scholarly journals Comparison between conventional dosing versus personalized pharmacokinetic dosing of vancomycin: a pilot study from a Malaysian private hospital

2021 ◽  
Vol 12 (2) ◽  
pp. 1020-1029
Author(s):  
Tsuey Li Yong ◽  
Chee Ping Chong
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Pilot Study ◽  
Private Hospital ◽  
Inhibitory Concentration ◽  
Hospital Setting ◽  
Total Daily Dose ◽  
Pharmacokinetic Parameters ◽  
Efficacy And Safety ◽  
Daily Dose ◽  
Dosing Method

Pharmacist led vancomycin dosing is not a common practice in private hospital settings of the Malaysian healthcare system. The lack of this pharmacist led system has led to conventional vancomycin dosing without considering the differences in patients pharmacokinetic parameters. This study aims to compare the differences in vancomycin doses between conventional dosing and pharmacist-led personalized pharmacokinetic dosing. A retrospective pilot study was conducted on inpatient adults who were prescribed with intravenous vancomycin in a private hospital. Personalized vancomycin doses were retrospectively calculated by using the pharmacokinetic parameters and was then compared with the actual conventional doses used in the patients. The area under concentration curve over 24 hours/minimum inhibitory concentration (AUC24/MIC) ratio achieved by the doses was also compared. The targeted AUC24/MIC ratio was 400-600 to ensure efficacy and safety of the therapy. A total of 24 patients with a median age of 55.50 years were conveniently sampled. The patients were mostly male (58.3%) and were admitted to the neurosurgical ward (33.3%). Vancomycin was mainly prescribed as empirical treatment (58.3%) for a median treatment period of 5.00 days (IQR 4.00 – 7.00 days). The conventional doses had significant (p < 0.001) lower median total daily dose (2000 mg versus 2500 mg) and lower AUC24/MIC ratio (385 versus 495) as compared to personalized doses. In conclusion, the personalized pharmacokinetic dosing method was significantly more able to achieve the targeted AUC24/MIC ratio. Vancomycin personalized dosing should be considered in the Malaysian private hospital setting.

Pilot Study on non-tuberculous mycobacteria infections in Italy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Fattorini ◽  
A Iacobino ◽  
F Giannoni ◽  
Keyword(s):  
Cystic Fibrosis ◽  
Minimum Inhibitory Concentration ◽  
Pilot Study ◽  
Inhibitory Concentration ◽  
Strategic Plan ◽  
Foreign Born ◽  
Old Patients ◽  
National Strategic Plan ◽  
Reported Data ◽  
Resistance Rates

Abstract Background The rise in non-tuberculous mycobacteria (NTM) diseases has been reported worldwide, but no major information is known for Italy. The purpose of this pilot study is to release nationwide data on distribution of NTM in our country. Methods In 2016, the Istituto Superiore di Sanità (National Institute of Health) began to collect microbiological, clinical and minimum inhibitory concentration (MIC) data on NTM infections, in collaboration with hospital laboratories located in 15 out of 20 regions (Studio Multicentrico Italiano NTM, SMI-NTM), which routinely isolate and characterize NTM by commercial identification (Genotype) and MIC (Sensititre) assays. Results In 2016-2018, 32 labs reported data on 4169 NTM strains, including 644 rapid growers (15%) and 3525 slow growers (85%). The most frequent species were Mycobacterium avium (MA) (29.2%), M. intracellulare (MI) (21.5%), M. xenopi (MX) (10.6%), M. gordonae (10.6%), M. abscessus (5.9%), M. chimaera (MC) (5.1%). Overall, 88% NTM strains were isolated from pulmonary sites, 84% from Italians, 51% from men. NTM infections in Italians occurred in 75-84 years old patients, while in foreign-born people were observed in 15-44 years old patients. Strains from cystic fibrosis were 11.9%. The MICs of clarithromycin (CLA) for MA or MI peaked at 2 µg/ml, while for amikacin (AK) peaked at 16 µg/ml. When MICs were interpreted according to the 2018 Clinical and Laboratory Institute Standards (CLSI) breakpoints, MA or MI resistances for CLA were 2.6% and 2.6% respectively, while for AK they were 7.2% and 4.5%, respectively. Higher resistance rates for MA and MI were observed for moxifloxacin and linezolid. MICs of MC, MX, M. kansasii, M. marinum and rapid grower NTM were also determined and interpreted on the basis of CLSI breakpoints. Conclusions This 3-years pilot study is the basis for a future multiannual national strategic plan for surveillance of NTM infections in Italy (collection of 2019 data is in progress). Key messages This 3-years pilot study is the basis for a future multiannual national strategic plan for surveillance of NTM infections in Italy. The purpose of this pilot study is to release nationwide data on distribution of NTM in our country.

A Pilot Study of the Health of the Nation Outcome Scale as a Measurement of Outcome in a Private Psychiatric Hospital

1996 ◽  
Vol 4 (6) ◽  
pp. 319-321 ◽  
Author(s):  
Robertd Goldney ◽  
Laura J. Fisher ◽  
Sonja Walmsley ◽  
Penny Kent ◽  
Ashley W. Cooper
Keyword(s):  
Health Care ◽  
Pilot Study ◽  
Psychiatric Hospital ◽  
Psychiatric Illness ◽  
Private Hospital ◽  
Hospital Setting ◽  
Reliable Instrument

In this era of increasing accountability in health care there is a need for an easily administered reliable instrument to assess the outcome of patients treated for psychiatric illness. This need has been reviewed comprehensively by Andrews et al [1]. One of the several instruments they recommended was the Health of the Nation Outcome Scale instrument (HoNOS) [2,3]. This paper describes the introduction of the HoNOS in a private hospital setting.

Development of Gentamicin Resistance During Treatment of Escherichia coli Ventilator-Associated Pneumonia in a Neonate

2020 ◽  
pp. 089719002094012
Author(s):  
Brandi D. Newby
Keyword(s):  
Escherichia Coli ◽  
Minimum Inhibitory Concentration ◽  
Treatment Failure ◽  
Inhibitory Concentration ◽  
Peak Level ◽  
Patient Specific ◽  
Pharmacokinetic Parameters ◽  
Ventilator Associated Pneumonia ◽  
Gentamicin Resistance

A neonate born at 25 + 1/7 weeks developed ventilator-associated pneumonia at 29 + 3/7 weeks post-menstrual age with Escherichia coli that was originally sensitive to gentamicin. After 3 days of treatment with gentamicin, the minimum inhibitory concentration (MIC) changed from less than 1 mg/L to more than 16 mg/L. It appears that suboptimal gentamicin dosing led to the development of gentamicin resistance. As the patient was not improving clinically, the antibiotics were changed once the gentamicin resistance was identified. To minimize resistance and treatment failure, clinicians should consider the patient-specific pharmacokinetic parameters, achieved peak level, and the amount of time the gentamicin level will remain below the MIC of the organism being treated.

scholarly journals Successful Treatment of Cryptococcal Meningitis and Cryptococcoma with Isavuconazole in a Patient Living with HIV

2021 ◽  
Vol 7 (6) ◽  
pp. 425
Author(s):  
Brendan O’Kelly ◽  
Aia Mohamed ◽  
Colm Bergin ◽  
Fiona Lyons ◽  
Thomas R. Rogers ◽  
...  
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Cryptococcal Meningitis ◽  
Inhibitory Concentration ◽  
Area Under The Curve ◽  
Hiv Positive ◽  
Days Of Therapy ◽  
Daily Dose ◽  
Living With Hiv ◽  
Inflammatory Syndrome ◽  
Modelling Data

We describe the successful use of isavuconazole for treatment of an HIV-positive patient with cryptococcal meningitis following induction therapy with liposomal amphotericin B and flucytosine. Because the Cryptococcus neoformans isolate from cerebrospinal fluid had a borderline minimum inhibitory concentration of 8 mg/L, initial consolidation therapy was given with a daily dose of fluconazole 1200 mg based on area under the curve to minimum inhibitory concentration modelling data. Toxicity, and the radiological emergence of a cryptococcoma in the setting of immune reconstitution inflammatory syndrome, prompted a therapeutic switch to isavuconazole. Subsequent imaging after 19 weeks of isavuconazole shows a significant reduction in cryptococcoma size from 11 mm to complete resolution. The patient remains well after 210 days of therapy with a view to completion of treatment after 1 year.

scholarly journals Clinical Pharmacokinetics of Cefamandole and Ceftazidime Administered by Continuous Intravenous Infusion

2003 ◽  
Vol 47 (6) ◽  
pp. 1862-1866 ◽  
Author(s):  
J. Berkhout ◽  
L. G. Visser ◽  
P. J. van den Broek ◽  
J. A. M. van de Klundert ◽  
H. Mattie
Keyword(s):  
Animal Studies ◽  
Total Daily Dose ◽  
Pharmacokinetic Parameters ◽  
Therapeutic Concentration ◽  
Continuous Administration ◽  
Clinical Pharmacokinetics ◽  
Interindividual Differences ◽  
Daily Dose ◽  
Close Relationship ◽  
Theoretical Considerations

ABSTRACT In view of the results of animal studies as well as theoretical considerations, continuous administration of β-lactam antibiotics should be superior to intermittent administration because of the close relationship between efficacy and the duration of time in which the concentration of unbound antibiotics in plasma remains above the MIC. The aim of the present study was to establish the pharmacokinetic parameters of cefamandole and ceftazidime for patients receiving these cephalosporins by continuous infusion. The interindividual differences in the concentrations in plasma at the steady state were mainly attributable to variations in renal function, as estimated by the rate of creatinine clearance. Using these results, we derived formulas for both cephalosporins that can be used to determine on an individual basis the total daily dose needed to obtain a therapeutic concentration in plasma. These formulas were tested with a group of subsequent patients and proved to be practical and fairly reliable. For some patients, a correction for a possible underestimation of the renal clearance at presentation might be required.

scholarly journals Successful Treatment of Invasive MRSA Infections in Children Using Area Under the Vancomycin Concentration-Time Curve Divided by the Minimum Inhibitory Concentration (AUC/MIC) to Measure Vancomycin Exposure

2021 ◽  
Vol 1 (S1) ◽  
pp. s31-s31
Author(s):  
Leslie Chiang ◽  
Alice Pong ◽  
John Bradley ◽  
Paige Anderson ◽  
William Murray
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Clinical Outcomes ◽  
Inhibitory Concentration ◽  
Renal Toxicity ◽  
Time Curve ◽  
Vancomycin Concentration ◽  
Concentration Time ◽  
Serum Trough ◽  
Trough Concentrations ◽  
Dosing Method

Background: Vancomycin is the treatment of choice for invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Previous guidelines issued by the Infectious Diseases Society of America (IDSA) recommended targeting vancomycin serum trough concentrations of 15–20 mg/L; however, troughs <15 mg/L are also associated with increased odds of renal toxicity. To minimize toxicity, recently updated ASHP/IDSA/PIDS vancomycin dosing guidelines recommend the use of an area under the vancomycin concentration-time curve divided by the minimum inhibitory concentration (AUC/MIC) pharmacodynamic index to measure vancomycin exposure, with an AUC/MIC ratio >400 correlating with clinical efficacy. However, data on vancomycin therapeutic drug monitoring (TDM) in children are limited. Our institutional practice since January 2009 has been to use AUC/MIC, rather than serum trough concentrations, to guide vancomycin dosing. In this study, we describe clinical outcomes in vancomycin-treated children with invasive MRSA infections using this dosing method. Methods: We performed a retrospective chart review of children hospitalized with invasive MRSA infections between 2006 and 2019 at Rady Children’s Hospital in San Diego, California. Clinical, microbiologic, and pharmacologic data including the site of MRSA infection, clinical failure or cure, occurrence of acute kidney injury (AKI), vancomycin MIC, vancomycin AUC, and serum trough concentrations were collected. Results: In total, 61 invasive MRSA cases were reviewed: 20 were admitted January 2016 through December 2008, and 41 were admitted January 2009 through June 2019 (Figure 1). Most patients did not have medical comorbidities. The most common types of infections were primary bacteremia (34%) and osteomyelitis (32%). Of 61 children, 50 (82%) had positive clinical outcomes regardless of vancomycin dosing method. Of 20 patients, 8 (40%) admitted prior to January 2009 developed AKI, compared with 5 (12%) of 41 patients admitted after January 2009. Conclusions: In our retrospective review, most patients had clinically successful outcomes regardless of which dosing strategy was used. We found higher rates of renal toxicity in patients who were admitted prior to 2009, with TDM based on measuring peak and trough concentrations, compared with those using AUC/MIC for TDM. Our findings suggest that AUC/MIC TDM for invasive MRSA infections may be associated with lower rates of renal toxicity.Funding: NoDisclosures: None

Clinical Evaluation of Rectally Administered Ampicillin in Acute Otitis Media

1988 ◽  
Vol 16 (5) ◽  
pp. 376-385 ◽  
Author(s):  
B. K. V. Bergström ◽  
S. O. Bertilson ◽  
G. Movin
Keyword(s):  
Body Weight ◽  
Minimum Inhibitory Concentration ◽  
Clinical Outcome ◽  
Otitis Media ◽  
Inhibitory Concentration ◽  
Plasma Concentrations ◽  
Acute Otitis Media ◽  
Good Alternative ◽  
Respiratory Pathogens ◽  
Daily Dose

An ampicillin suppository was compared with amoxycillin suspension in the treatment of acute otitis media in children. Both antibiotics were given three times daily for 5 days in a daily dose of 25–50 mg/kg body weight. Safety was evaluated in 454 patients in the group given suppository and in 229 given the suspension, and 421 and 229 patients, respectively, were evaluable for efficacy. Ampicillin was rapidly absorbed and produced plasma concentrations well above the minimum inhibitory concentration for common respiratory pathogens. The overall clinical outcome was satisfactory (cured plus improved) in 89% of the patients given the suppository and in 86% given the suspension. Gastro-intestinal disturbances occurred in 28.4% of the patients given the suppository compared with 14.4% of those given the suspension. Perianal irritation was recorded in 12.1% of the patients given the suppository and in 5.2% of those given the suspension. Treatment was interrupted in 9.8% of patients given the suppository and in 0.9% of those given the suspension. In spite of these discomforts rectally administered ampicillin is considered to be a good alternative in children when oral medication is not feasible.

scholarly journals An Evaluation of Gentamicin, Tobramycin, and Amikacin Pharmacokinetic/Pharmacodynamic Parameters in HIV-Infected Children

2003 ◽  
Vol 8 (4) ◽  
pp. 274-283
Author(s):  
Juan Carlos Rodriguez ◽  
Steve Schoenike ◽  
Gwendolyn B. Scott ◽  
Maria T. Rossique-Gonzalez ◽  
Orlando Gomez-Marin
Keyword(s):  
Steady State ◽  
Inhibitory Concentration ◽  
Pharmacokinetic Parameters ◽  
Serum Concentrations ◽  
Klebsiella Species ◽  
Once Daily ◽  
Gram Negative ◽  
Trough Serum ◽  
Steady State Model ◽  
Dosing Method

BACKGROUND The purpose of the study was to calculate gentamicin, tobramycin, and amikacin pharmacokinetic parameters in HIV-infected children and compare conventional multiple daily aminoglycoside dosing to once-daily aminoglycoside (ODA) dosing in attaining peak serum aminoglycoside concentrations (SACs) to minimum inhibitory concentration for 90% of isolates (MIC90) ratios ≥8 against selected pathogens. METHODS Patients (&lt;13yrs) receiving an aminoglycoside (15 patients/drug) in the treatment of gram-negative infection were studied. Intravenous gentamicin/ tobramycin were administered at a dose of 6–7.5 mg/kg/day and amikacin at 20–30 mg/kg/d divided every 8 hrs. Peak and trough serum concentrations were obtained and pharmacokinetic parameters were calculated utilizing a one-compartment steady-state model. SACs for gentamicin/tobramycin dosed at 7.5 mg/kg and amikacin at 22.5 mg/kg once daily were simulated using the calculated pharmacokinetic parameters. Peak SAC:MIC90 ratios were calculated for each dosing method. RESULTS Mean pharmacokinetic parameters were within 1 standard deviation of reported literature values. Mean peak:MIC90 ratio of ≥8 was attained only for Klebsiella species (MIC90 1 μg/mL) using conventional gentamicin/tobramycin dosing whereas mean amikacin peak:MIC90 ratios ≥8 were reached for Klebsiella, Enterobacter, and Citrobacter species (MIC90 4 μg/mL). ODA simulations predicted gentamicin/tobramycin peak:MIC90 ratios ≥8 in 100% of patients with an organism-MIC90 of 1 μcg/mL and in 80% of patients with an organism-MIC90 of 2 μg/mL. Amikacin peak:MIC90 ratio ≥8 was predicted for 93% of patients with an organism-MIC90 of 4 μg/mL but in only 27% if the MIC90 was 8 μg / mL. CONCLUSION Optimal peak SAC:MIC90 ratios using conventional aminoglycoside dosing were predicted only for organisms with low MIC90 values. ODA dosing represents an option for improving pharmacodynamic outcomes.

Sign in / Sign up

Export Citation Format

Share Document