maintenance period was 2.3 ± 0.5 μg/mL. Conclusions Piperacillin administered IP at 4 g reached plasma concentrations comparable to intravenous administration and considered therapeutic (above the MIC90 for Pseudomonas aeruginosa) in CAPD patients with or without peritonitis. The maintenance dose, however, should be augmented. Tazobactam could not be detected in the plasma of most patients and the therapeutic implications of IP administration of TAZ cannot be directly correlated to intravenous administration.

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