51
|
Haruki Y, Hagiya H, Haruki M, Inoue Y, Sugiyama T. Concomitant vancomycin and piperacillin/tazobactam treatment is associated with an increased risk of acute kidney injury in Japanese patients. J Infect Chemother 2020; 26:1026-1032. [DOI: 10.1016/j.jiac.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
|
52
|
Therapeutic drug monitoring of commonly used anti-infective agents: A nationwide cross-sectional survey of Australian hospital practices. Int J Antimicrob Agents 2020; 56:106180. [PMID: 32987102 DOI: 10.1016/j.ijantimicag.2020.106180] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/01/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022]
Abstract
When performed according to best-practice principles, therapeutic drug monitoring (TDM) can optimise anti-infective treatment and directly benefit clinical outcomes. We evaluated TDM performance and clinical decision-making for established anti-infective agents amongst Australian hospitals. A nationwide cross-sectional survey was conducted between August and September 2019. The survey consisted of multiple-choice questions regarding TDM of anti-infective agents in general as well as clinical vignettes specific to vancomycin, gentamicin and voriconazole. We sought to survey all Australian hospitals operating both in the public and private health sectors. Responses were captured from 85 unique institutions, from all Australian states and territories. Regarding guidelines, 26% of hospitals did not have endorsed guidelines to advise on the ordering, sampling and interpretation of TDM for any anti-infective agent. Admitting teams were predominantly responsible for ordering TDM (85%) and interpreting results (76%). Only 51% of hospitals had access to dose prediction software, with access generally better amongst principal referral (69%) (P = 0.01) and children's hospitals (100%) (P = 0.04). Whenever a laboratory-derived minimum inhibitory concentration (MIC) was not available to guide dosing decisions, a surrogate target MIC was assumed in 77% of hospitals. This was based on a 'worst-case' scenario infection in 11% of hospitals. The rates of clinical practice consistent with current guideline recommendations across all aspects of TDM were demonstrated to be 0% for vancomycin, 4% for gentamicin and 35% for voriconazole. At present, there is significant institutional variability in the clinical practice of TDM for anti-infective agents in Australia for established TDM drugs.
Collapse
|
53
|
Shah R, Hoffman GR, El-Dallal M, Goldowsky AM, Chen Y, Feuerstein JD. Is Therapeutic Drug Monitoring for Anti-tumour Necrosis Factor Agents in Adults With Inflammatory Bowel Disease Ready for Standard of Care? A Systematic Review and Meta-analysis. J Crohns Colitis 2020; 14:1057-1065. [PMID: 32064510 DOI: 10.1093/ecco-jcc/jjaa029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Using therapeutic drug monitoring [TDM] in adult patients with inflammatory bowel disease [IBD] remains controversial. We conducted a systematic review and meta-analysis to answer four clinical PICO [Population, Intervention, Comparator, Outcome] questions. METHODS We searched MEDLINE, Embase, Web of Science, and Cochrane Central from inception to June 30, 2019. Remission was defined by the manuscripts' definitions of clinical remission. Data were analysed using RevMan 5.3. Quality of evidence was assessed with GRADE methodology. RESULTS We identified and screened 3365 abstracts and 11 articles. PICO 1 Reactive vs No TDM: six studies pooled showed 57.1% [257/450] failed to achieve remission following reactive TDM vs 44.7% [268/600] in the no TDM group (risk ratio [RR]: 1.14; 95% confidence interval [CI] 0.88-1.47). PICO 2 Proactive vs no TDM: five studies pooled showed 19.5% [75/384] failed to maintain remission in the proactive TDM group vs 33.4% [248/742] in the no TDM group [RR: 0.60; 95% CI 0.35-1.04]. PICO 3 Proactive vs Reactive TDM: two retrospective studies pooled showed 14.2% [26/183] failure to maintain remission in the proactive TDM group and 64.7% [119/184] in the reactive TDM group [RR: 0.22; 95% CI 0.15-0.32]. PICO 4 TDM [proactive/reactive] vs No TDM: we pooled 10 studies showing 39.7% [332/837] failed to achieve remission in the TDM [proactive/reactive] cohort vs 40.3% [428/1063] in the no TDM cohort [RR: 0.94; 95% CI 0.77-1.14]. Overall, the quality of evidence in each PICO was very low when using GRADE. CONCLUSIONS This meta-analysis shows that data supporting use of TDM in adults are limited and of very low quality. Further well-designed randomized controlled trials are needed to determine the place of TDM in clinical practice.
Collapse
Affiliation(s)
- Raj Shah
- Division of Gastroenterology and Liver Disease, Department of Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gila R Hoffman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mohammed El-Dallal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Ye Chen
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
54
|
Wallenburg E, ter Heine R, Schouten JA, Brüggemann RJ. Personalised antimicrobial dosing: standing on the shoulders of giants. Int J Antimicrob Agents 2020; 56:106062. [DOI: 10.1016/j.ijantimicag.2020.106062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/02/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
|
55
|
Hennessy K, Capparelli EV, Romanowski G, Alejandro L, Murray W, Benador N. Intraperitoneal vancomycin for peritoneal dialysis-associated peritonitis in children: Evaluation of loading dose guidelines. Perit Dial Int 2020; 41:202-208. [DOI: 10.1177/0896860820950924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Current pediatric International Society for Peritoneal Dialysis guidelines for initial treatment of peritoneal dialysis (PD)-associated peritonitis suggest either monotherapy with cefepime or double therapy with first-generation cephalosporin or glycopeptide and ceftazidime or aminoglycoside. When using vancomycin, the intraperitoneal (IP) recommended pediatric loading dosage is 1000 mg/L of dialysate. This is based on adult pharmacokinetic (PK) studies and roughly translates to the adult recommendation where 30 mg/kg in 2 L is approximately 1000 mg/L. However, since the dialysate volume in pediatric patients is normalized to body surface area and not weight, the current recommended dosing can result in high vancomycin exposure in children. Vancomycin can potentially cause adverse effects. We aimed to determine if the IP vancomycin dosing of 1000 mg/L was causing elevated vancomycin levels and to offer possible dosing recommendations based on PK modeling and simulation. Methods: Retrospective review of pediatric patients who had been treated with IP vancomycin for PD-associated peritonitis. Vancomycin levels obtained for clinical monitoring were analyzed using NONMEM to generate population and individual (empiric Bayesian) estimates of vancomycin PK parameters and estimated peak levels. Predicted vancomycin peaks were also simulated from virtual pediatrics patients 3–70 kg following various dosing strategies. Results: Six episodes of peritonitis in three patients were analyzed. In the two episodes treated with 1000 mg/L, the first vancomycin levels (h post) were 95.6 ug/mL (3) and 49 (33) and following 500 mg/L were 33.2 (11), 30.2 (11), 23.6 (24), and 22.1 (11). All patients were cured of their peritonitis without the need for catheter removal. Based on our population PK model, a 1000 mg/L IP vancomycin loading dose will typically result in peak > 50 mg/L in patients weighing <35 kg and >60 mg/L in patients <15 kg. Vancomycin levels will remain above 20 mg/L for over 2 days without additional vancomycin dosing. Conclusion: The data suggest that a loading dose of vancomycin 1000 mg/L leads to higher than desired vancomycin levels and should be lowered. A 500 mg/L loading dosing appears more appropriate and needs further study.
Collapse
Affiliation(s)
- Kathleen Hennessy
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Edmund V Capparelli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Nadine Benador
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Rady Children’s Hospital, San Diego, CA, USA
| |
Collapse
|
56
|
Lewis SJ, Mueller BA. Evaluation and Development of Vancomycin Dosing Schemes to Meet New AUC/MIC Targets in Intermittent Hemodialysis Using Monte Carlo Simulation Techniques. J Clin Pharmacol 2020; 61:211-223. [PMID: 32851685 DOI: 10.1002/jcph.1727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022]
Abstract
Published vancomycin dosing recommendations for patients receiving maintenance hemodialysis were not designed to meet newly recommended 24-hour area under the curve/minimum inhibitory concentration (AUC24h /MIC) pharmacokinetic/pharmacodynamic targets. The aims of this study were to predict pharmacokinetic/pharmacodynamic target attainment rates with a commonly used vancomycin regimen and to design a new dosing scheme incorporating therapeutic drug monitoring (TDM) to maximize target attainment in patients receiving vancomycin and hemodialysis with high- or low-flux hemodialyzers. Vancomycin pharmacokinetic- and dialysis-specific parameters were incorporated into Monte Carlo simulations (MCS). A commonly used vancomycin regimen was modeled to determine its likelihood of attaining AUC24h /MIC targets for 1 week of thrice-weekly hemodialysis treatments. MCS was then used to develop optimal initial vancomycin dosing for patients receiving intradialytic or postdialytic vancomycin administration with either high- or low-flux hemodialyzers. Finally, a new MCS model incorporating TDM was built to further optimize the probability of pharmacokinetic/pharmacodynamic target attainment. Traditional vancomycin dosing methods are unlikely to meet AUC24h /MIC targets. Vancomycin doses necessary to attain AUC24h /MIC targets are significantly influenced by hemodialyzer permeability and whether vancomycin is administered intradialytically or after hemodialysis. Depending on dialyzer type and whether vancomycin is administered during or after hemodialysis, loading doses of 25 to 35 mg/kg followed by maintenance doses of 7.5 to 15 mg/kg are necessary to reach minimum AUC24h /MIC targets in 90% of virtual patients. For a 3-day interdialytic period, a 30% higher maintenance dose is required to maintain target attainment. Dosing based on a single vancomycin serum concentration obtained prior to the second dialysis session greatly enhances the probability of target attainment.
Collapse
Affiliation(s)
- Susan J Lewis
- Department of Pharmacy Practice, University of Findlay College of Pharmacy, Findlay, Ohio, USA.,Pharmacy Department, Mercy Health-St. Anne Hospital, Toledo, Ohio, USA
| | - Bruce A Mueller
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| |
Collapse
|
57
|
Brasier N, Widmer A, Osthoff M, Mutke M, De Ieso F, Brasier-Lutz P, Wolfe L, Aithal V, Broeckling CD, Prenni J, Eckstein J. Non-invasive Drug Monitoring of β-Lactam Antibiotics Using Sweat Analysis-A Pilot Study. Front Med (Lausanne) 2020; 7:476. [PMID: 32984371 PMCID: PMC7477313 DOI: 10.3389/fmed.2020.00476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Antimicrobial resistance is a major challenge in treating infectious diseases. Therapeutic drug monitoring (TDM) can optimize and personalize antibiotic treatment. Previously, antibiotic concentrations in tissues were extrapolated from skin blister studies, but sweat analyses for TDM have not been conducted. Objective: To investigate the potential of sweat analysis as a non-invasive, rapid, and potential bedside TDM method. Methods: We analyzed sweat and blood samples from 13 in-house patients treated with intravenous cefepime, imipenem, or flucloxacillin. For cefepime treatment, full pharmacokinetic sampling was performed (five subsequent sweat samples every 2 h) using ultra-high-performance liquid chromatography coupled with triple quadrupole mass spectrometry. The ClinicalTrials.gov registration number is NCT03678142. Results: In this study, we demonstrated for the first time that flucloxacillin, imipenem, and cefepime are detectable in sweat. Antibiotic concentration changes over time demonstrated comparable (age-adjusted) dynamics in the blood and sweat of patients treated with cefepime. Patients treated with standard flucloxacillin dosage showed the highest mean antibiotic concentration in sweat. Conclusions: Our results provide a proof-of-concept that sweat analysis could potentially serve as a non-invasive, rapid, and reliable method to measure antibiotic concentration and as a surrogate marker for tissue penetration. If combined with smart biosensors, sweat analysis may potentially serve as the first lab-independent, non-invasive antibiotic TDM method.
Collapse
Affiliation(s)
- Noé Brasier
- CMIO Research Group, University Hospital Basel, Basel, Switzerland
- Department of Internal Medicine, Kantonsspital Obwalden, Sarnen, Switzerland
| | - Andreas Widmer
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Markus Mutke
- CMIO Research Group, University Hospital Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Fiorangelo De Ieso
- CMIO Research Group, University Hospital Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascale Brasier-Lutz
- Department of Gynaecology, Standort Wolhusen Kantonsspital Luzern, Wolhusen, Switzerland
| | - Lisa Wolfe
- Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, CO, United States
| | - Vikas Aithal
- Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, CO, United States
| | - Corey D. Broeckling
- Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, CO, United States
| | - Jessica Prenni
- Department of Horticulture and Landscape, Colorado State University, Fort Collins, CO, United States
| | - Jens Eckstein
- CMIO Research Group, University Hospital Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
58
|
Ter Heine R, Keizer RJ, van Steeg K, Smolders EJ, van Luin M, Derijks HJ, de Jager CPC, Frenzel T, Brüggemann R. Prospective validation of a model-informed precision dosing tool for vancomycin in intensive care patients. Br J Clin Pharmacol 2020; 86:2497-2506. [PMID: 32415710 PMCID: PMC7688533 DOI: 10.1111/bcp.14360] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 02/04/2023] Open
Abstract
AIMS Vancomycin is an important antibiotic for critically ill patients with Gram-positive bacterial infections. Critically ill patients typically have severely altered pathophysiology, which leads to inefficacy or toxicity. Model-informed precision dosing may aid in optimizing the dose, but prospectively validated tools are not available for this drug in these patients. We aimed to prospectively validate a population pharmacokinetic model for purpose model-informed precision dosing of vancomycin in critically ill patients. METHODS We first performed a systematic evaluation of various models on retrospectively collected pharmacokinetic data in critically ill patients and then selected the best performing model. This model was implemented in the Insight Rx clinical decision support tool and prospectively validated in a multicentre study in critically ill patients. The predictive performance was obtained as mean prediction error and relative root mean squared error. RESULTS We identified 5 suitable population pharmacokinetic models. The most suitable model was carried forward to a prospective validation. We found in a prospective multicentre study that the selected model could accurately and precisely predict the vancomycin pharmacokinetics based on a previous measurement, with a mean prediction error and relative root mean squared error of respectively 8.84% (95% confidence interval 5.72-11.96%) and 19.8% (95% confidence interval 17.47-22.13%). CONCLUSION Using a systematic approach, with a retrospective evaluation and prospective verification we showed the suitability of a model to predict vancomycin pharmacokinetics for purposes of model-informed precision dosing in clinical practice. The presented methodology may serve a generic approach for evaluation of pharmacometric models for the use of model-informed precision dosing in the clinic.
Collapse
Affiliation(s)
- Rob Ter Heine
- Radboud Institute for Health Sciences, Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Krista van Steeg
- Department of Clinical Pharmacy, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Elise J Smolders
- Department of Pharmacy, Isala Hospital, Zwolle, The Netherlands & Department of Pharmacy, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Matthijs van Luin
- Department of Clinical Pharmacy, Rijnstate Hospital, Arnhem, The Netherlands
| | - Hieronymus J Derijks
- Department of Pharmacy, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands/Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Cornelis P C de Jager
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roger Brüggemann
- Radboud Institute for Health Sciences, Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
59
|
Al‐Sulaiti FK, Nader A, El‐Mekaty E, Elewa H, Al‐Badriyeh D, El‐Zubair A, Saad MO, Awaisu A. Vancomycin therapeutic drug monitoring service quality indices and clinical effectiveness outcomes: A retrospective cohort and clinical audit. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fatima K. Al‐Sulaiti
- Clinical Pharmacy and Practice Department College of Pharmacy, QU Health, Qatar University Doha Qatar
- Qatar National Research Fund Qatar Foundation Doha Qatar
| | - Ahmed Nader
- Clinical Pharmacology and Pharmacometrics Division Abbvie Chicago USA
| | - Eman El‐Mekaty
- Infectious Diseases Department, Communicable Disease Center Hamad Medical Corporation Doha Qatar
- Clinical Pharmacy Department Al‐Wakrah Hospital, Hamad Medical Corporation Doha Qatar
| | - Hazem Elewa
- Clinical Pharmacy and Practice Department College of Pharmacy, QU Health, Qatar University Doha Qatar
| | - Daoud Al‐Badriyeh
- Clinical Pharmacy and Practice Department College of Pharmacy, QU Health, Qatar University Doha Qatar
| | - Ahmed El‐Zubair
- Clinical Pharmacy Department Al‐Khor Hospital, Hamad Medical Corporation Doha Qatar
| | - Mohamed O. Saad
- Clinical Pharmacy Department Al‐Wakrah Hospital, Hamad Medical Corporation Doha Qatar
| | - Ahmed Awaisu
- Clinical Pharmacy and Practice Department College of Pharmacy, QU Health, Qatar University Doha Qatar
| |
Collapse
|
60
|
Bradley JS, Stone GG, Chan PLS, Raber SR, Riccobene T, Mas Casullo V, Yan JL, Hendrick VM, Hammond J, Leister-Tebbe HK. Phase 2 Study of the Safety, Pharmacokinetics and Efficacy of Ceftaroline Fosamil in Neonates and Very Young Infants With Late-onset Sepsis. Pediatr Infect Dis J 2020; 39:411-418. [PMID: 32091493 DOI: 10.1097/inf.0000000000002607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With increasing antimicrobial resistance, antibiotic treatment options for neonatal late-onset sepsis (LOS) are becoming limited. Primary objective of this study was assessment of the safety of ceftaroline fosamil in LOS. METHODS Eligible neonates and very young infants 7 to <60 days of age with LOS were enrolled in this phase 2, open-label, multicenter study (NCT02424734) and received ceftaroline fosamil 4 or 6 mg/kg every 8 hours by 1-hour intravenous infusion plus intravenous ampicillin and optional aminoglycoside for 48 hours-14 days. Safety was assessed through the final study visit (21-35 days after the last study therapy dose). Efficacy, assessed as clinical and microbiologic response, was evaluated at end-of-treatment and test-of-cure. Pharmacokinetic samples were collected via sparse-sampling protocol. RESULTS Eleven patients [54.5% male, median (range) age 24 (12-53) days] were enrolled and received ceftaroline fosamil for a median (range) duration of 8 (3-15) days. Ten adverse events (AEs) occurred in 5 (45.5%) patients (safety population); most frequent AE was diarrhea (n = 2). All except 1 AE (diarrhea) were nontreatment-related. Predominant baseline pathogen was Escherichia coli. No patients were clinical failures at end-of-treatment/test-of-cure. Observed sparse steady-state pharmacokinetics data (19 samples) were comparable to previous pediatric data and generally within 90% model prediction intervals; neonatal probability of target attainment was >95% based on established pharmacokinetic/pharmacodynamic targets. CONCLUSIONS Safety in neonates and very young infants was consistent with the known ceftaroline fosamil safety profile. These results support the use of ceftaroline fosamil (6 mg/kg every 8 hours) as a potential treatment option for LOS.
Collapse
Affiliation(s)
- John S Bradley
- From the Department of Pediatrics, Rady Children's Hospital/University of California San Diego School of Medicine, San Diego, California
| | - Gregory G Stone
- Microbiology, Internal Medicine, Pfizer, Groton, Connecticut
| | | | | | - Todd Riccobene
- Clinical Pharmacology, Allergan plc, Madison, New Jersey
| | | | | | | | | | | |
Collapse
|
61
|
Westerdijk K, Desar IME, Steeghs N, van der Graaf WTA, van Erp NP. Imatinib, sunitinib and pazopanib: From flat-fixed dosing towards a pharmacokinetically guided personalized dose. Br J Clin Pharmacol 2020; 86:258-273. [PMID: 31782166 PMCID: PMC7015742 DOI: 10.1111/bcp.14185] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) are anti‐cancer drugs that target tyrosine kinases, enzymes that are involved in multiple cellular processes. Currently, multiple oral TKIs have been introduced in the treatment of solid tumours, all administered in a fixed dose, although large interpatient pharmacokinetic (PK) variability is described. For imatinib, sunitinib and pazopanib exposure‐treatment outcome (efficacy and toxicity) relationships have been established and therapeutic windows have been defined, therefore dose optimization based on the measured blood concentration, called therapeutic drug monitoring (TDM), can be valuable in increasing efficacy and reducing the toxicity of these drugs. In this review, an overview of the current knowledge on TDM guided individualized dosing of imatinib, sunitinib and pazopanib for the treatment of solid tumours is presented. We summarize preclinical and clinical data that have defined thresholds for efficacy and toxicity. Furthermore, PK models and factors that influence the PK of these drugs which partly explain the interpatient PK variability are summarized. Finally, pharmacological interventions that have been performed to optimize plasma concentrations are described. Based on current literature, we advise which methods should be used to optimize exposure to imatinib, sunitinib and pazopanib.
Collapse
Affiliation(s)
- Kim Westerdijk
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, the Netherlands
| | - Nielka P van Erp
- Department of Clinical Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | | |
Collapse
|
62
|
Comparison of the Area Under the Curve for Vancomycin Estimated Using Compartmental and Noncompartmental Methods in Adult Patients With Normal Renal Function. Ther Drug Monit 2019; 41:726-731. [DOI: 10.1097/ftd.0000000000000690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
63
|
Garzón V, Pinacho DG, Bustos RH, Garzón G, Bustamante S. Optical Biosensors for Therapeutic Drug Monitoring. BIOSENSORS 2019; 9:E132. [PMID: 31718050 PMCID: PMC6955905 DOI: 10.3390/bios9040132] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 12/26/2022]
Abstract
Therapeutic drug monitoring (TDM) is a fundamental tool when administering drugs that have a limited dosage or high toxicity, which could endanger the lives of patients. To carry out this monitoring, one can use different biological fluids, including blood, plasma, serum, and urine, among others. The help of specialized methodologies for TDM will allow for the pharmacodynamic and pharmacokinetic analysis of drugs and help adjust the dose before or during their administration. Techniques that are more versatile and label free for the rapid quantification of drugs employ biosensors, devices that consist of one element for biological recognition coupled to a signal transducer. Among biosensors are those of the optical biosensor type, which have been used for the quantification of different molecules of clinical interest, such as antibiotics, anticonvulsants, anti-cancer drugs, and heart failure. This review presents an overview of TDM at the global level considering various aspects and clinical applications. In addition, we review the contributions of optical biosensors to TDM.
Collapse
Affiliation(s)
- Vivian Garzón
- Doctoral Programme of Biosciences, Universidad de La Sabana, Chía 140013, Colombia
- Therapeutic Evidence Group, Clinical Pharmacology, Universidad de La Sabana, Chía 140013, Colombia
| | - Daniel G. Pinacho
- Therapeutic Evidence Group, Clinical Pharmacology, Universidad de La Sabana, Chía 140013, Colombia
| | - Rosa-Helena Bustos
- Therapeutic Evidence Group, Clinical Pharmacology, Universidad de La Sabana, Chía 140013, Colombia
| | - Gustavo Garzón
- Faculty of Medicine, Universidad de La Sabana, Chía 140013, Colombia
| | - Sandra Bustamante
- Physics Department, the Centre for NanoHealth, Swansea University, Swansea SA2 8PP, UK
- Vedas, Corporación de Investigación e Innovación, Medellín 050001, Colombia
| |
Collapse
|
64
|
Zeng M, Yi Q, Zeng L, Chen Z, Mi X, Song H, Zhang X, Li Y, Wang Q, Zhao R, Miao L, Zhang L. Quality of therapeutic drug monitoring guidelines is suboptimal: an evaluation using the Appraisal of Guidelines for Research and Evaluation II instrument. J Clin Epidemiol 2019; 120:47-58. [PMID: 31678686 DOI: 10.1016/j.jclinepi.2019.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/05/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Although therapeutic drug monitoring (TDM) guidelines are available, systematic evaluations of their methodological quality are scarce. This study aimed to assess the quality of current TDM guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. STUDY DESIGN AND SETTING We performed a systematic search to identify the relevant TDM guidelines in PubMed, EMBASE, CNKI, Wan Fang Database, CBM, VIP, four main guideline databases (NICE, NGC, GIN, and WHO guideline databases), and official websites of the governments and societies associated with TDM from the inception date to May 2018. Four independent appraisers rated the quality of each TDM guideline using the AGREE II instrument, and the mean score of each AGREE II item was calculated. The overall agreement among the appraisers was evaluated using the intraclass correlation coefficient (ICC). RESULTS Twenty-eight TDM guidelines satisfied the eligibility criteria from among 12,235 references. The overall agreement among the appraisers was substantial (0.700-0.880). The mean scores for the six AGREE II domains were scope and purpose, 67.7% (95% CI, 64.0-71.4%); stakeholder involvement, 39.8% (95% CI, 33.3-46.3%); rigor of development, 36.0% (95% CI, 28.1-43.9%); clarity and presentation, 61.6% (95% CI, 55.7-67.4%); applicability, 30.6% (95% CI, 26.4-34.8%); and editorial independence, 49.2% (95% CI, 40.0-58.6%). The reviewers recommended only four guidelines, and most of the TDM guidelines were rated as "recommended with modifications." CONCLUSION Overall, the quality of TDM guidelines is suboptimal according to the evaluation using the AGREE II instrument. The domains of applicability, rigor of development, stakeholder involvement, and editorial independence of the guidelines need to be reported. In addition, guideline developers closely adhering to the AGREE II instrument and the Grading of Recommendations Assessment Development and Evaluation system are required to draft high-quality and reliable TDM guidelines.
Collapse
Affiliation(s)
- Min Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Qiusha Yi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Xue Mi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Haoxin Song
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China; West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xianglin Zhang
- Pharmaceutical Department, China-Japan Friendship Hospital, Beijing, China
| | - Youping Li
- Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wang
- Department of Standardization, National Center for Medical Service Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China.
| |
Collapse
|
65
|
Dauphin-Ducharme P, Yang K, Arroyo-Currás N, Ploense KL, Zhang Y, Gerson J, Kurnik M, Kippin TE, Stojanovic MN, Plaxco KW. Electrochemical Aptamer-Based Sensors for Improved Therapeutic Drug Monitoring and High-Precision, Feedback-Controlled Drug Delivery. ACS Sens 2019; 4:2832-2837. [PMID: 31556293 PMCID: PMC6886665 DOI: 10.1021/acssensors.9b01616] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The electrochemical aptamer-based (E-AB) sensing platform appears to be a convenient (rapid, single-step, and calibration-free) and modular approach to measure concentrations of specific molecules (irrespective of their chemical reactivity) directly in blood and even in situ in the living body. Given these attributes, the platform may thus provide significant opportunities to render therapeutic drug monitoring (the clinical practice in which dosing is adjusted in response to plasma drug measurements) as frequent and convenient as the measurement of blood sugar has become for diabetics. The ability to measure arbitrary molecules in the body in real time could even enable closed-loop feedback control over plasma drug levels in a manner analogous to the recently commercialized controlled blood sugar systems. As initial exploration of this, we describe here the selection of an aptamer against vancomycin, a narrow therapeutic window antibiotic for which therapeutic monitoring is a critical part of the standard of care, and its adaptation into an electrochemical aptamer-based (E-AB) sensor. Using this sensor, we then demonstrate: (i) rapid (seconds) and convenient (single-step and calibration-free) measurement of plasma vancomycin in finger-prick-scale samples of whole blood, (ii) high-precision measurement of subject-specific vancomycin pharmacokinetics (in a rat animal model), and (iii) high-precision, closed-loop feedback control over plasma levels of the drug (in a rat animal model). The ability to not only track (with continuous-glucose-monitor-like measurement frequency and convenience) but also actively control plasma drug levels provides an unprecedented route toward improving therapeutic drug monitoring and, more generally, the personalized, high-precision delivery of pharmacological interventions.
Collapse
Affiliation(s)
- Philippe Dauphin-Ducharme
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Kyungae Yang
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
| | - Netzahualcóyotl Arroyo-Currás
- Department of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Kyle L. Ploense
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Yameng Zhang
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
| | - Julian Gerson
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Department of Molecular, Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Martin Kurnik
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Tod E. Kippin
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Department of Molecular, Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Milan N. Stojanovic
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
- Department of Biomedical Engineering and Systems Biology, Columbia University, New York, New York 10032, United States
| | - Kevin W. Plaxco
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| |
Collapse
|
66
|
Colin PJ, Jonckheere S, Struys MMRF. Target-Controlled Continuous Infusion for Antibiotic Dosing: Proof-of-Principle in an In-silico Vancomycin Trial in Intensive Care Unit Patients. Clin Pharmacokinet 2019; 57:1435-1447. [PMID: 29512049 PMCID: PMC6182490 DOI: 10.1007/s40262-018-0643-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In this in-silico study, we investigate the clinical utility of target-controlled infusion for antibiotic dosing in an intensive care unit setting using vancomycin as a model compound. We compared target-controlled infusion and adaptive target-controlled infusion, which combines target-controlled infusion with data from therapeutic drug monitoring, with conventional (therapeutic drug monitoring-based) vancomycin dosing strategies. METHODS A clinical trial simulation was conducted. This simulation was based on a comprehensive database of clinical records of intensive care unit patients and a systematic review of currently available population-pharmacokinetic models for vancomycin in intensive care unit patients. Dosing strategies were compared in terms of the probability of achieving efficacious concentrations as well as the potential for inducing toxicity. RESULTS Adaptive target-controlled infusion outperforms rule-based dosing guidelines for vancomycin. In the first 48 h of treatment, the probability of target attainment is significantly higher for adaptive target-controlled infusion than for the second-best method (Cristallini). Probability of target attainments of 54 and 72% and 47 and 59% for both methods after 24 and 48 h, respectively. Compared to the Cristallini method, which is characterized by a probability of attaining concentrations above 30 mg.L-1 > 65% in the first few hours of treatment, adaptive target-controlled infusion shows negligible time at risk and a probability of attaining concentrations above 30 mg.L-1 not exceeding 25%. Finally, in contrast to the other methods, the performance of target-controlled infusion is consistent across subgroups within the population. CONCLUSIONS Our study shows that adaptive target-controlled infusion has the potential to become a practical tool for patient-tailored antibiotic dosing in the intensive care unit.
Collapse
Affiliation(s)
- Pieter J Colin
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
- Department of Anesthesiology, Groningen University, University Medical Center Groningen, Groningen, The Netherlands.
| | - Stijn Jonckheere
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Anesthesiology, Groningen University, University Medical Center Groningen, Groningen, The Netherlands
| | - Michel M R F Struys
- Department of Anesthesiology, Groningen University, University Medical Center Groningen, Groningen, The Netherlands
- Department of Anesthesiology and Peri-operative Medicine, Ghent University, Ghent, Belgium
| |
Collapse
|
67
|
Al-Sulaiti FK, Nader AM, Saad MO, Shaukat A, Parakadavathu R, Elzubair A, Al-Badriyeh D, Elewa H, Awaisu A. Clinical and Pharmacokinetic Outcomes of Peak-Trough-Based Versus Trough-Based Vancomycin Therapeutic Drug Monitoring Approaches: A Pragmatic Randomized Controlled Trial. Eur J Drug Metab Pharmacokinet 2019; 44:639-652. [PMID: 30919233 PMCID: PMC6746691 DOI: 10.1007/s13318-019-00551-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vancomycin therapeutic drug monitoring (TDM) is based on achieving 24-h area under the concentration-time curve to minimum inhibitory concentration cure breakpoints (AUC24/MIC). Approaches to vancomycin TDM vary, with no head-to-head randomized controlled trial (RCT) comparisons to date. OBJECTIVES We aimed to compare clinical and pharmacokinetic outcomes between peak-trough-based and trough-only-based vancomycin TDM approaches and to determine the relationship between vancomycin AUC24/MIC and cure rates. METHODS A multicentered pragmatic parallel-group RCT was conducted in Hamad Medical Corporation hospitals in Qatar. Adult non-dialysis patients initiated on vancomycin were randomized to peak-trough-based or trough-only-based vancomycin TDM. Primary endpoints included vancomycin AUC24/MIC ratio breakpoint for cure and clinical effectiveness (therapeutic cure vs therapeutic failure). Descriptive, inferential, and classification and regression tree (CART) statistical analyses were applied. NONMEM.v.7.3 was used to conduct population pharmacokinetic analyses and AUC24 calculations. RESULTS Sixty-five patients were enrolled [trough-only-based-TDM (n = 35) and peak-trough-based-TDM (n = 30)]. Peak-trough-based TDM was significantly associated with higher therapeutic cure rates compared to trough-only-based TDM [76.7% vs 48.6%; p value = 0.02]. No statistically significant differences were observed for all-cause mortality, neutropenia, or nephrotoxicity between the two groups. Compared to trough-only-based TDM, peak-trough-based TDM was associated with less vancomycin total daily doses by 12.05 mg/kg/day (p value = 0.027). CART identified creatinine clearance (CLCR), AUC24/MIC, and TDM approach as significant determinants of therapeutic outcomes. All patients [n = 19,100%] with CLCR ≤ 7.85 L/h, AUC24/MIC ≤ 1256, who received peak-trough-based TDM achieved therapeutic cure. AUC24/MIC > 565 was identified to be correlated with cure in trough-only-based TDM recipients [n = 11,84.6%]. No minimum AUC24/MIC breakpoint was detected by CART in the peak-trough-based group. CONCLUSION Maintenance of target vancomycin exposures and implementation of peak-trough-based vancomycin TDM may improve vancomycin-associated cure rates. Larger scale RCTs are warranted to confirm these findings.
Collapse
Affiliation(s)
- Fatima Khalifa Al-Sulaiti
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar
- Qatar National Research Fund, Qatar Foundation, Doha, Qatar
| | | | - Mohamed Omar Saad
- Clinical Pharmacy Department, Al-Wakrah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Adila Shaukat
- Infectious Diseases Department, Al-Wakrah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rakesh Parakadavathu
- Infectious Diseases Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elzubair
- Clinical Pharmacy Department, Al-Khor Hospital, Hamad Medical Corporation, Al-Khor, Qatar
| | - Daoud Al-Badriyeh
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Hazem Elewa
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Ahmed Awaisu
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar.
| |
Collapse
|
68
|
Šíma M, Hartinger J, Grus T, Slanař O. Initial dosing of intermittent vancomycin in adults: estimation of dosing interval in relation to dose and renal function. Eur J Hosp Pharm 2019; 28:276-279. [PMID: 34426481 DOI: 10.1136/ejhpharm-2019-002013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Due to the high interindividual variability in vancomycin pharmacokinetics, optimisation of its dosing is still challenging. This study aimed to explore vancomycin pharmacokinetics in adult patients and to propose an easy applicable dosing nomogram for initial treatment. METHODS Vancomycin pharmacokinetics was calculated in a two-compartmental model based on therapeutic drug monitoring data. A linear regression model was used to explore the relationship between vancomycin elimination half-life and glomerular filtration rate estimated according the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. RESULTS In the whole study population (n=66), vancomycin volume of distribution, clearance and half-life median (IQR) values were 0.69 (0.58-0.87) L/kg, 0.031 (0.022-0.050) L/h/kg and 14.4 (9.5-25.2) hours, respectively. Vancomycin half-life was associated with glomerular filtration rate (r2=0.4126, p<0.0001) according to the formula: t1/2 (h) = -0.247×eGFRCKD-EPI (mL/min/1.73 m2)+32.89. This relationship was used to construct a dosing nomogram. CONCLUSIONS We propose an easy-to-use dosing nomogram for vancomycin therapy initiation that allows individualisation of the dosing interval with respect to the administered dose size and functional renal status.
Collapse
Affiliation(s)
- Martin Šíma
- Department of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Hartinger
- Department of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomáš Grus
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondřej Slanař
- Department of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| |
Collapse
|
69
|
Choi R, Woo HI, Park HD, Lee SY. A nationwide utilization survey of therapeutic drug monitoring for five antibiotics in South Korea. Infect Drug Resist 2019; 12:2163-2173. [PMID: 31410036 PMCID: PMC6646174 DOI: 10.2147/idr.s208783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/31/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose The current status of therapeutic drug monitoring (TDM) assay utilization by clinical laboratories in South Korea remains little known. We investigated the TDM status of five antibiotics known for nephrotoxicity (vancomycin, amikacin, gentamicin, tobramycin, and teicoplanin) for the improvement of TDM in South Korea among patients with infectious diseases using a cross-sectional nationwide survey. Patients and methods We developed an online questionnaire and collected responses using a user-friendly web-based platform. The survey included questions about laboratory characteristics, implementation and operation of drug assays, implementation and operation of TDM consulting services, patient needs, and barriers to providing better TDM service including expectations and concerns about other platform-based drug assays. Results Among a total of 235 clinical laboratories, 112 (47.7%) responded, and 62 of the responding laboratories (55.4%) possessed drug assay facilities. Only 41.2% to 58.1% of respondents were providing TDM consulting services for each antibiotic. Respondents indicated that there are unmet needs regarding drug assays and TDM consultation as well as barriers to TDM utilization including high operating costs, lack of knowledge about TDM, lack of user-friendly software, lack of medical and laboratory information systems that can access patient information critical for TDM dose calculation, and reimbursement issues. Conclusion This study, the first nationwide survey addressing these questions, showed that there are barriers against the utilization of TDM in South Korea. These barriers may be addressed by improving drug assays and TDM consulting services with the goals of new analytical method development, better interpretation of results, consultation services, and quality control.
Collapse
Affiliation(s)
- Rihwa Choi
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Laboratory Medicine, Green Cross Laboratories, Yongin, Gyeonggi, Republic of Korea
| | - Hye In Woo
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
70
|
Abstract
PURPOSE OF REVIEW Skin and soft-tissue infections (SSIs) are among the commonest infections encountered in clinical practice. Spread of methicillin-resistant Staphylococcus aureus SSIs continues to increase in both health care and community settings and presents a challenge for the best treatment choice. Vancomycin has been the mainstay of SSIs treatment, but recently its use has been questioned because of concerns about its efficacy, tolerability, and unfavorable pharmacokinetic/pharmacodynamic profile. The purpose of this review is to establish the current role for vancomycin in light of the literature published from January 2007 to September 2017 on comparison with both old and new alternatives. RECENT FINDINGS Meta-analyses show better clinical and microbiological outcomes for drugs approved for the treatment of SSI, including those sustained by methicillin-resistant S. aureus, in the last 10 years than for vancomycin. The newer glycopeptides and linezolid decrease the total treatment costs compared with vancomycin, by reducing the length of stay or avoiding the hospitalization. SUMMARY Vancomycin is noninferior in efficacy and safety to all comparator drugs, including the newest on the market. However, the SSI treatment evidence base presents several shortcomings limiting the clinical applicability of the results. High-level clinical trials should be performed to obtain results that can be generalized and applied effectively in clinical practice.
Collapse
|
71
|
Bidu NS, Fernandes BJ, Dias EJ, Filho JN, Bastos RE, Godoy AL, Azeredo FJ, Pedreira JN, Couto RD. Vancomycin Therapeutic Regime Adjustment in Newborns and Infants with Bacterial Infection: Case Series. Curr Pharm Biotechnol 2019; 20:346-351. [DOI: 10.2174/1389201020666190319161511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/29/2018] [Accepted: 03/12/2019] [Indexed: 11/22/2022]
Abstract
Background:
Vancomycin is used mostly to overcome infections caused by methicillinresistant
microorganisms. There are no well-established administration protocols for neonates and infants,
so the leak of a specific administration regime in that population may lead to serum concentrations
beyond the specified range.
Objective:
This case series evaluated the pharmacokinetics adjustment from a vancomycin therapeutic
regimen prescribed to neonates and infants with bacterial infection at a neonatal public hospital intensive-
care-unit, with the primary purpose to verify cases of nephrotoxicity.
Methods:
Three neonates and four infants taking vancomycin therapy, hospitalized in a public hospital
from November 2014 to March 2015, were included in the study. Vancomycin serum concentrations
were determined by particle-enhanced-turbidimetric inhibition-immunoassay. The vancomycin concentrations
were used for dose adjustment by USC*Pack-PC-Collection®, a non-parametric maximization
program. The trough serum concentration range of 10 to 20mg.L-1 was considered therapeutic.
Results:
Three patients had serum concentration outside the reference-range, one with subtherapeutic,
and two with supratherapeutic concentrations. All patients had concomitant use of drugs which interfered
with vancomycin distribution and excretion pharmacokinetics parameters, including drugs that
may enhance nephrotoxicity. One patient showed signs of acute renal damage, by low vancomycin and
creatinine estimated clearances.
Conclusion:
The pharmacokinetic adjustment has been proven to be a useful and necessary tool to
increase therapeutic efficacy and treatment benefits. The standard dose of vancomycin can be used to
initiate therapy in neonates and infants admitted to the ICU, but after reaching the drug steady state,
the dosing regimen should be individualized and guided by pharmacokinetic parameters.
Collapse
Affiliation(s)
- Nadielle S. Bidu
- Pharmacy Postgraduate Program, Faculty of Pharmacy, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
| | - Bruno J.D. Fernandes
- Clinical Biochemistry Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
| | | | | | - Regina E.A. Bastos
- Department of Pediatrics, Hospital Roberto Santos, Salvador, Bahia, Brazil
| | - Ana L.P.C. Godoy
- Pharmacy Postgraduate Program, Faculty of Pharmacy, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
| | - Francine J. Azeredo
- Pharmacy Postgraduate Program, Faculty of Pharmacy, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
| | - Joice N.R. Pedreira
- Pharmacy Postgraduate Program, Faculty of Pharmacy, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
| | - Ricardo D. Couto
- Pharmacy Postgraduate Program, Faculty of Pharmacy, Federal University of Bahia/UFBA, Salvador, Bahia, Brazil
| |
Collapse
|
72
|
Malaeb DN, Fahs IM, Salameh P, Hallit S, Saad M, Bourji J, Hallit R. Assessment of vancomycin utilization among Lebanese hospitals. Saudi Med J 2019; 40:152-157. [PMID: 30723860 PMCID: PMC6402470 DOI: 10.15537/smj.2019.2.23872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To assess the appropriateness of vancomycin dosing and monitoring at Lebanese hospitals. Methods: This was a multicenter retrospective study conducted at 3 Lebanese hospitals between January and March 2018. Patients 18 years of age and older treated with vancomycin for a systemic infection or prophylaxis were eligible for study enrollment. Consistency with the Infectious Diseases Society of America guidelines was evaluated to determine whether the dose of vancomycin was appropriate, as well as for the time of trough measurement, and the target concentration obtained. Results: From a total of 120 patients who met the inclusion criteria, only 11 (12%) were given the appropriate maintenance dose of vancomycin with respect to actual body weight. The trough levels were monitored for 67 (55.8%) patients, with 20 (29.9%) of these patients achieving appropriate therapeutic trough levels of 15-20 mg/l. The trough concentration time measurement before the fourth dose was only carried out in 28 (41.8%) of the 67 patients. Conclusion: This study reveals a gap between the appropriate utilization of vancomycin with respect to the international guidelines in the studied Lebanese hospitals. It highlights the need for dosing and monitoring protocols suitable for vancomycin utilization in these hospitals.
Collapse
Affiliation(s)
- Diana N Malaeb
- Department of Clinical Practice, Lebanese International University, Mouseitbah, Lebanon. E-mail.
| | | | | | | | | | | | | |
Collapse
|
73
|
Fleuren LM, Roggeveen LF, Guo T, Waldauf P, van der Voort PHJ, Bosman RJ, Swart EL, Girbes ARJ, Elbers PWG. Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient: a cross-sectional study. Crit Care 2019; 23:185. [PMID: 31118061 PMCID: PMC6532162 DOI: 10.1186/s13054-019-2438-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Antibiotic exposure in intensive care patients with sepsis is frequently inadequate and is associated with poorer outcomes. Antibiotic dosing is challenging in the intensive care, as critically ill patients have altered and fluctuating antibiotic pharmacokinetics that make current one-size-fits-all regimens unsatisfactory. Real-time bedside dosing software is not available yet, and therapeutic drug monitoring is typically used for few antibiotic classes and only allows for delayed dosing adaptation. Thus, adequate and timely antibiotic dosing continues to rely largely on the level of pharmacokinetic expertise in the ICU. Therefore, we set out to assess the level of knowledge on antibiotic pharmacokinetics among these intensive care professionals. METHODS In May 2018, we carried out a cross-sectional study by sending out an online survey on antibiotic dosing to more than 20,000 intensive care professionals. Questions were designed to cover relevant topics in pharmacokinetics related to intensive care antibiotic dosing. The preliminary pass mark was set by members of the examination committee for the European Diploma of Intensive Care using a modified Angoff approach. The final pass mark was corrected for clinical relevance as assessed for each question by international experts on pharmacokinetics. RESULTS A total of 1448 respondents completed the survey. Most of the respondents were intensivists (927 respondents, 64%) from 97 countries. Nearly all questions were considered clinically relevant by pharmacokinetic experts. The pass mark corrected for clinical relevance was 52.8 out of 93.7 points. Pass rates were 42.5% for intensivists, 36.1% for fellows, 24.8% for residents, and 5.8% for nurses. Scores without correction for clinical relevance were worse, indicating that respondents perform better on more relevant topics. Correct answers and concise clinical background are provided. CONCLUSIONS Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient. This should be addressed given the importance of adequate antibiotic exposure in critically ill patients with sepsis. Solutions include improved education, intensified pharmacy support, therapeutic drug monitoring, or the use of real-time bedside dosing software. Questions may provide useful for teaching purposes.
Collapse
Affiliation(s)
- Lucas M. Fleuren
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Luca F. Roggeveen
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tingjie Guo
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Eleonora L. Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Armand R. J. Girbes
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul W. G. Elbers
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
74
|
Readiness to implement vancomycin monitoring based on area under the concentration–time curve: A cross-sectional survey of a national health consortium. Am J Health Syst Pharm 2019; 76:889-894. [DOI: 10.1093/ajhp/zxz070] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
|
75
|
Wang P, Long Z, Yu Z, Liu P, Wei D, Fang Q, Ma D, Wang J. The efficacy of topical gentamycin application on prophylaxis and treatment of wound infection: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13334. [PMID: 30809868 DOI: 10.1111/ijcp.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/03/2019] [Accepted: 02/24/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The purpose of this study was to conduct a systematic review and meta-analysis in patients with local wound infection or infective risk, evaluating effects of topical gentamycin application on prophylaxis and treatment of wound infection. METHODS Embase, the Cochrane Library, Pubmed, Medline (from Ovid) and three Chinese literature databases (CNKI, VIP and WANFANG) were searched. Randomised controlled studies (RCTs) and observational studies (OSs) that assessed the efficacy of topical gentamycin application on prophylaxis and treatment of local wound infection were included. The primary outcome was clinical efficacy. Secondary outcomes included duration of recovery time and length of hospital stay. RESULTS Fifteen studies (1781 patients) met inclusion criteria. Twelve studies were RCTs and other three studies were OSs. Compared with non-gentamycin group, topical gentamycin application had significantly higher rates of clinical efficacy (OR = 3.57, 95% CI 2.52-5.07). In terms of duration of wound healing, it's taken shorter time in gentamycin group than non-gentamycin group (OR = -4.94, 95% CI -8.37 to -1.51). However, the length of hospital stay had no significantly difference between the two groups (OR = -3.40, 95% CI -8.42 to 1.63). Subgroup analyses were conducted according to study design (RCTs or OSs), purpose and administration type. And the results showed that there were no significant difference of clinical efficacy in study design (P = 0.21, I2 = 35.4%), purpose (P = 0.32, I2 = 0%) and administration type subgroup (P = 0.74, I2 = 0%). However, topical gentamycin application had significantly shorter duration of wound healing in randomly controlled trials compared with observational studies, but had no difference in terms of administration type(P = 0.20, I2 = 38.6%). CONCLUSIONS Studies to date show that topical gentamycin application significantly increases the rate of clinical efficacy and decreases the duration of wound healing in patients with local wound infection or infective risk.
Collapse
Affiliation(s)
- Ping Wang
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Zhengmei Long
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Zhengyu Yu
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Ping Liu
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Danna Wei
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Qin Fang
- Department of Pharmacy, Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang, P. R. China
- Department of Pharmacy, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Dan Ma
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Jishi Wang
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| |
Collapse
|
76
|
Pokorná P, Šíma M, Černá O, Slanař O. Nomogram based on actual body weight for estimation of vancomycin maintenance dose in infants. Infect Dis (Lond) 2019; 51:334-339. [PMID: 30950674 DOI: 10.1080/23744235.2018.1541250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Vancomycin is the first-choice antibiotic for infants with β-lactam-resistant gram-positive bacterial infection. Despite long experience of prescribing of this drug optimal dosing is still challenging. This study aimed at investigating variables predicting vancomycin clearance in order to propose optimal maintenance dosing in infants treated for suspected or culture-proven sepsis. METHODS Vancomycin pharmacokinetics was calculated in a one-compartmental model based on serum concentrations. A linear regression model was used to explore relationships between vancomycin clearance and expected covariates. RESULTS Twenty-two patients were enrolled into the study. Median (IQR) postnatal age was 157 (112-238) days. The median (IQR) volume of distribution and clearance for vancomycin were 0.50 (0.39-0.94) L/kg and 0.112 (0.095-0.133) L/h/kg, respectively. Vancomycin clearance was associated with actual body weight, height, body surface area, gestational age, postnatal age, postmenstrual age and estimate glomerular filtration rate. Actual body weight was the best predictive variable for vancomycin clearance. Daily maintenance dose (mg) calculated as 76.28 × actual body weight (kg) - 41.57 most closely approximated optimal dosing based on individual pharmacokinetics. This relationship was used to construct a dosing nomogram. CONCLUSIONS We developed an easy-to-use dosing nomogram for maintaining a vancomycin average steady-state concentration of 22.5 mg/L based on actual body weight.
Collapse
Affiliation(s)
- Pavla Pokorná
- a Institute of Pharmacology, First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic.,b Department of Pediatrics and Adolescent Medicine (PICU/NICU), First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic.,c Intensive Care and Department of Pediatric Surgery , Erasmus MC - Sophia Childrens Hospital , Rotterdam , the Netherlands
| | - Martin Šíma
- a Institute of Pharmacology, First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic
| | - Olga Černá
- b Department of Pediatrics and Adolescent Medicine (PICU/NICU), First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic
| | - Ondřej Slanař
- a Institute of Pharmacology, First Faculty of Medicine , Charles University and General University Hospital in Prague , Prague , Czech Republic
| |
Collapse
|
77
|
A clinical decision support system to improve adequate dosing of gentamicin and vancomycin. Int J Med Inform 2019; 124:1-5. [DOI: 10.1016/j.ijmedinf.2019.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/29/2018] [Accepted: 01/01/2019] [Indexed: 12/21/2022]
|
78
|
|
79
|
Zamoner W, Prado IRS, Balbi AL, Ponce D. Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice. Clin Exp Pharmacol Physiol 2019; 46:292-301. [DOI: 10.1111/1440-1681.13066] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Welder Zamoner
- Botucatu School of Medicine University São Paulo State‐UNESP Botucatu Brazil
| | | | - André Luis Balbi
- Botucatu School of Medicine University São Paulo State‐UNESP Botucatu Brazil
| | - Daniela Ponce
- Botucatu School of Medicine University São Paulo State‐UNESP Botucatu Brazil
- Bauru School of Medicine – USPUniversity of São Paulo Bauru Brazil
| |
Collapse
|
80
|
Alves GCDS, Chequer FMD, Sanches C. Effective vancomycin concentrations in children: a cross-sectional study. EINSTEIN-SAO PAULO 2019; 17:eAO4396. [PMID: 30785491 PMCID: PMC6377041 DOI: 10.31744/einstein_journal/2019ao4396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/12/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Analyze the microbiological effectiveness, based on the pharmacokinetics/pharmacodynamics correlation of vancomycin in pediatric patients, and to propose dose adjustment. METHODS This is an observational, cross-sectional study, conducted in a pediatric hospital, over a 1-year period (2016 to 2017). Children of both sexes, aged 2 to 12 years, were included in the study; burn children, and children in renal replacement therapy were excluded. For the pharmacokinetic analysis, two samples of 2mL of whole blood were collected, respecting the 2-hour interval between each withdrawal. RESULTS Ten pediatric patients with median age of 5.5 years and interquartile range (IQR) of 3.2-9.0 years, median weight of 21kg (IQR: 15.5-24.0kg) and median height of 112.5cm (IQR: 95-133cm), were included. Only one child achieved trough concentrations between 10µg/mL and 15µg/mL. CONCLUSION The empirical use of vancomycin in the children studied did not achieve the therapeutic pharmacokinetic/pharmacodynamic target for minimum inhibitory concentration of 1µg/mL.
Collapse
Affiliation(s)
| | | | - Cristina Sanches
- Universidade Federal de São João del-Rei, Divinópolis, MG, Brazil
| |
Collapse
|
81
|
Target Controlled Infusion in the ICU: An Opportunity to Optimize Antibiotic Therapy. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2019 2019. [DOI: 10.1007/978-3-030-06067-1_38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
82
|
Yuan G, Liu D, Bu F, Wang Y, Wang B, Guo R. LC-MS for Simultaneous Determination of Vancomycin and Teicoplanin in Patient Plasma and its Application to Therapeutic Drug Monitoring. CURR PHARM ANAL 2018. [DOI: 10.2174/1573412914666180801095208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Therapeutic drug monitoring is recommended for patients taking vancomycin
and teicoplanin to ensure pharmaceutical efficacy and prevent toxicity. Only few studies were reported
regarding the simultaneous determination of vancomycin and teicoplanin in human plasma.
Objective:
The study aimed at developing and validating a Liquid Chromatography-Mass Spectrometry
(LC-MS) method for simultaneous determination and therapeutic drug monitoring of vancomycin and
teicoplanin in patients with severe infection.
Method:
Plasma was processed by protein precipitation extraction. The analytes were separated on a
C18 column by gradient elution with 0.1% formic acid and acetonitrile as mobile phase and measured by
electrospray ionization source in positive selective ion monitoring mode at m/z 724.7 (vancomycin),
940.7 (teicoplanin) and 329.0 (bergenin). The plasma samples (104) were obtained from patients who
were taking vancomycin or teicoplanin for further analysis.
Results:
The calibration curves were linear within the range of 0.25–40 µg/mL for vancomycin, and
0.5-40 µg/mL for teicoplanin. Either inter- or intra-day precision was less than 10.01 %. The extraction
recoveries ranged from 89.99 to 94.29% for vancomycin and from 39.83 to 40.16 % for teicoplanin.
Vancomycin and teicoplanin in plasma were stable at various storage conditions. The measured mean
trough concentrations were 12.313 µg/mL for vancomycin and 8.765 µg/mL for teicoplanin.
Conclusion:
This method was successfully applied to therapeutic drug monitoring of vancomycin and
teicoplanin in patients. It is with great clinic value for monitoring and predicting the individual response
of patients under treatment.
Collapse
Affiliation(s)
- Guiyan Yuan
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Danni Liu
- Department of Pharmacy, Jinan Maternity and Child Care Hospital, Jinan, Shandong Province, China
| | - Fanlong Bu
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yanyan Wang
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Benjie Wang
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Ruichen Guo
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| |
Collapse
|
83
|
Phillips CJ, Wisdom AJ, McKinnon RA, Woodman RJ, Gordon DL. Interventions targeting the prescribing and monitoring of vancomycin for hospitalized patients: a systematic review with meta-analysis. Infect Drug Resist 2018; 11:2081-2094. [PMID: 30464551 PMCID: PMC6219104 DOI: 10.2147/idr.s176519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Vancomycin prescribing requires individualized dosing and monitoring to ensure efficacy, limit toxicity, and minimize resistance. Although there are nationally endorsed guidelines from several countries addressing the complexities of vancomycin dosing and monitoring, there is limited consideration of how to implement these recommendations effectively. Methods We conducted a systematic search of multiple databases to identify relevant comparative studies describing the impact of interventions of educational meetings, implementation of guidelines, and dissemination of educational material on vancomycin dosing, monitoring, and nephrotoxicity. Effect size was assessed using ORs and pooled data analyzed using forest plots to provide overall effect measures. Results Six studies were included. All studies included educational meetings. Two studies used implementation of guidance, educational meetings, and dissemination of educational materials, one used guidance and educational meetings, one educational meetings and dissemination of educational materials, and two used educational meetings solely. Effect sizes for individual studies were more likely to be significant for multifaceted interventions. In meta-analysis, the overall effect of interventions on outcome measures of vancomycin dosing was OR 2.50 (95% CI 1.29–4.84); P< 0.01. A higher proportion of sampling at steady-state concentration was seen following intervention (OR 1.95, 95% CI 1.26–3.02; P<0.01). Interventions had no effect on appropriate timing of trough sample (OR 2.02, 95% CI 0.72–5.72; P=0.18), attaining target concentration in patients (OR 1.50, 95% CI 0.49–4.63; P=0.48, or nephrotoxicity (OR 0.75, 95% CI 0.42–1.34; P=0.33). Conclusion Multifaceted interventions are effective overall in improving the complex task of dosing vancomycin, as well as some vancomycin-monitoring outcome measures. However, the resulting impact of these interventions on efficacy and toxicity requires further investigation. These findings may be helpful to those charged with designing implementation strategies for vancomycin guidelines or complex prescribing processes in hospitals.
Collapse
Affiliation(s)
- Cameron J Phillips
- SA Pharmacy, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia, .,College of Medicine and Public Health, Flinders University, Adelaide, SA 5000, Australia, .,School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia, .,Infectious Diseases and Immunity, Department of Medicine, Imperial College, London W12 0NN, UK,
| | - Alice J Wisdom
- SA Pharmacy, Lyell McEwin Hospital, Elizabeth Vale, Adelaide, SA 5112, Australia
| | - Ross A McKinnon
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5000, Australia, .,School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia, .,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA 5000, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA 5000, Australia
| | - David L Gordon
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5000, Australia, .,SA Pathology, Department of Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia.,Division of Medicine, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia
| |
Collapse
|
84
|
Monteiro JF, Hahn SR, Gonçalves J, Fresco P. Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations. Pharmacol Res Perspect 2018; 6:e00420. [PMID: 30156005 PMCID: PMC6113434 DOI: 10.1002/prp2.420] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/20/2018] [Indexed: 01/02/2023] Open
Abstract
Vancomycin is a fundamental antibiotic in the management of severe Gram-positive infections. Inappropriate vancomycin dosing is associated with therapeutic failure, bacterial resistance and toxicity. Therapeutic drug monitoring (TDM) is acknowledged as an important part of the vancomycin therapy management, at least in specific patient subpopulations, but implementation in clinical practice has been difficult because there are no consensus and agglutinator documents. The aims of the present work are to present an overview of the current knowledge on vancomycin TDM and population pharmacokinetic (PPK) models relevant to specific patient subpopulations. Based on three published international guidelines (American, Japanese and Chinese) on vancomycin TDM and a bibliographic review on available PPK models for vancomycin in distinct subpopulations, an analysis of evidence was carried out and the current knowledge on this topic was summarized. The results of this work can be useful to redirect research efforts to address the detected knowledge gaps. Currently, TDM of vancomycin presents a moderate level of evidence and practical recommendations with great robustness in neonates, pediatric and patients with renal impairment. However, it is important to investigate in other subpopulations known to present altered vancomycin pharmacokinetics (eg neurosurgical, oncological and cystic fibrosis patients), where evidence is still unsufficient.
Collapse
Affiliation(s)
- Joaquim F. Monteiro
- Faculdade de Medicina da Universidade do Porto (FMUP)PortoPortugal
- Instituto de Investigação e Formação Avançadas em Ciências e Tecnologias da Saúde (IINFACTS)Instituto Universitário de Ciências da Saúde (IUCS)GandraPortugal
| | - Siomara R. Hahn
- Instituto de Ciências BiológicasCurso de FarmáciaUniversidade de Passo Fundo (UPF)Passo FundoBrasil
- Laboratório de FarmacologiaDepartamento de Ciências do MedicamentoFaculdade de Farmácia da Universidade do Porto (FFUP)PortoPortugal
| | - Jorge Gonçalves
- Laboratório de FarmacologiaDepartamento de Ciências do MedicamentoFaculdade de Farmácia da Universidade do Porto (FFUP)PortoPortugal
- I3SInstituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
| | - Paula Fresco
- Laboratório de FarmacologiaDepartamento de Ciências do MedicamentoFaculdade de Farmácia da Universidade do Porto (FFUP)PortoPortugal
- I3SInstituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
| |
Collapse
|
85
|
Tsai YW, Wang YC, Shie SS, Chen MC, Huang YC, Chen CJ. Serum trough level as a postmarketing quality measure of generic vancomycin products. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 53:300-306. [PMID: 29907539 DOI: 10.1016/j.jmii.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/03/2018] [Accepted: 04/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The vancomycin trough level (VTL) is the most widely used pharmacokinetic parameter for monitoring its clinical efficacy. Whether the VTL is affected in patients receiving different vancomycin products has not previously been determined. METHODS From 2005 to 2015, five vancomycin products, including the innovator (designated as VAN-Lilly) and four generic versions (designated as VAN-A, VAN-B, VAN-C and VAN-D), were sequentially used in a teaching hospital. The initial VTLs were compared between patients who received different vancomycin products after propensity score (PS) weighting and matching for clinical covariates. RESULTS Among 8735 patients with initial VTL levels available for analysis, a significant association was identified between the VTL and different vancomycin products in children aged 1 month to 12 years (P < 0.0001). The PS weighting analysis in the paediatric group disclosed children on VAN-C had higher VTL compared to those on other four products (P = 0.0008). PS matching analysis revealed that children who received VAN-C had significantly higher VTLs than those who received VAN-Lily (P = 0.0001), VAN-A (P = 0.0008), VAN-B (P = 0.0002) or VAN-D (P = 0.0015). Furthermore, the coefficient of variation of the VTL was much greater in patients who received VAN-C than in those who received the other four versions, suggesting an unstable quality of this product. CONCLUSION A generic version of vancomycin generated significantly higher concentrations and greater variation of VTLs than the innovator and other generic vancomycin products in children. The VTL can serve as an indicator to monitor the quality of vancomycin products after marketing.
Collapse
Affiliation(s)
- Ya-Wen Tsai
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yu-Chiang Wang
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Shian-Sen Shie
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Min-Chi Chen
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan
| | - Yhu-Chering Huang
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Paediatric Infectious Diseases, Department of Paediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Chih-Jung Chen
- School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan; Division of Paediatric Infectious Diseases, Department of Paediatrics, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan.
| |
Collapse
|
86
|
Pan KM, Wu Y, Chen C, Chen ZZ, Xu JA, Cao L, Xu Q, Wu W, Dai PF, Li XY, Lv QZ. Vancomycin-induced acute kidney injury in elderly Chinese patients: a single-centre cross-sectional study. Br J Clin Pharmacol 2018; 84:1706-1718. [PMID: 29607531 DOI: 10.1111/bcp.13594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/06/2018] [Accepted: 03/17/2018] [Indexed: 01/20/2023] Open
Abstract
AIMS The objective of the present study was to investigate the current situation concerning, and risk factors for, vancomycin (VAN)-induced acute kidney injury (VI-AKI) in elderly Chinese patients, to assess outcomes and risk factors in patients who have developed VI-AKI, in order to provide suggestions for improving the prevention and treatment of this condition in these patients. METHOD We retrospectively identified elderly older inpatients who had received four or more doses of VAN treatment. We compared patients with VI-AKI with those who received VAN treatment and had not developed AKI (NO-AKI). We defined VI-AKI as developing AKI during VAN therapy or within 3 days after withdrawal of VAN. RESULTS A total of 647 out of 862 elderly inpatients were included in the study. Among those excluded, in 89.3% of cases (192/215) this was because of lack of data on serum creatinine (SCr). Among included patients, 32.5% (210/647) of patients received therapeutic drug monitoring (TDM) during VAN therapy. In 66.9% of cases (424/634), there was insufficient TDM, and in 3.9% (25/634) this was appropriate. A total of 102 patients had confirmed VI-AKI, with an incidence of 15.8% (102/647). Multiple logistic regression analysis revealed that hyperuricaemia [odds ratio (OR) = 3.045; P = 0.000)], mechanical ventilation (OR = 1.906; P = 0.022) and concomitant vasopressor therapy (OR = 1.919; P = 0.027) were independent risk factors for VI-AKI; higher serum albumin (OR = 0.885; P = 0.000) was determined to be an independent protective factor for VI-AKI. CONCLUSIONS For the elderly Chinese patients treated with VAN, there was insufficient monitoring of SCr, too little use of VAN TDM, and lower rate of patients whose VAN though serum concentrations were not obtained at the correct time. We recommend that hospital managers increase investment in clinical pharmacists, to strengthen professional management. Patients with concomitant hyperuricaemia and on mechanical ventilation and vasopressor therapy should be paid more attention, and a higher serum albumin was determined to be an independent protective factor for VI-AKI.
Collapse
Affiliation(s)
- Kun-Ming Pan
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Yi Wu
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Can Chen
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Zhang-Zhang Chen
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Jian-An Xu
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Lei Cao
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Qing Xu
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Wei Wu
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Pei-Fang Dai
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Xiao-Yu Li
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| | - Qian-Zhou Lv
- Department of Pharmacy, Zhongshan Hospital FuDan University, Shanghai, China
| |
Collapse
|
87
|
Aleman J, Moojen DJF, van Ogtrop ML, Poolman RW, Franssen EJF. Long-term Conventionally Dosed Vancomycin Therapy In Patients With Orthopaedic Implant-related Infections Seems As Effective And Safe As Long-term Penicillin Or Clindamycin Therapy. A Retrospective Cohort Study Of 103 Patients. J Bone Jt Infect 2018; 3:82-86. [PMID: 29761071 PMCID: PMC5949572 DOI: 10.7150/jbji.20279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/03/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives: Antimicrobial therapy is one of the cornerstones of orthopaedic implant-related infections (OIRI) treatment. Infections with Gram-positive bacteria are often treated with vancomycin, penicillin or clindamycin. A recent IDSA guideline suggests increasing the dose of vancomycin to increase the trough vancomycin target serum concentrations. This is deemed necessary because of an observed decrease in vancomycin susceptibility among Gram-positive bacteria. However, elevated vancomycin concentrations are correlated with the risk of nephrotoxicity, especially with prolonged therapy. Compared to most countries, rates of resistance against antibiotics among bacteria in the Netherlands are lower for currently available antibiotics, therefore lower target concentrations of vancomycin are probably efficacious for the treatment of infections. In this study we evaluated the efficacy and safety of long-term conventionally dosed vancomycin therapy, as an initial therapy for OIRI, and compared this with long-term penicillin and clindamycin therapy, as initial therapy, in patients with Gram-positive orthopaedic implant-related infections. Methods: A retrospective, observational study was conducted in 103 adult patients treated for OIRI, with vancomycin, penicillin or clindamycin for at least 10 days. The target trough serum concentration of vancomycin was 10-15 mg/l. Results: 74% of our patients were treated successfully with vancomycin, as initial therapy, (no reinfection within 1 year) versus 55% of our patients treated with either an antibiotic of the penicillin class (mostly flucloxacillin) or clindamycin (p=0.08), as initial therapy. For patients treated with vancomycin we observed a serum creatinine increase of 6 μmol/l, for patients treated with either an antibiotic of the penicillin class or clindamycin the serum creatinine increase was 4 μmol/l (p=0.395). Conclusions: In our population of patients with OIRI long-term treatment with conventionally dosed vancomycin, as initial therapy, was not significantly less effective and safe as long-term treatment with an antibiotic of the penicillin class or clindamycin, as initial therapy.
Collapse
Affiliation(s)
- Jacomien Aleman
- Department of Clinical Pharmacy, OLVG Amsterdam (currently in HOH, Oranjestad Aruba)
| | | | | | | | - Eric J F Franssen
- Department of Clinical Pharmacy, OLVG Amsterdam (currently in HOH, Oranjestad Aruba)
| |
Collapse
|
88
|
Visser M. Techniques for Monitoring Drug Efficacy. Vet Clin North Am Exot Anim Pract 2018; 21:287-295. [PMID: 29655470 DOI: 10.1016/j.cvex.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The efficacy of drugs can vary greatly between species and individuals. Establishing efficacious drug doses for a species requires integration of population pharmacokinetic and pharmacodynamic data into a dose-response curve. Unfortunately, these data sets are rarely available for exotic species. The use of alternative monitoring techniques is required to determine drug efficacy and safety. This article discusses methods to integrate efficacy monitoring into clinical practice, including the use of diagnostic testing and therapeutic drug monitoring.
Collapse
Affiliation(s)
- Marike Visser
- Department of Anatomy, Physiology and Pharmacology, Auburn University, 1500 Wire Road, Auburn, AL 36849, USA.
| |
Collapse
|
89
|
Wilcox MH, Dmitrieva N, Gales AC, Petukhova I, Al-Obeid S, Rossi F, M Blondeau J. Susceptibility testing and reporting of new antibiotics with a focus on tedizolid: an international working group report. Future Microbiol 2017; 12:1523-1532. [PMID: 28812924 DOI: 10.2217/fmb-2017-0106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Inappropriate use and overuse of antibiotics are among the most important factors in resistance development, and effective antibiotic stewardship measures are needed to optimize outcomes. Selection of appropriate antimicrobials relies on accurate and timely antimicrobial susceptibility testing. However, the availability of clinical breakpoints and in vitro susceptibility testing often lags behind regulatory approval by several years for new antimicrobials. A Working Group of clinical/medical microbiologists from Brazil, Canada, Mexico, Saudi Arabia, Russia and the UK recently examined issues surrounding antimicrobial susceptibility testing for novel antibiotics. While commercially available tests are being developed, potential surrogate antibiotics may be used as marker of susceptibility. Using tedizolid as an example of a new antibiotic, this special report makes recommendations to optimize routine susceptibility reporting.
Collapse
Affiliation(s)
- Mark H Wilcox
- Leeds Teaching Hospitals NHS Trust & University of Leeds, Leeds, UK
| | | | - Ana Cristina Gales
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Suleiman Al-Obeid
- Microbiology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Flavia Rossi
- Hospital das Clínicas da Faculdade de Medicina, Seção de Microbiologia, Divisão de Laboratório Central LIM03, Universidade de São Paulo, São Paulo, Brazil
| | | |
Collapse
|
90
|
Determining the optimal vancomycin daily dose for pediatrics: a meta-analysis. Eur J Clin Pharmacol 2017; 73:1341-1353. [DOI: 10.1007/s00228-017-2306-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
|
91
|
Obara VY, Zacas CP, Carrilho CMDDM, Delfino VDA. Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients. Rev Bras Ter Intensiva 2017; 28:380-386. [PMID: 28099635 DOI: 10.5935/0103-507x.20160071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients. Methods: A prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours. Results: Considering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023). Conclusion: Surprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged.
Collapse
Affiliation(s)
- Vitor Yuzo Obara
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Londrina - Londrina (PR), Brasil
| | | | | | | |
Collapse
|
92
|
Bakke V, Sporsem H, Von der Lippe E, Nordøy I, Lao Y, Nyrerød HC, Sandvik L, Hårvig KR, Bugge JF, Helset E. Vancomycin levels are frequently subtherapeutic in critically ill patients: a prospective observational study. Acta Anaesthesiol Scand 2017; 61:627-635. [PMID: 28444760 PMCID: PMC5485054 DOI: 10.1111/aas.12897] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 12/15/2022]
Abstract
Background Appropriate utilization of vancomycin is important to attain therapeutic targets while avoiding clinical failure and the development of antimicrobial resistance. Our aim was to observe the use of vancomycin in an intensive care population, with the main focus on achievement of therapeutic serum concentrations (15–20 mg/l) and to evaluate how this was influenced by dose regimens, use of guidelines and therapeutic drug monitoring. Methods A prospective observational study was carried out in the intensive care units at two tertiary hospitals in Norway. Data were collected from 83 patients who received vancomycin therapy, half of these received continuous renal replacement therapy. Patients were followed for 72 h after initiation of therapy. Blood samples were drawn for analysis of trough serum concentrations. Urine was collected for calculations of creatinine clearance. Information was gathered from medical records and electronic health records. Results Less than 40% of the patients attained therapeutic trough serum concentrations during the first 3 days of therapy. Patients with augmented renal clearance had lower serum trough concentrations despite receiving higher maintenance doses and more loading doses. When trough serum concentrations were outside of therapeutic range, dose adjustments in accordance to therapeutic drug monitoring were made to less than half. Conclusion The present study reveals significant challenges in the utilization of vancomycin in critically ill patients. There is a need for clearer guidelines regarding dosing and therapeutic drug monitoring of vancomycin for patient subgroups.
Collapse
Affiliation(s)
- V. Bakke
- Faculty of Medicine; University of Oslo; Oslo Norway
| | | | - E. Von der Lippe
- Department of Infectious Diseases; Oslo University Hospital - Ullevaal; Oslo Norway
| | - I. Nordøy
- Section for Clinical Immunology and Infectious Diseases; Oslo University Hospital - Rikshospitalet; Oslo Norway
- Research Institute for Internal Medicine; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - Y. Lao
- Oslo Hospital Pharmacy; Oslo Norway
| | - H. C. Nyrerød
- Department of Anesthesiology; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - L. Sandvik
- Oslo Center for Biostatistics and Epidemiology; Research support services; Oslo Norway
| | - K. R. Hårvig
- Department of Anesthesiology; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - J. F. Bugge
- Department of Anesthesiology; Oslo University Hospital - Rikshospitalet; Oslo Norway
| | - E. Helset
- Department of Anesthesiology; Oslo University Hospital - Ullevaal; Oslo Norway
| |
Collapse
|
93
|
Filippone EJ, Kraft WK, Farber JL. The Nephrotoxicity of Vancomycin. Clin Pharmacol Ther 2017; 102:459-469. [PMID: 28474732 PMCID: PMC5579760 DOI: 10.1002/cpt.726] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/07/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022]
Abstract
Vancomycin use is often associated with nephrotoxicity. It remains uncertain, however, to what extent vancomycin is directly responsible, as numerous potential risk factors for acute kidney injury frequently coexist. Herein, we critically examine available data in adult patients pertinent to this question. We review the pharmacokinetics/pharmacodynamics of vancomycin metabolism. Efficacy and safety data are discussed. The pathophysiology of vancomycin nephrotoxicity is considered. Risk factors for nephrotoxicity are enumerated, including the potential synergistic nephrotoxicity of vancomycin and piperacillin‐tazobactam. Suggestions for clinical practice and future research are given.
Collapse
Affiliation(s)
- E J Filippone
- Department of Medicine, Sydney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Division of Nephrology, Sydney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - W K Kraft
- Department of Pharmacology and Experimental Therapeutics, Sydney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J L Farber
- Department of Pathology, Sydney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
94
|
Intérêt du suivi thérapeutique pharmacologique dans le cadre des infections pulmonaires. Rev Mal Respir 2017; 34:693-705. [DOI: 10.1016/j.rmr.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 08/30/2016] [Indexed: 12/31/2022]
|
95
|
Kourogi Y, Ogata K, Takamura N, Tokunaga J, Setoguchi N, Kai M, Tanaka E, Chiyotanda S. Establishment of a new initial dose plan for vancomycin using the generalized linear mixed model. Theor Biol Med Model 2017; 14:8. [PMID: 28388921 PMCID: PMC5385004 DOI: 10.1186/s12976-017-0054-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/20/2017] [Indexed: 11/29/2022] Open
Abstract
Background When administering vancomycin hydrochloride (VCM), the initial dose is adjusted to ensure that the steady-state trough value (Css-trough) remains within the effective concentration range. However, the Css-trough (population mean method predicted value [PMMPV]) calculated using the population mean method (PMM) often deviate from the effective concentration range. In this study, we used the generalized linear mixed model (GLMM) for initial dose planning to create a model that accurately predicts Css-trough, and subsequently assessed its prediction accuracy. Methods The study included 46 subjects whose trough values were measured after receiving VCM. We calculated the Css-trough (Bayesian estimate predicted value [BEPV]) from the Bayesian estimates of trough values. Using the patients’ medical data, we created models that predict the BEPV and selected the model with minimum information criterion (GLMM best model). We then calculated the Css-trough (GLMMPV) from the GLMM best model and compared the BEPV correlation with GLMMPV and with PMMPV. Results The GLMM best model was {[0.977 + (males: 0.029 or females: -0.081)] × PMMPV + 0.101 × BUN/adjusted SCr – 12.899 × SCr adjusted amount}. The coefficients of determination for BEPV/GLMMPV and BEPV/PMMPV were 0.623 and 0.513, respectively. Conclusion We demonstrated that the GLMM best model was more accurate in predicting the Css-trough than the PMM.
Collapse
Affiliation(s)
- Yasuyuki Kourogi
- Chiyoda Hospital, Social Medial Corporation Senwakai, Hyuga, Japan.,School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Nobeoka, Japan
| | - Kenji Ogata
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Nobeoka, Japan
| | - Norito Takamura
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Nobeoka, Japan. .,Second Department of Clinical Pharmacy, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki, 882-8508, Japan.
| | - Jin Tokunaga
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Nobeoka, Japan
| | - Nao Setoguchi
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, Nobeoka, Japan
| | - Mitsuhiro Kai
- Chiyoda Hospital, Social Medial Corporation Senwakai, Hyuga, Japan
| | - Emi Tanaka
- Chiyoda Hospital, Social Medial Corporation Senwakai, Hyuga, Japan
| | | |
Collapse
|
96
|
Awdishu L, Mehta RL. The 6R's of drug induced nephrotoxicity. BMC Nephrol 2017; 18:124. [PMID: 28372552 PMCID: PMC5379580 DOI: 10.1186/s12882-017-0536-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/25/2017] [Indexed: 01/05/2023] Open
Abstract
Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. Our current knowledge of drug induced kidney disease is limited due to varying definitions of kidney injury, incomplete assessment of concurrent risk factors and lack of long term outcome reporting. Electronic surveillance presents a powerful tool to identify susceptible populations, improve recognition of events and provide decision support on preventative strategies or early intervention in the case of injury. Research in the area of biomarkers for detecting kidney injury and genetic predisposition for this adverse event will enhance detection of injury, identify those susceptible to injury and likely mitigate risk. In this review we will present a 6R framework to identify and mange drug induced kidney injury – risk, recognition, response, renal support, rehabilitation and research.
Collapse
Affiliation(s)
- Linda Awdishu
- UC San Diego Skaggs School of Pharmacy, San Diego, USA. .,UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Ravindra L Mehta
- UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| |
Collapse
|
97
|
Griffin SP, Nelson JE. Impact of a Clinical Solid Organ Transplant Pharmacist on Tacrolimus Nephrotoxicity, Therapeutic Drug Monitoring, and Institutional Revenue Generation in Adult Kidney Transplant Recipients. Prog Transplant 2016; 26:314-321. [PMID: 27628498 DOI: 10.1177/1526924816667950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Tacrolimus requires close therapeutic drug monitoring (TDM) to ensure efficacy and minimize adverse effects. Pharmacists are uniquely positioned on transplant teams to interpret levels and recommend therapy modifications. Their impact in the immediate postoperative setting has not been described previously. OBJECTIVE To evaluate the impact of a clinical solid organ transplant pharmacist on nephrotoxicity, TDM, and revenue generation in adult kidney transplant recipients on tacrolimus. DESIGN, SETTING, AND PATIENTS Retrospective assessment of adult kidney transplant recipients at University of Florida Health Shands Hospital. INTERVENTION A transplant pharmacist rounded 5 days a week and made medication recommendations on transplant recipients-including tacrolimus dose modifications based on levels. Pharmacy services were expanded to include medication reconciliation, medication counseling, and delivery of discharge medications to bedside. MAIN OUTCOME MEASURE Incidence of nephrotoxicity during tacrolimus exposure. RESULTS Of the 70 kidney transplant recipients in the postpharmacist cohort, 18 (25.7%) experienced nephrotoxicity while on tacrolimus, compared to 18 (25%) of the 72 in the prepharmacist cohort ( P = .922). A significantly greater proportion of recipients who experienced nephrotoxicity were male, had hypertension, or experienced delayed or slow graft function. The rate of appropriately drawn tacrolimus troughs significantly increased from 23.4% to 30.3% in the postpharmacist cohort ( P < .001). The median outpatient pharmacy revenue generated per recipient significantly increased from US$345.49 (interquartile range [IQR]: 0-4727.56) to US$4834.95 per recipient (IQR: 3592.78-6224.60; P < .001). The length of stay (7 days, IQR: 6-9, vs 8 days, IQR: 6-9; P = .107) and the 30-day readmission rate were similar between groups (20.8% vs 21.4%; P = .931).
Collapse
Affiliation(s)
- Shawn P Griffin
- 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA
| | - Joelle E Nelson
- 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA.,2 College of Pharmacy, University of Florida, Gainesville, FL, USA, and College of Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
98
|
Abstract
PURPOSE OF REVIEW Recent studies suggest that contemporary antibiotic dosing is unlikely to achieve best outcomes for critically ill patients because of extensive pharmacokinetic variability and altered pharmacodynamics. Dose adaptation is considered quite challenging because of unpredictable dose-exposure relationships. Consequently, individualization of antibiotic dosing has been advocated. Herein, we describe recent developments in the optimization of antibiotic dosing in the critically ill. RECENT FINDINGS Conventional doses of many antibiotics frequently result in sub or supratherapeutic exposures in the critically ill. Clinical studies continue to illustrate that dose-exposure relationships are highly variable in severely ill patients. Dose optimization based on pharmacokinetic/pharmacodynamic principles can effectively improve antibiotic exposure. Therapeutic drug monitoring (TDM) with adaptive feedback is likely to be the most robust approach to optimize dosing for individual patients. This more accurate approach to dosing is made possible with the user-friendly dosing software that is emerging. SUMMARY The scope of TDM is broadening from the traditional focus on prevention of toxicity, to include optimization of antibiotic exposure thereby improving patient outcomes. However, the evidence relating TDM practice with improved clinical outcome remains limited. Well designed, multicentre, randomized controlled studies are warranted.
Collapse
|
99
|
Irikuchi J, Imai T, Yoshida Y, Orii T. [Influence of systemic inflammatory response syndrome on the pharmacokinetics of vancomycin]. YAKUGAKU ZASSHI 2016; 135:745-51. [PMID: 25948312 DOI: 10.1248/yakushi.14-00214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Therapeutic drug monitoring (TDM) of vancomycin (VCM) is recommended to minimize its nephrotoxicity and maximize efficacy. Recently, the concept of systemic inflammatory response syndrome (SIRS) has been introduced to describe a clinical state resulting from the actions of complex intrinsic mediators in an acute-phase systemic response. However, there are few reports on the pharmacokinetics of VCM in patients with SIRS. This study investigated the effect of SIRS on the pharmacokinetics of VCM by analyzing the predictability of TDM and pharmacokinetic parameters in 31 non-SIRS patients and 52 SIRS patients, with stratification by SIRS score. The mean prediction error (ME) and mean absolute prediction error in SIRS score 2 and 3 patients differed from those in non-SIRS patients. The ME in the score 4 group showed a negative value. In the comparison of pharmacokinetic parameters by SIRS score, a significantly lower CL(vcm) value was observed at score 4 compared with scores 2 and 3, a higher Vd value was observed at score 4 compared with non-SIRS and at score 3, and a longer T1/2 was observed at score 2. In the comparison of patient characteristics by SIRS score, albumin, aspartate aminotransferase, and alanine aminotransferase levels showed differences among the scores. However, no correlation was observed between VCM pharmacokinetics and these three laboratory parameters. These findings suggest that the pharmacokinetics of VCM may be affected by the pathology of SIRS rather than by patient characteristics.
Collapse
|
100
|
Ye ZK, Chen YL, Chen K, Zhang XL, Du GH, He B, Li DK, Liu YN, Yang KH, Zhang YY, Zhai SD. Therapeutic drug monitoring of vancomycin: a guideline of the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society. J Antimicrob Chemother 2016; 71:3020-3025. [PMID: 27494905 DOI: 10.1093/jac/dkw254] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Guideline development should be based on the quality of evidence, balance of benefits and harms, economic evaluation and patients' views and preferences. Therefore, these factors were considered in the development of a new guideline for therapeutic drug monitoring (TDM) of vancomycin. OBJECTIVES To develop an evidence-based guideline for vancomycin TDM and to promote standardized vancomycin TDM in clinical practice in China. METHODS We referred to the WHO Handbook for Guideline Development and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence and grade the strength of recommendations, according to economic evaluation and patients' views and preferences. We used the GRADE Grid method to formulate the recommendations. RESULTS The guideline presents recommendations about who should receive vancomycin TDM, how to monitor vancomycin efficacy and renal safety, therapeutic trough concentrations, time to start initial vancomycin TDM, loading dose and how to administer and adjust the vancomycin dose. CONCLUSIONS We developed an evidence-based guideline for vancomycin TDM, which provides recommendations for clinicians and pharmacists to conduct vancomycin TDM in China.
Collapse
Affiliation(s)
- Zhi-Kang Ye
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Yao-Long Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Gansu, China.,Chinese GRADE Center, Gansu, China
| | - Ken Chen
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Xiang-Lin Zhang
- Pharmaceutical Department of China-Japan Friendship Hospital, Beijing, China
| | - Guan-Hua Du
- Institute of Materia Medica, Chinese Academy of Medical Sciences, Beijing, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Da-Kui Li
- Pharmacy Department, Peking Union Medical College Hospital, Beijing, China
| | - You-Ning Liu
- Institute of Respiratory Disease, Chinese PLA General Hospital, Beijing, China
| | - Ke-Hu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Gansu, China.,Chinese GRADE Center, Gansu, China
| | - Ying-Yuan Zhang
- Institute of Antibiotics, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Suo-Di Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | | |
Collapse
|