scholarly journals Efficacy and Safety of Continuous Infusion of Vancomycin in Children: A Systematic Review

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 912
Author(s):  
Marta Alonso-Moreno ◽  
Marta Mejías-Trueba ◽  
Laura Herrera-Hidalgo ◽  
Walter Alfredo Goycochea-Valdivia ◽  
María Victoria Gil-Navarro
Keyword(s):  
Continuous Infusion ◽  
Clinical Efficacy ◽  
Pediatric Population ◽  
Intermittent Infusion ◽  
Target Population ◽  
Population Characteristics ◽  
Efficacy And Safety ◽  
Target Attainment ◽  
Bibliographic Search ◽  
Administration Method

Vancomycin is used to treat a wide variety of infections within the pediatric population. In adults, continuous infusion of vancomycin (CIV) has been evaluated as an alternative to intermittent infusion of vancomycin (IIV) with potential advantages. In children, the use of CIV is increasing; however, data is currently limited. The objective is to provide efficacy and safety evidence for CIV within this population. The review was carried out following PRISMA guidelines. A bibliographic search was performed for studies on PubMed and EMBASE. Clinical trials and observational studies that reported clinical efficacy and/or target attainment of CIV in pediatrics were included. Articles were reviewed to assess their design and target population, characteristics of vancomycin treatment and the main findings in terms of safety and efficacy. A total of 359 articles were identified, of which seven met the inclusion criteria. All of them evaluated the target attainment, six assessed safety but only three assessed clinical efficacy. The best administration method for this antibiotic within the pediatric population is still unknown due to limited evidence. However, studies conducted thus far suggest pharmacokinetic advantages for CIV. Further investigation is required, in particular for studies comparing IIV with CIV for clinical efficacy and toxicity outcomes.

scholarly journals Target Attainment and Clinical Efficacy for Vancomycin in Neonates: Systematic Review

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 347
Author(s):  
Marta Mejías-Trueba ◽  
Marta Alonso-Moreno ◽  
Laura Herrera-Hidalgo ◽  
Maria Victoria Gil-Navarro
Keyword(s):  
Clinical Practice ◽  
Clinical Efficacy ◽  
Therapeutic Regimen ◽  
Serum Concentrations ◽  
Target Attainment ◽  
Trough Serum ◽  
Serious Infections ◽  
Bibliographic Search ◽  
The Relationship ◽  
Neonatal Population

Vancomycin is commonly used as a treatment for neonatal infections. However, there is a lack of consensus establishing the optimal vancomycin therapeutic regimen and defining the most appropriate PK/PD parameter correlated with the efficacy. A recent guideline recommends AUC–guided therapeutic dosing in treating serious infections in neonates. However, in clinical practice, trough serum concentrations are commonly used as a surrogate PKPD index for AUC24. Despite this, target serum concentrations in a neonatal population remain poorly defined. The objective is to describe the relationship between therapeutic regimens and the achievement of clinical or pharmacokinetic outcomes in the neonatal population. The review was carried out following PRISMA guidelines. A bibliographic search was manually performed for studies published on PubMed and EMBASE. Clinical efficacy and/or target attainment and the safety of vancomycin treatment were evaluated through obtaining serum concentrations. A total of 476 articles were identified, of which 20 met the inclusion criteria. All of them evaluated the target attainment, but only two assessed the clinical efficacy. The enormous variability concerning target serum concentrations is noteworthy, which translates into a difficulty in determining which therapeutic regimen achieves the best results. Moreover, there are few studies that analyze clinical efficacy results obtained after reaching predefined trough serum concentrations, this information being essential for clinical practice.

Comparison of continuous versus intermittent infusion cyclosporine and impact on transplant related outcomes in allogeneic transplant recipients

2020 ◽  
pp. 107815522097060
Author(s):  
Jeff A Engle ◽  
Justin A Wasko ◽  
John Rogosheske ◽  
Todd E Defor ◽  
Armin Rashidi
Keyword(s):  
Overall Survival ◽  
Continuous Infusion ◽  
Medical Center ◽  
Chronic Gvhd ◽  
Intermittent Infusion ◽  
University Of Minnesota ◽  
Allogeneic Hct ◽  
Increased Risk ◽  
Administration Method ◽  
Grade Ii

Introduction Continuous infusion (CIVI) cyclosporine (CsA) is an alternative for allograft recipients intolerant of twice daily infusions (TDI). The importance of achieving therapeutic levels of CsA early after allogeneic HCT has been demonstrated in previous studies. Our study evaluated the incidence of acute graft versus host disease (GVHD) and survival among patients receiving CIVI vs. TDI CsA during their first allogeneic HCT. Methods A retrospective study of adult patients undergoing first allogeneic HCT at the University of Minnesota Medical Center between 2011 and 2017. Patients were grouped according to the administration method. The primary outcome was the occurrence of acute grade II-IV GVHD by day +180. Secondary outcomes included the 1-year incidence of chronic GVHD, relapse, and overall survival. Results 42 patients intolerant of TDI CsA received CsA via CIVI for >48 hours for a median of 9 days (range, 3–32 days). CsA concentrations were similar between groups. We found no difference between the rates of grade II–IV acute (45% vs 53%, p = 0.59) or chronic (17% vs 30%, p = 0.20) GVHD or overall survival (57% vs 67%, p = 0.10). Subgroup analysis of patients that received myeloablative conditioning or umbilical cord blood did not reveal significant differences in GVHD or overall survival. Cumulative incidence of relapse was higher among the continuous infusion group (39% vs. 23%, p < 0.01). Conclusion Due to the finding of increased risk of relapse, cyclosporine should be administered as traditional twice daily infusion unless necessary. A prospective clinical trial is needed to confirm these results.

scholarly journals Optimizing Antibiotic Treatment Strategies for Neonates and Children: Does Implementing Extended or Prolonged Infusion Provide any Advantage?

Antibiotics ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 329
Author(s):  
Paola Costenaro ◽  
Chiara Minotti ◽  
Elena Cuppini ◽  
Elisa Barbieri ◽  
Carlo Giaquinto ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Pediatric Population ◽  
Relevant Literature ◽  
Treatment Strategies ◽  
Intermittent Infusion ◽  
Target Attainment ◽  
Free Concentration ◽  
Dosing Strategy ◽  
Further Development ◽  
Antibiotic Infusion

Optimizing the use of antibiotics has become mandatory, particularly for the pediatric population where limited options are currently available. Selecting the dosing strategy may improve overall outcomes and limit the further development of antimicrobial resistance. Time-dependent antibiotics optimize their free concentration above the minimal inhibitory concentration (MIC) when administered by continuous infusion, however evidences from literature are still insufficient to recommend its widespread adoption. The aim of this review is to assess the state-of-the-art of intermittent versus prolonged intravenous administration of antibiotics in children and neonates with bacterial infections. We identified and reviewed relevant literature by searching PubMed, from 1 January 1 2000 to 15 April 2020. We included studies comparing intermittent versus prolonged/continuous antibiotic infusion, among the pediatric population. Nine relevant articles were selected, including RCTs, prospective and retrospective studies focusing on different infusion strategies of vancomycin, piperacillin/tazobactam, ceftazidime, cefepime and meropenem in the pediatric population. Prolonged and continuous infusions of antibiotics showed a greater probability of target attainment as compared to intermittent infusion regimens, with generally good clinical outcomes and safety profiles, however its impact in terms on efficacy, feasibility and toxicity is still open, with few studies led on children and adult data not being fully extendable.

Testing Antiepileptic Drugs In Children

1994 ◽  
Vol 9 (1_suppl) ◽  
pp. S26-S32 ◽  
Author(s):  
Jacqueline A. French ◽  
Ilo Leppik
Keyword(s):  
United States ◽  
Clinical Trials ◽  
Antiepileptic Drugs ◽  
Safety Profile ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Target Population ◽  
The United States ◽  
Efficacy And Safety ◽  
Patients With Epilepsy

Few drugs have been approved by the Food and Drug Administration specifically for the treatment of pediatric patients with epilepsy in the United States. There are many factors that make tests of drugs in this group different from studies among adults. This report reviews issues that must be considered in designing studies that will help bring to market antiepileptic drugs for children. Information on the wide variety of antiepileptic drugs rapidly being developed can only be obtained through well-controlled, well-designed clinical trials. Despite the obstacles and pitfalls, trials among the pediatric population are necessary to establish the unique efficacy and safety profile of each drug and to determine the target population most likely to benefit from each drug. (J Child Neurol 1994;9(Suppl):S26-S32)

ENDOSCOPIC TREATMENT OF CHRONIC PANCREATITIS IN PEDIATRIC POPULATION: LONG-TERM EFFICACY AND SAFETY

2019 ◽  
Author(s):  
D Kohoutova ◽  
A Tringali ◽  
G Paparella ◽  
V Perri ◽  
I Boškoski ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Treatment ◽  
Pediatric Population ◽  
Efficacy And Safety ◽  
Term Efficacy

Clinical efficacy and safety of the combination therapy of peginterferon alpha and ribavirin in cirrhotic patients with HCV infection

2010 ◽  
Vol 16 (1) ◽  
pp. 38 ◽  
Author(s):  
Hong Ryeol Cheong ◽  
Hyun Young Woo ◽  
Jeong Heo ◽  
Ki Tae Yoon ◽  
Dong Uk Kim ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Clinical Efficacy ◽  
Hcv Infection ◽  
Efficacy And Safety ◽  
Cirrhotic Patients

Review on the Clinical Pharmacology of Hydroxychloroquine Sulfate for the Treatment of COVID-19

2020 ◽  
Vol 21 (6) ◽  
pp. 427-435 ◽  
Author(s):  
Cheng Cui ◽  
Siqi Tu ◽  
Valerie Sia Jie En ◽  
Xiaobei Li ◽  
Xueting Yao ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Clinical Efficacy ◽  
Relevant Literature ◽  
The United States ◽  
Efficacy And Safety ◽  
Open Label ◽  
Infected People ◽  
Treatment Regimens ◽  
Therapeutic Drugs

Background: As the number of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infected people is greatly increasing worldwide, the international medical situation becomes very serious. Potential therapeutic drugs, vaccine and stem cell replacement methods are emerging, so it is urgent to find specific therapeutic drugs and the best treatment regimens. After the publications on hydroxychloroquine (HCQ) with anti- SARS-COV-2 activity in vitro, a small, non-randomized, open-label clinical trial showed that HCQ treatment was significantly associated with reduced viral load in patients with coronavirus disease-19 (COVID-19). Meanwhile, a large prophylaxis study of HCQ sulfate for COVID-19 has been initiated in the United States. HCQ offered a promising efficacy in the treatment of COVID-19, but the optimal administration is still being explored. Methods: We used the keyword "hydroxychloroquine" to conduct a literature search in PubMed to collect relevant literature on the mechanism of action of HCQ, its clinical efficacy and safety, pharmacokinetic characteristics, precautions for clinical use and drug interactions to extract and organize information. Results: This paper reviews the mechanism, clinical efficacy and safety, pharmacokinetic characteristics, exposureresponse relationship and precautions and drug interactions of HCQ, and summarizes dosage recommendations for HCQ sulfate. Conclusion: It has been proved that HCQ, which has an established safety profile, is effective against SARS-CoV-2 with sufficient pre-clinical rationale and evidence. Data from high-quality clinical trials are urgently needed worldwide.

Galcanezumab for the prevention of migraine

2020 ◽  
Author(s):  
Lindsay M Frerichs ◽  
Deborah I Friedman
Keyword(s):  
Monoclonal Antibody ◽  
Clinical Efficacy ◽  
Preventive Treatment ◽  
Calcitonin Gene Related Peptide ◽  
Efficacy And Safety ◽  
Related Peptide ◽  
Calcitonin Gene

Migraine is a common and disabling disorder affecting approximately 1.02 billion people worldwide. Calcitonin gene-related peptide (CGRP) has been identified as playing an important role in the pathophysiology of migraine and several migraine-specific therapies targeting the CGRP ligand or its receptor have been approved since 2018 for the acute and preventive treatment of migraine. This review focuses on the pharmacology, clinical efficacy and safety/tolerability of galcanezumab, an anti-CGRP monoclonal antibody approved for the prevention of migraine.

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