Effect of Multiple Staggered Doses of Calcium on the Bioavailability of Ciprofloxacin

1993 ◽  
Vol 27 (11) ◽  
pp. 1325-1328 ◽  
Author(s):  
Ben M. Lomaestro ◽  
George R. Bailie
Keyword(s):  
Calcium Carbonate ◽  
Maximum Concentration ◽  
Compartmental Model ◽  
Medical Center ◽  
Tertiary Care ◽  
Final Analysis ◽  
Relative Bioavailability ◽  
Outpatient Basis ◽  
Time Curve ◽  
Noncompartmental Model

OBJECTIVE: To determine the effect on the relative bioavailability (Fr) of a staggered single dose of ciprofloxacin given two hours after a morning dose of calcium carbonate given three times daily over the three previous days. DESIGN: Thirteen male volunteers participated in this randomized, nonblinded, crossover investigation; 12 subjects were included in the final analysis. SETTING: Data collection and ciprofloxacin administration occurred at Albany Medical Center, a tertiary-care teaching institution. Calcium carbonate administration was on an outpatient basis. RESULTS: For 12 volunteers, the mean ± SD Fr of ciprofloxacin staggered with calcium was 0.87 ± 0.23 (noncompartmental model) and 0.98 ± 0.27 (compartmental model). Other statistically significant findings were a decrease in the time to maximum concentration of ciprofloxacin staggered with calcium in serum compared with ciprofloxacin alone (from 1.76 ± 0.54 to 1.23 ± 0.52 h in the noncompartmental model; p<0.05), and a decrease in the same parameter (from 1.92 ± 0.96 to 0.77 ± 0.53 in the compartmental model; p<0.005). Maximum concentration of ciprofloxacin staggered with calcium was decreased in the noncompartmental model compared with ciprofloxacin alone (from 2.11 ± 0.72 to 1.60 ± 0.33, respectively; p<0.05). The elimination half-life and area under the concentration-time curve of ciprofloxacin were not significantly altered. CONCLUSIONS: Repeated doses of calcium carbonate, administered two hours before ciprofloxacin, did not significantly alter the Fr of this fluoroquinolone.

scholarly journals Effect of Calcium Carbonate on Bioavailability of Orally Administered Gemifloxacin

2003 ◽  
Vol 47 (7) ◽  
pp. 2158-2160 ◽  
Author(s):  
M. W. Pletz ◽  
P. Petzold ◽  
A. Allen ◽  
O. Burkhardt ◽  
H. Lode
Keyword(s):  
Calcium Carbonate ◽  
Oral Bioavailability ◽  
Half Life ◽  
Maximum Concentration ◽  
Time Curve ◽  
Concentration Time

ABSTRACT We investigated the effect of calcium carbonate on the oral bioavailability of gemifloxacin. Gemifloxacin was administered alone, 2 h before, simultaneously, or 2 h after calcium carbonate in 16 volunteers. Data for 320 mg of gemifloxacin alone were as follows: maximum concentration of drug in serum (C max),13 μg/ml; half-life, 7.33 h; and area under the concentration-time curve from 0 h to infinity (AUC∞), 6.79 μg · h/ml. Only simultaneous coadministration of calcium carbonate reduced C max (−17%) and AUC∞ (−21%) significantly.

Moxifloxacin versus levofloxacin for antibacterial prophylaxis in acute leukemia patients

2018 ◽  
Vol 25 (3) ◽  
pp. 758-761
Author(s):  
Pauline Lee ◽  
Randall W Knoebel ◽  
Jennifer Pisano ◽  
Natasha N Pettit
Keyword(s):  
Febrile Neutropenia ◽  
Acute Leukemia ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Final Analysis ◽  
Antibacterial Prophylaxis ◽  
Exact Test ◽  
Large Tertiary Care

Objective The primary endpoint of this study was to determine the incidence of febrile neutropenia among patients receiving either moxifloxacin or levofloxacin for antibacterial prophylaxis. Secondary endpoints were number of documented infections and in-hospital mortality in patients who develop febrile neutropenia. Methods A single-center retrospective cohort analysis at a large tertiary care academic medical center was conducted. This study included adult acute leukemia patients (age ≥18 years old) who received inpatient antibacterial prophylaxis (moxifloxacin or levofloxacin) from 1 July 2012 to 1 October 2014. Patients were excluded from the study if they were treated with antimicrobial therapy in the preceding five days or admitted to the hospital with neutropenic fever. Fisher’s exact test was used for categorical data and Mann–Whitney test for continuous data. Logistic regression analysis was used to determine risk factors for febrile neutropenia. Results Eighty-five patients were included in the final analysis with 40 patients who received moxifloxacin and 45 patients who received levofloxacin. Baseline characteristics were similar between the two groups. Twenty-two patients experienced febrile neutropenia requiring intravenous antibiotics in the moxifloxacin group and 30 patients in the levofloxacin group (P = 0.190). Age and duration of neutropenia appeared to predict for febrile neutropenia; however, after multivariate analysis, longer duration of neutropenia was shown to be the best predictor for febrile neutropenia with an odds ratio of 4.69 (95% CI, 1.697–12.968). Both groups had similar rates of documented infections and in-hospital morality. Conclusion Moxifloxacin and levofloxacin showed similar rates of febrile neutropenia when used for neutropenic antibacterial prophylaxis in acute leukemia patients.

Safety of 2-Octyl Cyanoacrylate in Spreader Grafting

2017 ◽  
Vol 33 (02) ◽  
pp. 213-216 ◽  
Author(s):  
Aurora Standlee ◽  
Marc Hohman
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Final Analysis ◽  
Spreader Graft ◽  
Chi Square ◽  
Inflammatory Reactions ◽  
Graft Placement ◽  
Postoperative Inflammation ◽  
Academic Medical

AbstractCyanoacrylate adhesives can make the placement of spreader grafts in open septorhinoplasty technically easier, but its use is off-label beneath the skin. There is a theoretical risk of toxicity from cyanoacrylate breakdown products, but this risk has not been thoroughly studied in rhinoplasty. The objective was to evaluate the effects of subcutaneous cyanoacrylate use during spreader graft placement in rhinoplasty in a retrospective review of open septorhinoplasties in which 2-octyl cyanoacrylate was used to aid placement of spreader grafts. The review was carried out in a tertiary care military academic medical center. A total of 140 adults underwent open septorhinoplasty between September 2013 and May 2016 with spreader graft placement. The authors excluded patients in whom 2-octyl cyanoacrylate was not used to aid graft placement and those who did not follow up postoperatively in our clinic. 108 (85 males and 23 females) patients were included in the final analysis. Nine (8.3%) patients had inflammatory reactions possibly attributable to 2-octyl cyanoacrylate toxicity. The overall rate of postoperative inflammation possibly attributable to 2-octyl cyanoacrylate was 17% among females and 5.9% among males, and this difference was not statistically significant (p = 0.07). However, the rate of postoperative inflammation attributable to 2-octyl cyanoacrylate that required an intervention (incision and drainage or antibiotics) was 2.7% overall, 13% among women and 0% among men, and this difference was significant based on chi-square testing (p < 0.001). Further, revision cases were significantly more likely to develop abnormal postoperative inflammation than initial cases (p = 0.02). Herein, the authors present the largest series of patients in whom 2-octyl cyanoacrylate was used to assist placement of cartilage spreader grafts during open septorhinoplasty. While 2-octyl cyanoacrylate is an effective adjunct to facilitate graft placement, they recommend against its use, as the risk of postoperative inflammation is significant.

scholarly journals Randomized Trial of Food Effect on Pharmacokinetic Parameters of ABX464 Administered Orally to Healthy Male Subjects

2016 ◽  
Vol 61 (1) ◽  
Author(s):  
Didier Scherrer ◽  
Regine Rouzier ◽  
Marine Cardona ◽  
P. Noel Barrett ◽  
Jean-Marc Steens ◽  
...  
Keyword(s):  
Maximum Concentration ◽  
Food Effect ◽  
Randomized Study ◽  
Relative Bioavailability ◽  
Pharmacokinetic Parameters ◽  
Open Label ◽  
Time Curve ◽  
Novel Approach ◽  
Elimination Half ◽  
Group 2

ABSTRACT ABX464 is an antiviral that provides a novel approach to the reduction and control of HIV infection. Investigation of food influence is important in the optimization of treatment. An open-label, food effect, randomized study which included 2 groups of 24 subjects each was carried out to assess the bioavailability and safety of single (group 1) and repeated (group 2) oral doses of ABX464 (50 mg) under fed or fasted conditions. The maximum concentration (C max) and the area under the concentration-time curve from time zero to infinity (AUC0–∞) of ABX464 were demonstrated to increase with food after a single dose of ABX464 (219% and 188%, respectively). The apparent terminal elimination half-lives (t 1/2s) under fed and fasted conditions were comparable, at about 0.80 h. The median time to maximum concentration (T max) was delayed from 1.5 to 2.8 h, and the ratio of the AUC0–∞ obtained under fed conditions to the AUC0–∞ obtained under fasted conditions (F rel) was 2.69. Comparable results were obtained on day 1 and day 10 in group 2. The increases in C max and AUC0–∞ of the metabolite ABX464–N-glucuronide (ABX464-NGlc) were, however, much more limited when ABX464 was given with food. The t 1/2s were also comparable under the two conditions (around 100 h). Between day 1 and day 10, the C max increased by 5% under the fasted condition and by 25% under the fed condition. The most common related treatment-emergent adverse events were headaches, vomiting, and nausea. It was concluded that food has a significant impact on the levels of ABX464 in plasma with a delay in absorption and increased relative bioavailability, with a lesser impact on its biotransformation into ABX464-NGlc. ABX464 was well tolerated under both fasted and fed conditions. (This study has been registered at ClinicalTrials.gov under registration no. NCT02731885.)

scholarly journals Pharmacokinetics of Ethionamide Administered under Fasting Conditions or with Orange Juice, Food, or Antacids

2001 ◽  
Vol 45 (3) ◽  
pp. 810-814 ◽  
Author(s):  
Barbara Auclair ◽  
David E. Nix ◽  
Rodney D. Adam ◽  
Gordon T. James ◽  
Charles A. Peloquin
Keyword(s):  
Least Squares ◽  
Confidence Intervals ◽  
Orange Juice ◽  
Maximum Concentration ◽  
High Performance ◽  
Relative Bioavailability ◽  
Empty Stomach ◽  
Population Pharmacokinetic ◽  
Serum Samples ◽  
Time Curve

ABSTRACT This study was conducted in order to (i) determine the effect of food, orange juice, or antacids on the absorption of a single oral 500-mg dose of ethionamide (ETA) in healthy volunteers, including an assessment of bioequivalence, and (ii) determine ETA population pharmacokinetic (PK) parameters. The pharmacokinetics of ETA in serum was determined for 12 healthy males and females in a randomized, four-period crossover study. Volunteers received single 500-mg doses of ETA either on an empty stomach (reference) or with food, orange juice, or antacids. Serum samples were collected for 48 h and assayed by high-performance liquid chromatography. Data were analyzed by noncompartmental and population methods. Mean test/reference ratios and 90% confidence intervals were determined. No statistically significant differences were seen in the maximum concentration of ETA (C max), time to maximum concentration (T max), or area under the concentration-time curve from 0 h to infinity (AUC0–∞) between the four treatments (P > 0.05 by analysis of variance). The least-squares mean ratios (with confidence intervals in parentheses) for C maxwere 105% (81.2 to 135%) after orange juice, 94% (72.8 to 121%) after food, and 88% (68.4 to 114%) after antacids. The least-squares mean ratios (with confidence intervals is in parentheses) for AUC0–∞ were 91% (72.7 to 115%) after orange juice, 96% (76.4 to 121%) after food, and 95% (75.5 to 120%) after antacids. The mean T max was slightly prolonged following antacid or food administration (2.3 to 2.6 h) compared to administration on an empty stomach or with juice (1.7 to 1.9 h). The median population PK parameters were as follows:K a = 0.37 to 0.48 h−1,V/F = 2.0 to 2.8 liters/kg, CL/F = 56.5 to 72.2 liters/h, and terminal half-life = 1.7 to 2.1 h, where Ka is the absorption rate constant,V is the volume of distribution, and CL is clearance. The PK behavior of ETA was not significantly modified by the different conditions studied. Mean ratios for AUC ranged from 0.91 to 0.96 for the orange juice, food, and antacid treatments, indicating a minimal effect on relative bioavailability. ETA can, therefore, be administered with food if tolerance is an issue.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

scholarly journals Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

2021 ◽  
pp. 1-26
Author(s):  
Akane Takamatsu ◽  
Hitoshi Honda ◽  
Tomoya Kojima ◽  
Kengo Murata ◽  
Hilary Babcock
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Vaccination Rate ◽  
Multifaceted Intervention ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Tertiary Care Center ◽  
Post Intervention ◽  
Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

scholarly journals EVALUATION OF FACTORS ASSOCIATED WITH MORTALITY AMONGST PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL CENTER FOR COVID-19 INFECTION

2021 ◽  
Vol 77 (18) ◽  
pp. 3123
Author(s):  
Anish Samuel ◽  
Ashesha Mechineni ◽  
Robin Craven ◽  
Wilbert Aronow ◽  
Mourad Ismail ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Factors Associated ◽  
Tertiary Care Medical Center

Implementation of a Leeches + Antimicrobial Prophylaxis Order Panel to Optimize Medicinal Leech Use at a Tertiary Care Academic Medical Center

2021 ◽  
pp. 089719002199368
Author(s):  
Nicole M. Palm ◽  
Jill C. Wesolowski ◽  
Janet Y. Wu ◽  
Pavithra Srinivas
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Medicinal Leech ◽  
Aeromonas Species ◽  
Leech Therapy ◽  
Before And After ◽  
Timing Of Initiation ◽  
Medicinal Leeches

Medicinal leech therapy promotes vascular flow and can be used to salvage grafts. Medicinal leeches have a symbiotic relationship with Aeromonas species and can therefore present a risk of bacterial transmission to patients. Antimicrobial prophylaxis is warranted for the duration of leech therapy, however, an institutional evaluation of 40 patients receiving medicinal leech therapy demonstrated poor adherence with recommendations. An electronic medical record order panel for antimicrobial prophylaxis with medicinal leech therapy was implemented, leading to a subsequent improvement in adherence to prophylaxis use, including significant increases in the ordering of antibiotics and the appropriate timing of initiation in the subsequent 10 patients receiving medicinal leech therapy after panel implementation. Aeromonas infections were rare before and after panel implementation, and developed only in the patient subset with non-optimized prophylaxis.

Sign in / Sign up

Export Citation Format

Share Document