Erratum: E. A. Sokova et al., Risk factors and characteristics of adverse reactions associated with the use of beta-lactam antibiotics in older patients

Sоkоvа Е.А., Arkhipov V.V., Demidova O.A., Mazerkina I.A., Alexandrova T.V., Zhuravleva M.V. Risk factors and characteristics of adverse reactions associated with the use of beta-lactam antibiotics in older patients. Bezopasnost’ i risk farma koterapii = Safety and Risk of Pharmacotherapy. 2021;9(3):128–135. https://doi.org/10.30895/2312-7821-2021-9-3-128-135Dear readers, a technical error was made on page 134, issue 3 of the Safety and Risk of Pharmacotherapy, 2021 (2021;9(3):128–135). The following statement:“Acknowledgements. The study reported in this publication was carried out as part of a publicly funded research project No. 056-00005-21-00 and was supported by the Scientific Centre for Expert Evaluation of Medicinal Products (R&D public accounting No. 121021800098-4)”should read:“Acknowledgements. The study reported in this publication was carried out as part of a publicly funded research project No. 056-00005-21-00 and was supported by the Scientific Centre for Expert Evaluation of Medicinal Products (R&D public accounting No. 121022000154-2)”.The correction did not have any effect on the conclusions made by the authors.The text of the online version of the journal was corrected accordingly.

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Risk Factors and Characteristics of Adverse Reactions Associated with the Use of Beta-Lactam Antibiotics in Older Patients

Safety and Risk of Pharmacotherapy ◽

10.30895/2312-7821-2021-9-3-128-135 ◽

2021 ◽

Vol 9 (3) ◽

pp. 128-135

Author(s):

E. A. Sokova ◽

V. V. Arkhipov ◽

O. A. Demidova ◽

I. A. Mazerkina ◽

T. V. Alexandrova ◽

...

Keyword(s):

Risk Factors ◽

Adverse Drug Reactions ◽

Older Patients ◽

Geriatric Patients ◽

Scientific Literature ◽

Community Acquired Pneumonia ◽

Drug Reactions ◽

Beta Lactam ◽

Younger Patients ◽

Beta Lactam Antibiotics

The frequency of adverse drug reactions (ADRs) in older patients is approximately 11.0%, according to scientific literature. Antibiotics are the third largest group (19.5%) of medicinal products in terms of ADR frequency in geriatric patients. Beta-lactam antibiotics are the empiric treatment of choice for older outpatients and inpatients with community-acquired pneumonia. The mortality in this group of patients accounts for 85% of the overall mortality from community-acquired pneumonia. The aim of the study was to analyse scientific data on risk factors and characteristics of adverse drug reactions associated with the use of beta-lactam antibiotics in older patients. Specificity of ADRs to beta-lactam antibiotics in this group of patients is due to age-related changes in pharmacokinetics and pharmacodynamics as well as polymorbidity and polypharmacy. The analysis of scientific literature demonstrated that there have not been so many pharmacoepidemiological studies in this group of patients, and their results have been inconsistent. The frequency, causes, and clinical manifestations of ADRs in geriatric patients are diverse and differ considerably from those in younger patients. Of the most widely used antibiotics, ceftriaxone and cefaclor exhibited a statistically lower risk of ADRs in older patients than in younger patients. At the same time, ceftriaxone was associated with a relatively higher frequency of serious ADRs in older patients as compared to younger patients, whereas the frequency of serious ADRs was lower with cefaclor. The likelihood of nephrotoxic, neurotoxic, and hepatotoxic ADRs associated with the use of beta-lactam antibiotics is becoming more and more obvious but it is still underestimated in clinical and geriatric practice. Safety monitoring, therapeutic drug monitoring with due consideration of ADR risk factors in older patients, and inclusion of older patients in clinical trials of antimicrobial drugs, would improve efficacy and safety of antibiotic treatment.

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Allergy to beta-lactam antibiotics in children: Risk factors for a positive diagnostic work-up

Allergologia et Immunopathologia ◽

10.1016/j.aller.2020.01.005 ◽

2020 ◽

Vol 48 (5) ◽

pp. 417-423 ◽

Cited By ~ 1

Author(s):

E. Dias de Castro ◽

F. Carolino ◽

L. Carneiro-Leão ◽

J. Barbosa ◽

L. Ribeiro ◽

...

Keyword(s):

Risk Factors ◽

Beta Lactam ◽

Beta Lactam Antibiotics ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

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Generalized Periodic Discharges With Triphasic Morphology in the Setting of Aztreonam Neurotoxicity

Clinical EEG and Neuroscience ◽

10.1177/1550059420917842 ◽

2020 ◽

Vol 52 (1) ◽

pp. 66-68

Author(s):

Andrew Billnitzer ◽

Peter W. Kaplan

Keyword(s):

Risk Factors ◽

Gaba Receptor ◽

Kidney Injury ◽

Neurological Injury ◽

Beta Lactam ◽

Multiple Risk Factors ◽

Periodic Discharges ◽

Beta Lactam Antibiotics ◽

Neurotoxic Effects ◽

Lactam Ring

Generalized periodic discharges with triphasic morphology (GPDs + TWm) have been reported with multiple metabolic and drug toxicities. Beta-lactam antibiotics in some cases can cause neurotoxicity with GPDs + TWm on EEG. There are no reports in the literature of aztreonam causing neurotoxicity and GPDs + TWm. Here we describe GPDs + TWm and encephalopathy developing in a patient with underlying dementia and acute kidney injury who was started on aztreonam for cystitis. Neurotoxic effects of beta-lactam antibiotics have been well studied at this point, likely related to GABA receptor antagonism by the beta lactam ring. Risk factors for toxicity include, advanced age, prior neurological injury and decreased renal clearance. This patient carried multiple risk factors for beta-lactam neurotoxicity. Discontinuation of aztreonam led to a resolution of GPDs + TWm on EEG, and regression of encephalopathy.

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Failure of target attainment of beta-lactam antibiotics in critically ill patients and associated risk factors: a two-center prospective study (EXPAT)

Critical Care ◽

10.1186/s13054-020-03272-z ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Alan Abdulla ◽

Annemieke Dijkstra ◽

Nicole G. M. Hunfeld ◽

Henrik Endeman ◽

Soma Bahmany ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Male Gender ◽

Beta Lactam ◽

Target Attainment ◽

Dosing Interval ◽

Beta Lactam Antibiotics ◽

Antibiotic Dosing

Abstract Background Early and appropriate antibiotic dosing is associated with improved clinical outcomes in critically ill patients, yet target attainment remains a challenge. Traditional antibiotic dosing is not suitable in critically ill patients, since these patients undergo physiological alterations that strongly affect antibiotic exposure. For beta-lactam antibiotics, the unbound plasma concentrations above at least one to four times the minimal inhibitory concentration (MIC) for 100% of the dosing interval (100%ƒT > 1–4×MIC) have been proposed as pharmacodynamic targets (PDTs) to maximize bacteriological and clinical responses. The objectives of this study are to describe the PDT attainment in critically ill patients and to identify risk factors for target non-attainment. Methods This prospective observational study was performed in two ICUs in the Netherlands. We enrolled adult patients treated with the following beta-lactam antibiotics: amoxicillin (with or without clavulanic acid), cefotaxime, ceftazidime, ceftriaxone, cefuroxime, and meropenem. Based on five samples within a dosing interval at day 2 of therapy, the time unbound concentrations above the epidemiological cut-off (ƒT > MICECOFF and ƒT > 4×MICECOFF) were determined. Secondary endpoints were estimated multivariate binomial and binary logistic regression models, for examining the association of PDT attainment with patient characteristics and clinical outcomes. Results A total of 147 patients were included, of whom 63.3% achieved PDT of 100%ƒT > MICECOFF and 36.7% achieved 100%ƒT > 4×MICECOFF. Regression analysis identified male gender, estimated glomerular filtration rate (eGFR) ≥ 90 mL/min/1.73 m2, and high body mass index (BMI) as risk factors for target non-attainment. Use of continuous renal replacement therapy (CRRT) and high serum urea significantly increased the probability of target attainment. In addition, we found a significant association between the 100%ƒT > MICECOFF target attainment and ICU length of stay (LOS), but no significant correlation was found for the 30-day survival. Conclusions Traditional beta-lactam dosing results in low target attainment in the majority of critically ill patients. Male gender, high BMI, and high eGFR were significant risk factors for target non-attainment. These predictors, together with therapeutic drug monitoring, may help ICU clinicians in optimizing beta-lactam dosing in critically ill patients. Trial registration Netherlands Trial Registry (EXPAT trial), NTR 5632. Registered on 7 December 2015.

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Cross With Caution: Antibiotic Cross-Reactivity and Co-Reactivity Patterns in Severe Cutaneous Adverse Reactions

Frontiers in Immunology ◽

10.3389/fimmu.2021.601954 ◽

2021 ◽

Vol 12 ◽

Author(s):

Grace Thompson ◽

Andrew McLean-Tooke ◽

Michaela Lucas

Keyword(s):

Adverse Reactions ◽

Case Series ◽

Tertiary Hospital ◽

Cross Reactivity ◽

Beta Lactam ◽

Beta Lactam Antibiotics ◽

Lactam Antibiotic ◽

Practical Algorithm ◽

Severe Cutaneous Adverse Reactions ◽

Cutaneous Adverse Reactions

Current understanding of cross-reactivity in severe cutaneous adverse reactions to beta-lactam antibiotics is limited, thereby making recommendations for future prescribing difficult. The underlying immunopathogenesis of these reactions is not completely understood but involves interactions between small molecule drugs, T cells and HLA molecules. Historically, these reactions were considered to be specific to the inciting antibiotic and therefore likely to have minimal cross-reactivity. We assessed patients presenting with non-SJS/TEN severe cutaneous adverse reactions to a tertiary hospital drug allergy clinic. In our case series cross-reactivity or co-reactivity commonly occurred among the beta-lactam antibiotic class, however further research is required to investigate and understand patterns of cross-reactivity. Based on our experience we provide clinicians with a practical algorithm for testing for cross-reactivity in non-SJS/TEN severe cutaneous adverse reactions.

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