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Debray A, Callot D, Hirt D, Bille E, Renolleau S, Chouchana L, Tréluyer JM, Oualha M, Béranger A. Beta-lactam exposure and safety in intermittent or continuous infusion in critically ill children: an observational monocenter study. Eur J Pediatr 2023; 182:965-973. [PMID: 36422708 DOI: 10.1007/s00431-022-04716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess the pharmacokinetic (PK) exposure and clinical toxicity for three beta-lactams: cefotaxime, piperacillin/tazobactam, and meropenem, depending on two lengths of infusion: continuous and intermittent, in critically ill children. This single center observational prospective study was conducted in a pediatric intensive care unit. All hospitalized children who had one measured plasma concentration of the investigated antibiotics were included. Plasma antibiotic concentrations were interpreted by a pharmacologist, using a Bayesian approach based on previously published population pharmacokinetic models in critically ill children. Exposure was considered optimal, low, or high according to the PK target 100% fT> 4 × MIC and a trough concentration below the toxic concentration (50 mg.L-1 for cefotaxime, 150 mg.L-1 for piperacillin, and 44 mg.L-1 for meropenem). Between May 2019 and January 2020, 80 patients were included and received 106 antibiotic courses: 74 (70%) were administered in intermittent infusion (II) and 32 (30%) in continuous infusion (CI). Compared to II, CI provided more optimal PK exposure (n = 22/32, 69% for CI versus n = 35/74, 47% for II, OR 1.2, 95%CI 1.01-1.5, p = 0.04), less underexposure (n = 4/32, 13% for CI versus n = 36/74, 49% for II, OR 0.7, 95%CI 0.6-0.84, p < 0.001), and more overexposure (n = 6/32, 19% for CI versus n = 3/74, 4% for II, OR 1.2, 95%CI 1.03-1.3, p = 0.01). Five adverse events have been reported during the study period, although none has been attributed to beta-lactam treatment. CONCLUSION CI provided a higher probability to attain an optimal PK target compared to II, but also a higher risk for overexposure. Regular therapeutic drug monitoring is recommended in critically ill children receiving beta-lactams, regardless of the length of infusion. WHAT IS KNOWN • Since beta-lactams are time-dependent antibiotics, the probability to attain the pharmacokinetic target is higher with continuous infusion compared to that with intermittent infusion. • In daily practice, continuous or extended infusions are rarely used despite recent guidelines, and toxicity is hardly reported. WHAT IS NEW • Continuous infusion provided a higher probability to attain an optimal pharmacokinetic target compared to intermittent infusion, but also a higher risk of overexposure. • Regular therapeutic drug monitoring is recommended in critically ill children receiving beta-lactams, regardless of the length of infusion.
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Affiliation(s)
- Agathe Debray
- Pédiatrie Générale Et Maladies Infectieuses, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France
| | - Delphine Callot
- Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Pharmacovigilance, Paris, France
- Pharmacologie Et Évaluations Thérapeutiques Chez L'enfant Et La Femme Enceinte, EA7323, Paris, France
| | - Déborah Hirt
- Pharmacologie Et Évaluations Thérapeutiques Chez L'enfant Et La Femme Enceinte, EA7323, Paris, France
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Paris, France
| | - Emmanuelle Bille
- Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France
| | - Sylvain Renolleau
- Réanimation Et Surveillance Continue Médico-Chirurgicales Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, 149 Rue de Sèvres, 75015, Paris, France
| | - Laurent Chouchana
- Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Pharmacovigilance, Paris, France
- Pharmacologie Et Évaluations Thérapeutiques Chez L'enfant Et La Femme Enceinte, EA7323, Paris, France
| | - Jean-Marc Tréluyer
- Pharmacologie Et Évaluations Thérapeutiques Chez L'enfant Et La Femme Enceinte, EA7323, Paris, France
- Service de Pharmacologie Clinique, Hôpital Cochin, AP-HP, Paris, France
- Unité de Recherche Clinique - Centre d'Investigation Clinique 1419, Hôpital Cochin-Necker, Université de Paris, Inserm, Paris, France
| | - Mehdi Oualha
- Pharmacologie Et Évaluations Thérapeutiques Chez L'enfant Et La Femme Enceinte, EA7323, Paris, France
- Réanimation Et Surveillance Continue Médico-Chirurgicales Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, 149 Rue de Sèvres, 75015, Paris, France
| | - Agathe Béranger
- Pharmacologie Et Évaluations Thérapeutiques Chez L'enfant Et La Femme Enceinte, EA7323, Paris, France.
- Réanimation Et Surveillance Continue Médico-Chirurgicales Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, 149 Rue de Sèvres, 75015, Paris, France.
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An Artificial Intelligence Approach to Support Detection of Neonatal Adverse Drug Reactions Based on Severity and Probability Scores: A New Risk Score as Web-Tool. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121826. [PMID: 36553270 PMCID: PMC9777414 DOI: 10.3390/children9121826] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Critically ill neonates are at greater risk for adverse drug reactions (ADRs). The differentiation of ADRs from reactions associated with organ dysfunction/immaturity or genetic variability is difficult. METHODS In this prospective cohort study, each ADR was assessed using newborn-specific severity and probability scales by the clinical pharmacist. Subsequently, a machine learning-based risk score was designed to predict ADR presence in neonates. RESULTS In 98/412 (23.8%) of (56.3%; male) neonates included, 187 ADRs (0.42 ADR/patient) were determined related to 49 different drugs (37.12%). Drugs identified as high risk were enoxaparin, dexmedetomidine, vinblastine, dornase alfa, etoposide/carboplatin and prednisolone. The independent variables included in the risk score to predict ADR presence, according to the random forest importance criterion, were: systemic hormones (2 points), cardiovascular drugs (3 points), diseases of the circulatory system (1 point), nervous system drugs (1 point), and parenteral nutrition treatment (1 point), (cut-off value: 3 points). This risk score correctly classified 91.1% of the observations in the test set (c-index: 0.914). CONCLUSIONS Using the high-performing risk score specific to neonates, it is expected that high-risk neonatal ADRs can be determined and prevented before they occur. Moreover, the awareness of clinicians of these drugs can be improved with this web-tool, and mitigation strategies (change of drug, dose, treatment duration, etc.) can be considered, based on a benefit-harm relationship for suspected drugs with a newborn-centered approach.
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Cao H, Jiang Y, Wang S, Cao H, Li Y, Huang J. Dried Plasma Spot Based LC-MS/MS Method for Monitoring of Meropenem in the Blood of Treated Patients. Molecules 2022; 27:molecules27061991. [PMID: 35335353 PMCID: PMC8949976 DOI: 10.3390/molecules27061991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Meropenem (MER) is widely used to treat complicated and serious infections. Therapeutic drug monitoring (TDM) provides a valid clinical tool to avoid suboptimal concentrations and dose−related adverse reactions. However, TDM seems to face challenges since the limited stability of MER in plasma makes transport difficult between clinics and laboratories. Dried plasma spot (DPS) sampling is an attractive but underutilized method for TDM that has the desired features of easy collection, storage, and transport, and overcomes known hematocrit (HCT) issues in dried blood spot (DBS) analysis. This study was designed to investigate a DPS−based liquid chromatography−tandem mass spectrometry (LC−MS/MS) method for quantification of MER. The method was developed and validated for DPS and wet plasma samples. Calibration curves were linear (R2 > 0.995) over the concentration range of 0.5−50 µg/mL. Overall accuracy and precision did not exceed 15% and no significant matrix effect was observed. MER has been more stable in DPS than in wet plasma samples. A comparison of DPS and wet plasma concentrations was assessed in 32 patients treated with MER. The results showed that there was no significant difference between the two methods. So the DPS method developed in this study is appropriate and practical for the monitor of MER in the daily clinical laboratory practice.
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Affiliation(s)
- Haiwei Cao
- Department of Medicine Laboratory, The First Hospital of Jilin University, Jilin University, Changchun 130061, China; (H.C.); (S.W.)
| | - Yi Jiang
- Department of Breast Disease, The Second Hospital of Jilin University, Jilin University, Changchun 130061, China;
| | - Shaomin Wang
- Department of Medicine Laboratory, The First Hospital of Jilin University, Jilin University, Changchun 130061, China; (H.C.); (S.W.)
| | - Haihuan Cao
- Drug and Agricultural Products Laboratory, Changchun Customs Technology Center, Department of Food, Changchun Customs, Changchun 130062, China;
| | - Yanyan Li
- Department of Medicine Laboratory, The First Hospital of Jilin University, Jilin University, Changchun 130061, China; (H.C.); (S.W.)
- Correspondence: (Y.L.); (J.H.)
| | - Jing Huang
- Department of Medicine Laboratory, The First Hospital of Jilin University, Jilin University, Changchun 130061, China; (H.C.); (S.W.)
- Correspondence: (Y.L.); (J.H.)
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4
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Khan MR, Saleem Z, Batool N, Babar M, Shabbir A. Retrospective drug utilization review of meropenem and role of infectious disease pharmacist in specialized cancer care hospital. J Oncol Pharm Pract 2022; 28:910-915. [DOI: 10.1177/10781552221077929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Carbapenem antimicrobials are considered for the treatment of serious bacterial infections. The objective of this study was to review the use of meropenem in cancer patients and to evaluate the impact of clinical pharmacist's intervention in this practice to reduce possible risks associated with use of meropenem. Methods This retrospective study was conducted among 100 patients who received meropenem at hospital. A structured questionnaire was used to collect data. Descriptive statistics was used to analyze the collected data. Results A total of 100 patients were included in this retrospective study with aim to review rationality and possible side effects associated with meropenem use in our study population. It was revealed that meropenem used was associated with rise in bilirubin in many of our study patients. Pharmacist were found to be instrumental in placing timely interventions for either de-escalation or switch of meropenem to imipenem/cilastatin to reduce that risk. Interventions were accepted by physicians in most of the cases. Conclusion De-escalation and switching were performed in accordance with pharmacist recommendations in more than half of study population with empirically started/ study population in which meropenem was used.
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Affiliation(s)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Narjis Batool
- Department of Pharmacology, Punjab University College of Pharmacy, University of the Punjab, Old Campus, Lahore, Pakistan
| | - Mahrukh Babar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Aleena Shabbir
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
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Decheng S, Xia F, Zhiming X, Liyang, Peilong W. Simultaneous determination of eight carbapenems in milk by modified QuEChERS and ultra high performance liquid chromatography coupled with high-field quadrupole-orbitrap high-resolution mass spectrometry. J Chromatogr A 2022; 1670:462979. [DOI: 10.1016/j.chroma.2022.462979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Lu PH, Yu MC, Wei MJ, Kuo KL. The Therapeutic Strategies for Uremic Toxins Control in Chronic Kidney Disease. Toxins (Basel) 2021; 13:573. [PMID: 34437444 PMCID: PMC8402511 DOI: 10.3390/toxins13080573] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 12/27/2022] Open
Abstract
Uremic toxins (UTs) are mainly produced by protein metabolized by the intestinal microbiota and converted in the liver or by mitochondria or other enzymes. The accumulation of UTs can damage the intestinal barrier integrity and cause vascular damage and progressive kidney damage. Together, these factors lead to metabolic imbalances, which in turn increase oxidative stress and inflammation and then produce uremia that affects many organs and causes diseases including renal fibrosis, vascular disease, and renal osteodystrophy. This article is based on the theory of the intestinal-renal axis, from bench to bedside, and it discusses nonextracorporeal therapies for UTs, which are classified into three categories: medication, diet and supplement therapy, and complementary and alternative medicine (CAM) and other therapies. The effects of medications such as AST-120 and meclofenamate are described. Diet and supplement therapies include plant-based diet, very low-protein diet, probiotics, prebiotics, synbiotics, and nutraceuticals. The research status of Chinese herbal medicine is discussed for CAM and other therapies. This review can provide some treatment recommendations for the reduction of UTs in patients with chronic kidney disease.
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Affiliation(s)
- Ping-Hsun Lu
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan; (P.-H.L.); (M.-C.Y.); (M.-J.W.)
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97048, Taiwan
| | - Min-Chien Yu
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan; (P.-H.L.); (M.-C.Y.); (M.-J.W.)
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97048, Taiwan
| | - Meng-Jiun Wei
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan; (P.-H.L.); (M.-C.Y.); (M.-J.W.)
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien 97048, Taiwan
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7
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Miller LE, DeRienzo C, Smith PB, Bose C, Clark RH, Cotten CM, Benjamin DK, Hornik CD, Greenberg RG. Association between neonatal intensive care unit medication safety practices, adverse events, and death. J Perinatol 2021; 41:1739-1744. [PMID: 33033390 DOI: 10.1038/s41372-020-00857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Determine the associations between neonatal intensive care unit (NICU) medication safety practices, laboratory-based adverse events (lab-AEs), and death. STUDY DESIGN We combined data from a 2016 survey of Pediatrix NICUs on use of medication safety practices with 2014-2016 infant data. We grouped NICUs based on the number of safety practices used (≤5, 6-7, and 8-10) and evaluated the association between the number of safety practices used and lab-AEs and deaths using logistic regressions. RESULTS Of the 94 NICUs included, 17% used ≤5 medication safety practices, 51% used 6-7, and 32% used 8-10. NICUs with more safety practices did not have a difference in lab-AEs or death. CONCLUSION In this cohort, the use of more medication safety practices was not associated with fewer lab-AEs or decreased death.
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Affiliation(s)
- Laura E Miller
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Chris DeRienzo
- Department of Medicine, Division of Population Health, Stanford University, Stanford, CA, USA
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Chi D Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
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Kong X, Guo D, Liu S, Zhu Y, Yu C. Incidence, characteristics and risk factors for drug-induced liver injury in hospitalized patients: A matched case-control study. Br J Clin Pharmacol 2021; 87:4304-4312. [PMID: 33948989 DOI: 10.1111/bcp.14847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS The diagnosis of drug-induced liver injury (DILI) is relatively complex and involves a wide variety of drugs. The purpose of this study was to use algorithms to quickly screen DILI patients, determine its incidence and identify risk factors. METHODS The Adverse Drug Events Active Surveillance and Assessment System-2 was used to extract the data of patients hospitalized in 2019 according to the set standards and the Roussel Uclaf Causality Assessment Method was used to evaluate patients who met the standards. A retrospective case-control study was conducted according to suspected drugs, length of hospital stay and height- and weight-matched controls, and logistic regression was used to identify risk factors. RESULTS Among the 156 570 hospitalized patients, 480 patients (499 cases) with DILI were confirmed and the incidence of DILI was 0.32%. Anti-infective agents, antineoplastic agents and nonsteroidal anti-inflammatory drugs were the major categories of drugs causing DILI, and the highest incidence of DILI was due to voriconazole. The latency period and hospital stay of patients with cholestasis were both relatively long. Patients with hyperlipidaemia (adjusted odds ratio [AOR] 1.884), cardiovascular disease (AOR 1.465), pre-existing liver disease (AOR 1.827) and surgical history (AOR 1.312) were at higher risk for DILI. CONCLUSIONS The incidence of DILI in hospitalized patients was uncommon (0.32%) and its pathogenic drugs were widely distributed. The incidence of DILI for many drugs has been seriously underestimated. It is recommended to focus on patients with hyperlipidaemia, cardiovascular disease, pre-existing liver disease and surgical history.
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Affiliation(s)
- Xianghao Kong
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China.,College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Daihong Guo
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Siyuan Liu
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Zhu
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chengxuan Yu
- Pharmacy Department, Medical Security Center, Chinese People's Liberation Army General Hospital, Beijing, China
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Population Pharmacokinetics and Pharmacodynamics of Meropenem in Critically Ill Pediatric Patients. Antimicrob Agents Chemother 2021; 65:AAC.01909-20. [PMID: 33199385 DOI: 10.1128/aac.01909-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022] Open
Abstract
This study investigates the optimal meropenem (MEM) dosing regimen for critically ill pediatric patients, for which there is a lack of pharmacokinetic (PK) studies. We conducted a retrospective single-center PK and pharmacodynamic (PD) analysis of 34 pediatric intensive care unit patients who received MEM. Individual PK parameters were determined by a two-compartment analysis. The median (range) age and body weight were 1.4 (0.03 to 14.6) years and 8.9 (2.7 to 40.9) kg, respectively, and eight (23.5%) patients received continuous renal replacement therapy (CRRT), three of whom received extracorporeal membrane oxygenation. Renal function, the systemic inflammatory response syndrome (SIRS) score for the clearance (CL), and the use of CRRT for the central volume of distribution (V c) were identified as significant covariates. The mean CL, V c, and peripheral volume of distribution (V p) were 0.45 liters/kg/h, 0.49 liters/kg, and 0.34 liters/kg, respectively. The mean population CL of MEM increased by 35% in patients with SIRS and V c increased by 66% in patients on CRRT in the final model. Dosing simulations suggested that the standard dosing regimen provided insufficient PD exposures of a 100% free time above the MIC, and higher doses (40 to 80 mg/kg of body weight/dose every 8 h) with a prolonged 3-h infusion were required to ensure the appropriate PD exposures for patients with SIRS. Our PK model indicated that critically ill pediatric patients are at risk of subtherapeutic exposure under the standard dosing regimen of MEM. A larger, prospective investigation confirming the safety and efficacy of higher concentrations and prolonged infusion of MEM is necessary.
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Kuroda T, Nagata SI, Tamura N, Kinoshita Y, Niwa H, Mita H, Minami T, Fukuda K, Hobo S, Kuwano A. Single-dose pharmacokinetics of orally administered metronidazole and intravenously administered imipenem in healthy horses and computer-based simulation of pleural fluid concentrations with multiple dosing. Am J Vet Res 2020; 81:783-789. [DOI: 10.2460/ajvr.81.10.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Approaches to Dose Finding in Neonates, Illustrating the Variability between Neonatal Drug Development Programs. Pharmaceutics 2020; 12:pharmaceutics12070685. [PMID: 32698409 PMCID: PMC7408157 DOI: 10.3390/pharmaceutics12070685] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
Drug dosing in neonates should be based on integrated knowledge concerning the disease to be treated, the physiological characteristics of the neonate, and the pharmacokinetics (PK) and pharmacodynamics (PD) of a given drug. It is critically important that all sources of information be leveraged to optimize dose selection for neonates. Sources may include data from adult studies, pediatric studies, non-clinical (juvenile) animal models, in vitro studies, and in silico models. Depending on the drug development program, each of these modalities could be used to varying degrees and with varying levels of confidence to guide dosing. This paper aims to illustrate the variability between neonatal drug development programs for neonatal diseases that are similar to those seen in other populations (meropenem), neonatal diseases related but not similar to pediatric or adult populations (clopidogrel, thyroid hormone), and diseases unique to neonates (caffeine, surfactant). Extrapolation of efficacy from older children or adults to neonates is infrequently used. Even if a disease process is similar between neonates and children or adults, such as with anti-infectives, additional dosing and safety information will be necessary for labeling, recognizing that dosing in neonates is confounded by maturational PK in addition to body size.
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12
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Rehm S, Rentsch KM. HILIC LC-MS/MS method for the quantification of cefepime, imipenem and meropenem. J Pharm Biomed Anal 2020; 186:113289. [DOI: 10.1016/j.jpba.2020.113289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 01/19/2023]
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13
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Chosidow A, Benaboud S, Beranger A, Zheng Y, Moulin F, Dupic L, Renolleau S, Treluyer JM, Oualha M. Are β-lactam concentrations adequate in severe sepsis and septic shock in children? Therapie 2020; 75:633-640. [PMID: 32593420 DOI: 10.1016/j.therap.2020.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/18/2019] [Accepted: 04/02/2020] [Indexed: 01/16/2023]
Abstract
AIM OF THE STUDY Early administration of appropriate antibiotic therapy with adequate concentration is the cornerstone of the severe sepsis and septic shock's treatment. We aim to describe the plasma concentration of the most used β-lactams in critically ill children, to describe the rate of patients with suboptimal exposure, and associated clinical and biological factors. METHODS From January 2016 to May 2017, children less than 18 years old with severe sepsis or septic shock were included. Samples were collected in pediatric intensive care unit for children with severe sepsis or septic shock. β-lactam plasma concentrations were analysed using high performance liquid chromatography. RESULTS Among the 37 enrolled patients, 24 (64.9%) had insufficient concentration [cefotaxime 7/14 (43%); piperacillin-tazobactam, 10/13 (77%); amoxicillin 6/7 (86%); meropenem 3/6 (50%), cefazolin 1/4 (25%), imipenem 0/2 (0%); ceftazidime 0/1 (0%)]. Insufficient concentrations were associated with early measurements [<72hours from the sepsis' onset (P=0.035) and an increased creatinine clearance (P=0.01)]. CONCLUSION β-lactams current dosing in critically ill septic children could be suboptimal.
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Affiliation(s)
- Anais Chosidow
- Armand-Trousseau hospital, AP-HP, pediatric department, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - Sihem Benaboud
- Pharmacology department, Cochin hospital, 75014 Paris, France
| | - Agathe Beranger
- Pediatric intensive care unit, Necker hospital, 75015 Paris, France
| | - Yi Zheng
- Pharmacology department, Cochin hospital, 75014 Paris, France
| | - Florence Moulin
- Pediatric intensive care unit, Necker hospital, 75015 Paris, France
| | - Laurent Dupic
- Pediatric intensive care unit, Necker hospital, 75015 Paris, France
| | | | - Jean-Marc Treluyer
- Pharmacology department, Cochin hospital, 75014 Paris, France; Pediatric intensive care unit, Necker hospital, 75015 Paris, France
| | - Mehdi Oualha
- Pediatric intensive care unit, Necker hospital, 75015 Paris, France
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14
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Huo X, Meng Q, Wang C, Wu J, Zhu Y, Sun P, Ma X, Sun H, Liu K. Targeting renal OATs to develop renal protective agent from traditional Chinese medicines: Protective effect of Apigenin against Imipenem-induced nephrotoxicity. Phytother Res 2020; 34:2998-3010. [PMID: 32468621 DOI: 10.1002/ptr.6727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/11/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
Imipenem (Imp) is a widely used broad-spectrum antibiotic. However, renal adverse effects limit its clinical application. We previously reported that organic anion transporters (OATs) facilitated the renal transport of Imp and contributed its nephrotoxicity. Natural flavonoids exhibited renal protective effect. Here, we aimed to develop potent OAT inhibitors from traditional Chinese medicines (TCMs) and to evaluate its protective effect against Imp-induced nephrotoxicity. Among 50 TCMs, Tribuli Fructus, Platycladi Cacumen, and Lycopi Herba exhibited potent inhibition on OAT1/3. After screening their main components, Apigenin strongly inhibited Imp uptake by OAT1/3-HEK293 cells with IC50 values of 1.98 ± 0.36 μM (OAT1) and 2.29 ± 0.88 μM (OAT3). Moreover, Imp exhibited OAT1/3-dependent cytotoxicity, which was alleviated by Apigenin. Furthermore, Apigenin ameliorated Imp-induced nephrotoxicity in rabbits, and reduced the renal secretion of Imp. Apigenin inhibited intracellular accumulation of Imp and sequentially decreased the nephrocyte toxicity in rabbit primary proximal tubule cells (rPTCs). Apigenin, a flavone widely distributed in TCMs, was a potent OAT1/3 inhibitor. Through OAT inhibition, at least in part, Apigenin decreased the renal exposure of Imp and consequently protected against the nephrotoxicity of Imp. Apigenin can be used as a promising agent to reduce the renal adverse reaction of Imp in clinic.
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Affiliation(s)
- Xiaokui Huo
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China.,College (Institute) of Integrative Medicine, Dalian Medical University, Dalian, China.,Provincial Key Laboratory for Pharmacokinetics and Transport Liaoning, Dalian Medical University, Dalian, China
| | - Qiang Meng
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China.,College (Institute) of Integrative Medicine, Dalian Medical University, Dalian, China.,Provincial Key Laboratory for Pharmacokinetics and Transport Liaoning, Dalian Medical University, Dalian, China
| | - Changyuan Wang
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China.,College (Institute) of Integrative Medicine, Dalian Medical University, Dalian, China.,Provincial Key Laboratory for Pharmacokinetics and Transport Liaoning, Dalian Medical University, Dalian, China
| | - Jingjing Wu
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China
| | - Yanna Zhu
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China
| | - Pengyuan Sun
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China
| | - Xiaodong Ma
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China
| | - Huijun Sun
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China.,College (Institute) of Integrative Medicine, Dalian Medical University, Dalian, China.,Provincial Key Laboratory for Pharmacokinetics and Transport Liaoning, Dalian Medical University, Dalian, China
| | - Kexin Liu
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian, China.,College (Institute) of Integrative Medicine, Dalian Medical University, Dalian, China.,Provincial Key Laboratory for Pharmacokinetics and Transport Liaoning, Dalian Medical University, Dalian, China
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15
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Focal seizures with a migrating aspect in infants treated with beta-lactam antibiotics - Report of two cases. Neurophysiol Clin 2020; 50:81-86. [PMID: 32044228 DOI: 10.1016/j.neucli.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/21/2022] Open
Abstract
Seizures caused by beta-lactam antibiotics are relatively rare. However, they represent a clinically significant phenomenon and have been widely reported in all age groups. Here we describe two infants presenting subtle multifocal seizures with a migrating aspect on EEG during beta-lactam antibiotic treatment with agents from the carbapenem group (meropenem) and the cephalosporin group (ceftazidime).
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16
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Hassan HE, Ivaturi V, Gobburu J, Green TP. Dosage Regimens for Meropenem in Children with Pseudomonas Infections Do Not Meet Serum Concentration Targets. Clin Transl Sci 2019; 13:301-308. [PMID: 31692264 PMCID: PMC7070814 DOI: 10.1111/cts.12710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022] Open
Abstract
There have been literature reports that some recommended meropenem dosage regimens may fail to meet therapeutic targets in some high‐risk children and adults. We evaluated this observation in children using literature studies conducted in infants and children. Observed and, as necessary, simulated data from the literature were combined, yielding a data set of 288 subjects (1 day to ~ 17 years). A population pharmacokinetic model was fit to the data and then used to simulate the recommended dosing regimens and estimate the proportion of subjects achieving recommended target exposures. A two‐compartment model best fit the data with weight, postnatal age, gestational age, and serum creatinine as covariates. The US Food and Drug Administration (FDA)‐approved dosing regimens achieved targets in ~ 90% or more of subjects less than 3 months of age for organisms with minimum inhibitory concentration (MIC)'s of 2 and 4 mg/L; however, only 68.4% and 41.7% of subjects older than 3 months and weighing < 50 kg achieved target exposures for organisms with MIC's of 2 and 4 mg/L, respectively [Correction added on January 23, 2020, after first online publication: "> 3 months" corrected to "less than 3 months".]. Moreover, for subjects weighing more than 50 kg, only 41.3% and 17% achieved these respective targets. Simulation studies were used to explore the impact of changing dose, dosing interval, and infusion duration on the likelihood of achieving therapeutic targets in these groups. Our findings illustrate that current dosing recommendations for children over 3 months of age fail to meet therapeutic targets in an unacceptable fraction of patients. Further investigation is needed to develop new dosing strategies in these patients.
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Affiliation(s)
- Hazem E Hassan
- School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Vijay Ivaturi
- School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Jogarao Gobburu
- School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Thomas P Green
- Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
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17
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Zou L, Meng F, Wang W, Ye Q, Hu L, Li T, Yin T. A novel analytical method to assess the effect of imipenem/cilastatin on liver function laboratory indexes in Chinese underage inpatients: Probability distribution curve. PLoS One 2019; 14:e0224352. [PMID: 31648284 PMCID: PMC6812810 DOI: 10.1371/journal.pone.0224352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/12/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives The primary objective of this study was to establish a novel method to assess the effect of imipenem/cilastatin (IMP) on liver function laboratory indexes in Chinese underage inpatients (inpatients aged <18 year-old). Methods A retrospective study was conducted in 188 underage inpatients who received IMP in Xiangya Hospital from January 2016 to April 2018. Demographic data and clinical information of these inpatients were collected. As there was no reference interval of minors, the occurrence of abnormal liver function was estimated by that of adults, temporarily. A new concept (mean-variance induced by drug, MVID) was introduced to analyze the characteristics of total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Effect of MVID of TBil, DBil, ALT and AST in different patients (aged<1 year old and aged ≥ 1 year old) were compared by Mann-Whitney U test. Results Estimating by reference intervals of adults, 57.4% underage inpatients (108/188) had abnormal liver function. According to the probability distribution curve of MVID, IMP can cause the increase of AST in 24% (0.62–0.38) Chinese underage inpatients, and the increase of ALT in 20% (0.60–0.40) Chinese underage inpatients. And liver protecting drugs can decrease MVID of ALT and AST. There were not statistically significant differences in MVID of TBil, DBil, ALT and AST in different patients (aged<1 year old and aged ≥ 1 year old); P value was 0.711, 0.734, 0.067 and 0.086, respectively. Conclusion IMP can affect the liver function of 20–24% Chinese underage inpatients mainly by increasing the AST and ALT. IMP may induce hepatocellular injury, but not cholestasis. And liver protecting drugs can reverse the side effects caused by IMP. Age may not affect the effect of IMP on liver function.
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Affiliation(s)
- Le Zou
- Pharmacy Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- The Seventh Affiliated Hospital, Sun Yet-sun University, Shenzhen, Guangdong Province, China
| | - Fanqi Meng
- The Seventh Affiliated Hospital, Sun Yet-sun University, Shenzhen, Guangdong Province, China
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, Hunan Province, China
| | - Weici Wang
- Pharmacy Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Pharmacy Department, Hubei University of Science and Technology, Xianning, Hubei Province, China
| | - Qianqian Ye
- Pharmacy Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lin Hu
- Pharmacy Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Taoming Li
- Pharmacy Department, The Fourth Hospital of Changsha, Changsha, Hunan Province, China
| | - Tao Yin
- Pharmacy Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- * E-mail:
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18
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Cilastatin protects against imipenem-induced nephrotoxicity via inhibition of renal organic anion transporters (OATs). Acta Pharm Sin B 2019; 9:986-996. [PMID: 31649848 PMCID: PMC6804466 DOI: 10.1016/j.apsb.2019.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/29/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
Imipenem is a carbapenem antibiotic. However, Imipenem could not be marketed owing to its instability and nephrotoxicity until cilastatin, an inhibitor of renal dehydropeptidase-I (DHP-I), was developed. In present study, the potential roles of renal organic anion transporters (OATs) in alleviating the nephrotoxicity of imipenem by cilastatin were investigated in vitro and in rabbits. Our results indicated that imipenem and cilastatin were substrates of hOAT1 and hOAT3. Cilastatin inhibited hOAT1/3-mediated transport of imipenem with IC50 values comparable to the clinical concentration, suggesting the potential to cause a clinical drug–drug interaction (DDI). Moreover, imipenem exhibited hOAT1/3-dependent cytotoxicity, which was alleviated by cilastatin and probenecid. Furthermore, cilastatin and probenecid ameliorated imipenem-induced rabbit acute kidney injury, and reduced the renal secretion of imipenem. Cilastatin and probenecid inhibited intracellular accumulation of imipenem and sequentially decreased the nephrocyte toxicity in rabbit primary proximal tubule cells. Renal OATs, besides DHP-I, was also the target of interaction between imipenem and cilastatin, and contributed to the nephrotoxicity of imipenem. This therefore gives in part the explanation about the mechanism by which cilastatin protected against imipenem-induced nephrotoxicity. Thus, OATs can potentially be used as a therapeutic target to avoid the renal adverse reaction of imipenem in clinic.
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Key Words
- BUN, blood urea nitrogen
- CKD, chronic kidney disease
- CLp, plasma clearance
- CLr, renal clearance
- CRE, creatinine
- Cil, cilastatin
- Cilastatin
- DDIs, drug-drug interactions
- DHP-I, renal dehydropeptidase-I
- ES, estrone-3-sulfate
- GSH, glutathione
- Imipenem
- Imp, imipenem
- MDA, malonaldehyde
- Nephrotoxicity
- OATs
- OATs, renal organic anion transporters
- PAH, p-aminophenol acid
- Prb, probenecid
- Probenecid
- SNP, single nucleotide polymorphism
- hOAT, human OAT
- hOAT1
- hOAT3
- rOAT, rat OAT
- rPTCs, rabbit primary proximal tubule cells
- raOAT, rabbit OAT
- t1/2, half life
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19
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Population Pharmacokinetics and Dosing Optimization of Imipenem in Children with Hematological Malignancies. Antimicrob Agents Chemother 2019; 63:AAC.00006-19. [PMID: 30962334 DOI: 10.1128/aac.00006-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/28/2019] [Indexed: 11/20/2022] Open
Abstract
Imipenem is widely used for the treatment of children with serious infections. Currently, studies on the pharmacokinetics of imipenem in children with hematological malignancies are lacking. Given the significant impact of disease on pharmacokinetics and increased resistance, we aimed to conduct a population pharmacokinetic study of imipenem and optimize the dosage regimens for this vulnerable population. After children were treated with imipenem-cilastatin (IMP-CS), blood samples were collected from the children and the concentrations of imipenem were quantified using high-performance liquid chromatography with UV detection. Then, a population-level pharmacokinetic analysis was conducted using NONMEM software. Data were collected from 56 children (age range, 2.03 to 11.82 years) with hematological malignancies to conduct a population pharmacokinetic analysis. In this study, a two-compartment model that followed first-order elimination was found to be the most suitable. The parameters of current weight, age, and creatinine elimination rate were significant covariates that influenced imipenem pharmacokinetics. As a result, 41.4%, 56.1%, and 67.1% of the children reached the pharmacodynamic target (the percentage of the time during the total dosing interval that the free drug concentration remains above the MIC of 70%) against sensitive pathogens with an MIC of 0.5 mg/liter with imipenem at 15, 20, and 25 mg/kg of body weight every 6 h (q6h), respectively. However, only 11.1% of the children achieved the pharmacodynamic target against Pseudomonas aeruginosa isolates with an MIC of 2 mg/liter at a dose of 25 mg/kg q6h. The population pharmacokinetics of imipenem were assessed in children. The current dosage regimens of imipenem result in underdosing against resistant pathogens, including Pseudomonas aeruginosa and Acinetobacter baumannii However, for sensitive pathogens, imipenem has an acceptable pharmacodynamic target rate at a dosage of 25 mg/kg q6h. (The study discussed in this paper has been registered at ClinicalTrials.gov under identifier NCT03113344.).
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20
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Hornik CP, Atz AM, Bendel C, Chan F, Downes K, Grundmeier R, Fogel B, Gipson D, Laughon M, Miller M, Smith M, Livingston C, Kluchar C, Heath A, Jarrett C, McKerlie B, Patel H, Hunter C. Creation of a Multicenter Pediatric Inpatient Data Repository Derived from Electronic Health Records. Appl Clin Inform 2019; 10:307-315. [PMID: 31067576 DOI: 10.1055/s-0039-1688477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Integration of electronic health records (EHRs) data across sites and access to that data remain limited. OBJECTIVE We developed an EHR-based pediatric inpatient repository using nine U.S. centers from the National Institute of Child Health and Human Development Pediatric Trials Network. METHODS A data model encompassing 147 mandatory and 99 optional elements was developed to provide an EHR data extract of all inpatient encounters from patients <17 years of age discharged between January 6, 2013 and June 30, 2017. Sites received instructions on extractions, transformation, testing, and transmission to the coordinating center. RESULTS We generated 177 staging reports to process all nine sites' 147 mandatory and 99 optional data elements to the repository. Based on 520 prespecified criteria, all sites achieved 0% errors and <2% warnings. The repository includes 386,159 inpatient encounters from 264,709 children to support study design and conduct of future trials in children. CONCLUSION Our EHR-based data repository of pediatric inpatient encounters utilized a customized data model heavily influenced by the PCORnet format, site-based data mapping, a comprehensive set of data testing rules, and an iterative process of data submission. The common data model, site-based extraction, and technical expertise were key to our success. Data from this repository will be used in support of Pediatric Trials Network studies and the labeling of drugs and devices for children.
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Affiliation(s)
- Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Catherine Bendel
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Francis Chan
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California, United States
| | - Kevin Downes
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robert Grundmeier
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ben Fogel
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Debbie Gipson
- Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan, United States
| | - Matthew Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Michael Miller
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Michael Smith
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, United States.,Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham North Carolina, United States
| | - Chad Livingston
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
| | - Cindy Kluchar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
| | - Anne Heath
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
| | - Chanda Jarrett
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
| | - Brian McKerlie
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
| | - Hetalkumar Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
| | - Christina Hunter
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
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21
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Pang WB, Zhang TC, Chen YJ, Peng CH, Wang ZM, Wu DY, Wang K. Ten-Year Experience in the Prevention of Post-Kasai Cholangitis. Surg Infect (Larchmt) 2019; 20:231-235. [PMID: 30657432 DOI: 10.1089/sur.2018.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cholangitis is the most common complication after the Kasai procedure. It can be life-threatening and may affect long- and short-term outcomes of children with biliary atresia. We summarize our experiences in the prevention of early-onset cholangitis. PATIENTS AND METHODS From January 2002 to March 2013, children with biliary atresia (BA) who underwent the Kasai procedure in the General Surgical Department were included in a retrospective cohort study. These patients were divided into group A (therapy 1) and group B (therapy 2) depending on the infection prevention protocol and occurrences of cholangitis within the six months after surgery were recorded. Two hundred eighteen children were included in this cohort study. Seventy-six children (35 females and 41 males) were included in group A. One hundred forty-two children (65 females and 77 males) were included in group B. Therapy 1 was our primary protocol and included a third-generation cephalosporin, metronidazole, and human immunoglobulin. Therapy 2 was a modification of therapy 1 that involved imipenem-cilastatin and human immunoglobulin. Statistical analyses were performed. A p value below 0.05 was regarded as significant. RESULTS In group A, 45 children developed cholangitis within the six months after the Kasai procedure. In group B, 14 of these children experienced post-operative cholangitis. A χ2 analysis was used to examine the difference in the incidence of cholangitis between groups A and B. There was a substantial difference in the morbidity of post-operative cholangitis between groups A and B (59.2% vs. 9.9%, p = 0.000). CONCLUSION Cholangitis in the early period after a Kasai procedure can be prevented effectively with an advanced prophylactic protocol.
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Affiliation(s)
- Wen-Bo Pang
- Department of General Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ting-Chong Zhang
- Department of General Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ya-Jun Chen
- Department of General Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chun-Hui Peng
- Department of General Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zeng-Meng Wang
- Department of General Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dong-Yang Wu
- Department of General Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Kai Wang
- Department of General Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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22
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Sun W, Hesse S, Xu M, Childs RW, Zheng W, Williamson PR. "Real-Time" High-Throughput Drug and Synergy Testing for Multidrug-Resistant Bacterial Infection: A Case Report. Front Med (Lausanne) 2018; 5:267. [PMID: 30298132 PMCID: PMC6160733 DOI: 10.3389/fmed.2018.00267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022] Open
Abstract
Antibiotic management of infections with multidrug-resistant organisms (MDRO) represents a complex clinical challenge. We report here the first patient with a severe MDRO infection managed with assistance of a novel “real-time” 3-day high-throughput screen (HTS) that allowed screening of 9 drugs in 14 combinations in 2,304 total samplings. Identified synergies were used to modify patient therapy with the goal of reducing drug-induced toxicity. The desired clinical outcome was achieved on the HTS-informed therapeutic regimen, supporting the utility of HTS technology to expand standard antimicrobial susceptibility testing.
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Affiliation(s)
- Wei Sun
- National Center for Advancing Translational Sciences, Bethesda, MD, United States
| | - Shayla Hesse
- Laboratory of Molecular Biology, National Cancer Institute, Bethesda, MD, United States
| | - Miao Xu
- National Center for Advancing Translational Sciences, Bethesda, MD, United States
| | - Richard W Childs
- Transplantation Immunotherapy, Hematology Branch, National Heart Lung and Blood Institute, Bethesda, MD, United States
| | - Wei Zheng
- National Center for Advancing Translational Sciences, Bethesda, MD, United States
| | - Peter R Williamson
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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23
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Deshayes S, Coquerel A, Verdon R. Neurological Adverse Effects Attributable to β-Lactam Antibiotics: A Literature Review. Drug Saf 2018; 40:1171-1198. [PMID: 28755095 DOI: 10.1007/s40264-017-0578-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
β-lactam antibiotics are commonly prescribed antibiotic drugs. To describe the clinical characteristics, risk markers and outcomes of β-lactam antibiotic-induced neurological adverse effects, we performed a general literature review to provide updated clinical data about the most used β-lactam antibiotics. For selected drugs in each class available in France (ticarcillin, piperacillin, temocillin, ceftazidime, cefepime, cefpirome, ceftaroline, ceftobiprole, ceftolozane, ertapenem and aztreonam), a systematic literature review was performed up to April 2016 via an electronic search on PubMed. Articles that reported original data, written in French, Spanish, Portuguese or English, with available individual data for patients with neurological symptoms (such as seizure, disturbed vigilance, confusional state, myoclonia, localising signs, and/or hallucinations) after the introduction of a β-lactam antibiotic were included. The neurological adverse effects of piperacillin and ertapenem are often described as seizures and hallucinations (>50 and 25% of cases, respectively). Antibiotic treatment is often adapted to renal function (>70%), and underlying brain abnormalities are seen in one in four to one in three cases. By contrast, the neurological adverse drug reactions of ceftazidime and cefepime often include abnormal movements but few hallucinations and seizures. These reactions are associated with renal insufficiency (>80%) and doses are rarely adapted to renal function. Otherwise, it appears that monobactams do not have serious neurological adverse drug reactions and that valproic acid and carbapenem combinations should be avoided. The onset of disturbed vigilance, myoclonus, and/or seizure in a patient taking β-lactam antibiotics, especially if associated with renal insufficiency or underlying brain abnormalities, should lead physicians to suspect adverse drug reactions and to consider changes in antibacterial therapy.
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Affiliation(s)
- Samuel Deshayes
- Department of Internal Medicine, CHU de Caen, 14000, Caen, France. .,Department of Infectious Diseases, CHU de Caen, Université de Caen-Normandie, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Antoine Coquerel
- Department of Pharmacology, CHU de Caen, Regional Pharmacovigilance Center, 14000, Caen, France.,University of Caen-Normandy, INSERM Unit 1075, 14000, Caen, France
| | - Renaud Verdon
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN, UNIROUEN, GRAM, 14000, Caen, France. .,Department of Infectious Diseases, CHU de Caen, Université de Caen-Normandie, Avenue de la Côte de Nacre, 14000, Caen, France.
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24
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Kong L, Xu H, Wu C, Zhao X, Wu X. Pharmacokinetics of imipenem in plasma and cerebrospinal fluid in patients with intracerebral hemorrhage. Eur J Clin Pharmacol 2018; 74:1193-1195. [PMID: 29797035 DOI: 10.1007/s00228-018-2488-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Lingti Kong
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Hongzhou Xu
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Chenchen Wu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Xuguang Zhao
- Department of Emergency Medicine, Taihe People's Hospital, Fuyang, 236600, China
| | - Xiaofei Wu
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China.
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25
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Vardakas KZ, Kalimeris GD, Triarides NA, Falagas ME. An update on adverse drug reactions related to β-lactam antibiotics. Expert Opin Drug Saf 2018; 17:499-508. [DOI: 10.1080/14740338.2018.1462334] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Konstantinos Z. Vardakas
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Georgios D. Kalimeris
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Nikolaos A. Triarides
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Matthew E. Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Mulugeta LY, Yao L, Mould D, Jacobs B, Florian J, Smith B, Sinha V, Barrett JS. Leveraging Big Data in Pediatric Development Programs: Proceedings From the 2016 American College of Clinical Pharmacology Annual Meeting Symposium. Clin Pharmacol Ther 2018; 104:81-87. [PMID: 29319159 DOI: 10.1002/cpt.975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/21/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022]
Abstract
This article discusses the use of big data in pediatric drug development. The article covers key topics discussed at the ACCP annual meeting symposium in 2016 including the extent to which big data or real-world data can inform clinical trial design and substitute for efficacy and safety data typically obtained in clinical trials. The current states of use, opportunities, and challenges with the use of big data in future pediatric drug development are discussed.
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Affiliation(s)
| | - Lynne Yao
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Diane Mould
- Projections Research Inc, Phoenixville, Pennsylvania, USA
| | - Brian Jacobs
- Children's National Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jeffrey Florian
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Brian Smith
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vikram Sinha
- Quantitative Pharmacology and Pharmacometrics, Merck and Co, North Wales, Pennsylvania, USA
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Li G, Standing JF, Bielicki J, Hope W, van den Anker J, Heath PT, Sharland M. The Potential Role of Fosfomycin in Neonatal Sepsis Caused by Multidrug-Resistant Bacteria. Drugs 2017; 77:941-950. [PMID: 28456943 DOI: 10.1007/s40265-017-0745-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The broad-spectrum activity of fosfomycin, including against multidrug-resistant (MDR) strains, has led to renewed interest in its use in recent years. Neonatal sepsis remains a substantial cause of morbidity and mortality at a global level, with evidence that MDR bacteria play an increasing role. The evidence for use of fosfomycin in neonatal subjects is limited. We summarise current knowledge of the pharmacokinetics and clinical outcomes for the use of fosfomycin in neonatal sepsis and issues specific to neonatal physiology. While fosfomycin has a broad range of coverage, we evaluate the extent to which it may be effective against MDR bacteria in a neonatal setting, in light of recent evidence suggesting it to be most effective when administered in combination with other antibiotics. Given the urgency of clinical demand for treatment of MDR bacterial sepsis, we outline directions for further work, including the need for future clinical trials in this at-risk population.
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Affiliation(s)
- Grace Li
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Joseph F Standing
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.,UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.,Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), Spitalstrasse 33, Postfach, 4031, Basel, Switzerland
| | - William Hope
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Liverpool, L69 3GE, UK
| | - John van den Anker
- Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), Spitalstrasse 33, Postfach, 4031, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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Park K, Soukavong M, Kim J, Kwon KE, Jin XM, Lee J, Yang BR, Park BJ. Signal Detection of Imipenem Compared to Other Drugs from Korea Adverse Event Reporting System Database. Yonsei Med J 2017; 58:564-569. [PMID: 28332362 PMCID: PMC5368142 DOI: 10.3349/ymj.2017.58.3.564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/29/2016] [Accepted: 11/29/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To detect signals of adverse drug events after imipenem treatment using the Korea Institute of Drug Safety & Risk Management-Korea adverse event reporting system database (KIDS-KD). MATERIALS AND METHODS We performed data mining using KIDS-KD, which was constructed using spontaneously reported adverse event (AE) reports between December 1988 and June 2014. We detected signals calculated the proportional reporting ratio, reporting odds ratio, and information component of imipenem. We defined a signal as any AE that satisfied all three indices. The signals were compared with drug labels of nine countries. RESULTS There were 807582 spontaneous AEs reports in the KIDS-KD. Among those, the number of antibiotics related AEs was 192510; 3382 reports were associated with imipenem. The most common imipenem-associated AE was the drug eruption; 353 times. We calculated the signal by comparing with all other antibiotics and drugs; 58 and 53 signals satisfied the three methods. We compared the drug labelling information of nine countries, including the USA, the UK, Japan, Italy, Switzerland, Germany, France, Canada, and South Korea, and discovered that the following signals were currently not included in drug labels: hypokalemia, cardiac arrest, cardiac failure, Parkinson's syndrome, myocardial infarction, and prostate enlargement. Hypokalemia was an additional signal compared with all other antibiotics, and the other signals were not different compared with all other antibiotics and all other drugs. CONCLUSION We detected new signals that were not listed on the drug labels of nine countries. However, further pharmacoepidemiologic research is needed to evaluate the causality of these signals.
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Affiliation(s)
- Kyounghoon Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Mick Soukavong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jungmee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Eun Kwon
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Xue Mei Jin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Hornik CP, Benjamin DK, Smith PB, Pencina MJ, Tremoulet AH, Capparelli EV, Ericson JE, Clark RH, Cohen-Wolkowiez M. Electronic Health Records and Pharmacokinetic Modeling to Assess the Relationship between Ampicillin Exposure and Seizure Risk in Neonates. J Pediatr 2016; 178:125-129.e1. [PMID: 27522443 PMCID: PMC5085855 DOI: 10.1016/j.jpeds.2016.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/27/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the relationship between ampicillin dosing, exposure, and seizures. STUDY DESIGN This was a retrospective observational cohort study of electronic health record (EHR) data combined with pharmacokinetic model derived drug exposure predictions. We used the EHR from 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. We included all infants 24-41 weeks gestational age, 500-5400 g birth weight, first exposed to ampicillin prior to 25 days postnatal age. Using a 1-compartment pharmacokinetic model and EHR data, we simulated maximum ampicillin concentration at steady state (Cmaxss, µg/mL) and area under the concentration time curve from 0 to 24 hours (AUC24, µg*h/dL). Using multivariable logistic regression, we evaluated association between ampicillin dosing, exposure, and seizures as documented in the EHR. RESULTS We identified 131 723 infants receiving 134 041 courses of ampicillin for 653 506 infant-days of exposure. The median daily dose was 200 mg/kg/d (25th, 75th percentile; 100, 200). Median Cmaxss and AUC24 were 256.6 µg/mL (164.3, 291.5) and 2593 µg*h/dL (1917, 3334). On multivariable analysis, dosing was not associated with seizures. However increasing Cmaxss (OR = 1.10, 95% CI 1.03, 1.17) and AUC24 (OR 1.11, 95% CI 1.05, 1.18) were associated with increased odds of seizures. CONCLUSIONS In this cohort of hospitalized infants, higher ampicillin exposure was associated with seizures as documented in the EHR.
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Affiliation(s)
- Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Michael J Pencina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Edmund V Capparelli
- Deparment of Biostatistics and Bioinformatics, Duke University, Durham, NC; Skaggs School of Pharmacy, University of California, San Diego, La Jolla, CA
| | | | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
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Garcia-Prats AJ, Schaaf HS, Hesseling AC. The safety and tolerability of the second-line injectable antituberculosis drugs in children. Expert Opin Drug Saf 2016; 15:1491-1500. [PMID: 27548570 DOI: 10.1080/14740338.2016.1223623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION A growing number of children globally are being treated for multidrug-resistant tuberculosis (MDR-TB). The second-line injectable antituberculosis medications amikacin, kanamycin and capreomycin, traditionally a mainstay of MDR-TB treatment, cause important adverse effects including permanent sensorineural hearing loss, nephrotoxicity, electrolyte abnormalities, injection pain and local injection site complications. Areas covered: To characterize the safety and tolerability of the second-line injectables in children treated for MDR-TB, we reviewed data on the mechanism of injectable associated adverse effects, risk factors for their development, and the incidence of injectable-associated adverse effects in adults and children treated for MDR-TB. Expert opinion: Despite a substantial evidence base in adults demonstrating the frequent and potentially serious adverse effects of second-line injectables, important knowledge gaps remain. Improved characterization of the incidence of injectable-associated adverse effects will inform rational guidance on monitoring children with TB on injectables. Eliminating the need for injectables in MDR-TB treatment regimens is a high priority, and will rely on the use of novel antituberculosis TB drugs. Strategies to reduce the risk of adverse effects of injectables, if used, deserve evaluation. This includes evaluation of potentially otoprotective medications N-acetylcysteine or aspirin, high frequency hearing screening for earlier detection of ototoxicity and therapeutic drug monitoring.
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Affiliation(s)
- Anthony J Garcia-Prats
- a Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Tygerberg , South Africa
| | - H Simon Schaaf
- a Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Tygerberg , South Africa
| | - Anneke C Hesseling
- a Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Tygerberg , South Africa
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Salehifar E, Shiva A, Moshayedi M, Kashi TS, Chabra A. Drug use evaluation of Meropenem at a tertiary care university hospital: A report from Northern Iran. J Res Pharm Pract 2015; 4:222-5. [PMID: 26645030 PMCID: PMC4645136 DOI: 10.4103/2279-042x.167047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The inappropriate use of antibiotics remains the primary factor in antimicrobial drug resistance. In this study, we evaluate the use of meropenem in surgical/medical wards of Imam Khomeini Tertiary Referral Hospital, Sari, Iran. Methods: This retrospective observational study was used to assess rational use of meropenem. The study was conducted by reviewing medical records of 100 admitted patients who received meropenem during March 2013 to January 2014. Findings: Meropenem was prescribed most frequently in Intensive Care Unit (22%), and pneumonia was the most common diagnosis (35%). The third-generation cephalosporins were the most frequently prescribed antimicrobials after meropenem (53%). In 21% of the patients, imipenem was changed to meropenem. Most of the inappropriate uses were seen in terms of frequency of meropenem use (34%), followed by duration of meropenem therapy (28%). Conclusion: Comparing our study results has shown higher inappropriate use. It is necessary to take action to improve prescribing habit in order to reduce the unnecessary usage of antibiotic thus enhance rational antibiotic use.
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Affiliation(s)
- Ebrahim Salehifar
- Department of Clinical Pharmacy, Thalassemia Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Afshin Shiva
- Department of Clinical Pharmacy, Urmia University of Medical Sciences, Urmia, Iran ; Department of Clinical Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mona Moshayedi
- Department of Clinical Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Taravat Samiei Kashi
- Student's Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aroona Chabra
- Student's Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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Arnold CJ, Ericson J, Cho N, Tian J, Wilson S, Chu VH, Hornik CP, Clark RH, Benjamin DK, Smith PB. Cefepime and Ceftazidime Safety in Hospitalized Infants. Pediatr Infect Dis J 2015; 34:964-8. [PMID: 26376308 PMCID: PMC4573537 DOI: 10.1097/inf.0000000000000778] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cefepime and ceftazidime are cephalosporins used for the treatment of serious Gram-negative infections. These cephalosporins are used off-label in the setting of minimal safety data for young infants. METHODS We identified all infants discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012 who were exposed to either cefepime or ceftazidime in the first 120 days of life. We reported clinical and laboratory adverse events occurring in infants exposed to cefepime or ceftazidime and used multivariable logistic regression to compare the odds of seizures and death between the 2 groups. RESULTS A total of 1761 infants received 13,293 days of ceftazidime, and 594 infants received 4628 days of cefepime. Laboratory adverse events occurred more frequently on days of therapy with ceftazidime than with cefepime (373 vs. 341 per 1000 infant days, P < 0.001). Seizure was the most commonly observed clinical adverse event, occurring in 3% of ceftazidime-treated infants and 4% of cefepime-treated infants (P = 0.52). Mortality was similar between the ceftazidime and cefepime groups (5% vs. 3%, P = 0.07). There was no difference in the adjusted odds of seizure [odds ratio (OR) = 0.96 (95% confidence interval: 0.89-1.03)] or the combined outcome of mortality or seizures [OR = 1.00 (0.96-1.04)] in infants exposed to ceftazidime versus those exposed to cefepime. CONCLUSIONS In this cohort of infants, cefepime was associated with fewer laboratory adverse events than ceftazidime, although this may have been due to a significant difference in clinical exposures and severity of illness between the 2 groups. There was no difference in seizure risk or mortality between the 2 drugs.
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Affiliation(s)
- Christopher J. Arnold
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Jessica Ericson
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Nathan Cho
- Duke Clinical Research Institute, Durham, NC
| | - James Tian
- Duke Clinical Research Institute, Durham, NC
| | | | - Vivian H. Chu
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | | | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
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McMahon AW, Wharton GT, Bonnel R, DeCelle M, Swank K, Testoni D, Cope JU, Smith PB, Wu E, Murphy MD. Pediatric post-marketing safety systems in North America: assessment of the current status. Pharmacoepidemiol Drug Saf 2015; 24:785-92. [DOI: 10.1002/pds.3813] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Ann W. McMahon
- Office of Pediatric Therapeutics, Office of the Commissioner; US Food and Drug Administration; Silver Spring MD USA
| | - Gerold T. Wharton
- Office of Pediatric Therapeutics, Office of the Commissioner; US Food and Drug Administration; Silver Spring MD USA
| | - Renan Bonnel
- Office of Pediatric Therapeutics, Office of the Commissioner; US Food and Drug Administration; Silver Spring MD USA
| | - Mary DeCelle
- Office of Pediatric Therapeutics, Office of the Commissioner; US Food and Drug Administration; Silver Spring MD USA
| | - Kimberley Swank
- Office of Pharmacovigilance and Epidemiology; US Food and Drug Administration; Silver Spring MD USA
| | - Daniela Testoni
- Duke Clinical Research Institute; Duke School of Medicine; Durham NC USA
| | - Judith U. Cope
- Office of Pediatric Therapeutics, Office of the Commissioner; US Food and Drug Administration; Silver Spring MD USA
| | | | - Eileen Wu
- Office of Pharmacovigilance and Epidemiology; US Food and Drug Administration; Silver Spring MD USA
| | - Mary Dianne Murphy
- Office of Pediatric Therapeutics, Office of the Commissioner; US Food and Drug Administration; Silver Spring MD USA
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Kelly MS, Benjamin DK, Smith PB. The epidemiology and diagnosis of invasive candidiasis among premature infants. Clin Perinatol 2015; 42:105-17, viii-ix. [PMID: 25677999 PMCID: PMC4328135 DOI: 10.1016/j.clp.2014.10.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Invasive candidiasis is a leading infectious cause of morbidity and mortality in premature infants. Improved recognition of modifiable risk factors and antifungal prophylaxis has contributed to the recent decline in the incidence of this infection among infants. Invasive candidiasis typically occurs in the first 6 weeks of life and presents with nonspecific signs of sepsis. Definitive diagnosis relies on the growth of Candida in blood culture or cultures from other normally sterile sites, but this may identify fewer than half of cases. Improved diagnostics are needed to guide the initiation of antifungal therapy in premature infants.
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Affiliation(s)
- Matthew S. Kelly
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, Duke University, Durham, North Carolina
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Laughon MM, Chantala K, Aliaga S, Herring AH, Hornik CP, Hughes R, Clark RH, Smith PB. Diuretic exposure in premature infants from 1997 to 2011. Am J Perinatol 2015; 32:49-56. [PMID: 24801161 PMCID: PMC4223004 DOI: 10.1055/s-0034-1373845] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Diuretics are often prescribed off-label to premature infants, particularly to prevent or treat bronchopulmonary dysplasia. We examined their use and safety in this group. STUDY DESIGN Retrospective cohort study of infants < 32 weeks gestation and < 1,500 g birth weight exposed to diuretics in 333 neonatal intensive care units from 1997 to 2011. We examined use of acetazolamide, amiloride, bumetanide, chlorothiazide, diazoxide, ethacrynic acid, furosemide, hydrochlorothiazide, mannitol, metolazone, or spironolactone combination. Respiratory support and fraction of inspired oxygen on the first day of each course of diuretic use were identified. RESULTS About 37% (39,357/107,542) infants were exposed to at least one diuretic; furosemide was the most commonly used (93% with ≥ 1 recorded dose), followed by spironolactone, chlorothiazide, hydrochlorothiazide, bumetanide, and acetazolamide. About 74% patients were exposed to one diuretic at a time, 19% to two diuretics simultaneously, and 6% to three diuretics simultaneously. The most common combination was furosemide/spironolactone, followed by furosemide/chlorothiazide and chlorothiazide/spironolactone. Many infants were not receiving mechanical ventilation on the first day of each new course of furosemide (47%), spironolactone (69%), chlorothiazide (61%), and hydrochlorothiazide (68%). Any adverse event occurred on 42 per 1,000 infant-days for any diuretic and 35 per 1,000 infant-days for furosemide. Any serious adverse event occurred in 3.8 for any diuretic and 3.2 per 1,000 infant-days for furosemide. The most common laboratory abnormality associated with diuretic exposure was thrombocytopenia. CONCLUSION Despite no Food and Drug Administration (FDA) indication and little safety data, over one-third of premature infants in our population were exposed to a diuretic, many with minimal respiratory support.
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Affiliation(s)
- Matthew M. Laughon
- Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kim Chantala
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sofia Aliaga
- Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amy H. Herring
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Rachel Hughes
- Duke Clinical Research Institute, Durham, NC 27710, USA
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Ochoa SA, Cruz-Córdova A, Rodea GE, Cázares-Domínguez V, Escalona G, Arellano-Galindo J, Hernández-Castro R, Reyes-López A, Xicohtencatl-Cortes J. Phenotypic characterization of multidrug-resistant Pseudomonas aeruginosa strains isolated from pediatric patients associated to biofilm formation. Microbiol Res 2014; 172:68-78. [PMID: 25530579 DOI: 10.1016/j.micres.2014.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/22/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is an opportunistic pathogen that has acquired several mechanisms of resistance to multiple groups of antibiotic agents and has been widely employed as a model organism for the study of biofilm formation. Many P. aeruginosa structures embedded in the extracellular matrix, such as exopolysaccharides (EPS), flagella, and type-IV pili (T4P), have been associated with biofilm formation. In this study, we assess biofilm formation by crystal violet quantification in clinical strains of multidrug-resistant (MDR) P. aeruginosa isolated from the Hospital Infantil de México Federico Gómez (HIMFG) associated to total and reducing EPS production (quantification by the anthrone and DNS method, respectively), twitching motility activity by T4P, and flagellar-mediated motility. RESULTS The determination of Minimum Inhibitory Concentration (MIC) showed that >50% of P. aeruginosa strains were resistant to 12 different antibiotics (TIC, CAZ, CTX, CRO, FEP, AZT, GM, CIP, LEV, PZT, IMP, and MEM). Total and reducing EPS analysis of the 58 biofilm-forming MDR P. aeruginosa strains showed heterogeneous values ranging from OD600 9.06 to 212.33, displaying a linear correlation with the production of total EPS (59.66μg/ml to 6000.33μg/ml; R(2)=0.89), and a higher correlation with reducing EPS (88.33μg/ml to 1100.66μg/ml; R(2)=0.96). T4P twitching motility showed a moderated linear correlation (2.00mm to 28.33mm; R(2)=0.74). Even though it has been demonstrated that flagella contribute to the initial stages of biofilm formation, crystal violet analysis showed a moderate correlation (R(2)=0.49) with flagellar-mediated motility in MDR P. aeruginosa under the tested conditions. In addition, PFGE profiles revealed two subgroups generating profiles group A, consisting of 89.63% (52/58) of the strains, and group B, consisting of 13.09% (6/58) of the strains. CONCLUSIONS Phenotypic analysis showed a correlation among the biofilms developed in the MDR P. aeruginosa strains with EPS (total and reducing) production, T4P-activity by twitching motility and flagellar-mediated motility.
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Affiliation(s)
- Sara A Ochoa
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Hemato-Onocología e Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico
| | - Ariadnna Cruz-Córdova
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Hemato-Onocología e Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico
| | - Gerardo E Rodea
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Hemato-Onocología e Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico
| | - Vicenta Cázares-Domínguez
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Hemato-Onocología e Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico
| | - Gerardo Escalona
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Hemato-Onocología e Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico
| | - José Arellano-Galindo
- Laboratorio de Infectología, Departamento de Infectología. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General "Dr. Manuel Gea González", Tlalpan, México, D.F. 14080, Mexico
| | - Alfonso Reyes-López
- Dirección de Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico
| | - Juan Xicohtencatl-Cortes
- Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Hemato-Onocología e Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico.
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Hornik CP, Chu PY, Li JS, Clark RH, Smith PB, Hill KD. Comparative effectiveness of digoxin and propranolol for supraventricular tachycardia in infants. Pediatr Crit Care Med 2014; 15:839-45. [PMID: 25072477 PMCID: PMC4221410 DOI: 10.1097/pcc.0000000000000229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Supraventricular tachycardia is the most common arrhythmia in infants, and antiarrhythmic medications are frequently used for prophylaxis. The optimal prophylactic antiarrhythmic medication is unknown, and prior randomized trials have been underpowered. We used data from a large clinical registry to compare efficacy and safety of digoxin and propranolol for infant supraventricular tachycardia prophylaxis. We hypothesized that supraventricular tachycardia recurrence is less common on digoxin when compared with propranolol. DESIGN Retrospective cohort study. SETTING Pediatrix Medical Group neonatal ICUs. PATIENTS Infants discharged from 1998 to 2012 with supraventricular tachycardia who were treated with digoxin or propranolol. We excluded infants discharged before completing 2 days of therapy, those with Wolff-Parkinson-White syndrome, structural heart defects (except atrial/ventricular septal defects and patent ductus arteriosus), and those started on multidrug therapy. MEASUREMENTS AND MAIN RESULTS We used Cox proportional hazards to evaluate supraventricular tachycardia recurrence, defined as need for adenosine or electrical cardioversion while exposed to digoxin versus propranolol, controlling for infant characteristics, inotropic support, supplemental oxygen, and presence of a central line. We identified 342 infants exposed to digoxin and 142 infants exposed to propranolol. The incidence rate of treatment failure was 6.7/1,000 infant-days of exposure to digoxin and 15.4/1,000 infant-days of exposure to propranolol. On multivariable analysis, treatment failure was higher on propranolol when compared with that on digoxin (hazard ratio, 1.97; 95% CI, 1.05-3.71). Hypotension was more frequent during exposure to digoxin versus propranolol (39.4 vs 11.1/1,000 infant-days; p < 0.001). There was no difference in frequency of other clinical adverse events. CONCLUSIONS Digoxin was associated with fewer episodes of supraventricular tachycardia recurrence but more frequent hypotension in hospitalized infants relative to propranolol.
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Affiliation(s)
- Christoph P Hornik
- 1Department of Pediatrics, Duke University, Durham, NC 2Duke Clinical Research Institute, Durham, NC 3Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
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