Home Therapy With Subcutaneous Immunoglobulin Infusions in Children With Congenital Immunodeficiencies

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1127-1131
Author(s):  
Tore G. Abrahamsen ◽  
Heidi Sandersen ◽  
Alfhild Bustnes
Keyword(s):  
Severe Combined Immunodeficiency ◽  
Immunoglobulin M ◽  
Subcutaneous Immunoglobulin ◽  
Home Therapy ◽  
Subcutaneous Infusion ◽  
Therapy Program ◽  
Trough Serum ◽  
Serious Infections ◽  
Syringe Driver ◽  
The Family

Objectives. Patients with congenital, humoral immunodeficiencies are usually treated with intravenous immunoglobulin infusions. Subcutaneous infusions have emerged as an alternative treatment modality also in children. Our institution has run a subcutaneous infusion home therapy program for 6 years, and the purpose of this report is to describe our experience with this regimen. Methods. The subcutaneous therapy of eight patients with immunodeficiency (three with agammaglobulinemia, one with common variable immunodeficiency, one with severe combined immunodeficiency and bone marrow transplantation, and three with hyper-immunoglobulin M syndrome) was evaluated by chart review and a questionnaire answered by all the families. The infusions were given for at least 3 hours each week by a small syringe driver at home after the family had attended an intensive educational course at the hospital. Results. The children were given a total of approximately 1100 infusions. They started at the age of 2 to 8 (mean, 4.5) years and received these infusions for 1.5 to 6 (mean, 3) years. By administering immunoglobulin doses from 58 to 149 (mean, 97) mg/kg per week, trough serum immunoglobulin G values from 5.2 to 9.6 (mean, 7) g/L were obtained. No serious infections occurred. Short-lasting, local side effects such as swelling and redness were frequently reported, but pain or systemic adverse reactions during or after the infusions were never encountered. Conclusions. Home therapy with subcutaneous immunoglobulin infusions in children with congenital immunodeficiencies is a feasible and safe treatment alternative.

Use of an Ambulatory Infusion Pump in a 12-Year-Old with Salmonella Osteomyelitis

DICP ◽  
1989 ◽  
Vol 23 (5) ◽  
pp. 379-381
Author(s):  
Allen J. Vaida ◽  
Chantel J. Mattiucci ◽  
Steven A. Shapiro ◽  
Linda A. Gusenko ◽  
Anna M. King
Keyword(s):  
Cost Saving ◽  
Antibiotic Therapy ◽  
Infusion Pump ◽  
Medication Administration ◽  
Sterile Water ◽  
Home Therapy ◽  
Parenteral Antibiotic ◽  
The Family ◽  
The Stability ◽  
Salmonella Osteomyelitis

A 12-year-old girl with sickle cell hemoglobinopathy presented with a Salmonella osteomyelitis of her right humerus requiring six weeks of parenteral antibiotic therapy. Home therapy was evaluated. Due to the frequency of the medication administration (every six hours) and the apprehension of the family members, a Pharmacia-Deltec CADD-VT Infusion Pump was chosen for drug administration. Based on the stability of ampicillin, 1.3 g q6h was administered to provide a minimum of 1 g for the last dose of a 24-hour cycle. Ampicillin 6 g contained in 100 mL of sterile water for injection provided a 60 mg/mL solution with an osmolarity of 347 mOsmol. The pump was programmed to deliver 22 mL of solution over one hour, every six hours. A keep-vein-open rate of 0.2 mL/h maintained line patency. A 100 mL cassette of solution prepared daily was replaced on the pump by a home therapy nurse each morning. At the end of six weeks of therapy, the osteomyelitis was eradicated. We found the use of an ambulatory infusion pump an effective, convenient, and cost-saving method of treatment for our patient.

Stress Reduction in Child-Abusing Families: Global and Specific Measures

1994 ◽  
Vol 75 (1) ◽  
pp. 287-304 ◽  
Author(s):  
Keith Barton ◽  
Christopher Scott Baglio ◽  
Marc T. Braverman
Keyword(s):  
At Risk ◽  
Stress Reduction ◽  
Home Treatment ◽  
Stress Factors ◽  
Home Therapy ◽  
Total Stress ◽  
Therapy Program ◽  
The Individual ◽  
Over Time ◽  
County Services

This study compared in-home treatment to traditional county services for their ability to reduce stress in child-abusing families. 47 families who were at risk for having at least one child removed from the home for child abuse were referred to Families First for an intensive 6-wk., in-home therapy program. A comparison group of 29 families who were also at risk for having at least one child removed for abuse received traditional county services but no in-home therapy. Stress scores used were derived from a factor analysis of the Family Inventory of Life Events and Changes (FILE) that had identified 10 stress factors. The stress data were analyzed by a series of 2 × 2 analyses of variance, group and time being the independent variables and the stress factors the dependent variables. Total stress was significantly reduced over time for both groups, and several specific stress factors were also significantly reduced over time. In secondary analyses, 2 × 3 (group by time) analyses identified interactions for total stress and three of the individual stress factors. In-home treatment was effective in reducing stress, but traditional services were also effective. Some possible explanations were discussed. A major finding was that, by including analyses using the specific stress factors (rather than just the Total Stress score), a much richer understanding of the role stress plays in abusive families is provided. It was concluded that, although global stress may be reduced by different methods, some specific types of stress are more likely to be reduced than others.

scholarly journals Implementation of vancomycin dosing nomogram in an electronic prescribing system: an innovative tool in antibiotic stewardship

2014 ◽  
Vol 50 (3) ◽  
pp. 567-572 ◽  
Author(s):  
Tácio de Mendonça Lima ◽  
Sabrina Calil Elias ◽  
Rita de Cássia Elias Estrela ◽  
Fernando Luiz Lopes Cardoso
Keyword(s):  
Electronic Prescribing ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Trough Serum ◽  
Serious Infections ◽  
Serum Trough ◽  
Dosing Regimens ◽  
Basic Parameters ◽  
Innovative Tool ◽  
Computer Based ◽  
Dosing Nomogram

Vancomycin (VAN) is the gold standard therapy for Methicillin-resistant Staphylococcus aureus(MRSA) infections such as bacteremia and endocarditis. However, VAN suboptimal dosing for serious infections caused by S. aureus isolates that have elevated minimum inhibitory concentration (MIC), could be associated with poor outcome. Better understanding of VAN pharmacokinetics and pharmacodynamics (PK/PD) has led to the creation of new recommendations with optimized dosing regimens for the treatment of MRSA infections. For severe infectious, such as pneumonia and endocarditis, a VAN serum trough concentration of 15-20 mg/L at the steady state should be targeted. The aim of this study was to show how a nomogram with updated VAN dosing was devised and how it was implemented in the electronic prescribing (e-prescribing) system of a teaching hospital. VAN loading dose and maintenance doses were calculated from a pharmacokinetic equation using basic parameters: weight, estimated creatinine clearance, as well as peak and trough serum concentrations. The implementation of the VAN dosing nomogram in the hospital e-prescribing system definitively changed the long-standing medical prescription fallacy of "same dose fits all". Finally, this computer-based electronic program has allowed a wide-ranging intervention and should be recognized as a powerful tool for implementation in antimicrobial stewardship programs.

Serratia no longer an opportunistic uncommon pathogen – case series & review of literature

2021 ◽  
Vol 21 ◽  
Author(s):  
Varsha Gupta ◽  
Shiwani Sharma ◽  
Kritika Pal ◽  
Poonam Goyal ◽  
Deepak Agarwal ◽  
...  
Keyword(s):  
Serratia Marcescens ◽  
Case Series ◽  
Opportunistic Pathogen ◽  
Morphological Characters ◽  
Enteric Bacterium ◽  
Human Pathogen ◽  
Review Of Literature ◽  
Medical College ◽  
Serious Infections ◽  
The Family

Background: Serratia spp. is a common enteric bacterium generally thought not to be pathogenic in the gastrointestinal tract. Serratia marcescens is a member of the genus Serratia, which is a part of the family Enterobacteriales..Of all Serratia species, S. marcescens is the most common clinical isolate and the most important human pathogen. Objective: We are discussing here four cases of Serratia marcescens which we reported in our laboratory in the Department of Microbiology Government Medical College and Hospital Chandigarh during six months of duration. Method: All the samples were processed and identified as per standard microbiological techniques.The isolates of Serratia marcescens were identified, depending upon their biochemical and morphological characters and further confirmed by MALDI-TOF-MS ,PGIMER Chandigarh. Result: In one of the four cases there was polymicrobial infection and one patient was diabetic and rest three patients were immunocompetent. The importance of detection and reporting of Serratia marcescens is related to the concern regarding its increase spread in hospital settings as nosocomial infection . Conclusion: We need to identify and isolate this pathogen ,not thinking of only contaminant and opportunistic pathogen but as a pathogen which can lead to serious infections in hospital settings .

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