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Stewart SD, Allen S, Eisenberg B, Sakakeeny K, Hammond TN, Schneider B, Mochel J, Zhou T. Comparison of the pharmacokinetics of continuous and intermittent infusions of ampicillin-sulbactam in dogs with septic peritonitis. Am J Vet Res 2022; 84:ajvr.22.08.0139. [PMID: 36520648 DOI: 10.2460/ajvr.22.08.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the time-course of ampicillin-sulbactam and percentage of time that its concentration is above a given MIC (T% > MIC) in dogs with septic peritonitis when delivered as either a continuous infusion (CI) or intermittent infusion (II). ANIMALS 11 dogs with septic peritonitis. PROCEDURES Dogs were randomized to receive ampicillin-sulbactam as either CI or II. Continuous infusions were delivered as a 50 mg/kg bolus IV followed by a rate of 0.1 mg/kg/min. Intermittent infusions were administered as 50 mg/kg IV q8h. Serum ampicillin-sulbactam concentrations were measured at hours 0, 1, 6, and every 12 hours after until patients were transitioned to an oral antimicrobial equivalent. All other care was at the discretion of the attending clinician. Statistical analysis was used to determine each patient's percentage of time T% > MIC for 4 MIC breakpoints (0.25, 1.25, 8, and 16 µg/mL). RESULTS No dogs experienced adverse events related to ampicillin-sulbactam administration. Both CI and II maintained a T% > MIC of 100% of MIC 0.25 µg/mL and MIC 1.25 µg/mL. The CI group maintained a higher T% > MIC for MIC 8 µg/mL and MIC 16 µg/mL; however, these differences did not reach statistical significance (P = .15 and P = .12, respectively). CLINICAL RELEVANCE This study could not demonstrate that ampicillin-sulbactam CI maintains a greater T% > MIC in dogs with septic peritonitis than II; however, marginal differences were noted at higher antimicrobial breakpoints. While these data support the use of antimicrobial CI in septic and critically ill patients, additional prospective trials are needed to fully define the optimal doses and the associated clinical responses.
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Affiliation(s)
- Samuel D Stewart
- Massachusetts Veterinary Referral Hospital, Ethos Veterinary Health, Woburn, MA
| | - Sarah Allen
- Massachusetts Veterinary Referral Hospital, Ethos Veterinary Health, Woburn, MA
| | - Beth Eisenberg
- Massachusetts Veterinary Referral Hospital, Ethos Veterinary Health, Woburn, MA
| | - Katie Sakakeeny
- Department of Emergency and Critical Care, Tufts Veterinary Emergency Treatment and Specialties, Walpole, MA
| | - Tara N Hammond
- Department of Emergency and Critical Care, Tufts Veterinary Emergency Treatment and Specialties, Walpole, MA
| | | | - Jonathan Mochel
- SMART Pharmacology, Iowa State College of Veterinary Medicine, Ames, IA
| | - Tianjian Zhou
- Department of Statistics, Colorado State University, Fort Collins, CO
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Avedissian SN, Skochko SM, Le J, Hingtgen S, Harvey H, Capparelli EV, Richardson A, Momper J, Mak RH, Neely M, Bradley JS. Use of Simulation Strategies to Predict Subtherapeutic Meropenem Exposure Caused by Augmented Renal Clearance in Critically Ill Pediatric Patients With Sepsis. J Pediatr Pharmacol Ther 2020; 25:413-422. [PMID: 32641911 PMCID: PMC7337137 DOI: 10.5863/1551-6776-25.5.413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objectives of this study were to 1) define extent and potential clinical impact of increased or decreased renal elimination of meropenem in children with sepsis, based on analysis of renal function during the first 2 days of PICU stay; and 2) estimate the risk of subtherapeutic meropenem exposure attributable to increased renal clearance. METHODS This retrospective study evaluated patients with a diagnosis of sepsis, receiving meropenem from the PICU at Rady Children's Hospital San Diego from 2015-2017. Meropenem exposure was estimated by using FDA-approved doses (20 and 40 mg/kg/dose) on day 1 and day 2 of PICU stay, based on a population pharmacokinetic (PK) model. For this population with sepsis, we assessed time-above-minimum inhibitory concentration (T>MIC) for pathogen MICs. RESULTS Meropenem treatment was documented in 105 episodes of sepsis with a 48% rate of pathogen detection. By day 2, increased eGFR (>120 mL/min/1.73 m2) was documented in 49% of patients, with 17% meeting criteria for augmented renal clearance ([ARC] >160 mL/min/1.73 m2) and 10%, for decreased function. Simulations documented that 80% of PICU patients with ARC did not achieve therapeutic meropenem exposure for Pseudomonas aeruginosa with a MIC of 2, using standard doses to achieve a pharmacodynamic goal of 80% T>MIC. CONCLUSIONS Approximately 3 of every 20 children with sepsis exhibited ARC during the first 48 hours of PICU stay. Simulations documented an increased risk for subtherapeutic meropenem exposure, suggesting that higher meropenem doses may be required to achieve adequate antibiotic exposure early in the PICU course.
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Berti AD, Hutson PR, Schulz LT, Webb AP, Rose WE. Compatibility of cefepime and vancomycin during simulated Y-site administration of prolonged infusion. Am J Health Syst Pharm 2015; 72:390-5. [PMID: 25694414 DOI: 10.2146/ajhp140369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The physical and chemical compatibility of cefepime and vancomycin at concentrations typically used in prolonged-infusion cefepime infusions was assessed. METHODS Samples from a typical Y-site configuration of standard-infusion vancomycin and prolonged-infusion cefepime were collected at various time points during the simulated 4-hour infusion. Samples were analyzed by visual inspection, spectrophotometry, and high-performance liquid chromatography (HPLC). Infusion antibiotics were reconstituted in pairwise combinations of 0.9% sodium chloride injection and 5% dextrose injection to determine the effects of solvent selection on stability. Infusion simulations were performed in triplicate without light protection under fluorescent lighting at room temperature (22.5 °C). Experimental replicates were not run simultaneously but on sequential days due to the considerable time (~12 hours) required to analyze samples obtained from a single infusion simulation and the known time-dependent instability of reconstituted cefepime beyond 24 hours. Physical stability was assessed visually for evidence of particulate formation, haze, precipitation, color change, and gas evolution. Samples were also assessed spectrophotometrically at 600 nm at the time of collection and 24 hours after collection. RESULTS Cefepime was compatible with vancomycin at the concentrations tested. The solvent selected (0.9% sodium chloride or 5% dextrose) to reconstitute either antibiotic had no impact on compatibility. Solutions were indistinguishable from positive and negative controls (heat-degraded cefepime and freshly reconstituted cefepime, respectively) at all time points assessed in terms of visual clarity, spectrophotometric absorbance, and HPLC recovery. CONCLUSION Cefepime and vancomycin were physically and chemically compatible during simulated Y-site administration of prolonged-infusion cefepime.
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Affiliation(s)
- Andrew D Berti
- Andrew D. Berti, Ph.D., Pharm.D., is Infectious Diseases Research Fellow; and Paul R. Hutson, M.S., Pharm.D., is Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison. Lucas T. Schulz, Pharm.D., BCPS AQ-ID, is Infectious Diseases Clinical Coordinator and Postgraduate Year 2 Infectious Diseases Residency Program Director; and Aaron P. Webb, M.S., Pharm.D., is Pharmacy Manager, Patient Care Services and Operations, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Warren E. Rose, Pharm.D., is Associate Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy.
| | - Paul R Hutson
- Andrew D. Berti, Ph.D., Pharm.D., is Infectious Diseases Research Fellow; and Paul R. Hutson, M.S., Pharm.D., is Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison. Lucas T. Schulz, Pharm.D., BCPS AQ-ID, is Infectious Diseases Clinical Coordinator and Postgraduate Year 2 Infectious Diseases Residency Program Director; and Aaron P. Webb, M.S., Pharm.D., is Pharmacy Manager, Patient Care Services and Operations, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Warren E. Rose, Pharm.D., is Associate Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy
| | - Lucas T Schulz
- Andrew D. Berti, Ph.D., Pharm.D., is Infectious Diseases Research Fellow; and Paul R. Hutson, M.S., Pharm.D., is Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison. Lucas T. Schulz, Pharm.D., BCPS AQ-ID, is Infectious Diseases Clinical Coordinator and Postgraduate Year 2 Infectious Diseases Residency Program Director; and Aaron P. Webb, M.S., Pharm.D., is Pharmacy Manager, Patient Care Services and Operations, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Warren E. Rose, Pharm.D., is Associate Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy
| | - Aaron P Webb
- Andrew D. Berti, Ph.D., Pharm.D., is Infectious Diseases Research Fellow; and Paul R. Hutson, M.S., Pharm.D., is Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison. Lucas T. Schulz, Pharm.D., BCPS AQ-ID, is Infectious Diseases Clinical Coordinator and Postgraduate Year 2 Infectious Diseases Residency Program Director; and Aaron P. Webb, M.S., Pharm.D., is Pharmacy Manager, Patient Care Services and Operations, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Warren E. Rose, Pharm.D., is Associate Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy
| | - Warren E Rose
- Andrew D. Berti, Ph.D., Pharm.D., is Infectious Diseases Research Fellow; and Paul R. Hutson, M.S., Pharm.D., is Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy, Madison. Lucas T. Schulz, Pharm.D., BCPS AQ-ID, is Infectious Diseases Clinical Coordinator and Postgraduate Year 2 Infectious Diseases Residency Program Director; and Aaron P. Webb, M.S., Pharm.D., is Pharmacy Manager, Patient Care Services and Operations, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Warren E. Rose, Pharm.D., is Associate Professor, Pharmacy Practice Division, University of Wisconsin-Madison School of Pharmacy
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