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Alghamdi WA, Al-Shaer MH, Klinker KP, Peloquin CA. Variable linezolid exposure and response and the role of therapeutic drug monitoring: Case series. Clin Case Rep 2020; 8:1126-1129. [PMID: 32695341 PMCID: PMC7364108 DOI: 10.1002/ccr3.2835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/07/2020] [Accepted: 03/20/2020] [Indexed: 11/06/2022] Open
Abstract
Two patients with normal renal function, yet each showed unexpected, supra- and subtherapeutic linezolid plasma concentrations resulting in toxicity and ineffective therapy, respectively. TDM helps to early identify and correct such excursions.
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Affiliation(s)
- Wael A Alghamdi
- Department of Clinical Pharmacy College of Pharmacy King Khalid University Abha Saudi Arabia
| | - Mohammad H Al-Shaer
- Department of Pharmacotherapy and Translational Research College of Pharmacy University of Florida Gainesville FL USA
| | - Kenneth P Klinker
- Department of Pharmacotherapy and Translational Research College of Pharmacy University of Florida Gainesville FL USA
- Present address: Merck & Co., Inc Kenilworth NJ USA
| | - Charles A Peloquin
- Department of Pharmacotherapy and Translational Research College of Pharmacy University of Florida Gainesville FL USA
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2
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Selvaskandan H, Modha DE, Denton-Beaumont R, Ashton C, Hamilton RA. High-dose oral linezolid achieved rapid clinical and microbiological recovery in a severely overweight male with long-standing infected ulcers. J Antimicrob Chemother 2019; 74:1755-1757. [PMID: 30783670 DOI: 10.1093/jac/dkz071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Haresh Selvaskandan
- Department of Acute Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Deborah E Modha
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ruth Denton-Beaumont
- Department of Acute Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Corrine Ashton
- Department of Pharmacy, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ryan A Hamilton
- Department of Pharmacy, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
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Narayanan N, Adams CD, Kubiak DW, Cheng S, Stoianovici R, Kagan L, Brunetti L. Evaluation of treatment options for methicillin-resistant Staphylococcus aureus infections in the obese patient. Infect Drug Resist 2019; 12:877-891. [PMID: 31114267 PMCID: PMC6490236 DOI: 10.2147/idr.s196264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/12/2019] [Indexed: 12/30/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a major cause of infection in both the hospital and community setting. Obesity is a risk factor for infection, and the prevalence of this disease has reached epidemic proportions worldwide. Treatment of infections in this special population is a challenge given the lack of data on the optimal antibiotic choice and dosing strategies, particularly for treatment of MRSA infections. Obesity is associated with various physiological changes that may lead to altered pharmacokinetic parameters. These changes include altered drug biodistribution, elimination, and absorption. This review provides clinicians with a summary of the literature pertaining to the pharmacokinetic and pharmacodynamic considerations when selecting antibiotic therapy for the treatment of MRSA infections in obese patients.
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Affiliation(s)
- Navaneeth Narayanan
- Department of Pharmacy Practice, Rutgers University, Ernest Mario School of Pharmacy, Piscataway, NJ, USA
- Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher D Adams
- Department of Pharmacy Practice, Rutgers University, Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - David W Kubiak
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Serena Cheng
- Department of Pharmacy, VA San Diego Healthcare System, San Diego, CA, USA
| | - Robyn Stoianovici
- Department of Pharmacy, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Leonid Kagan
- Department of Pharmacy Practice, Rutgers University, Ernest Mario School of Pharmacy, Piscataway, NJ, USA
- Department of Pharmaceutics, Rutgers University, Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Luigi Brunetti
- Department of Pharmacy Practice, Rutgers University, Ernest Mario School of Pharmacy, Piscataway, NJ, USA
- Department of Pharmaceutics, Rutgers University, Ernest Mario School of Pharmacy, Piscataway, NJ, USA
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Abstract
We assessed the effect of body weight and BMI on plasma concentrations of venlafaxine (VEN), O-desmethylvenlafaxine (ODVEN), active moiety (AM=VEN+ODVEN), and dose-corrected plasma concentrations (C/D). A database containing concentrations of VEN and ODVEN including 737 of 1594 eligible patients was analyzed. Analyses included sex, body weight, and BMI as well as concentrations of VEN, ODVEN, AM, and C/D. A positive correlation was detected between body weight and daily dosage (rs=0.168, P<0.001). A negative correlation was found between body weight and AM (rs=-0.124, P=0.001) and ODVEN (rs=-0.137, P<0.001). Negative correlations were also found between body weight and C/D ratios (C/D VEN: rs=-0.134, P<0.001, C/D ODVEN: rs=-0.239, P<0.001, C/D AM: rs=-0.256, P<0.001). No correlations were detected between BMI and concentrations for VEN, ODVEN, and AM. Comparing low-BMI (<20 kg/m²), medium-BMI (20-29.9 kg/m²), and high-BMI (≥30 kg/m²) groups, higher values of some pharmacokinetic variables in the lower BMI group did not remain significant after controlling for sex. Women had higher VEN, ODVEN, AM, and C/D values for AM, VEN, and ODVEN than men (P<0.001 for all comparisons). Our results highlight the role of different pharmacokinetically relevant parameters and foremost of sex as mediators for the effect of BMI on VEN metabolism.
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Taubert M, Zander J, Frechen S, Scharf C, Frey L, Vogeser M, Fuhr U, Zoller M. Optimization of linezolid therapy in the critically ill: the effect of adjusted infusion regimens. J Antimicrob Chemother 2018; 72:2304-2310. [PMID: 28541510 DOI: 10.1093/jac/dkx149] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/21/2017] [Indexed: 12/17/2022] Open
Abstract
Objectives Insufficient linezolid levels, which are associated with a poorer outcome, are often observed in ICU patients who receive standard dosing. Although strategies to overcome these insufficient levels have been discussed, appropriate alternative dosing regimens remain to be identified. Methods Various infusion regimens (1200-3600 mg/day; q6h, q8h, q12h and continuous) were simulated in 67 000 ICU patients. The probability of attaining pharmacodynamic targets ( T >MIC ≥85%, AUC/MIC ≥100, cumulative fraction of response for Staphylococcus aureus and Enterococcus spp., PTA for an MIC of 0.5-4 mg/L) as well as the avoidance of toxic concentrations and concentrations constantly below the MIC (lack of antibiotic effect) or inside a mutant selection window (resistance development) were evaluated. Results Best target attainment according to T >MIC was observed for continuous infusions, followed by q6h, q8h and q12h. A substantially reduced target attainment was observed in patients with acute respiratory distress syndrome (ARDS). In patients without ARDS, 1200 mg/day was insufficient irrespective of the regimen, while a dose of 1400 mg/day administered q6h or by continuous infusions provided an acceptable target attainment (e.g. cumulative fraction of response with regards to T >MIC ≥93%). Higher rates of potentially toxic trough concentrations (28% versus 12%) and concentrations constantly inside the mutant selection window (15% versus <0.1%) were observed with continuous infusions compared with q6h infusions (1400 mg/day, patients without ARDS). Conclusions Irrespective of the regimen, 1200 mg/day linezolid might be insufficient for the treatment of ICU patients. Patients without ARDS might particularly benefit from q6h infusions with increased daily doses (e.g. 1400 mg/day).
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Affiliation(s)
- Max Taubert
- Department I of Pharmacology, Clinical Pharmacology Unit, Hospital of the University of Cologne, Cologne, Germany
| | - Johannes Zander
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sebastian Frechen
- Department I of Pharmacology, Clinical Pharmacology Unit, Hospital of the University of Cologne, Cologne, Germany
| | - Christina Scharf
- Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Lorenz Frey
- Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Uwe Fuhr
- Department I of Pharmacology, Clinical Pharmacology Unit, Hospital of the University of Cologne, Cologne, Germany
| | - Michael Zoller
- Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
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Corcione S, D'Avolio A, Allegra S, Fanelli V, Urbino R, Ranieri MV, Di Perri G, De Rosa FG. Pharmacokinetics of linezolid in critically ill patients: impact of continuous venovenous haemofiltration. Int J Antimicrob Agents 2017; 49:784-785. [PMID: 28412274 DOI: 10.1016/j.ijantimicag.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/06/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy.
| | - Antonio D'Avolio
- Department of Medical Sciences, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy
| | - Sarah Allegra
- Department of Medical Sciences, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy
| | - Vito Fanelli
- Department of Surgical Sciences, University of Turin, Division of Anesthesia and Critical Care, City of Health and Science, Molinette Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Rosario Urbino
- Department of Surgical Sciences, University of Turin, Division of Anesthesia and Critical Care, City of Health and Science, Molinette Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Marco V Ranieri
- Department of Anesthesia and Critical Care, Ospedale Policlinico Umberto I, Università La Sapienza di Roma, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy
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Cattaneo D, Alffenaar JW, Neely M. Drug monitoring and individual dose optimization of antimicrobial drugs: oxazolidinones. Expert Opin Drug Metab Toxicol 2016; 12:533-44. [DOI: 10.1517/17425255.2016.1166204] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dario Cattaneo
- Unit of Clinical Pharmacology, Department of Laboratory Medicine, Luigi Sacco University Hospital, Milan, Italy
| | - Jan-Willem Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michael Neely
- Laboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angels, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angels, CA, USA
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Corcione S, Pagani N, Baietto L, Fanelli V, Urbino R, Ranieri VM, Di Perri G, D'Avolio A, De Rosa FG. Pharmacokinetics of high dosage of linezolid in two morbidly obese patients—authors' response: Figure 1. J Antimicrob Chemother 2015; 70:3169. [DOI: 10.1093/jac/dkv240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lopez-Garcia B, Luque S, Maseda E, Grau S. Comment on: Pharmacokinetics of high dosage of linezolid in two morbidly obese patients. J Antimicrob Chemother 2015; 70:3168. [PMID: 26169559 DOI: 10.1093/jac/dkv209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Belén Lopez-Garcia
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar. Paseo Marítimo 25-29, 08003 Barcelona, Spain
| | - Sonia Luque
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar. Paseo Marítimo 25-29, 08003 Barcelona, Spain Infectious Diseases Research Group, IMIM (Institut Municipal d'investigacions Biomédiques), Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Emilio Maseda
- Anaesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar. Paseo Marítimo 25-29, 08003 Barcelona, Spain Infectious Diseases Research Group, IMIM (Institut Municipal d'investigacions Biomédiques), Doctor Aiguader 88, 08003 Barcelona, Spain Medicine Department, Universitat Autónoma de Barcelona, Barcelona, Spain
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