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Facchin A, Benyoub N, Elie V, Magreault S, Jacqz-Aigrain E. Limited Sampling Strategies to Predict Ganciclovir Exposure after Valganciclovir Administration and to Reduce Monitoring Constraints in Renal Transplant Children. Antimicrob Agents Chemother 2023; 67:e0159722. [PMID: 36880779 PMCID: PMC10112176 DOI: 10.1128/aac.01597-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Valganciclovir, the ganciclovir prodrug, is an antiviral agent used to prevent cytomegalovirus infection in renal transplant children. Therapeutic drug monitoring is still necessary to ensure optimal therapeutic area under the concentration-time curve from 0 to 24 h (AUC0-24) of 40 to 60 μg·h/mL since valganciclovir presents a high pharmacokinetic variability. To calculate ganciclovir AUC0-24 with the trapezoidal method, 7 samples are needed. The objective of this study was to develop and validate a reliable and clinically applicable limited sampling strategy (LSS) for individualizing valganciclovir dose in renal transplant children. Rich pharmacokinetic data from ganciclovir plasmatic dosages measured in renal transplant children who received valganciclovir to prevent cytomegalovirus infection at Robert Debré University Hospital were collected retrospectively. Ganciclovir AUC0-24s were calculated using the trapezoidal method. The LSS was developed using a multilinear regression approach to predict AUC0-24. The patients included were divided into two groups for model development (50 patients) and validation (30 patients). A total of 80 patients were included between February 2005 and November 2018. Multilinear regression models were developed on 50 pharmacokinetic profiles (50 patients) and validated with an independent group of 43 pharmacokinetic profiles (30 patients). Regressions based on samples collected at T1h-T4h-T8h, T2h-T4h-T8h, or T1h-T2h-T8h presented the best AUC0-24 predictive performances with an average difference between reference and predicted AUC0-24 of -0.27, 0.34, and -0.40 μg·h/mL, respectively. In conclusion, valganciclovir dosage adaptation was required in children to achieve the target AUC0-24. Three LSS models using three pharmacokinetic blood samples instead of seven will be useful for individualizing valganciclovir prophylaxis in renal transplant children.
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Affiliation(s)
- A. Facchin
- Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris, France
- Service of Pharmacy, Centre Hospitalier Intercommunal Nord Ardennes, Charleville-Mézières, France
| | - N. Benyoub
- Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - V. Elie
- Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - S. Magreault
- Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - E. Jacqz-Aigrain
- Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris, France
- University Paris -Cité, Paris, France
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D'Agate S, Musuamba FT, Jacqz-Aigrain E, Della Pasqua O. Simplified Dosing Regimens for Gentamicin in Neonatal Sepsis. Front Pharmacol 2021; 12:624662. [PMID: 33762945 PMCID: PMC7982486 DOI: 10.3389/fphar.2021.624662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The effectiveness of antibiotics for the treatment of severe bacterial infections in newborns in resource-limited settings has been determined by empirical evidence. However, such an approach does not warrant optimal exposure to antibiotic agents, which are known to show different disposition characteristics in this population. Here we evaluate the rationale for a simplified regimen of gentamicin taking into account the effect of body size and organ maturation on pharmacokinetics. The analysis is supported by efficacy data from a series of clinical trials in this population. Methods: A previously published pharmacokinetic model was used to simulate gentamicin concentration vs. time profiles in a virtual cohort of neonates. Model predictive performance was assessed by supplementary external validation procedures using therapeutic drug monitoring data collected in neonates and young infants with or without sepsis. Subsequently, clinical trial simulations were performed to characterize the exposure to intra-muscular gentamicin after a q.d. regimen. The selection of a simplified regimen was based on peak and trough drug levels during the course of treatment. Results: In contrast to current World Health Organization guidelines, which recommend gentamicin doses between 5 and 7.5 mg/kg, our analysis shows that gentamicin can be used as a fixed dose regimen according to three weight-bands: 10 mg for patients with body weight <2.5 kg, 16 mg for patients with body weight between 2.5 and 4 kg, and 30 mg for those with body weight >4 kg. Conclusion: The choice of the dose of an antibiotic must be supported by a strong scientific rationale, taking into account the differences in drug disposition in the target patient population. Our analysis reveals that a simplified regimen is feasible and could be used in resource-limited settings for the treatment of sepsis in neonates and young infants with sepsis aged 0–59 days.
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Affiliation(s)
- S D'Agate
- Clinical Pharmacology and Therapeutics Group, University College London, London, United Kingdom
| | - F Tshinanu Musuamba
- Clinical Pharmacology and Therapeutics Group, University College London, London, United Kingdom
| | - E Jacqz-Aigrain
- Department of Paediatric Pharmacology and Pharmacogenetics, Centre Hospitalier Universitaire, Hôpital Robert Debré, Paris, France
| | - O Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, United Kingdom
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Bui S, Facchin A, Ha P, Bouchet S, Leroux S, Nacka F, Fayon M, Jacqz-Aigrain E. Population pharmacokinetics of ceftazidime in critically ill children: impact of cystic fibrosis. J Antimicrob Chemother 2020; 75:2232-2239. [PMID: 32457995 DOI: 10.1093/jac/dkaa170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pharmacokinetics data on ceftazidime are sparse for the paediatric population, particularly for children with cystic fibrosis (CF) or severe infections. OBJECTIVES To characterize the population pharmacokinetics of ceftazidime in critically ill children, identify covariates that affect drug disposition and evaluate the current dosing regimens. METHODS The study was registered with Clinicaltrials.gov (NCT01344512). Children receiving ceftazidime were selected in 13 French hospitals. Plasma concentrations were determined by UPLC-MS/MS. Population pharmacokinetic analyses were performed using NONMEN software. RESULTS One hundred and eight patients, aged 28 days to 12 years, with CF (n = 32), haematology and/or oncology disorders (n = 47) or severe infection (n = 29) were included. Ceftazidime was administered by continuous or intermittent infusions; 271 samples were available for analysis. A two-compartment model with first-order elimination and allometric scaling was developed and covariate analysis showed that ceftazidime pharmacokinetics were also significantly affected by CLCR and CF. Ceftazidime clearance was 82% higher in CF than in non-CF patients. Monte Carlo simulations showed that the percentage of target attainment (PTA) for the target of T>MIC = 65% was (i) lower in CF than in non-CF children with intermittent infusions and (ii) higher with continuous than intermittent infusion in all children. CONCLUSIONS The population pharmacokinetics model for ceftazidime in children was influenced by body weight, CLCR and CF. A higher PTA was obtained with continuous versus intermittent infusions. Further studies should explore the benefits of continuous versus intermittent infusion of ceftazidime, including current versus increased doses in CF children.
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Affiliation(s)
- S Bui
- Centre d'Investigation Clinique (CIC1401), Centre de Ressources et de Compétences de la Mucoviscidose (CRCM), Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - A Facchin
- Département de Pharmacologie Pédiatrique et Pharmacogénétique, Centre Hospitalier Universitaire Robert Debré APHP, Paris, France.,Service de Pharmacie, Centre hospitalier Intercommunal Robert Ballanger, Aulnay-sous-Bois, France.,Université de Paris, Paris, France
| | - P Ha
- Département de Pharmacologie Pédiatrique et Pharmacogénétique, Centre Hospitalier Universitaire Robert Debré APHP, Paris, France
| | - S Bouchet
- Département de Pharmacologie et de toxicologie, Centre Hospitalier Universitaire de Bordeaux, Groupe hospitalier Pellegrin, Bordeaux, France
| | - S Leroux
- Département de Pharmacologie Pédiatrique et Pharmacogénétique, Centre Hospitalier Universitaire Robert Debré APHP, Paris, France
| | - F Nacka
- Centre d'Investigation Clinique (CIC1401), Centre de Ressources et de Compétences de la Mucoviscidose (CRCM), Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - M Fayon
- Centre d'Investigation Clinique (CIC1401), Centre de Ressources et de Compétences de la Mucoviscidose (CRCM), Centre de Recherche Cardio-thoracique de Bordeaux (U1045), Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - E Jacqz-Aigrain
- Département de Pharmacologie Pédiatrique et Pharmacogénétique, Centre Hospitalier Universitaire Robert Debré APHP, Paris, France.,Université de Paris, Paris, France.,Centre d'Investigation Clinique (CIC1426), Centre Hospitalier Universitaire Robert Debré APHP, Paris, France
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Konofal E, Lecendreux M, Kaguelidou F, Mentré F, Laouenan C, Jacqz-Aigrain E. FC13-11 - Effectiveness of mazindol in children with ADHD : open-label study. Eur Psychiatry 2020. [DOI: 10.1016/s0924-9338(11)73596-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Mazindol is a central nervous system stimulant, which blocks reuptake of dopamine and norepinephrine. Mazindol (1–6 mg/d) has previously been studied in the treatment of excessive daytime sleepiness with relative therapeutic benefit. Our hypothesis suggests that mazindol may be effective for the treatment of Attention Deficit Hyperactivity Disorder symptoms.Based on clinical assessments after oral administration of mazindol to 24 children (9–12 years) with ADHD (according to DSM-IVTR criteria), this open-label study evaluates the efficacy, safety and tolerability of mazindol (1 mg/d, 7 days). Safety evaluations included routine hematology, electrocardiograms, blood pressure, and pulse rate. Efficacy rating measurements included ADHD-RS score (primary outcome measure), CPRS-R:L, CGI-S and CGI-I (secondary outcome measures). This clinical trial reports data obtained from 21 boys (10 ± 1 years).Based on primary outcome (ADHD-RS), change in ADHD-RS mean total score after one week of mazindol was −24.6 (p < 0.0001) ; greater than a 90% improvement from baseline. Change in CPRS-R:L (80 items) mean total score after one week of mazindol was −55.5 (p < 0.0001); CGI-S after one week of mazindol was -3,02 (p< 0.01). Adverse events were mild to moderate in severity and decreased appetite, weight loss, headache, and abdominal pain were most common (95%).Changes in laboratory values, ECG, blood pressure, pulse rate and body weight were not clinically meaningful. Blood pressure and pulse rate were unchanged (p > 0.05) after one week of treatment.This preliminary investigation suggests that mazindol is still a new well-tolerated and active psychostimulant for the treatment of ADHD in children.
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Facchin A, Bui S, Leroux S, Nacka F, Koehl B, Maksoud E, Fayon M, Jacqz-Aigrain E. Variability of ciprofloxacin pharmacokinetics in children: impact on dose range in sickle cell patients. J Antimicrob Chemother 2018; 73:3423-3429. [DOI: 10.1093/jac/dky328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Facchin
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
- Ecole Doctorale MTCI, Université Paris Descartes, Paris, France
| | - S Bui
- Département de Pédiatrie, CIC1401, CHU de Bordeaux, Bordeaux, France
| | - S Leroux
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
| | - F Nacka
- Département de Pédiatrie, CIC1401, CHU de Bordeaux, Bordeaux, France
| | - B Koehl
- Service d’hématologie, Centre de référence de la drépanocytose, Hôpital Robert Debré, APHP, Paris, France
- Département de Pédiatrie, Hôpital Robert Debré, APHP, Paris, France
| | - E Maksoud
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
| | - M Fayon
- Département de Pédiatrie, CIC1401, CHU de Bordeaux, Bordeaux, France
| | - E Jacqz-Aigrain
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
- Université Paris Diderot, Sorbonne Paris-Cité, Paris, France
- Centre d’investigation clinique, CIC1426, INSERM, Paris, France
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Leroux S, Jacqz-Aigrain E, Elie V, Legrand F, Barin-Le Guellec C, Aurich B, Biran V, Dusang B, Goudjil S, Coopman S, Garcia Sanchez R, Zhao W, Manzoni P. Pharmacokinetics and safety of fluconazole and micafungin in neonates with systemic candidiasis: a randomized, open-label clinical trial. Br J Clin Pharmacol 2018; 84:1989-1999. [PMID: 29744900 DOI: 10.1111/bcp.13628] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022] Open
Abstract
AIMS The pharmacokinetics (PK) of fluconazole and micafungin differ in neonates compared with children and adults. Dosing instructions in product labels appear to be inconsistent with the emerging scientific evidence. Limited information is available on the safety profile of these agents in neonates. Our objective was to study the population PK and safety of both drugs, randomly administered in neonates with suspected or confirmed systemic candidiasis. METHODS Neonates were randomized 1:1 to fluconazole (loading dose 25 mg kg-1 ; maintenance dose 12 mg kg-1 day-1 or 20 mg kg-1 day-1 , respectively, for infants <30 weeks or ≥30 weeks' corrected gestational age) or micafungin (loading dose 15 mg kg-1 day-1 ; maintenance dose 10 mg kg-1 day-1 ). PK samples were taken on treatment days 1 and 5. Population parameters were determined using NONMEM and Monte Carlo simulations performed to reach predefined targets. Clinical and laboratory data, and adverse events were collected up to 36 weeks' corrected gestational age or hospital discharge. RESULTS Thirty-six neonates were enrolled. The median (range) gestational age was 28.2 (24.1-40.1) and 26.8 (23.5-40.0) weeks for fluconazole and micafungin, respectively. Based on 163 PK samples, the median population clearance (l h-1 kg-1 ) and volume of distribution (l kg-1 ) for fluconazole were: 0.015 [95% confidence interval (CI) 0.008, 0.039] and 0.913, and for micafungin were: 0.020 (95% CI 0.010, 0.023) and 0.354 (95% CI 0.225, 0.482), respectively. The loading dose was well tolerated. No adverse events associated with micafungin or fluconazole were reported. CONCLUSION Based on Monte Carlo simulations, a loading dose for fluconazole and dosing higher than recommended for both drugs are required to increase the area under the plasma drug concentration-time curve target attainment rate in neonates.
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Affiliation(s)
- S Leroux
- Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigation Center 1426 Robert-Debré Paediatric Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - E Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigation Center 1426 Robert-Debré Paediatric Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - F Legrand
- Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigation Center 1426 Robert-Debré Paediatric Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - C Barin-Le Guellec
- EA4245, Faculté de Médecine, Université François Rabelais, Tours, France
| | - B Aurich
- Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigation Center 1426 Robert-Debré Paediatric Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - V Biran
- UMR 1141 INSERM, Université Paris 7-Diderot, Neonatal Intensive Care Unit, Robert-Debré Paediatric Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - B Dusang
- Neonatal Intensive Care Unit, CHU de La Réunion, Saint Pierre, La Réunion, France
| | - S Goudjil
- Neonatal Care Unit, CHU Amiens, Amiens, France
| | - S Coopman
- Centre d'Investigation Clinique, CIC1403, Lille University Hospital, Lille, France
| | | | - W Zhao
- Department of Pediatric Pharmacology and Pharmacogenetics, Clinical Investigation Center 1426 Robert-Debré Paediatric Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - P Manzoni
- Neonatal Intensive Care Unit, S. Anna Hospital, Torino, Italy
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Gouyon B, Iacobelli S, Saliba E, Quantin C, Pignolet A, Jacqz-Aigrain E, Gouyon JB. A Computer Prescribing Order Entry-Clinical Decision Support system designed for neonatal care: results of the ‘preselected prescription’ concept at the bedside. J Clin Pharm Ther 2016; 42:64-68. [DOI: 10.1111/jcpt.12474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/02/2016] [Indexed: 02/03/2023]
Affiliation(s)
- B. Gouyon
- Centre d'Etudes Périnatales de l'Océan Indien (EA 7388); CHU de La Réunion; Saint Pierre La Réunion France
| | - S. Iacobelli
- Centre d'Etudes Périnatales de l'Océan Indien (EA 7388); CHU de La Réunion; Saint Pierre La Réunion France
| | - E. Saliba
- Service de médecine néonatale; CHU de Tours; Tours France
| | | | - A. Pignolet
- Centre d'Etudes Périnatales de l'Océan Indien (EA 7388); CHU de La Réunion; Saint Pierre La Réunion France
| | - E. Jacqz-Aigrain
- CIC 1426, Pharmacologie Pédiatrique et Pharmacogénétique; Hôpital Robert Debré; Paris France
| | - J. B. Gouyon
- Centre d'Etudes Périnatales de l'Océan Indien (EA 7388); CHU de La Réunion; Saint Pierre La Réunion France
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Ramos-Martín V, Johnson A, Livermore J, McEntee L, Goodwin J, Whalley S, Docobo-Pérez F, Felton TW, Zhao W, Jacqz-Aigrain E, Sharland M, Turner MA, Hope WW. Pharmacodynamics of vancomycin for CoNS infection: experimental basis for optimal use of vancomycin in neonates. J Antimicrob Chemother 2016; 71:992-1002. [PMID: 26755499 DOI: 10.1093/jac/dkv451] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/20/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES CoNS are the most common cause of neonatal late-onset sepsis. Information on the vancomycin pharmacokinetics/pharmacodynamics against CoNS is limited. The aim of this study was to characterize vancomycin pharmacokinetic/pharmacodynamic relationships for CoNS and investigate neonatal optimal dosage regimens. METHODS A hollow fibre and a novel rabbit model of neonatal central line-associated bloodstream CoNS infections were developed. The results were then bridged to neonates by use of population pharmacokinetic techniques and Monte Carlo simulations. RESULTS There was a dose-dependent reduction in the total bacterial population and C-reactive protein levels. The AUC/MIC and Cmax/MIC ratios were strongly linked with total and mutant resistant cell kill. Maximal amplification of resistance was observed in vitro at an fAUC/MIC of 200 mg · h/L. Simulations predicted that neonates <29 weeks post-menstrual age are underdosed with standard regimens with respect to older age groups. CONCLUSIONS The AUC/MIC and Cmax/MIC ratios are the pharmacodynamic indices that best explain total and resistant cell kill in CoNS infection. This suggests that less-fractionated regimens are appropriate for clinical use and continuous infusions may be associated with increased risk of emergence of antimicrobial resistance. This study has provided the pharmacodynamic evidence to inform an optimized neonatal dosage regimen to take into a randomized controlled trial.
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Affiliation(s)
- V Ramos-Martín
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - A Johnson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - J Livermore
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - L McEntee
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - J Goodwin
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - S Whalley
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - F Docobo-Pérez
- Department of Microbiology, Universidad de Sevilla, Seville, Spain
| | - T W Felton
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - W Zhao
- Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Paris, France
| | - E Jacqz-Aigrain
- Department of Paediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Paris, France
| | - M Sharland
- Paediatric Infectious Diseases Unit, St George's Hospital, London, UK
| | - M A Turner
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - W W Hope
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Bremond-Gignac D, Jacqz-Aigrain E, Abdoul H, Beresniak A, Baud O, Alberti C. Ophthalmic insert for pupillary mydriasis in neonates. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. Bremond-Gignac
- Pediatric Ophthalmology; APHP-Hôpital Universitaire Necker Enfants Malades; Paris France
- CNRS Unit FR3636; Binocular Vision; Paris V University; France
| | | | - H. Abdoul
- APHP-Hôpital Universitaire Robert Debre; 75019 Paris France
| | | | - O. Baud
- APHP-Hôpital Universitaire Robert Debre; 75019 Paris France
| | - C. Alberti
- APHP-Hôpital Universitaire Robert Debre; 75019 Paris France
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Bremond-Gignac D, Jacqz-Aigrain E, Abdoul H, Beresniak A, Baud O, Alberti C. Ophthalmic insert for pupillary mydriasis in neonates. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Bremond-Gignac
- Pediatric Ophthalmology; APHP- Hôpital Universitaire Necker Enfants Malades; Paris France
- CNRS Unit FR3636; Binocular Vision; Paris V University; France
| | | | - H. Abdoul
- APHP- Hôpital Universitaire Robert Debre; 75019 Paris France
| | | | - O. Baud
- APHP- Hôpital Universitaire Robert Debre; 75019 Paris France
| | - C. Alberti
- APHP- Hôpital Universitaire Robert Debre; 75019 Paris France
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Nacka F, Benadjaoud L, Fayon M, Jacqz-Aigrain E, Demarez JP. [Legal aspects of consent in children (Part 1)]. Arch Pediatr 2015; 22:983-8. [PMID: 26228811 DOI: 10.1016/j.arcped.2015.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 02/10/2015] [Accepted: 06/15/2015] [Indexed: 11/19/2022]
Abstract
In pediatric research, the patient is legally a minor and therefore protected by law. Research can only be conducted after parental consent and patient assent have been obtained. In this context, this review discusses the historical events and documents related to all ethical precautions and obligations. It also underlines that physicians shall respect all legal measures, but that individual involvement must comply with ethical standards while taking into account issues particular to pediatric research related to parental consent and child assent to clinical trials.
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Affiliation(s)
- F Nacka
- CIC 005, pédiatrie, hôpital Pellegrin enfants, CHU de Bordeaux, 33076 Bordeaux, France
| | - L Benadjaoud
- CIC 1426, pharmacologie pédiatrique et pharmacogénétique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - M Fayon
- CIC 005, pédiatrie, hôpital Pellegrin enfants, CHU de Bordeaux, 33076 Bordeaux, France
| | - E Jacqz-Aigrain
- CIC 1426, pharmacologie pédiatrique et pharmacogénétique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Nacka F, Benadjaoud L, Fayon M, Jacqz-Aigrain E, Demarez JP. [Consent in children: Practical situations (part 2)]. Arch Pediatr 2015; 22:989-95. [PMID: 26228807 DOI: 10.1016/j.arcped.2015.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 02/10/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
Ethical and regulatory documents frame informed consent in pediatric research; their application is obligatory but may be complex. In this specific context, pediatric investigators have a central ethical role to play to ensure the strict respect of regulatory and ethical requirements adapted to the French legal, social, and cultural context as well as good clinical practices. This article attempts to shed light on the considerations that can allow researchers to come to terms with industrial and institutional demands while responding to the needs of patients, particularly in the domain of pediatric research.
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Affiliation(s)
- F Nacka
- CIC 005 pédiatrie, hôpital Pellegrin enfants, CHU de Bordeaux, 33076 Bordeaux, France
| | - L Benadjaoud
- CIC 1426, pharmacologie pédiatrique et pharmacogénétique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - M Fayon
- CIC 005 pédiatrie, hôpital Pellegrin enfants, CHU de Bordeaux, 33076 Bordeaux, France
| | - E Jacqz-Aigrain
- CIC 1426, pharmacologie pédiatrique et pharmacogénétique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Andriss B, Husson I, Guilmin Crepon S, Jacqz-Aigrain E, Zohar S, Alberti C. Application de la méthodologie bayésienne a un essai clinique de petit effectif. Exemple de l’essai ACTFRIE : étude de l’effet de la pioglitazone dans l’ataxie de Friedreich. Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.03.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Adam de Beaumais T, Jacqz-Aigrain E. Leucémies de l’enfant : Comment utiliser les données pharmacogénétiques ? Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elie V, Leroux S, Zhao W, Jacqz-Aigrain E. Variabilité pharmacocinétique et thérapeutique individualisée chez l’enfant Pourquoi et quand s’y intéresser ? Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Nacka F, Benadjaoud L, Corvez L, Kaguelidou F, Fayon M, Jacqz-Aigrain E. Modalités d’information et de recueil du consentement des parents d’un mineur participant à une recherche biomédicale. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Abstract
Fluconazole is a triazole antifungal agent that is widely used in the nursery. It is available in both intravenous and oral formulation, and is active against most of the fungal pathogens that require treatment when retrieved from culture samples in neonatal intensive care units. Although clinical use has been wide for over 15 years, there have been small safety and efficacy studies completed in young infants. Randomised clinical trials assessing effectiveness of this agent in prevention of systemic fungal infections in neonates have been published in the last decade, and one large additional randomised study has been recently completed. Nevertheless, a certain degree of uncertainty still exists regarding the kinetics and appropriate dosing of this agent in premature and term infants, as well as regarding safety. Areas of poignant debate include the feasibility of loading dose strategies, appropriate dosages in the early days of life in the different subgroups of preterm infants, and long-term safety of fluconazole administered in prophylaxis during the first weeks of life in extremely premature infants. This paper reviews the most recent evidence on fluconazole and its role in the NICU settings.
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MESH Headings
- Antifungal Agents/administration & dosage
- Antifungal Agents/adverse effects
- Antifungal Agents/therapeutic use
- Candida/drug effects
- Candidiasis, Invasive/drug therapy
- Candidiasis, Invasive/prevention & control
- Fluconazole/administration & dosage
- Fluconazole/adverse effects
- Fluconazole/therapeutic use
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/microbiology
- Intensive Care Units, Neonatal
- Nurseries, Infant
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Affiliation(s)
- E Castagnola
- Infectious Disease Unit, Gaslini Institute, Genova, Italy
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Manzoni P, Rizzollo S, Monetti C, Carbonara C, Priolo C, Mastretta E, Barberis L, Galletto P, Cigna P, Leonessa ML, Sala U, Gomirato G, Mostert M, Stronati M, Ruffinazzi G, Tzialla C, Jacqz-Aigrain E, Kaguelidou F, Farina D. Neonatal cutaneous disseminated aspergillosis in a preterm extremely-low-birth-weight infant with favourable outcome at 3-year follow-up: a case report. Early Hum Dev 2012; 88 Suppl 2:S65-8. [PMID: 22633518 DOI: 10.1016/s0378-3782(12)70018-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. Early recognition and diagnosis of these lesions as a due to cutaneous initial symptom of cutaneous disseminated aspergillosis, as well as prompt treatment with Liposomal amphotericin B + Itraconazole, secured successful recovery from the systemic infection. Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. To our knowledge, this is one of the very few cases of survival, free from sequelae, for a preterm infant affected by neonatal cutaneous disseminated aspergillosis.
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Affiliation(s)
- P Manzoni
- Neonatology and NICU, AO Regina Margherita-S Anna S Anna Hospital, Torino, Italy.
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Manzoni P, Stronati M, Jacqz-Aigrain E, Maragliano R, Ruffinazzi G, Rizzollo S, Castagnola E, Farina D. Correct choices for correct treatments: key issues in the management of Candida infections in preterm neonates. Early Hum Dev 2012; 88 Suppl 2:S98-S100. [PMID: 22633526 DOI: 10.1016/s0378-3782(12)70026-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Invasive Candida infections (ICI) have a high burden of morbidity and mortality in the neonatal setting. Although the identification of effective prophylactic strategies has recently led to the prevention of many episodes of systemic fungal disease, the identification of effective treatment strategies is still a priority. The correct choice of the most appropriate antifungal drug for treatment of such infections requires specific expertise, as well as careful consideration of a number of variables related both to the characteristics of the patient and to the peculiarities of these infections in neonates. The ideal antifungal drug for preterm neonates should have a good ability to target fungal biofilms, in order to prevent or improve the course of end-organ localisations. It should also be active against fluconazole-resistant species, as well as safe enough to be used with no or limited interference with other neonatal drugs. In this view, the echinocandin class of antifungal agents has recently proven to be a suitable option for treatment. However, further studies are warranted to better establish kinetics and appropriate dosing of these agents in premature and term infants, as well as their ability to improve late outcomes of ICI.
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Affiliation(s)
- P Manzoni
- Neonatology and NICU, S Anna Hospital, Torino, Italy.
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Manzoni P, Mostert M, Latino MA, Pugni L, Stolfi I, Decembrino L, Vagnarelli F, Corona G, Tridapalli E, Vetrano G, Memo L, Priolo C, Galletto P, Giovannozzi C, Gallo E, Pedicino R, Barberi I, Faldella G, Mosca F, Saia OS, Bollani L, Maragliano R, Ruffinazzi G, Tzialla C, Stronati M, Rizzollo S, Farina D, Benjamin DK, Smith PB, Jacqz-Aigrain E, Kaguelidou F, Cohen-Wolkowiez M. Clinical characteristics and response to prophylactic fluconazole of preterm VLBW neonates with baseline and acquired fungal colonisation in NICU: data from a multicentre RCT. Early Hum Dev 2012; 88 Suppl 2:S60-4. [PMID: 22633517 DOI: 10.1016/s0378-3782(12)70017-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fungal colonisation by Candida spp. affects a high proportion of VLBW neonates in NICU. However, few data are available on the clinical characteristics of colonisation in preterm infants who are colonised at baseline via vertical transmission, compared to preterms who become colonised during their stay in NICU via horizontal transmission. MATERIAL AND METHODS We reviewed the database of a multicentre, randomised trial of prophylactic fluconazole in VLBW neonates conducted in 8 Italian NICUs in the years 2004 and 2005 (Manzoni et al., NEJM 2007;356(24):2483-95). Per the protocol, all enrolled infants underwent weekly surveillance cultures from birth till discharge. We investigated the frequency of the two different modalities of Candida colonisation in this population, as well as the clinical and outcome characteristics possibly related to them. RESULTS Overall, Candida colonisation affected 54 of 336 infants (16.1%). Baseline (i.e., detected <3(rd) day of life) colonisation affected 16 (4.7%), and acquired 38 (11.4%), of the 54 colonised preterms. Infants with baseline colonisation had significantly higher birth weight (1229 ± 28 g vs. 1047 g ± 29, p = 0.01) and gestational age (30.2 wks ± 2.7 vs. 28.5 wks ± 2.6, p = 0.01), and were significantly more likely to limit progression from colonisation to invasive Candida infection when fluconazole prophylaxis was instituted (21.6% vs. 42.7%, p = 0.009). Isolation of C. parapsilosis was significantly more frequent in infants with acquired colonisation. CONCLUSIONS Infants with baseline and acquired colonisation differ for demographics characteristics and for their response to fluconazole prophylaxis. This information may be useful for targeting more accurate management strategies for these two different groups of colonised preterms in NICU.
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MESH Headings
- Antifungal Agents/therapeutic use
- Candida/drug effects
- Candida/isolation & purification
- Candida/pathogenicity
- Candidiasis, Invasive/drug therapy
- Candidiasis, Invasive/prevention & control
- Candidiasis, Invasive/transmission
- Female
- Fluconazole/therapeutic use
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/prevention & control
- Infant, Very Low Birth Weight
- Infectious Disease Transmission, Vertical
- Intensive Care Units, Neonatal
- Male
- Premature Birth
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Affiliation(s)
- P Manzoni
- Neonatal Intensive Care Unit, S. Anna Hospital, Torino, Italy
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Hornik CP, Fort P, Clark RH, Watt K, Benjamin DK, Smith PB, Cohen-Wolkowiez M, Jacqz-Aigrain E, Kaguelidou F, Cohen-Wolkowiez M. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev 2012; 88 Suppl 2:S69-74. [PMID: 22633519 PMCID: PMC3513766 DOI: 10.1016/s0378-3782(12)70019-1] [Citation(s) in RCA: 293] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Very-low-birth-weight (VLBW, <1500 g birth weight) infants are at high risk for both early- and late-onset sepsis. Prior studies have observed a predominance of Gram-negative organisms as a cause of early-onset sepsis and Gram-positive organisms as a cause of late-onset sepsis. These reports are limited to large, academic neonatal intensive care units (NICUs) and may not reflect findings in other units. The purpose of this study was to determine the risk factors for sepsis, the causative organisms, and mortality following infection in a large and diverse sample of NICUs. METHODS We analysed the results of all cultures obtained from VLBW infants admitted to 313 NICUs from 1997 to 2010. RESULTS Over 108,000 VLBW infants were admitted during the study period. Early-onset sepsis occurred in 1032 infants, and late-onset sepsis occurred in 12,204 infants. Gram-negative organisms were the most commonly isolated pathogens in early-onset sepsis, and Gram-positive organisms were most commonly isolated in late-onset sepsis. Early- and late-onset sepsis were associated with increased risk of death controlling for other confounders (odds ratio 1.45 [95% confidence interval [CI] 1.21,1.73], and OR 1.30 [95%CI 1.21, 1.40], respectively). CONCLUSIONS This is the largest report of sepsis in VLBW infants to date. Incidence for early-onset sepsis and late-onset sepsis has changed little over this 14-year period, and overall mortality in VLBW infants with early- and late-onset sepsis is higher than in infants with negative cultures.
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Affiliation(s)
- Christoph P. Hornik
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
| | - Prem Fort
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida
| | - Kevin Watt
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
| | - Daniel K. Benjamin
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
| | - P. Brian Smith
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina,Corresponding author: P. Brian Smith, MD, MPH, MHS, Duke Clinical Research Institute, Box 17969, Durham, NC 27715; phone: 919-668-8951; fax: 919-668-7058;
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
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Irtan S, Maisin A, Baudouin V, Nivoche Y, Azoulay R, Jacqz-Aigrain E, El Ghoneimi A, Aigrain Y. Renal transplantation in children: critical analysis of age related surgical complications. Pediatr Transplant 2010; 14:512-9. [PMID: 20070565 DOI: 10.1111/j.1399-3046.2009.01260.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine age-related risk factors of urological and vascular complications. We performed a retrospective analysis of the data of 202 renal transplantations in 193 children between 1989 and 2007 at a single institution. Out of 193 grafts (combined renal and liver grafts were excluded), we observed urological complications in 42 cases (21.7%) leading to graft loss in one case and vascular complications in 27 cases (13.9%) leading to graft loss in seven. The urological complications were VUR (n=25, 12.4%), ureteral stricture (n=10, 5%), anastomotic leak (n=4, 2%), ureteral necrosis (n=2, 1%), and incrustative pyelitis (n=1, 0.5%). Vascular complications were arterial stricture (n=14, 7.2%), arterial thrombosis (n=4, 2%), venous thrombosis (n=2, 1%), and others (n=7). Donors aged less than six yr were a risk factor of vascular complications leading to graft loss (p=0.0001), whereas patients with PUV had more urological complications (p=0.001). Overall patient and graft survival is 93.1% and 84% at five yr, respectively. Surgical complications remain a major cause of graft loss (12%) and morbidity in children's kidney transplantation (38.9%). Young age of donors is the major risk factor of early graft loss as a result of vascular complication. However, donor selection based on age is limited by the shortage of organs.
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Affiliation(s)
- S Irtan
- Paediatric Surgery and Urology, Department of Paediatric Nephrology, Robert Debre Hospital, Paris, France.
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24
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Adam de Beaumais T, Dervieux T, Fakhoury M, Medard Y, Azougagh S, Zhang D, Yakouben K, Jacqz-Aigrain E. The impact of high-dose methotrexate on intracellular 6-mercaptopurine disposition during interval therapy of childhood acute lymphoblastic leukemia. Cancer Chemother Pharmacol 2009; 66:653-8. [PMID: 20033410 DOI: 10.1007/s00280-009-1205-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 11/27/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Low-dose methotrexate (MTX) therapy is the cornerstone treatment of acute lymphoblastic leukemia (ALL) and may enhance the activation of 6-mercaptopurine (6-MP) to 6-thioguanine nucleotides (6-TGN). Yet, data have established that high-dose MTX (HDMTX) hampers the accumulation of 6-TGN in red blood cells (RBC) and lymphoblasts. METHODS To clarify the pharmacokinetic interactions between these two antimetabolites, we serially measured RBC 6-TGN and MTX polyglutamates (MTXPG) levels following repeated courses of HDMTX (5 g/m(2) over 24 h) with daily oral 6-MP (25 mg/m(2)) during interval therapy in 20 children with ALL. RESULTS HDMTX produced a rapid reduction in RBC 6-TGN 24 h after the start of MTX, and this effect was sustained at least by the third day (median decrease -21%; P < 0.001). However, a return to pre-infusion of 6-TGN levels was observed by the time of the following HDMTX course 14 days later (P < 0.001). RBC MTX polyglutamates accumulation followed Michaelis-Menten kinetics but was not associated with the change in pre-infusion 6-TGN levels which remained stable during the interval period. CONCLUSION HDMTX does not appear to enhance 6-MP activation to 6-TGN. Moreover, given that the deleterious effect of HDMTX on intracellular 6-MP disposition has been shown to be several folds greater in lymphoblasts than in RBC. Our data warrant additional studies elucidating the optimal MTX dose synergizing with 6-MP.
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Affiliation(s)
- T Adam de Beaumais
- Department of Pediatric Pharmacology and Pharmacogenetics, Robert Debre Hospital, 48 Boulevard Serurier, Paris, France
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Abstract
Preterm neonates in neonatal intensive care units (NICU) are at high risk of invasive fungal infection (IFI), mostly by Candida spp. IFI in such patients is increasingly leading to high morbidity and mortality and frequent neurodevelopmental disabilities in the survivors. Most conditions and risk factors associated with neonatal IFI are unavoidable, being intrinsic to prematurity or related to the aggressive nature of the care these patients require. Neonatal IFI is difficult to diagnose, as candidaemia may be transient and difficult to eradicate due to the high rates of end-organ dissemination. The best option to decrease the burden of disease is thus to prevent it. Fluconazole administration is a suitable strategy and proved effective in many retrospective, single-centre studies and in four randomised, prospective clinical trials. Nevertheless, the use of this azole in high-risk preterm neonates in NICU is not yet a standard of care. This article summarises current evidence on the use of fluconazole in preterm neonates and discusses the concerns surrounding its use in nurseries.
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Affiliation(s)
- P Manzoni
- Neonatology and NICU, S Anna Hospital. Azienda Ospedaliera Regina Margherita, S Anna, C so Spezia 60, 10126 Torino, Italy.
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Jacquemin E, Hermeziu B, Kibleur Y, Friteau I, Mathieu D, Le Coz F, Moyse D, Gérardin M, Jacqz-Aigrain E, Munck A. Bioavailability of oral vitamin E formulations in adult volunteers and children with chronic cholestasis or cystic fibrosis. J Clin Pharm Ther 2009; 34:515-22. [DOI: 10.1111/j.1365-2710.2009.01027.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Irtan S, Maisin A, Jacqz-Aigrain E, Bonnard A, Philippe-Chomette P, El Ghoneimi A, Aigrain Y. SFCP-023 – Urologie – Analyse rétrospective des complications chirurgicales de 203 greffes rénales pédiatriques. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)71975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fakhoury M, Andreu-Gallien J, Mahr A, Medard Y, Azougagh S, Vilmer E, Jacqz-Aigrain E. Should TPMT genotype and activity be used to monitor 6-mercaptopurine treatment in children with acute lymphoblastic leukaemia? J Clin Pharm Ther 2008; 32:633-9. [PMID: 18021342 DOI: 10.1111/j.1365-2710.2007.00858.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE The activity of thiopurine S-methyltransferase (TPMT), a key enzyme in the metabolism of purine analogues, displays wide inter-subject variability partly due to a genetic polymorphism. Previous studies have suggested adjusting purine analogues dosing according to TPMT activity but measurements are costly and time-consuming. It is still unclear, especially under treatment, whether the simpler TPMT genotyping reliably predicts enzyme activity. Our aim was to study the possible correlation of TPMT genotype with phenotype. METHODS We determined the genotypic status and TMPT activity, at diagnosis and after 6 months of maintenance therapy, of 118 children with acute lymphoblastic leukaemia (ALL). RESULTS AND DISCUSSION Eighty-nine per cent of the children had a homozygous wild-type genotype (group 1), 11% had one or two mutant allele(s) (group 2). At both time points, TPMT activity (U/mL peripheral red blood cell) was significantly higher in group 1 than in group 2 (P < 0.001) but inter-group levels overlapped considerably. There was considerable heterogeneity in the percentage increase in TPMT activity after therapy, and little correlation between metabolites ratio [6-methylmercaptopurine derivative/6-thioguanine nucleotides (6-TGN)] and TPMT activity at the end of 6 months' maintenance treatment. These results show that TPMT activity cannot be used as an accurate tool for 6-mercaptopurine monitoring. CONCLUSION Genotyping at diagnosis identifies patients with a homozygous mutant TPMT and may prevent severe and life-threatening toxicity. ALL treatment monitoring should preferentially be based on repeated determinations of intracellular active metabolites (6-TGN) and methylated metabolites.
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Affiliation(s)
- M Fakhoury
- Paediatric Pharmacology and Pharmacogenetic Department, Robert Debre Hospital, Paris, France
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Allorge D, Beaune PH, Becquemont L, Bessard G, Bezieau S, Boisdron-Celle M, Boyer JC, Broly F, Dhaneens CM, Fonrose X, Gagnieu MC, Gamelin E, Gozé C, Jacqz-Aigrain E, Loric S, Loriot MA, Marquet P, Morel A, Namour B, Paintaud G, Peoc’h K, Picard N, Watier H, Verstuyft C. La pharmacogénétique moléculaire hospitalière en France : données actuelles et perspectives. Annales Pharmaceutiques Françaises 2007; 65:371-81. [DOI: 10.1016/s0003-4509(07)74196-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Irtan S, Saint-Marcoux F, Rousseau A, Zhang D, Leroy V, Marquet P, Jacqz-Aigrain E. Population pharmacokinetics and bayesian estimator of cyclosporine in pediatric renal transplant patients. Ther Drug Monit 2007; 29:96-102. [PMID: 17304156 DOI: 10.1097/ftd.0b013e3180310f9d] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cyclosporine A (CsA) is an immunosuppressive drug widely used in pediatric renal graft recipients. Its large interindividual pharmacokinetic variability and narrow therapeutic index render therapeutic drug monitoring necessary. However, information about CsA pharmacokinetics is scarce and no population pharmacokinetic (popPK) studies in these populations have been reported so far. to the objectives of this study were 1) to develop a PKpop model and identify the individual factors influencing the variability of CsA pharmacokinetics in pediatric kidney recipients; and 2) to build a Bayesian estimator allowing the estimation of the main PK parameters and exposure indices to CsA on the basis of a limited sampling strategy (LSS). The popPK analysis was performed using the NONMEM program. A total of 256 PK profiles of CsA collected in 98 pediatric renal transplant patients (mean age 9.7 +/- 4.5 years old) within the first year posttransplantation were studied. A 2-compartment model with first-order elimination, and Erlang distribution to describe the absorption phase, fitted the data adequately. For Bayesian estimation, the best LSS was determined based on its performance in estimating area under the concentration-time curve (AUC0-12h) and validated in an independent group of 20 patients. The popPK analysis identified body weight and posttransplant delay as individual factors influencing the apparent central volume of distribution and the apparent clearance, respectively. Bayesian estimation allowed accurate prediction of AUC0-12h using predose, C1h, and C3h blood samples with a mean bias between observed and estimated AUC of 0.5% +/- 11% and good precision (root mean square error = 10.9%). This article reports the first popPK study of CsA in pediatric renal transplant patients. It confirms the reliability and feasibility of CsA AUC estimation in this population. The body weight and the posttransplantation delay were identified to influence PK interindividual variability of CsA and were included in the Bayesian estimator developed, which could be helpful in further clinical trials.
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Affiliation(s)
- S Irtan
- Department of Paediatric Pharmacology and Pharmacogenetics, Hospital Robert Debré, Paris, France
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Monchaud C, Irtan S, Jacqz-Aigrain E. Effets à long terme des médicaments immunosuppresseurs en transplantation d'organe chez l'enfant. Arch Pediatr 2007; 14:599-602. [PMID: 17442546 DOI: 10.1016/j.arcped.2007.02.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/21/2022]
Affiliation(s)
- C Monchaud
- Service de pharmacologie pédiatrique et pharmacogénétique, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France.
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van der Marel CD, Peters JWB, Bouwmeester NJ, Jacqz-Aigrain E, van den Anker JN, Tibboel D. Rectal acetaminophen does not reduce morphine consumption after major surgery in young infants. Br J Anaesth 2007; 98:372-9. [PMID: 17284514 DOI: 10.1093/bja/ael371] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The safety and value of acetaminophen (paracetamol) in addition to continuous morphine infusion has never been studied in newborns and young infants. We investigated the addition of acetaminophen to evaluate whether it decreased morphine consumption in this age group after major thoracic (non-cardiac) or abdominal surgery. METHODS A randomized controlled trial was performed in 71 patients given either acetaminophen 90-100 mg kg(-1) day(-1)or placebo rectally, in addition to a morphine loading dose of 100 microg kg(-1) and 5-10 microg kg(-1) h(-1) continuous infusion. Analgesic efficacy was assessed using Visual Analogue Scale (VAS) and COMFORT scores. Extra morphine was administered if VAS was > or = 4. RESULTS We analysed data of 54 patients, of whom 29 received acetaminophen and 25 received placebo. Median (25-75th percentile) age was 0 (0-2) months. Additional morphine bolus requirements and increases in continuous morphine infusion were similar in both groups (P = 0.366 and P = 0.06, respectively). There was no significant difference in total morphine consumption, respectively, 7.91 (6.59-14.02) and 7.19 (5.45-12.06) mug kg(-1) h(-1) for the acetaminophen and placebo group (P = 0.60). COMFORT [median (25-75th percentile) acetaminophen 10 (9-12) and placebo 11 (9-13)] and VAS [median (25-75th percentile) acetaminophen 0.0 (0.0-0.2) and placebo 0.0 (0.0-0.3)] scores did not differ between acetaminophen and placebo group (P = 0.06 and P = 0.73, respectively). CONCLUSIONS Acetaminophen, as an adjuvant to continuous morphine infusion, does not have an additional analgesic effect and should not be considered as standard of care in young infants, 0-2 months of age, after major thoracic (non-cardiac) or abdominal surgery.
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MESH Headings
- Abdomen/surgery
- Acetaminophen/administration & dosage
- Acetaminophen/blood
- Administration, Rectal
- Algorithms
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/blood
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/blood
- Drug Administration Schedule
- Drug Therapy, Combination
- Female
- Humans
- Infant
- Infant, Newborn
- Infusions, Intravenous
- Male
- Morphine/administration & dosage
- Morphine/blood
- Pain Measurement/methods
- Pain, Postoperative/blood
- Pain, Postoperative/drug therapy
- Thoracic Surgical Procedures
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Affiliation(s)
- C D van der Marel
- Department of Paediatric Surgery, ErasmusMC Rotterdam, Rotterdam, The Netherlands.
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Kassaï B, Treluyer JM, Jacqz-Aigrain E, Pons G. Réseau d'investigation pédiatrique des produits de santé (RIPS). Arch Pediatr 2006; 13:631-4. [PMID: 16697606 DOI: 10.1016/j.arcped.2006.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- B Kassaï
- Inserm, CIC201, service de pharmacologie clinique, faculté RTH Laennec, université Lyon I, hôpital Louis-Pradel, CHU de Lyon, rue Guillaume-Paradin, BP 8071, 69376 Lyon cedex 8, Lyon, France
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Jacqz-Aigrain E, Zarrabian S, Pandolfini C, Bonati M, Sammons H, Choonara I, Danés I, Fuentes I, Arnau J. DEC-net, le registre européen des essais cliniques pédiatriques, est une réalité. Arch Pediatr 2006; 13:333-5. [PMID: 16531023 DOI: 10.1016/j.arcped.2006.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 01/12/2006] [Indexed: 11/26/2022]
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Payen S, Zhang D, Maisin A, Popon M, Bensman A, Bouissou F, Loirat C, Gomeni R, Bressolle F, Jacqz-Aigrain E. Population pharmacokinetics of mycophenolic acid in kidney transplant pediatric and adolescent patients. Ther Drug Monit 2005; 27:378-88. [PMID: 15905811 DOI: 10.1097/01.ftd.0000159784.25872.f6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current data on mycophenolate mofetil (MMF) suggest that there is a pharmacokinetic/pharmacodynamic relationship between the mycophenolic acid (MPA) area under the curve (AUC) during treatment and both the risk of acute rejection and the occurrence of side effects. The aim of this study was to characterize the population pharmacokinetics of MPA in kidney transplant patients between the ages of 2 and 21 years and to propose a limited sampling strategy to estimate individual MPA AUCs. Forty-one patients received long-term oral MMF continuous therapy as part of a triple immunosuppressive regimen, which also included cyclosporine or tacrolimus (n=3) and corticosteroids. Therapy was initiated at a dose of 600 mg/m twice daily. The population parameters were calculated from an initial group of 32 patients. The data were analyzed by nonlinear mixed-effect modeling using a 2-compartment structural model with first-order absorption and a lag time. The interindividual variability in the initial volume of distribution was partially explained by the fact that this parameter was weight-dependent. Fifteen concentration-time profiles from 13 patients were used to evaluate the predictive performance of the Bayesian approach and to devise a limited sampling strategy. The protocol, involving two sampling times, 1 and 4 hours after oral administration, allows the precise and accurate determination of MPA AUCs (bias -0.9 microg.h/mL; precision 6.02 microg.h/mL). The results of this study combine the relationships between the pharmacokinetic parameters of MPA and patient covariates, which may be useful for dose adjustment, with a convenient sampling procedure that may aid in optimizing pediatric patient care.
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Affiliation(s)
- S Payen
- Clinical Pharmacokinetics Laboratory, Faculty of Pharmacy, University Montpellier I, Montpellier, France
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Abstract
Most drugs are not labelled for use in pregnancy. Consequently, large numbers of women expose their fetus to potential risks, either because they do not know that they are pregnant or because they require treatment for gestational pathologies. The present review focuses on drug classes for which the risk:benefit ratio during pregnancy has been discussed recently based on human data. Selective serotonin reuptake inhibitors have gained wide acceptance in the treatment of depression and data on their risk for neonatal adaptation after late exposure are reviewed. Angiotensin converting enzyme inhibitors and angiotensin II receptors antagonists interact with the renin-angiotensin system, although with different mechanisms, and might cause severe fetal tubular dysgenesis. Non-steroidal anti-inflammatory and antiviral drugs and recreational drugs are also presented.
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Affiliation(s)
- E Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Hopital Robert Debré and Faculté de medicine Bichat/Robert Debré, 48 Boulevard Serurier University Paris VII, 75019 Paris, France.
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Serreau R, Polack M, Leger J, Vuillard E, Thurninger O, Chemouny S, Heid M, Guibourdenche J, Jacqz-Aigrain E, Oury JF, Luton D. Fetal thyroid goiter after massive iodine exposure. Prenat Diagn 2004; 24:751-3. [PMID: 15386468 DOI: 10.1002/pd.860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Romain O, Jacqz-Aigrain E, Preud'homme D. Actualités pharmaceutiques. Arch Pediatr 2004. [DOI: 10.1016/j.arcped.2004.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Romain O, Jacqz-Aigrain E, Preud'homme D. Actualités pharmaceutiques. Arch Pediatr 2004; 11:889-91. [PMID: 15234395 DOI: 10.1016/j.arcped.2004.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- O Romain
- Hôpital Saint-Michel, Paris, France.
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41
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Danés Carreras I, Fuentes Camps I, Arnau de Bolós JM, Pandolfini C, Bonati M, Sammons H, Choonara I, Jacqz-Aigrain E. [European registry of clinical trials in children]. An Pediatr (Barc) 2004; 60:212-4. [PMID: 14987510 DOI: 10.1016/s1695-4033(04)78253-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Romain O, Jacqz-Aigrain E. [Pharmaceutical news]. Arch Pediatr 2004; 11:495-7. [PMID: 15135446 DOI: 10.1016/j.arcped.2004.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Serreau R, Le Heuzey MF, Gilbert A, Mouren MC, Jacqz-Aigrain E. Unlicensed and off-label use of psychotropic medications in French children: a prospective study. ACTA ACUST UNITED AC 2004. [DOI: 10.1185/146300904125004155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Payen S, Serreau R, Munck A, Aujard Y, Aigrain Y, Bressolle F, Jacqz-Aigrain E. Population pharmacokinetics of ciprofloxacin in pediatric and adolescent patients with acute infections. Antimicrob Agents Chemother 2004; 47:3170-8. [PMID: 14506027 PMCID: PMC201120 DOI: 10.1128/aac.47.10.3170-3178.2003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the present study was to characterize the population pharmacokinetics of ciprofloxacin in patients with and without cystic fibrosis ranging in age from 1 day to 24 years and to propose a limited sampling strategy to estimate individual pharmacokinetic parameters. Patients were divided into four groups according to the treatment schedule. They received ciprofloxacin by intravenous infusion (30 min) or by the oral route. The number of samples collected from each patient ranged from 1 to 12. The population parameters were computed for an initial group of 37 patients. The data were analyzed by nonlinear mixed-effect modeling by use of a two-compartment structural model. The interindividual variability in clearance (CL) was partially explained by a dependence on age and the patient's clinical status. In addition, a significant relationship was found between weight and the initial volume of distribution. Eighteen additional patients were used for model validation and evaluation of limited sampling strategies. When ciprofloxacin was administered intravenously, sampling at a single point (12 h after the start of infusion) allowed the precise and accurate estimation of CL and the elimination half-life, as well as the ciprofloxacin concentration at the end of the infusion. It should be noted that to take into account the presence of a lag time after oral administration, a schedule based on two sampling times of 1 and 12 h is needed. The results of this study combine relationships between ciprofloxacin pharmacokinetic parameters and patient covariates that may be useful for dose adjustment and a convenient sampling procedure that can be used for further studies.
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Affiliation(s)
- S Payen
- Clinical Pharmacokinetic Laboratory, Faculty of Pharmacy, University Montpellier I, Montpellier, France
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Jacqz-Aigrain E. Population pharmacokinetic model for nelfinavir and its active metabolite hydroxy-tert-butylamide, in infants perinatally infected with human immunodeficiency virus type 1. Clin Pharmacol Ther 2004. [DOI: 10.1016/j.clpt.2003.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chauvenet M, Rimailho A, Hoog-Labouret N, Audibert F, Bavoux F, Boutroy M, Brasseur D, Carlier P, Elefant E, Gersberg M, Goffinet F, Jacqz-Aigrain E, Lemery D, Mandelbrot L, Mirelesse V, Saint-Salvi B, Tchinou C, Vial T. Methodology for the Evaluation of Drugs in Pregnant Women. Therapie 2003. [DOI: 10.2515/therapie:2003040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jacqz-Aigrain E. Argumentaire pour une évaluation spécifique des médicaments chez l'enfant. Arch Pediatr 2003; 10 Suppl 1:1s-3s. [PMID: 14509718 DOI: 10.1016/s0929-693x(03)90358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E Jacqz-Aigrain
- Service de pharmacologie pédiatrique et pharmacogénétique, hôpital Robert-Debré, 75019 Paris, France.
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Romain O, Jacqz-Aigrain E. Actualités pharmaceutiques. Arch Pediatr 2003. [DOI: 10.1016/s0929-693x(03)00143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jacqz-Aigrain E, Zhang D, Maillard G, Luton D, André J, Oury JF. Maternal smoking during pregnancy and nicotine and cotinine concentrations in maternal and neonatal hair. BJOG 2002; 109:909-11. [PMID: 12197371 DOI: 10.1111/j.1471-0528.2002.01322.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Conflicting data have been reported in the association between maternal smoking and adverse effects during pregnancy and in neonates. Some studies, conducted on a limited number of patients have evaluated maternal consumption and fetal exposure by measuring nicotine and cotinine in the hair. Our aims were to evaluate the relationship among maternal cigarette consumption, fetal smoking exposure and outcome of pregnancy in a population of pregnant women who smoked. DESIGN Mothers smoking during pregnancy were included at their first prenatal visit and followed prospectively. Maternal data (demographic variables, obstetrical history and cigarette consumption), neonatal data and birth indicators (number of weeks of gestation, type of delivery, weight) were collected. Hair samples from the mothers and the babies were collected at birth. SETTING The present study was conducted in the Department of Obstetrics of the University Hospital Robert Debré in Paris. POPULATION A total of 254 women smokers were included in the study and 182 mother/neonate pairs were analyzed after exclusion of 50 babies whose hair samples were inadequate and 22 for various other reasons. METHODS Nicotine and cotinine concentrations in the maternal and neonatal hair were measured at birth by radio-immunoassay. MAIN OUTCOME MEASURES Cigarette consumption was based on self reporting and quantified each trimester. It was expressed more precisely during the third trimester by the mean number per cigarette per day. Nicotine and cotinine concentrations in the maternal and neonatal hair at birth were also analysed. RESULTS Nicotine and cotinine concentrations in maternal hair were associated with cigarette consumption during the third trimester of pregnancy (P < 0.003 and P < 0.01, respectively). In neonates, only cotinine concentrations were associated to maternal cigarette consumption (P < 0.0001). This association remained significant in a multivariate analysis, which included maternal cotinine hair concentrations and the ethnic group. CONCLUSIONS Our results have shown a strong relationship between maternal cigarette consumption and fetal exposure to smoking measured by cotinine concentrations in neonatal hair. Further studies are required to look for associations between fetal exposure and adverse pregnancy outcome.
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Affiliation(s)
- E Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France
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Affiliation(s)
- M F Le Heuzey
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert Debré, 48, boulevard Sérurier, 75019 Paris, France.
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