scholarly journals Comparison of Trimethoprim-Sulfamethoxazole vs. Clindamycin for the Treatment of Children with Musculoskeletal Infections

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Julian Tyte ◽  
Kelsey Russell ◽  
James B. Wood
Keyword(s):  
Treatment Failure ◽  
Adverse Drug Reactions ◽  
Infection Type ◽  
Treatment Options ◽  
Treatment Success ◽  
Drug Reactions ◽  
Eligibility Criteria ◽  
White Males ◽  
Invasive Infections

Background: Musculoskeletal infections ([MSKI]; osteomyelitis, septic arthritis, pyomyositis) are common invasive infections in children. With increasing antibiotic resistance and allergies, treatment options are limited. Trimethoprim-sulfamethoxazole (TMP-SMX) has activity against common MSKI pathogens, yet pediatric MSKI outcomes data are limited. Our aim was to evaluate outcomes of children with MSKI treated with TMP-SMX compared to clindamycin. We hypothesized that outcomes would be similar between groups. Methods: We conducted a retrospective review of children <18 years old, admitted to Riley Hospital for Children from January 2010-June 2021 treated with TMP-SMX or clindamycin for MSKI. Patients were identified by ICD-9/10 codes. Patients were excluded if TMP-SMX or clindamycin was not the main treatment, they had symptoms >30 days, hardware associated infection, or an alternative diagnosis. Treatment success was defined as no evidence of infection at the end therapy. Treatment failure was defined as antibiotic intolerance, or development of recurrent/chronic osteomyelitis. Adverse drug reactions were recorded. Results: One-hundred-sixty-three patients (30 TMP-SMX, 133 clindamycin) met eligibility criteria. The majority were non-Hispanic white males, median age of 1.75 years (IQR, 1-3.75) for the TMP-SMX group, and 7 years (IQR 3-10) for the clindamycin group. Osteomyelitis was the most common infection type in both groups (TMP-SMX 43.3%, clindamycin 54.1%).  S. aureus was the most common pathogen in both groups (TMP-SMX 36.7%, clindamycin 48.1%). Of the patients that completed follow-up, 84% successfully completed treatment with TMP-SMX, compared to 86.4% with clindamycin (odds ratio [OR] 0.82; 95% CI 0.25-2.46, p=0.75). Adverse drug reactions occurred in 6.7% of the TMP-SMX group, compared to 10.5% in the clindamycin group (OR 0.61; 95% CI 0.13-2.57, p=0.52). Conclusions: Preliminary results show that TMP-SMX is well tolerated and not associated with higher risk of treatment failure compared to clindamycin in the treatment of pediatric MSKI. Randomized controlled trials to evaluate optimal treatment are needed.

scholarly journals The Burden of Adverse Drug Reactions Due to Artemisinin-Based Antimalarial Treatment in Selected Ugandan Health Facilities: An Active Follow-Up Study

Drug Safety ◽  
2018 ◽  
Vol 41 (8) ◽  
pp. 753-765 ◽  
Author(s):  
Helen Byomire Ndagije ◽  
Victoria Nambasa ◽  
Leonard Manirakiza ◽  
Donna Kusemererwa ◽  
Dan Kajungu ◽  
...  
Keyword(s):  
Adverse Drug Reactions ◽  
Health Facilities ◽  
Drug Reactions ◽  
Antimalarial Treatment ◽  
Follow Up Study

scholarly journals Follow-up of suspected ocular adverse drug reactions

2009 ◽  
Vol 88 (7) ◽  
pp. e279-e280 ◽  
Author(s):  
Gordon A. Reeks ◽  
Ghee S. Ang
Keyword(s):  
Adverse Drug Reactions ◽  
Drug Reactions

scholarly journals The spectrum of adverse drug reactions in a multidisciplinary kidney clinic

2019 ◽  
Vol 9 (1) ◽  
pp. 61-67
Author(s):  
Shaima Al-Bader ◽  
Shaikha Al-Bader ◽  
Kamel El-Reshaid
Keyword(s):  
Adverse Drug Reactions ◽  
Kidney Diseases ◽  
Immunosuppressive Treatment ◽  
Drug Side Effects ◽  
Drug Reactions ◽  
Drug Compliance ◽  
Chronic Kidney Diseases ◽  
The Past ◽  
Morbid Conditions

Introduction: Data on adverse drug-reactions (ADR) in the medical field are rare. Objective: To report on the pattern of such problem in a multidisciplinary kidney clinic Patients and Methods: Medical records of patients were reviewed retrospectively for such phenomenon in the past 6 years Results: A total of 4834 patients were included for analysis.   The unit is responsible for a large proportion of patients with acute and chronic kidney diseases of diverse etiologies and multiple co-morbid conditions.  Acute and maintenance dialysis as well as immunosuppressive treatment for idiopathic glomerulopathy and autoimmune systemic diseases were common practice.  Results: A total of 70044 ADR were diagnosed in 4438 patients.  Most patients were adults (39+14) and had median follow up of 38 months. Nearly half of the ADR were due to drug-side effects while idiosyncrasy accounted for 1.2%.  The former is due to misuse/abuse of medications while the latter is due to genetic, co-morbid conditions or synergetic between 2 drugs or a drug and disease.  Details of drugs ADR are outlined with their respective prevalence.  Our study indicates the need for careful auditing of patient’s response during follow up to improve their drug-compliance. Keywords: adverse drug reaction, allergy, medical clinic, kidney disease.

Evaluation of intraperitoneal vancomycin in peritoneal dialysis-associated peritonitis

2021 ◽  
pp. 089686082110515
Author(s):  
Wui Ming Chang ◽  
Elaine Cheng ◽  
Karen Shalansky ◽  
Suneet R Singh
Keyword(s):  
Peritoneal Dialysis ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Drug Level ◽  
Optimal Dose ◽  
Therapeutic Drug ◽  
Loading Dose ◽  
Eligibility Criteria ◽  
Serum Vancomycin

Background: Intraperitoneal (IP) vancomycin is recommended as one of the treatment options for gram-positive coverage in the management of peritoneal dialysis (PD)-associated peritonitis. There is a lack of literature supporting the optimal dose and approach to vancomycin therapeutic drug-level monitoring. Methods: A retrospective chart review was conducted using the BC Renal Agency PROMIS Database and our hospital records from 1 June 2011 to 1 July 2019. Adult patients with PD-associated peritonitis who received IP vancomycin and had at least one serum vancomycin level drawn were included. All patients received a loading dose of 30 mg/kg, which was repeated every 3–5 days depending on PD modality. Serum vancomycin levels were drawn prior to the second vancomycin dose, then at the discretion of the prescriber. The primary end point was the rate of therapeutic serum vancomycin levels ≥15 mg/L. Results: Twenty-three episodes of PD-associated peritonitis in 20 patients met the eligibility criteria. Only 15/23 serum vancomycin levels were drawn appropriately after the first dose. Sixty per cent of these levels were subtherapeutic at <15 mg/L. All subsequent serum vancomycin levels were above the therapeutic target. Most peritonitis episodes (78%) achieved resolution of infection. Residual kidney function was not significantly correlated with serum vancomycin levels ( p = 0.19). Conclusions: An IP vancomycin regimen of 30 mg/kg every 3–5 days resulted in subtherapeutic serum vancomycin levels in most patients following the loading dose but therapeutic levels thereafter. A large percentage of vancomycin levels were drawn inappropriately due to misalignment of outpatient follow-up visits and timing of blood work.

scholarly journals Management and outcomes of real-world use of non-vitamin-K oral anticoagulants (NOACs) in patients with atrial fibrillation: experience of a dedicated NOAC clinic

2019 ◽  
Vol 27 (12) ◽  
pp. 605-612 ◽  
Author(s):  
A. J. W. M. de Veer ◽  
N. Bennaghmouch ◽  
M. C. E. F. Wijffels ◽  
J. M. ten Berg
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Drug Reactions ◽  
Vitamin K ◽  
Real World ◽  
Oral Anticoagulants ◽  
Daily Practice ◽  
Drug Reactions ◽  
Real World Data ◽  
First Choice

Abstract Background Current guidelines recommend non-vitamin‑K oral anticoagulants (NOACs) as the first-choice therapy for stroke prevention in patients with atrial fibrillation (AF). The use of drugs in a clinical trial setting differs from that in real-world populations. Real-world data are important to accrue more heterogeneous patient populations with respect to co-morbidities and co-medication use. The aim of this study was to evaluate the use of NOACs in daily practice in a large tertiary hospital in the Netherlands. Methods A single-centre prospective study was conducted among all patients with AF using a NOAC in the St. Antonius Hospital between 2013 and June 2017. The outcomes were the rates of any bleeding, stroke/transient ischaemic attack, mortality, discontinuation rate and adverse drug reactions. Results In total, 799 patients were enrolled with a mean follow-up of 1.7 years. Mean age was 69.8 (SD ± 11) and 61.2% were male. Mean CHA2DS2-VASc score was 2.8 (SD ± 1.6) and mean HAS-BLED score was 1.4 (SD ± 0.9). Bleeding occurred in 6.0, major bleeding in 1.8, stroke in 1.2 patients per 100 patient-years, and 87 patients (10.9%) died during the follow-up period. Adverse drug reactions were reported by 59 patients (7.4%). Finally, 249 patients (31.2%) reported a temporary interruption and 132 (16.5%) permanent discontinuation of NOAC treatment, of whom 33 (25%) patients switched to a vitamin‑K antagonist. Conclusions We observed low rates of bleeding and adverse drug reactions. However, rates of mortality and discontinuation were relatively high. These results could possibly be explained by the real-world nature of the data including higher-risk patients.

scholarly journals More than skin deep. Ten year follow-up of delayed cutaneous adverse drug reactions (CADR)

2016 ◽  
Vol 82 (4) ◽  
pp. 1040-1047 ◽  
Author(s):  
Linda Velta Graudins ◽  
Jenny Ly ◽  
Jason Trubiano ◽  
Ar Kar Aung
Keyword(s):  
Adverse Drug Reactions ◽  
Drug Reactions

scholarly journals A retrospective study of Adverse Drug Reactions in a tertiary care centre

2018 ◽  
Vol 7 (7) ◽  
pp. 1339
Author(s):  
V. J. Ambika Abhishake ◽  
S. Basalingappa ◽  
Arun Gopi ◽  
More Pankaj Daulat
Keyword(s):  
Adverse Drug Reactions ◽  
Tertiary Care ◽  
Unintended Effects ◽  
Age Group ◽  
Test Results ◽  
Drug Reactions ◽  
Tertiary Care Centre ◽  
Common System ◽  
Males And Females

Background: Adverse drug reactions (ADRs) are a major concern in present day clinical practice. They are inevitable consequences of drug therapy; as no pharmacotherapeutic agent is completely free from noxious and unintended effects. They are major contributors for morbidity, mortality and hospitalization of the patients increasing the economic burden on the society and uncertainty in clinical outcomes.Methods: This was a retrospective observational study, extending over 6 months (September 2016 to February 2017). A total of 290 cases were studied, excluding the geriatric age group. The data was collected using CDSCO ADR reporting form. A comparison of ADR between males and females was made; based on the organ system affected and the category of drug using “proportion test”.Results: The study showed the ADR incidence was equal in both sexes (≈50%). It was observed that majority ADRs were from gastro intestinal system (39%) followed by CNS (20%) and skin and soft tissue (14%). Constipation was found to be the most common of the reported ADRs (18%) followed by vomiting (9%) and diarrhoea (8%).Conclusions: ADRs are a major cause of morbidity worldwide. Several studies; including the present one, has shown GIT to be the most common system affected. Frequency of ADRs can be reduced by careful follow up and a robust hospital based pharmacovigilance setup.

scholarly journals 604. Factors Associated with Adverse Drug Reactions Leading to Discontinuation of Vancomycin in Outpatient Parenteral Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S364-S364
Author(s):  
Josh McDonald ◽  
Russell J Benefield ◽  
Laura Certain
Keyword(s):  
Adverse Drug Reactions ◽  
Antimicrobial Therapy ◽  
Plasma Concentrations ◽  
The United States ◽  
High Rate ◽  
Unplanned Readmission ◽  
Drug Reactions ◽  
Research Support ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Over 250,000 patients receive outpatient parenteral antimicrobial therapy (OPAT) in the United States each year. Vancomycin is commonly used in OPAT but has a high rate of discontinuations due to adverse drug reactions (ADRs). Being able to predict the occurrence of these ADRs and assess their impact could improve the overall quality of OPAT services when utilizing vancomycin. Methods This was a retrospective chart review of all adult University of Utah Health (UUH) patients who received vancomycin OPAT and had planned follow-up with UUH infectious disease (ID) providers between October 25, 2018 and July 31, 2019. Patients were excluded if they were less than 18 years of age, pregnant, did not have planned follow up with UUH ID physicians, or were on any form of renal replacement therapy. The primary outcome assessed was discontinuation of vancomycin due to ADR, as documented by the ID provider. Type of ADR leading to discontinuation and 30-day unplanned readmission were also assessed. Results One hundred fifty-eight patients met inclusion criteria (n=158). The mean age of patients was 55 years with a median Charlson comorbidity score of 3. Most patients utilized a non-UUH infusion service (116, 73% vs 42, 27%) and utilized vancomycin as their sole antibiotic (83, 53%). The majority of patients were being treated for orthopedic infections (78, 49%). Twenty-eight patients discontinued vancomycin OPAT due to an ADR (18%). The most common ADR leading to discontinuation was acute kidney injury (10, 36%). Variables associated with ADRs leading to discontinuation included utilization of UUH home infusion services (54% vs 21%, P &lt; 0.001) and initial vancomycin plasma concentrations obtained less than 7 days after discharge (92% vs 71%, P &lt; 0.001). The overall 30 day readmission rate was 10% and the rate among patients who experienced an ADR leading to discontinuation was higher than those who did not (25% vs 8%, P &lt; 0.001). Conclusion The overall rate of discontinuation of vancomycin OPAT due to ADR in the UUH population is similar to what has been described in previous literature. The higher rate of unplanned readmission in the population of patients who experienced ADRs warrants further study. The results of this study will be utilized for future quality improvement interventions at our institution. Disclosures Russell J. Benefield, PharmD, Merck and Co (Grant/Research Support)Paratek Pharmaceuticals (Grant/Research Support)Rempex Pharmaceuticals (Grant/Research Support)

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