THERAPEUTIC DRUG MONITORING OF VANCOMYCIN IN PEDIATRIC PATIENTS WITH EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT (ECMO)

2017 ◽  
Author(s):  
Giannina Izquierdo
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Drug Monitoring ◽  
Pediatric Patients ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

scholarly journals Therapeutic Drug Monitoring of Vancomycin in Pediatric Patients With Extracorporeal Membrane Oxygenation Support

2018 ◽  
Vol 23 (4) ◽  
pp. 305-310 ◽  
Author(s):  
Brenda L. Zylbersztajn ◽  
Giannina Izquierdo ◽  
Roxana C. Santana ◽  
Christian Fajardo ◽  
Juan P. Torres ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Therapeutic Range ◽  
Drug Monitoring ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Therapeutic Drug ◽  
Optimal Dosage ◽  
Membrane Oxygenation ◽  
Adjusted Dose

OBJECTIVES Determine pharmacokinetic (PK) parameters and optimal dosage of vancomycin for children on extracorporeal membrane oxygenation (ECMO). METHODS Retrospective PK study of vancomycin in pediatric patients on ECMO who received IV vancomycin 40 to 60 mg/kg/day every 6 hours. Patients were analyzed according to the presence of acute kidney injury (AKI) and requirement of renal replacement therapy (RRT). RESULTS Data from 40 children, with a median age of 2.7 years of age (1 month to 14 years) were evaluated. Thirty-two patients (80%) received vancomycin. Vancomycin therapeutic drug monitoring was performed in 29 patients. The subgroup without AKI or RRT were 15. With initial doses, vancomycin trough levels were within therapeutic range in 53% of patients. After dose change, 93% of patients achieved therapeutic levels. The adjusted dose was 40 (34–60) mg/kg/day every 6 hours. Estimated PK parameters were clearance (CL) 1.67 (1–1.67) mL/kg/min; volume of distribution (Vd) 0.73 (0.7–0.9) L/kg; and half-life (t½) 6.2 (4.9–8.06) hours. In the AKI subgroup, 11 patients, the initial median dose was 40 (30–45) mg/kg/day every 8 (6–12) hours. Trough concentrations of vancomycin were within therapeutic range in 27% of patients. After dose modifications, 63% of patients achieved target trough concentration. The final adjusted dose was 20 mg/kg/day (15–30) every 12 (12–24) hours. Estimated PK parameters were Vd 1.16 (0.68–1.6) L/kg; CL 0.83 (0.38–1) mL/kg/min; and a t½ of 23.6 (16.2–31) hours. CONCLUSIONS In patients without AKI or RRT, Vd of vancomycin was similar and CL was lower compared to pediatric critically ill patients without ECMO. Treatment could be started at 40 mg/kg/day every 6 hours. In patients with AKI, the use of lower doses should be used.

scholarly journals Flucloxacillin therapeutic drug monitoring in a neonate on extracorporeal membrane oxygenation

2019 ◽  
Vol 55 (2) ◽  
pp. 246-247
Author(s):  
Laila S Al Yazidi ◽  
Sofia A Badran ◽  
Indy Sandaradura ◽  
Kevin Swil ◽  
Brendan McMullan
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

Therapeutic drug monitoring of vancomycin in a patient on extracorporeal membrane oxygenation therapy in intensive care unit

2018 ◽  
Vol 74 (8) ◽  
pp. 1093-1094 ◽  
Author(s):  
L. Herrera Hidalgo ◽  
A. B. Guisado Gil ◽  
M. V. Gil Navarro ◽  
L. Martín Villén ◽  
Y. Corcia Palomo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

scholarly journals Effectiveness of Vancomycin Dosing Guided by Therapeutic Drug Monitoring in Adult Patients Receiving Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 64 (9) ◽  
Author(s):  
Prashanti Marella ◽  
Jason Roberts ◽  
Karen Hay ◽  
Kiran Shekar
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Therapeutic Range ◽  
Drug Monitoring ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Ecmo Support ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

ABSTRACT The clinical situation for patients receiving extracorporeal membrane oxygenation (ECMO) is complex, and drug dosing is complicated by significant pharmacokinetic alterations. We sought to describe the frequency of achievement of therapeutic vancomycin concentrations in critically ill patients receiving ECMO with therapeutic drug monitoring (TDM). In this retrospective observational study, we included all critically ill patients receiving TDM for vancomycin while on ECMO. The primary outcome was the proportion of plasma vancomycin concentrations in the therapeutic range (15 to 20 mg/liter). Factors associated with not achieving therapeutic concentrations were investigated, including ECMO duration and use of renal replacement therapies. Vancomycin TDM was performed for 77 of 116 (66%) patients on ECMO. Median (interquartile range) duration of ECMO support was 7 days (4 to 16 days). The proportion of measurements in the therapeutic range (15 to 20 mg/liter) was 24%, while 46% were subtherapeutic (<15 mg/liter) and 30% were supratherapeutic (>20 mg/liter). The proportion of measures in the therapeutic range was significantly higher on ECMO days for 6 to 13 (incidence rate ratio [IRR], 2.4; 95% confidence interval [CI], 1.2 to 4.6; P = 0.01). Supratherapeutic concentrations were more frequently observed in patients on renal replacement therapy (RRT) (IRR, 2.0; 95% CI, 1.3 to 3.1; P = 0.002). The vancomycin concentrations in patients did not vary with age, gender, or type of ECMO support. Patients receiving vancomycin had suboptimal concentrations early in the course of ECMO. Patients not receiving RRT and those with mild to moderate acute kidney injury (AKI) were at a risk of underdosing, while those with established AKI on RRT were likelier to experience supratherapeutic concentrations.

Compassionate Use of Letermovir in a 2-Year-Old Immunocompromised Child With Resistant Cytomegalovirus Disease

2019 ◽  
Author(s):  
Maria Pérez Marín ◽  
Laurent Arthur Decosterd ◽  
Pascal Andre ◽  
Thierry Buclin ◽  
Thomas Mercier ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Compassionate Use ◽  
Cytomegalovirus Disease ◽  
Membrane Oxygenation ◽  
Immunocompromised Child

Abstract Little information on the efficacy and pharmacokinetics of letermovir among immunocompromised children is currently available. We describe here the use of letermovir in a 2-year-old immunocompromised child with ganciclovir-resistant cytomegalovirus disease who required extracorporeal membrane oxygenation. Detailed information on therapeutic-drug-monitoring measures and dosage adjustments for letermovir is provided.

scholarly journals Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
pp. 40 ◽  
Author(s):  
Florian Lemaitre ◽  
Nesrine Hasni ◽  
Pascal Leprince ◽  
Emmanuel Corvol ◽  
Ghassen Belhabib ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Human Blood ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

Therapeutic Drug Monitoring of Voriconazole in a Child With Invasive Aspergillosis Requiring Extracorporeal Membrane Oxygenation

2008 ◽  
Vol 30 (6) ◽  
pp. 643-646 ◽  
Author(s):  
Roger J M Brüggemann ◽  
Tim Antonius ◽  
Arno van Heijst ◽  
Peter M Hoogerbrugge ◽  
David M Burger ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Invasive Aspergillosis ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

Oxacillin therapeutic drug monitoring in a patient on extracorporeal membrane oxygenation support

2020 ◽  
Vol 75 (9) ◽  
pp. 2699-2700
Author(s):  
Megan M Seddon ◽  
Kirsten V Busey ◽  
Sara B Kutner ◽  
Ryan E Mejia ◽  
Rishi Bhattacharyya
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Drug Monitoring ◽  
Therapeutic Drug ◽  
Membrane Oxygenation

scholarly journals Imipenem Population Pharmacokinetics: Therapeutic Drug Monitoring Data Collected in Critically Ill Patients with or without Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 64 (6) ◽  
Author(s):  
Wenqian Chen ◽  
Dan Zhang ◽  
Wenwen Lian ◽  
Xiaoxue Wang ◽  
Wenwen Du ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Drug Monitoring ◽  
Critically Ill Patients ◽  
Small Sample ◽  
Therapeutic Drug ◽  
Blood Concentrations ◽  
Membrane Oxygenation ◽  
Population Pk

ABSTRACT Carbapenem pharmacokinetic (PK) profiles are significantly different in critically ill patients because of the drastic variability of the patients’ physiological parameters. Published population PK studies have mainly focused on specific diseases, and the majority of these studies had small sample sizes. The aim of this study was to develop a population PK model of imipenem in critically ill patients that estimated the influence of various clinical and biological covariates and the use of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). A two-compartment population PK model with creatinine clearance (CLCR), body weight (WT), and ECMO as fixed effects was developed using the nonlinear mixed-effects model (NONMEM). A Monte Carlo simulation was performed to evaluate various dosing schemes and different levels of covariates based on the pharmacokinetic/pharmacodynamic index (ƒ%T>MIC) for the range of clinically relevant MICs. The results showed that there may be insufficient drug use in the clinical routine drug dose regimen, and 750 mg every 6 h (q6h) could achieve a higher treatment success rate. The blood concentrations of imipenem in ECMO patients were lower than those in non-ECMO patients; therefore, dosages may need to be increased. The dosage may need adjustment for patients with a CLCR of ≤70 ml/min, but the dose should be lowered carefully to avoid the insufficient drug exposure. Dose adjustment is not necessary for patients with WT ranging from 50 to 80 kg. Due to the large variation in PK profile of imipenem in critically ill patients, therapeutic drug monitoring (TDM) should be carried out to optimize drug regimens.

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