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Ponthier L, Autmizguine J, Franck B, Åsberg A, Ovetchkine P, Destere A, Marquet P, Labriffe M, Woillard JB. Optimization of Ganciclovir and Valganciclovir Starting Dose in Children by Machine Learning. Clin Pharmacokinet 2024:10.1007/s40262-024-01362-7. [PMID: 38492206 DOI: 10.1007/s40262-024-01362-7] [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] [Accepted: 02/15/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND OBJECTIVES Ganciclovir (GCV) and valganciclovir (VGCV) show large interindividual pharmacokinetic variability, particularly in children. The objectives of this study were (1) to develop machine learning (ML) algorithms trained on simulated pharmacokinetics profiles obtained by Monte Carlo simulations to estimate the best ganciclovir or valganciclovir starting dose in children and (2) to compare its performances on real-world profiles to previously published equation derived from literature population pharmacokinetic (POPPK) models achieving about 20% of profiles within the target. MATERIALS AND METHODS The pharmacokinetic parameters of four literature POPPK models in addition to the World Health Organization (WHO) growth curve for children were used in the mrgsolve R package to simulate 10,800 pharmacokinetic profiles. ML algorithms were developed and benchmarked to predict the probability to reach the steady-state, area-under-the-curve target (AUC0-24 within 40-60 mg × h/L) based on demographic characteristics only. The best ML algorithm was then used to calculate the starting dose maximizing the target attainment. Performances were evaluated for ML and literature formula in a test set and in an external set of 32 and 31 actual patients (GCV and VGCV, respectively). RESULTS A combination of Xgboost, neural network, and random forest algorithms yielded the best performances and highest target attainment in the test set (36.8% for GCV and 35.3% for the VGCV). In actual patients, the best GCV ML starting dose yielded the highest target attainment rate (25.8%) and performed equally for VGCV with the Franck model formula (35.3% for both). CONCLUSION The ML algorithms exhibit good performances in comparison with previously validated models and should be evaluated prospectively.
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Affiliation(s)
- Laure Ponthier
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, 87000, Limoges, France
- Department of Pediatrics, University Hospital of Limoges, Limoges, France
| | - Julie Autmizguine
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
| | - Benedicte Franck
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Clinical Investigation Center, CIC-P 1414, Rennes, France
- University of Rennes, Centre Hospitalier Universitaire Rennes, École des Hautes Études en Santé Publique, IRSET (Institut de Recherche en Santé, Environnement et Travail), UMR S 1085, Rennes, France
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- Section of Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Philippe Ovetchkine
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Alexandre Destere
- Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Nice, Nice, France
| | - Pierre Marquet
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, 87000, Limoges, France
- Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | - Marc Labriffe
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, 87000, Limoges, France
- Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | - Jean-Baptiste Woillard
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, 87000, Limoges, France.
- Department of Pharmacology, Toxicology and Pharmacovigilance, University Hospital of Limoges, Limoges, France.
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Yeung CHT, Autmizguine J, Dalvi P, Denoncourt A, Ito S, Katz P, Rahman M, Theoret Y, Edginton AN. Maternal Ezetimibe Concentrations Measured in Breast Milk and Its Use in Breastfeeding Infant Exposure Predictions. Clin Pharmacokinet 2024; 63:317-332. [PMID: 38278872 DOI: 10.1007/s40262-023-01345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Lactating mothers taking ezetimibe, an antihyperlipidemic agent, may be hesitant to breastfeed despite the known benefit of breastfeeding to both mother and infant. Currently, no data exist on the presence or concentration of ezetimibe and its main active metabolite, ezetimibe-glucuronide (EZE-glucuronide), in human breast milk. METHODS Voluntary breast milk samples containing ezetimibe and EZE-glucuronide were attained from lactating mothers taking ezetimibe as part of their treatment. An assay was developed and validated to measure ezetimibe and EZE-glucuronide concentrations in breast milk. A workflow that utilized a developed and evaluated pediatric physiologically based pharmacokinetic (PBPK) model, the measured concentrations in milk, and weight-normalized breast milk intake volumes was applied to predict infant exposures and determine the upper area under the curve ratio (UAR). RESULTS Fifteen breast milk samples from two maternal-infant pairs were collected. The developed liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay showed an analytical range of 0.039-5.0 ng/mL and 0.39-50.0 ng/mL for ezetimibe and EZE-glucuronide, respectively. The measured concentrations in the breast milk samples were 0.17-1.02 ng/mL and 0.42-2.65 ng/mL of ezetimibe and EZE-glucuronide, respectively. The evaluated pediatric PBPK model demonstrated minimal exposure overlap in adult therapeutic dose and breastfed infant simulated area under the concentration-time curve from time zero to 24 h (AUC24). Calculated UAR across infant age groups ranged from 0.0015 to 0.0026. CONCLUSIONS PBPK model-predicted ezetimibe and EZE-glucuronide exposures and UAR suggest that breastfeeding infants would receive non-therapeutic exposures. Future work should involve a 'mother-infant pair study' to ascertain breastfed infant plasma ezetimibe and EZE-glucuronide concentrations to confirm the findings of this work.
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Affiliation(s)
- Cindy H T Yeung
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Julie Autmizguine
- Department of Clinical Pharmacology Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Department of Pharmacology and Physiology, Universite de Montreal, Montreal, QC, Canada
| | - Pooja Dalvi
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Audrey Denoncourt
- Department of Clinical Pharmacology Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Pamela Katz
- Division of Endocrinology and Metabolism, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Mehzabin Rahman
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Yves Theoret
- Department of Clinical Pharmacology Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, ON, N2G 1C5, Canada.
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Piché-Renaud PP, Chiasson CO, Autmizguine J, Ovetchkine P, Lachance C, Théorêt Y, Martin B. Treatment of Congenital Cytomegalovirus and Ganciclovir Therapeutic Drug Monitoring in Twin Preterm Infants. J Pediatr Pharmacol Ther 2023; 28:93-101. [PMID: 36777981 PMCID: PMC9901313 DOI: 10.5863/1551-6776-28.1.93] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
Congenitally acquired cytomegalovirus (CMV) infection is the most prevalent congenital infection worldwide and the most frequent cause of acquired sensorineural hearing loss. The burden of the disease is even more important in premature and very low birth weight infants. However, few data exist on the treatment with intravenous ganciclovir and oral valganciclovir in this vulnerable population. We report the case of twins congenitally infected with CMV and born prematurely at 27 weeks' gestation. Treatment regimens were initially individualized for their prematurity and renal function, and then adjusted with therapeutic drug monitoring (TDM) to adapt to their continuously evolving physiologic maturation. As infants were aging, the plasmatic half-life of ganciclovir slowly decreased to term infant values around 10 weeks of chronological age, or 37 weeks of postmenstrual age. Results for blood polymerase chain reaction tests became negative and long-term follow-ups were satisfactory in both twins. The limited data for infants born before 32 weeks of gestation or at less than 1200 g and evolution of ganciclovir pharmacokinetic parameters justify the use of TDM in these settings.
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Affiliation(s)
| | | | - Julie Autmizguine
- Service of Infectious Disease (JA, PO), CHU Sainte-Justine, Montréal, Québec,Department of Clinical Pharmacology Unit (JA, YT), CHU Sainte-Justine, Montréal, Québec,Department of Pharmacology and Physiology (JA), Université de Montréal, Montréal, Québec
| | - Philippe Ovetchkine
- Service of Infectious Disease (JA, PO), CHU Sainte-Justine, Montréal, Québec
| | | | - Yves Théorêt
- Department of Clinical Pharmacology Unit (JA, YT), CHU Sainte-Justine, Montréal, Québec
| | - Brigitte Martin
- Department of Pharmacy (COC, BM), CHU Sainte-Justine, Montréal, Québec
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Autmizguine J, Barton M, Burton C, Dixit D, Papenburg J, Robinson J, Top KA, Rubin E. AMMI Canada Practice Point on the treatment of acute COVID-19 in pediatrics. J Assoc Med Microbiol Infect Dis Can 2022; 7:307-316. [PMID: 37397826 PMCID: PMC10312226 DOI: 10.3138/jammi-2022-09-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Julie Autmizguine
- Department of Pharmacology and Physiology, Université de Montréal, Montréal, Québec, Canada
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Michelle Barton
- Division of Infectious Diseases, Department of Pediatrics, Western University, London, Ontario, Canada
| | - Catherine Burton
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Devika Dixit
- Division of Infectious Diseases, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montréal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Joan Robinson
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Karina A Top
- Division of Infectious Diseases, Department of Pediatrics, IWK Health and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Earl Rubin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montréal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Québec, Canada
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Abda A, Drouin O, Kakkar F, Autmizguine J, del Giorgio F, Gauvin L. 88 Association between area level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal. Paediatr Child Health 2022; 27. [PMCID: PMC9586059 DOI: 10.1093/pch/pxac100.087] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. Objectives The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children. Design/Methods We conducted a retrospective cohort study of all children (0-17 years of age) with a PCR-confirmed SARS-CoV-2 infection between March 1, 2020, and May 31, 2021, at a tertiary care pediatric hospital. Data were collected through chart review and included age, sex, and postal code. Postal codes were then assigned a dissemination area-level material deprivation score, measured via the Pampalon Material Deprivation Index (PMDI) quintiles. The Pampalon Material Deprivation Index (PMDI) uses postal codes to describe factors related to material deprivation obtained from the Canadian census, which are proxies for individual data in a geographic area. Specifically, the PMDI integrates data regarding (i) the proportion of persons without a high school diploma; (ii) the employment-to-population ratio; (iii) average personal income which is aggregated at the dissemination area level. We examined the association between PMDI quintiles and hospitalization using Poisson regression. Results During the study period, 964 children had a positive PCR-confirmed SARS-CoV-2 test and 124 were hospitalized due to SARS-CoV-2 infection. Children from the most deprived PMDI quintile represented 31.6% of positive cases and 40.7% of hospitalizations (Figure 1 and 2). Both in bivariate and multivariable regression analyses, there was evidence of greater proportion of positive test results in the most deprived PMDI quintile (Quintile 5) compared to the least deprived quintile (Quintile 1) (rate ratio 1.77, 95%CI: 1.36; 2.62) (Table 1). The incidence of hospitalization due to SARS-CoV-2 infection was 2.42 times greater in the most deprived quintile compared to the least deprived quintile (95%CI: 1.33; 4.41) (table 1). In a post-hoc analysis, the risk for severe disease appeared higher for children living in Q5 areas relative to other areas but the difference did not reach statistical significance. Conclusion In conclusion, in this study we found evidence that Canadian children living in neighbourhoods with high material deprivation had a higher incidence of infection and hospitalizations related to SARS-Cov-2 compared to children living in neighbourhoods with less material deprivation. Public health authorities should take these disparities into account when devising public health policy and interventions especially at this crucial point in the pandemic. Special efforts should be deployed to protect children from these more disadvantaged areas, especially as vaccination is not yet available to a majority of children. ![]()
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Affiliation(s)
- Assil Abda
- Université de Montréal - CHU Sainte-Justine
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine
| | | | | | | | - Lise Gauvin
- School of Public Health, Université de Montréal
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Abda A, del Giorgio F, Gauvin L, Autmizguine J, Kakkar F, Drouin O. Association between area-level material deprivation and incidence of hospitalization among children with SARS-CoV-2 in Montreal. Paediatr Child Health 2022; 27:S27-S32. [PMID: 35620560 PMCID: PMC9126283 DOI: 10.1093/pch/pxab106] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although sociodemographic factors have been linked with SARS-CoV-2 infection and hospitalizations in adults, there are little data on the association between sociodemographic characteristics and SARS-CoV-2-related hospitalization in children. The objective of this study was to determine the association between area-level material deprivation and incidence of hospitalization with SARS-CoV-2 among children. Methods We conducted a retrospective cohort study of all children (0 to 17 years of age) with a PCR-confirmed SARS-CoV-2 infection March 1, 2020 through May 31, 2021 at a tertiary-care paediatric hospital, in Montreal, Canada. Data were collected through chart review and included age, sex, and postal code, allowing linkage to dissemination area-level material deprivation, measured with the Pampalon Material Deprivation Index (PMDI) quintiles. We examined the association between PMDI quintiles and hospitalization using Poisson regression. Results During the study period, 964 children had a positive PCR-confirmed SARS-CoV-2 test and 124 were hospitalized. Children living in the most deprived quintile of PMDI represented 40.7% of hospitalizations. Incidence rate ratio of hospitalization for this group compared to the most privileged quintile was 2.42 (95%CI: 1.33; 4.41). Conclusion Children living in the most materially deprived areas had more than twice the rate of hospitalizations for COVID-19 than children living in most privileged areas. Special efforts should be deployed to protect children who live in disadvantaged areas, especially pending vaccination of younger children.
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Affiliation(s)
- Assil Abda
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Francesca del Giorgio
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
| | - Lise Gauvin
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Julie Autmizguine
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Fatima Kakkar
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Olivier Drouin
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
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Abda A, del Giorgio F, Gauvin L, Autmizguine J, Kakkar F, Drouin O. L’association entre la défavorisation matérielle par quartier et l’incidence d’hospitalisation chez les enfants infectés par le SRAS-CoV-2 à Montréal. Paediatr Child Health 2022; 27:S108-S114. [PMID: 36092292 PMCID: PMC9384184 DOI: 10.1093/pch/pxac015] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/25/2021] [Indexed: 11/15/2022] Open
Abstract
Historique Même si les facteurs sociodémographiques sont liés à l’infection par le SRAS-CoV-2 et aux hospitalisations chez les adultes, peu de données portent sur l’association entre ces caractéristiques et les hospitalisations attribuables au SRAS-CoV-2 chez les enfants. La présente étude visait à déterminer l’association entre la défavorisation matérielle par quartier et l’incidence d’hospitalisations à cause du SRAS-CoV-2 chez les enfants. Méthodologie Les chercheurs ont réalisé une étude de cohorte rétrospective de tous les enfants (de 0 à 17 ans) atteints d’une infection par le SRAS-CoV-2 confirmée par un test d’amplification en chaîne par polymérase après transcription inverse (PCR) entre le 1er mars et le 31 mai 2021 dans un hôpital pédiatrique de soins tertiaires de Montréal, au Canada. Ils ont colligé les données par examen des dossiers et ont inclus l’âge, le sexe et les codes postaux, afin de pouvoir lier la défavorisation matérielle à l’échelle de l’aire de diffusion, mesurée au moyen des quintiles de l’indice de défavorisation matérielle de Pampalon. Ils ont examiné l’association entre les quintiles de cet indice et les hospitalisations à l’aide de la régression de Poisson. Résultats Pendant la période de l’étude, 964 enfants ont reçu un résultat positif au SRAS-CoV-2 confirmé par un test PCR, et 124 d’entre eux ont été hospitalisés. Au total, 40,7 % des enfants hospitalisés habitaient dans le quintile le plus défavorisé d’après l’indice de défavorisation matérielle de Pampalon. Le rapport du taux d’incidence des hospitalisations dans ce groupe était de 2,42 (intervalle de confiance à 95 % : 1,33; 4,41) par rapport au quintile le plus privilégié. Conclusion Plus du double des enfants qui habitaient dans les quartiers les plus défavorisés sur le plan matériel étaient hospitalisés à cause de la COVID-19 par rapport à ceux qui habitaient dans les quartiers les plus privilégiés. Il faudrait déployer des efforts particuliers pour protéger les enfants qui habitent dans des quartiers défavorisés, particulièrement dans l’attente de la vaccination des plus jeunes.
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Affiliation(s)
- Assil Abda
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
| | - Francesca del Giorgio
- Faculté de médecine, Université McGill , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
| | - Lise Gauvin
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal , Montréal (Québec) Canada
| | - Julie Autmizguine
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
- Département de pharmacologie et de physiologie, faculté de médecine, Université de Montréal , Montréal (Québec) Canada
| | - Fatima Kakkar
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
- Service d’infectiologie, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
| | - Olivier Drouin
- Département de pédiatrie, Université de Montréal , Montréal (Québec) Canada
- Centre de recherche du Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal , Montréal (Québec) Canada
- Service de pédiatrie générale, département de pédiatrie, Centre hospitalier universitaire Sainte-Justine , Montréal (Québec) Canada
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Trottier ED, Farley St-Amand B, Vincent M, Chevalier I, Autmizguine J, Tremblay S, Gouin S. Outpatient management of moderate cellulitis in children using high-dose oral cephalexin. Paediatr Child Health 2022; 27:213-219. [PMID: 35859686 PMCID: PMC9291389 DOI: 10.1093/pch/pxac031] [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: 04/30/2021] [Accepted: 02/25/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients.
Methods
In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution’s HD oral cephalexin guideline over a 2-year period. All children had standardized follow-up at a medical day hospital (MDH). Treatment was considered effective in the absence of treatment failure, defined as admission, switch to IV treatment or ED visit within 2 weeks of discharge from the MDH. Safety was ascertained by recording adverse events and severe complications at follow-up.
Results
A total of 123 children were treated as outlined in the guideline, including 117 treated with HD oral cephalexin. The success rate was 89.7% (105/117). Among 12 (10.3%) children who had treatment failure, 10 (8.5%) required admission, 1 (0.9%) received IV antibiotics at the MDH and 1 (0.9%) had a return visit to the ED without admission. No severe complications were reported; four abscesses required drainage and one patient had a rash. The mean number of visits per child at the MDH was 1.6 (SD 1.0).
Conclusions
With a success rate of 89.7%, HD oral cephalexin seems effective and safe for the treatment of children with moderate cellulitis. Its use potentially reduces hospitalization rates for this condition and decreases the need for IV insertion.
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Affiliation(s)
- Evelyne D Trottier
- Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Beatrice Farley St-Amand
- Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Mélanie Vincent
- Department of Paediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Isabelle Chevalier
- Department of Paediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Julie Autmizguine
- Department of Paediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Department Pharmacology and Physiology, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Stéphanie Tremblay
- Department of Pharmacy, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Serge Gouin
- Department of Paediatric Emergency Medicine, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
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Ting JY, Autmizguine J, Dunn MS, Choudhury J, Blackburn J, Gupta-Bhatnagar S, Assen K, Emberley J, Khan S, Leung J, Lin GJ, Lu-Cleary D, Morin F, Richter LL, Viel-Thériault I, Roberts A, Lee KS, Skarsgard ED, Robinson J, Shah PS. Practice Summary of Antimicrobial Therapy for Commonly Encountered Conditions in the Neonatal Intensive Care Unit: A Canadian Perspective. Front Pediatr 2022; 10:894005. [PMID: 35874568 PMCID: PMC9304938 DOI: 10.3389/fped.2022.894005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Neonates are highly susceptible to infections owing to their immature cellular and humoral immune functions, as well the need for invasive devices. There is a wide practice variation in the choice and duration of antimicrobial treatment, even for relatively common conditions in the NICU, attributed to the lack of evidence-based guidelines. Early decisive treatment with broad-spectrum antimicrobials is the preferred clinical choice for treating sick infants with possible bacterial infection. Prolonged antimicrobial exposure among infants without clear indications has been associated with adverse neonatal outcomes and increased drug resistance. Herein, we review and summarize the best practices from the existing literature regarding antimicrobial use in commonly encountered conditions in neonates.
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Affiliation(s)
- Joseph Y Ting
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie Autmizguine
- Division of Infectious Diseases, Department of Pediatrics, Université de Montreal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
| | - Michael S Dunn
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Julie Choudhury
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Blackburn
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montreal, Montreal, QC, Canada
| | - Shikha Gupta-Bhatnagar
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katrin Assen
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie Emberley
- Division of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Sarah Khan
- Department of Microbiology, McMaster University, Hamilton, ON, Canada
| | - Jessica Leung
- Department of Pediatrics, University of Massachusetts, Worcester, MA, United States
| | - Grace J Lin
- School of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Frances Morin
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Pediatrics, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Joan Robinson
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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10
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Franck B, Autmizguine J, Marquet P, Ovetchkine P, Woillard JB. Pharmacokinetics, Pharmacodynamics, and Therapeutic Drug Monitoring of Valganciclovir and Ganciclovir in Transplantation. Clin Pharmacol Ther 2021; 112:233-276. [PMID: 34596243 DOI: 10.1002/cpt.2431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023]
Abstract
Ganciclovir and valganciclovir are first choice drugs for the prevention and treatment of cytomegalovirus infection and disease in solid organ and stem cell transplant recipients. Only a few studies on the pharmacokinetics and exposure/efficacy or exposure/safety relationships of ganciclovir and valganciclovir in transplant recipients have been published so far, and there are still controversies about the exposure parameter to use for therapeutic drug monitoring (TDM). We performed an extensive literature review of the clinical pharmacokinetics data, the exposure/effect relationships in terms of efficacy and safety, and the available tools for valganciclovir and ganciclovir TDM in adults and pediatrics transplant recipients. The pharmacokinetics of ganciclovir and valganciclovir is well described in adults and children, and a high interindividual variability is commonly observed. In contrast, the drug pharmacodynamics has been poorly described in adults and barely in children. The average 24-hour area under the concentration-time curve (AUC0-24h ) seems to be the best predictor of efficacy and toxicity. The benefit of TDM remains controversial in adult patients but should be considered in children due to higher interindividual variability and lower probability of target attainment. Several bayesian estimators based on limited sampling strategies have been developed with this aim and may be used in clinical practice for the AUC-based individual dose adjustment of ganciclovir and valganciclovir.
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Affiliation(s)
- Bénédicte Franck
- Individual Profiling and Prevention of Risks With Immunosuppressive Therapies and Transplantations, Unité Mixte de Recherche 1248 Université de Limoges, Institut National de la Santé et de la Recherche Médicale, Limoges, France.,Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Julie Autmizguine
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Marquet
- Individual Profiling and Prevention of Risks With Immunosuppressive Therapies and Transplantations, Unité Mixte de Recherche 1248 Université de Limoges, Institut National de la Santé et de la Recherche Médicale, Limoges, France.,Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Philippe Ovetchkine
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Jean-Baptiste Woillard
- Individual Profiling and Prevention of Risks With Immunosuppressive Therapies and Transplantations, Unité Mixte de Recherche 1248 Université de Limoges, Institut National de la Santé et de la Recherche Médicale, Limoges, France.,Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Hospitalier Universitaire de Limoges, Limoges, France
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11
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Maharaj AR, Wu H, Zimmerman KO, Muller WJ, Sullivan JE, Sherwin CMT, Autmizguine J, Rathore MH, Hornik CD, Al-Uzri A, Payne EH, Benjamin DK, Hornik CP. Pharmacokinetics of Ceftazidime in Children and Adolescents with Obesity. Paediatr Drugs 2021; 23:499-513. [PMID: 34302290 PMCID: PMC9706343 DOI: 10.1007/s40272-021-00460-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate ceftazidime pharmacokinetics (PK) in a cohort that includes a predominate number of children and adolescents with obesity and assess the efficacy of competing dosing strategies. METHODS A population PK model was developed using opportunistically collected plasma samples. For each dosing strategy, model-based probability of target attainment (PTA) estimates were computed for study participants using empirical Bayes estimates. In addition, the effects of body size and renal function on PTA were evaluated using stochastic model simulations with virtually generated subjects. RESULTS Twenty-nine participants, 24 of whom were obese, contributed data towards the analysis. The median (range) age, body weight, and body mass index of participants were 12.2 years (2.3-20.6), 59.2 kg (8.4-121), and 25.2 kg/m2 (13.8-42.9), respectively. Administration of 50 mg/kg intravenously (IV) every 8 hours (q8h; max 6 g/day) or 40 mg/kg IV q6h (max 6 g/day) resulted in PTA values of ≥ 90% (minimum inhibitory concentration 8 mg/L) for the subset of obese participants with estimated glomerular filtration rates (GFR) ≥ ~ 80 mL/min/1.73 m2. However, for both regimens, stochastic model simulations denoted lower PTA values (< 90%) with increasing body weight for virtual subjects with GFR ≥ 120 mL/min/1.73 m2. Alternatively, permitting for a maximum daily dose of 8 g/day using a 40 mg/kg IV q6h regimen provided PTA values that were near or above target (90%) for virtual subjects between 10 to 120 kg with GFR ≥ 80 mL/min/1.73 m2. CONCLUSION Our analysis suggests administration of 40 mg/kg IV q6h (max 8 g/day) maximizes PTA in children and adolescents with obesity and GFR ≥ 80 mL/min/1.73 m2. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01431326.
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Affiliation(s)
- Anil R Maharaj
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
| | - Huali Wu
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - William J Muller
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University, Chicago, IL, USA
| | - Janice E Sullivan
- Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, KY, USA
| | - Catherine M T Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH, USA
| | - Julie Autmizguine
- Department of Pharmacology and Pediatrics, Research Center, CHU Sainte-Justine, Montreal, QC, Canada
| | - Mobeen H Rathore
- Division of Pediatric Infectious Diseases and Immunology, University of Florida Center for HIV/AIDS Research, Education, and Service, Wolfson Children's Hospital, Jacksonville, FL, USA
| | - Chi D Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Amira Al-Uzri
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | | | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, 300 West Morgan Street, Box 3850, Durham, NC, 27701, USA.
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
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12
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Yeung CHT, Ito S, Autmizguine J, Edginton AN. Correction to: Incorporating Breastfeeding-Related Variability with Physiologically Based Pharmacokinetic Modeling to Predict Infant Exposure to Maternal Medication Through Breast Milk: a Workflow Applied to Lamotrigine. AAPS J 2021; 23:93. [PMID: 34255186 DOI: 10.1208/s12248-021-00615-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A Correction to this paper has been published: 10.1208/s12248-021-00615-8
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Affiliation(s)
- Cindy H T Yeung
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie Autmizguine
- Department of Pediatrics & Department of Pharmacology and Physiology, Université de Montréal, Montréal, Québec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
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13
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Wu YSS, Cohen-Wolkowiez M, Hornik CP, Gerhart JG, Autmizguine J, Cobbaert M, Gonzalez D. External Evaluation of Two Pediatric Population Pharmacokinetics Models of Oral Trimethoprim and Sulfamethoxazole. Antimicrob Agents Chemother 2021; 65:e0214920. [PMID: 33903114 PMCID: PMC8407045 DOI: 10.1128/aac.02149-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/17/2021] [Indexed: 12/30/2022] Open
Abstract
The antibiotic combination trimethoprim (TMP)-sulfamethoxazole (SMX) has a broad spectrum of activity and is used for the treatment of numerous infections, but pediatric pharmacokinetic (PK) data are limited. We previously published population PK (popPK) models of oral TMP-SMX in pediatric patients based on sparse opportunistically collected data (POPS study) (J. Autmizguine, C. Melloni, C. P. Hornik, S. Dallefeld, et al., Antimicrob Agents Chemother 62:e01813-17, 2017, https://doi.org/10.1128/AAC.01813-17). We performed a separate PK study of oral TMP-SMX in infants and children with more-traditional PK sample collection and independently developed new popPK models of TMP-SMX using this external data set. The POPS data set and the external data set were each used to evaluate both popPK models. The external TMP model had a model and error structure identical to those of the POPS TMP model, with typical values for PK parameters within 20%. The external SMX model did not identify the covariates in the POPS SMX model as significant. The external popPK models predicted higher exposures to TMP (median overprediction of 0.13 mg/liter for the POPS data set and 0.061 mg/liter for the external data set) and SMX (median overprediction of 1.7 mg/liter and 0.90 mg/liter) than the POPS TMP (median underprediction of 0.016 mg/liter and 0.39 mg/liter) and SMX (median underprediction of 1.2 mg/liter and 14 mg/liter) models. Nonetheless, both models supported TMP-SMX dose increases in infants and young children for resistant pathogens with a MIC of 1 mg/liter, although the required dose increase based on the external model was lower. (The POPS and external studies have been registered at ClinicalTrials.gov under registration no. NCT01431326 and NCT02475876, respectively.).
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Affiliation(s)
- Yi Shuan S. Wu
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacqueline G. Gerhart
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julie Autmizguine
- Research Center, CHU Sainte-Justine, Montréal, Quebec, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Marjan Cobbaert
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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14
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Yeung CHT, Ito S, Autmizguine J, Edginton AN. Correction to: Incorporating Breastfeeding-Related Variability with Physiologically Based Pharmacokinetic Modeling to Predict Infant Exposure to Maternal Medication Through Breast Milk: a Workflow Applied to Lamotrigine. AAPS J 2021; 23:83. [PMID: 34114050 DOI: 10.1208/s12248-021-00614-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A Correction to this paper has been published: https://doi.org/10.1208/s12248-021-00614-9.
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Affiliation(s)
- Cindy H T Yeung
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie Autmizguine
- Department of Pediatrics & Department of Pharmacology and Physiology, Université de Montréal, Montréal, Québec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
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15
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Smith MJ, Boutzoukas A, Autmizguine J, Hudak ML, Zinkhan E, Bloom BT, Heresi G, Lavery AP, Courtney SE, Sokol GM, Cotten CM, Bliss JM, Mendley S, Bendel C, Dammann CE, Weitkamp JH, Saxonhouse MA, Mundakel GT, Debski J, Sharma G, Erinjeri J, Gao J, Benjamin DK, Hornik CP, Smith PB, Cohen-Wolkowiez M. Antibiotic Safety and Effectiveness in Premature Infants With Complicated Intraabdominal Infections. Pediatr Infect Dis J 2021; 40:550-555. [PMID: 33902072 PMCID: PMC9844130 DOI: 10.1097/inf.0000000000003034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In premature infants, complicated intraabdominal infections (cIAIs) are a leading cause of morbidity and mortality. Although universally prescribed, the safety and effectiveness of commonly used antibiotic regimens have not been established in this population. METHODS Infants ≤33 weeks gestational age and <121 days postnatal age with cIAI were randomized to ≤10 days of ampicillin, gentamicin, and metronidazole (group 1); ampicillin, gentamicin, and clindamycin (group 2); or piperacillin-tazobactam and gentamicin (group 3) at doses stratified by postmenstrual age. Due to slow enrollment, a protocol amendment allowed eligible infants already receiving study regimens to enroll without randomization. The primary outcome was mortality within 30 days of study drug completion. Secondary outcomes included adverse events, outcomes of special interest, and therapeutic success (absence of death, negative cultures, and clinical cure score >4) 30 days after study drug completion. RESULTS One hundred eighty infants [128 randomized (R), 52 nonrandomized (NR)] were enrolled: 63 in group 1 (45 R, 18 NR), 47 in group 2 (41 R, 6 NR), and 70 in group 3 (42 R, 28 NR). Thirty-day mortality was 8%, 7%, and 9% in groups 1, 2, and 3, respectively. There were no differences in safety outcomes between antibiotic regimens. After adjusting for treatment group and gestational age, mortality rates through end of follow-up were 4.22 [95% confidence interval (CI): 1.39-12.13], 4.53 (95% CI: 1.21-15.50), and 4.07 (95% CI: 1.22-12.70) for groups 1, 2, and 3, respectively. CONCLUSIONS Each of the antibiotic regimens are safe in premature infants with cIAI. CLINICAL TRIAL REGISTRATION NCT0199499.
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Affiliation(s)
- Michael J. Smith
- Division of Pediatric Infectious Diseases, Duke University, Durham, NC
| | | | - Julie Autmizguine
- Division of Pediatric Infectious Diseases, Universitaire Sainte-Justine, Montreal, Canada
| | - Mark L. Hudak
- Division of Neonatology, University of Florida College of Medicine, Jacksonville, FL
| | - Erin Zinkhan
- Division of Neonatology, University of Utah, Salt Lake City, UT
| | - Barry T. Bloom
- Division of Neonatology, Wesley Medical Center, Wichita, KS
| | - Gloria Heresi
- Division of Pediatric Infectious Diseases, University of Texas, Houston, TX
| | | | - Sherry E. Courtney
- Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - C. Michael Cotten
- Division of Neonatal-Perinatal Medicine, Duke University, Durham, NC
| | | | - Susan Mendley
- Division of Nephrology, University of Maryland, Baltimore, MD
| | - Catherine Bendel
- Division of Neonatology, University of Minnesota, Minneapolis, MN
| | | | | | | | | | | | | | | | - Jamie Gao
- Duke Clinical Research Institute, Durham, NC
| | - Daniel K. Benjamin
- Division of Pediatric Infectious Diseases, Duke University, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | | | - P. Brian Smith
- Division of Neonatal-Perinatal Medicine, Duke University, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Michael Cohen-Wolkowiez
- Division of Pediatric Infectious Diseases, Duke University, Durham, NC
- Duke Clinical Research Institute, Durham, NC
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16
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Yeung CHT, Ito S, Autmizguine J, Edginton AN. Incorporating Breastfeeding-Related Variability with Physiologically Based Pharmacokinetic Modeling to Predict Infant Exposure to Maternal Medication Through Breast Milk: a Workflow Applied to Lamotrigine. AAPS J 2021; 23:70. [PMID: 34002327 DOI: 10.1208/s12248-021-00599-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
Current methods to assess risk in infants exposed to maternal medication through breast milk do not specifically account for infants most vulnerable to high drug exposure. A workflow applied to lamotrigine incorporated variability in infant anatomy and physiology, milk intake volume, and milk concentration to predict infant exposure. An adult physiologically based pharmacokinetic model of lamotrigine was developed and evaluated. The model was scaled to account for growth and maturation of a virtual infant population (n=100). Daily infant doses were simulated using milk intake volume and concentration models described by a nonlinear equation of weight-normalized intake across infant age and a linear function on the relationship of observed milk concentrations and maternal doses, respectively. Average infant plasma concentration at steady state was obtained through simulation. Models were evaluated by comparing observed to simulated infant plasma concentrations from breastfeeding infants based on a 90% prediction interval (PI). Upper AUC ratio (UAR) was defined as a novel risk metric. Twenty-five paired (milk concentrations measured) and 18 unpaired (milk concentrations unknown) infant plasma samples were retrieved from the literature. Forty-four percent and 11% of the paired and unpaired infant plasma concentrations were outside of the 90% PI, respectively. Over all ages (0-7 months), unpaired predictions captured more observed infant plasma concentrations within 90% PI than paired. UAR was 0.18-0.44 when mothers received 200 mg lamotrigine, suggesting that infants can receive 18-44% of the exposure per dose as compared to adults. UARs determined for further medications could reveal trends to better classify at-risk mother-infant pairs.
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Affiliation(s)
- Cindy H T Yeung
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie Autmizguine
- Department of Pediatrics & Department of Pharmacology and Physiology, Université de Montréal, Montréal, Québec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
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17
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Boucoiran I, Roy M, Poliquin V, Elwood C, Sheehan NL, Thibaudeau R, Ferreira E, Autmizguine J, Kakkar F, Boucher M, Money D, Tulloch K. Evaluation of cabergoline for lactation inhibition in women living with HIV. Int J STD AIDS 2021; 32:654-661. [PMID: 33612017 DOI: 10.1177/0956462420984694] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We wished to evaluate the efficacy, safety, and acceptability of cabergoline for lactation inhibition in women who live with HIV. In this multicenter prospective observational study, cabergoline was offered as a single oral dose of 1 mg within the first 48 h postpartum. Women were recruited if they delivered a live infant after 35 weeks of gestational age. Participants filled out a questionnaire regarding symptoms of lactation and cabergoline adverse effects on day 2 and day 14 postpartum. On day 14, they also completed a questionnaire about their satisfaction with cabergoline treatment. Prolactin serum level was measured on both visits. Among 68 participants, all but one received cabergoline. The overall effectiveness defined by partial or complete success at day 14 was 98.3% (confidence intervals: 89.5-99.9). At day 14, 67.4% of women who received cabergoline had prolactin serum levels <25 mcg/L (threshold necessary for galactopoiesis). Mild nonspecific adverse effects were experienced by 24 (29.9%) women on day 2 and 24 (41.4%) on day 14, and lasted 48 h or less. Overall, 96% of women were satisfied with cabergoline's ability to prevent postpartum lactation symptoms. In conclusion, cabergoline is an effective, well-accepted, and well-tolerated medication for lactation inhibition in WLWH.
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Affiliation(s)
- Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada.,Department of Social and Preventive Medicine, 5622École de Santé Publique de Université de Montréal, Montreal, QC, Canada.,Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
| | - Melissa Roy
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada
| | - Vanessa Poliquin
- Department of Obstetrics and Gynecology, 8664University of Manitoba, Winnipeg, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, 12358University of British Columbia, Vancouver, Canada.,Women's Health Research Institute, Vancouver, Canada
| | - Nancy L Sheehan
- Québec Antiretroviral Therapeutic Drug Monitoring Program, 54473McGill University Health Centre, Montréal, Canada.,Department of Pharmacology and Physiology, 5622Université de Montréal, Montréal, Canada
| | - Rosie Thibaudeau
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada
| | - Ema Ferreira
- Department of Pharmacology and Physiology, 5622Université de Montréal, Montréal, Canada.,Department of Pharmacy, CHU Sainte-Justine, Montreal, Canada
| | - Julie Autmizguine
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada.,Department of Pharmacology and Physiology, 5622Université de Montréal, Montréal, Canada.,Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, 5622Université de Montréal, Montreal, Canada
| | - Fatima Kakkar
- Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada.,Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, 5622Université de Montréal, Montreal, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Division of Maternofetal Medicine, 5622Université de Montréal, Montreal, Canada.,Women and Children's Infectious Diseases Center, CHU Sainte-Justine Research Center, Montreal, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, 12358University of British Columbia, Vancouver, Canada.,Women's Health Research Institute, Vancouver, Canada
| | - Karen Tulloch
- Department of Pharmacy, BC Women's Hospital and Health Centre, Vancouver, Canada
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18
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Maharaj AR, Wu H, Zimmerman KO, Autmizguine J, Kalra R, Al-Uzri A, Sherwin CMT, Goldstein SL, Watt K, Erinjeri J, Payne EH, Cohen-Wolkowiez M, Hornik CP. Population pharmacokinetics of olanzapine in children. Br J Clin Pharmacol 2021; 87:542-554. [PMID: 32497307 PMCID: PMC9008710 DOI: 10.1111/bcp.14414] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS The aim of this study was to evaluate the population pharmacokinetics (PopPK) of olanzapine in children and devise a model-informed paediatric dosing scheme. METHODS The PopPK of olanzapine was characterized using opportunistically collected plasma samples from children receiving olanzapine per standard of care for any indication. A nonlinear mixed effect modelling approach was employed for model development using the software NONMEM (v7.4). Simulations from the developed PopPK model were used to devise a paediatric dosing scheme that targeted comparable plasma exposures to adolescents and adults. RESULTS Forty-five participants contributed 83 plasma samples towards the analysis. The median (range) postnatal age and body weight of participants were 3.8 years (0.2-19.2) and 14.1 kg (4.2-111.7), respectively. The analysis was restricted to pharmacokinetic (PK) samples collected following enteral administration (oral and feeding tube). A one-compartment model with linear elimination provided an appropriate fit to the data. The final model included the covariates body weight and postmenstrual age (PMA) on apparent olanzapine clearance (CL/F). Typical CL/F and apparent volume of distribution (scaled to 70 kg) were 16.8 L/h (21% RSE) and 663 L (13% RSE), respectively. Developed dosing schemes used weight-normalized doses for children ≤6 months postnatal age or <15 kg and fixed doses for children ≥15 kg. CONCLUSION We developed a paediatric PopPK model for enterally-administered olanzapine. To our knowledge, this analysis is the first study to characterize the PK of olanzapine in participants ranging from infants to adolescents. Body weight and PMA were identified as influential covariates for characterizing developmental changes in olanzapine apparent clearance.
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Affiliation(s)
- Anil R. Maharaj
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Huali Wu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Rohit Kalra
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Amira Al-Uzri
- Oregon Health and Science University, Portland, OR, USA
| | - Catherine M. T. Sherwin
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA*
| | | | - Kevin Watt
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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19
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Franck B, Woillard JB, Théorêt Y, Bittencourt H, Demers E, Briand A, Marquet P, Lapeyraque AL, Ovetchkine P, Autmizguine J. Population pharmacokinetics of ganciclovir and valganciclovir in paediatric solid organ and stem cell transplant recipients. Br J Clin Pharmacol 2021; 87:3105-3114. [PMID: 33373493 DOI: 10.1111/bcp.14719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/17/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022] Open
Abstract
AIMS Ganciclovir (GCV) and its prodrug valganciclovir (VGCV) are first-line agents to prevent and treat cytomegalovirus in transplant recipients. There is high pharmacokinetic (PK) interindividual variability and PK data are scarce, especially in paediatric stem cell transplant (SCT) recipients. We sought to determine the optimal GCV and VGCV dosing in transplanted children. METHODS We conducted a single-centre retrospective population PK (POPPK) study of IV GCV and enteral VGCV in paediatric solid organ transplant (SOT) and SCT recipients. We included children who were transplanted and had available plasma GCV concentrations, done per standard of care. POPPK analysis was performed using a nonlinear mixed effects modelling approach with NONMEM. Optimal dosing was determined based on the achievement of the surrogate efficacy target: GCV 24 h area under the concentration-time curve (AUC0-24h ) of 40-60 mg.h.L-1 . RESULTS Fifty children with a median [range] age of 7.5 years [0.5-17.4] contributed 580 PK samples. A two-compartment model with first-order absorption with a lag time and first-order elimination fit the data well. Creatinine clearance and body weight (WT) were significant covariates for GCV clearance (CL); and WT for the volumes of distribution. IV GCV 15-20 mg.kg-1 .day-1 divided every 12 hours achieved the highest probability of target achievement (PTA) (33.0-33.8%). Enteral VGCV 30 and 40 mg.kg-1 .day-1 divided every 12 hours in children 0-<6 years, and 6-18 years, respectively, achieved the highest PTA (29.1-33.0%). CONCLUSION This is the first POPPK model developed in children with either SOT or SCT. Concentration target achievement was low, suggesting a potential benefit for therapeutic drug monitoring to ensure optimal exposure.
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Affiliation(s)
- Bénédicte Franck
- INSERM, IPPRITT, U1248, Limoges, France.,Univ. Limoges, IPPRITT, Limoges, France.,Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France
| | - Jean-Baptiste Woillard
- INSERM, IPPRITT, U1248, Limoges, France.,Univ. Limoges, IPPRITT, Limoges, France.,Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France
| | - Yves Théorêt
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, Quebec, Canada
| | | | - Emile Demers
- Department of Pharmacy, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annabelle Briand
- Research Center, CHU Sainte-Justine, Quebec, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Marquet
- INSERM, IPPRITT, U1248, Limoges, France.,Univ. Limoges, IPPRITT, Limoges, France.,Department of Pharmacology and Toxicology, CHU Limoges, Limoges, France
| | | | | | - Julie Autmizguine
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Quebec, Montreal, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
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20
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Jutras C, Autmizguine J, Chomton M, Marquis C, Nguyen TTD, Roumeliotis N, Emeriaud G. Inhaled Antibiotics for the Prevention of Respiratory Tract Infections in Children With a Tracheostomy. Front Pediatr 2021; 9:633039. [PMID: 33614559 PMCID: PMC7893104 DOI: 10.3389/fped.2021.633039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: To describe the use of prophylactic inhaled antibiotics in children with a tracheostomy and assess if its use is associated with a reduction in exposition to broad-spectrum antibiotics and a lower risk of acquired respiratory tract infections. Methods: A case series study was performed in a tertiary care university affiliated hospital. All consecutive children (<18 years old) with a tracheostomy, hospitalized between January 2004 and November 2016, and treated with prophylactic inhaled antibiotics were identified. We analyzed the 3 month- period before and after initiation of prophylactic inhaled antibiotics and described exposure to broad spectrum antibiotics, the number of respiratory tract infections and the associated adverse events. Results: Six children (median age: 11 months, range: 8-100) were included. One received colimycin, 3 received tobramycin and 2 were treated with both antibiotics in alternance. The median duration of treatment was 74 days (22-173) with one patient still being treated at the end of the study. Patients were exposed to systemic antibiotics for 18 days (2-49) in the 3 months preceding the treatment vs. 2 days (0-15) in the 3 months following the treatment initiation (p = 0.115). The number of respiratory tract infections went from median of 2 (0-3) to 1 (0-1) during the same periods (p = 0.07). Adverse events most commonly reported were cough (n = 2) and increased respiratory secretions post-inhalation (n = 4). Only one new bacterial resistance was observed. Conclusions: This series of consecutive cases underlines the need for future studies evaluating the potential benefit of prophylactic inhaled antibiotics in children with a tracheostomy.
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Affiliation(s)
- Camille Jutras
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Julie Autmizguine
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montréal, QC, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Maryline Chomton
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Christopher Marquis
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - The Thanh-Diem Nguyen
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Nadia Roumeliotis
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada
| | - Guillaume Emeriaud
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, QC, Canada.,Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC, Canada
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21
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Ting JY, Roberts A, Tilley P, Robinson JL, Dunn MS, Paquette V, Lee KS, Shah V, Yoon E, Richter LL, Lodha A, Shivananda S, Thampi N, Autmizguine J, Shah PS. Development of a national neonatal intensive care unit-specific antimicrobial stewardship programme in Canada: protocol for a cohort study. BMJ Open 2020; 10:e043403. [PMID: 33303471 PMCID: PMC7733165 DOI: 10.1136/bmjopen-2020-043403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Early empiric treatment with broad-spectrum antimicrobials is common in neonatal intensive care units (NICU) due to the non-specific clinical presentation of infection. However, excessive and inappropriate antimicrobial use can lead to the emergence of drug-resistant organisms and adverse neonatal outcomes. This study aims to develop and implement a nationwide NICU-specific antimicrobial stewardship programme (ASP) to promote judicious antimicrobial use and control the emergence of multidrug-resistant organisms (MDROs) in Canada. METHODS AND ANALYSIS Our study population will include all very low-birth-weight neonates admitted to participating tertiary NICU in Canada. Based on the existing limited literature, we will develop consensus on NICU antimicrobial stewardship interventions to enhance best practices. Using an expanded Canadian Neonatal Network (CNN) platform, we will collect data on antimicrobial use and the susceptibility of organisms identified in clinical samples from blood and cerebrospinal fluid over a period of 2 years. These data will be used to provide all NICU stakeholders with benchmarked centre-adjusted antimicrobial use and MDRO prevalence reports. An ASP plan will be developed at both individual unit and national levels in the subsequent years. Knowledge translation strategies will be implemented through the well-established Evidence-based Practice for Improving Quality methodology. ETHICS AND DISSEMINATION Ethics for the study has been granted by the University of British Columbia Children's & Women's Research Ethics Board (H19-02490) and supported by CNN Executive Committee. The study results will be disseminated through national organisations and open access peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04388293.
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Affiliation(s)
- Joseph Y Ting
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Tilley
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michael S Dunn
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Paquette
- School of Pharmaceutical Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyong-Soon Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Vibhuti Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yoon
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abhay Lodha
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Sandesh Shivananda
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nisha Thampi
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Autmizguine
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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22
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Panetta L, Proulx C, Drouin O, Autmizguine J, Luu TM, Quach C, Kakkar F. Clinical Characteristics and Disease Severity Among Infants With SARS-CoV-2 Infection in Montreal, Quebec, Canada. JAMA Netw Open 2020; 3:e2030470. [PMID: 33315110 PMCID: PMC7737086 DOI: 10.1001/jamanetworkopen.2020.30470] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/24/2022] Open
Abstract
This case series describes clinical characteristics and disease severity in infants who had SARS-CoV-2 infection in Montreal, Quebec, Canada.
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Affiliation(s)
- Luc Panetta
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Catherine Proulx
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Oliver Drouin
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Julie Autmizguine
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Pharmacology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Thuy M. Luu
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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23
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Litalien C, Autmizguine J, Carli A, Giroux D, Lebel D, Leclerc JM, Théorêt Y, Gilpin A, Bérubé S. Providing Suitable Pediatric Formulations for Canadian Children: A Call for Action. Can J Hosp Pharm 2020. [DOI: 10.4212/cjhp.v73i4.3023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Many medications given to children have no commercially available, age-appropriate formulations. This leads to manipulation of dosage forms designed for adults (compounding), which can result in an increased risk of dosing errors and adverse events, lack of medication adherence because of taste issues, and suboptimal dosing with therapeutic failure.Objectives: To determine which drugs required compounding for oral administration to children in a Canadian hospital and, for each compounded drug, to determine whether it was available as licensed oral pediatric formulations in the United States or the European Union.Methods: Drugs requiring compounded liquid formulations for oral administration, dispensed from January 1 to December 31, 2015, at a Canadian university-affiliated tertiary pediatric hospital, and prepared in a quantity exceeding 0.5 L per year, were retrospectively identified. The online drug databases of Health Canada, the US Food and Drug Administration, the European Medicines Agency (EMA), and the UK Medicines and Healthcare Products Regulatory Agency were searched to determine the availability of child-friendly oral formulations for these drugs. The regulatory status in each jurisdiction was also compared. For licensed formulations with potential concerns about excipient safety, EMA guidelines for sorbitol, propylene glycol, ethanol, and sodium benzoate were used to determine pediatric suitability.Results: Of the 56 compounded drugs investigated, 27 (48%) had a suitable commercialized child-friendly formulation available outside Canada. Overall, these drugs had been on the Canadian market for a median of 35 years, and almost half (27 [48%]) had a pediatric indication in Canada.Conclusions: Canada is lagging behind the United States and the European Union in ensuring availability of and access to suitable pediatric formulations. Potential explanations for this gap include small market size, regulatory uncertainties, and reimbursement shortcomings. Steps must be taken to implement pediatric-sensitive regulations and incentives, as well as reimbursement policies, to address these unmet needs.Keywords: compounding, child-friendly medicines, pediatric oral medicinesRÉSUMÉContexte : Plusieurs médicaments administrés aux enfants ne sont pas disponibles commercialement sous une forme pharmaceutique adaptée à leur âge. Ceci entraîne une manipulation des formes destinées aux adultes (préparation magistrale) et peut conduire à une augmentation du risque d’erreurs de dosage et d’effets indésirables, un manque d’observance médicamenteuse secondairement à des problèmes de goût, et un dosage sous-optimal associé à des échecs thérapeutiques.Objectifs : Définir les médicaments qui exigent une préparation magistrale pour être administrés par voie orale aux enfants dans un hôpital canadien et, pour chaque médicament faisant l’objet d’une préparation magistrale, déterminer s’il est disponible sous une forme pharmaceutique orale autorisée pour les enfants aux États-Unis ou dans l’Union européene.Méthodes : Les médicaments nécessitant des préparations magistrales liquides pour administration orale, distribués entre le 1er janvier et le 31 décembre 2015 dans un hôpital de soins pédiatriques tertiaires affilié à une université canadienne et dont la quantité préparée était supérieure à 0.5 L par an, ont été déterminés rétrospectivement. Les bases de données en ligne de médicaments de Santé Canada, de la Food and Drug Administration américaine, de l’Agence européenne des médicaments (AEM) et de la Medicines and Healthcare Products Regulatory Agency (Royaume-Uni) ont été interrogées pour déterminer la disponibilité de formes pharmaceutiques orales adaptées aux enfants pour ces médicaments. Le statut réglementaire de chaque pays a également fait l’objet d’une comparaison. Pour les formes pharmaceutiques autorisées présentant des problèmes potentiels d’innocuité des excipients, les directives de l’AEM concernant le sorbitol, le propylène glycol, l’éthanol et le benzoate de sodium ont servi à déterminer si un usage pédiatrique était acceptable.Résultats : Des 56 médicaments étudiés faisant l’objet d’une préparation magistrale, 27 (48 %) avaient une forme pharmaceutique commercialisée adaptée aux enfants en dehors du Canada. Au total, ces médicaments sont sur le marché canadien depuis une médiane de 35 ans et près de la moitié (27 [48 %]) ont une indication pédiatrique au Canada.Conclusions : Le Canada accuse un retard par rapport aux États-Unis et à l’Union européenne quant à la disponibilité et à l’accès à des formes pharmaceutiques adéquates pour les enfants. La petite taille du marché, les incertitudes en matière réglementaire et les lacunes concernant le remboursement pourraient notamment expliquer cet écart. Il est nécessaire de prendre des mesures pour mettre en place des réglementations et des incitatifs ainsi que des politiques de remboursement axés sur les enfants pour répondre à ces besoins criants.Mots-clés : préparation magistrale, médicaments adaptés aux enfants, médicaments pédiatriques pour administration orale
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24
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Litalien C, Autmizguine J, Carli A, Giroux D, Lebel D, Leclerc JM, Théorêt Y, Gilpin A, Bérubé S. Providing Suitable Pediatric Formulations for Canadian Children: A Call for Action. Can J Hosp Pharm 2020; 73:247-256. [PMID: 33100356 PMCID: PMC7556390] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many medications given to children have no commercially available, age-appropriate formulations. This leads to manipulation of dosage forms designed for adults (compounding), which can result in an increased risk of dosing errors and adverse events, lack of medication adherence because of taste issues, and suboptimal dosing with therapeutic failure. OBJECTIVES To determine which drugs required compounding for oral administration to children in a Canadian hospital and, for each compounded drug, to determine whether it was available as licensed oral pediatric formulations in the United States or the European Union. METHODS Drugs requiring compounded liquid formulations for oral administration, dispensed from January 1 to December 31, 2015, at a Canadian university-affiliated tertiary pediatric hospital, and prepared in a quantity exceeding 0.5 L per year, were retrospectively identified. The online drug databases of Health Canada, the US Food and Drug Administration, the European Medicines Agency (EMA), and the UK Medicines and Healthcare Products Regulatory Agency were searched to determine the availability of child-friendly oral formulations for these drugs. The regulatory status in each jurisdiction was also compared. For licensed formulations with potential concerns about excipient safety, EMA guidelines for sorbitol, propylene glycol, ethanol, and sodium benzoate were used to determine pediatric suitability. RESULTS Of the 56 compounded drugs investigated, 27 (48%) had a suitable commercialized child-friendly formulation available outside Canada. Overall, these drugs had been on the Canadian market for a median of 35 years, and almost half (27 [48%]) had a pediatric indication in Canada. CONCLUSIONS Canada is lagging behind the United States and the European Union in ensuring availability of and access to suitable pediatric formulations. Potential explanations for this gap include small market size, regulatory uncertainties, and reimbursement shortcomings. Steps must be taken to implement pediatric-sensitive regulations and incentives, as well as reimbursement policies, to address these unmet needs.
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Affiliation(s)
- Catherine Litalien
- , MD, FRCPC, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre, the Department of Medical Biology, and the Research Centre of the CHU Sainte-Justine, Montréal, Quebec. She is also with the Department of Pediatrics and the Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec
| | - Julie Autmizguine
- , MD, FRCPC, MSc, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre, the Department of Medical Biology, and the Research Centre of the CHU Sainte-Justine, Montréal, Quebec. She is also with the Department of Pediatrics and the Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec
| | - Antoine Carli
- , BPharm, MSc, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre of the CHU Sainte-Justine, Montréal, Quebec
| | - Denis Giroux
- , BPharm, MSc, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre of the CHU Sainte-Justine, Montréal, Quebec
| | - Denis Lebel
- , BPharm, MSc, FCSHP, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre and the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Jean-Marie Leclerc
- , MD, FRCPC, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre and the Department of Medical Biology of the CHU Sainte-Justine, Montréal, Quebec. He is also with the Department of Pediatrics, Université de Montréal, Montréal, Quebec
| | - Yves Théorêt
- ê, BPharm, PhD, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre, the Department of Medical Biology, and the Research Centre of the CHU Sainte-Justine, Montréal, Quebec. He is also with the Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec
| | - Andrea Gilpin
- , PhD, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre of the CHU Sainte-Justine, Montréal, Quebec
| | - Sophie Bérubé
- , BPharm, MSc, is with the Rosalind & Morris Goodman Family Pediatric Formulations Centre of the CHU Sainte-Justine, Montréal, Quebec
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25
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Deschenes PC, Autmizguine J, Major P, Kleiber N. Valproic Acid Induced Pancreatitis Presenting With Decreased Level of Consciousness in a Child With Tuberous Sclerosis Complex. J Pediatr Pharmacol Ther 2020; 25:256-260. [PMID: 32265611 DOI: 10.5863/1551-6776-25.3.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A 2-year-old Caucasian boy with tuberous sclerosis complex presented to the emergency department with lethargy and new onset myoclonias. Pancreatitis, thrombocytopenia, and coagulopathy associated to a decreased level of consciousness were diagnosed. Valproic acid had been initiated 13 months before and had been slowly increased to a dose of approximately 38 mg/kg/day. All the symptoms resolved after discontinuation of the medication. The clinical presentation of this child highlights that valproic acid-related pancreatitis can present with decreased level of consciousness without associated gastrointestinal symptoms. Adverse drug reactions associated with valproic acid can lead to damage of multiple organs and may prove fatal if not promptly recognized and managed.
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26
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Viel-Thériault I, Martin B, Thompson-Desormeaux F, Blackburn J, Moussa A, Autmizguine J. Vancomycin drug monitoring in infants with CoNS sepsis-target attainment, microbiological response and nephrotoxicity. J Perinatol 2020; 40:97-104. [PMID: 31576000 DOI: 10.1038/s41372-019-0519-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 03/15/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To characterize residual vancomycin concentrations (Cmin) and assess the relationships between Cmin, the risk of nephrotoxicity and persistent CoNS sepsis. METHODS In this 5-year retrospective study among infants treated with vancomycin, the primary outcome was the proportion of those with a steady state Cmin between 10 and 20 mg/L. The secondary outcomes were nephrotoxicity and persistent CoNS sepsis. RESULTS Of 120 infants included, the median first steady state Cmin was 12.4 mg/L and 77 (64%) had a Cmin between 10 and 20 mg/L. Six percent developed nephrotoxicity. This risk was not associated with Cmin. Of the 30 infants with CoNS sepsis, 17 (57%) had persistent bacteremia, and this risk did not correlate significantly with Cmin, CoNS minimal inhibitory concentration (MIC) for vancomycin, or Cmin/MIC. CONCLUSIONS The majority of infants achieved targeted levels of vancomycin, but persistent bacteremia was common. We did not identify a Cmin threshold associated with nephrotoxicity, nor with microbiological clearance.
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Affiliation(s)
| | - Brigitte Martin
- Department of Pharmacy, CHU Sainte-Justine, Montreal, QC, Canada
| | | | - Julie Blackburn
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Ahmed Moussa
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Julie Autmizguine
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada.,Clinical Pharmacology Unit, Université de Montréal, Montreal, QC, Canada
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27
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Hepburn CM, Gilpin A, Autmizguine J, Denburg A, Dupuis LL, Finkelstein Y, Gruenwoldt E, Ito S, Jong G, Lacaze-Masmonteil T, Levy D, Macleod S, Miller SP, Offringa M, Pinsk M, Power B, Rieder M, Litalien C. L’amélioration des médicaments à usage pédiatrique : une prescription pour les enfants et les adolescents canadiens. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz094] [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: 11/14/2022] Open
Affiliation(s)
| | - Andrea Gilpin
- Le Centre de formulations pédiatriques de la famille Rosalind et Morris Goodman du Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)
| | - Julie Autmizguine
- Le Centre de formulations pédiatriques de la famille Rosalind et Morris Goodman du Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Catherine Litalien
- Le Centre de formulations pédiatriques de la famille Rosalind et Morris Goodman du Centre hospitalier universitaire Sainte-Justine, Montréal (Québec)
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28
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Hepburn CM, Gilpin A, Autmizguine J, Denburg A, Dupuis LL, Finkelstein Y, Gruenwoldt E, Ito S, Jong G', Lacaze-Masmonteil T, Levy D, Macleod S, P Miller S, Offringa M, Pinsk M, Power B, Rieder M, Litalien C. Improving paediatric medications: A prescription for Canadian children and youth. Paediatr Child Health 2019; 24:333-339. [PMID: 31379437 DOI: 10.1093/pch/pxz079] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/18/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Andrea Gilpin
- The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Julie Autmizguine
- The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Avram Denburg
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - L Lee Dupuis
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Yaron Finkelstein
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Emily Gruenwoldt
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Shinya Ito
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Geert 't Jong
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Thierry Lacaze-Masmonteil
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Deborah Levy
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Stuart Macleod
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Steven P Miller
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Martin Offringa
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Maury Pinsk
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Barry Power
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Michael Rieder
- Canadian Paediatric Society, Ottawa, Ontario.,The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
| | - Catherine Litalien
- The Rosalind and Morris Goodman Family Pediatric Formulations Centre of the Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec
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29
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Viel-Thériault I, Bittencourt H, Autmizguine J, Ovetchkine P. Skeletal fluorosis after prolonged voriconazole therapy. Paediatr Child Health 2019; 25:7-8. [PMID: 33390733 DOI: 10.1093/pch/pxz023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/22/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Isabelle Viel-Thériault
- Infectious Diseases Division, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Henrique Bittencourt
- Hematology-Oncology Division, Department of Pediatrics, CHU Sainte-Justine - Université de Montréal, Montréal, Québec
| | - Julie Autmizguine
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine - Université de Montréal, Montréal, Québec
| | - Philippe Ovetchkine
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine - Université de Montréal, Montréal, Québec
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30
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Autmizguine J, Smith PB, Prather K, Bendel C, Natarajan G, Bidegain M, Kaufman DA, Burchfield DJ, Ross AS, Pandit P, Schell WA, Gao J, Benjamin DK. Effect of fluconazole prophylaxis on Candida fluconazole susceptibility in premature infants. J Antimicrob Chemother 2018; 73:3482-3487. [PMID: 30247579 PMCID: PMC6927883 DOI: 10.1093/jac/dky353] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Extremely premature infants are at high risk of developing invasive candidiasis; fluconazole prophylaxis is safe and effective for reducing invasive candidiasis in this population but further study is needed. We sought to better understand the effect of prophylactic fluconazole on a selection of fluconazole-resistant Candida species. METHODS We evaluated the susceptibility to fluconazole of Candida isolates from premature infants (<750 g birth weight) enrolled in a multicentre, randomized, placebo-controlled trial of fluconazole prophylaxis. Candida species were isolated through surveillance cultures at baseline (study day 0-7), period 1 (study day 8-28) and period 2 (study day 29-49). Fluconazole MICs were determined for all Candida isolates. RESULTS Three hundred and sixty-one infants received fluconazole (n = 188) or placebo (n = 173). After the baseline period, Candida colonization was significantly lower in the fluconazole group compared with placebo during periods 1 (5% versus 27%; P < 0.001) and 2 (3% versus 27%; P < 0.001). After the baseline period, two infants (1%) were colonized with at least one fluconazole-resistant Candida in each group. Median fluconazole MIC was similar in both treatment groups at baseline and period 1. However, in period 2, median MIC was higher in the fluconazole group compared with placebo (1.00 versus 0.50 mg/L, P = 0.01). There was no emergence of resistance observed and no patients developed invasive candidiasis with a resistant Candida isolate. CONCLUSIONS Fluconazole prophylaxis decreased Candida albicans and 'non-albicans' Candida colonization and was associated with a slightly higher fluconazole MIC for colonizing Candida isolates.
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Affiliation(s)
- Julie Autmizguine
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Canada
- Research Center, CHU Ste-Justine, Montréal, Canada
| | - P Brian Smith
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Kristi Prather
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | | | | | | | | | - Ashley S Ross
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paresh Pandit
- Children’s Hospital of Philadelphia at Vitua West Jersey Hospital Voorhees, Voorhees, NJ, USA
| | - Wiley A Schell
- Department of Medicine, Duke University, Durham, NC, USA
| | - Jamie Gao
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Daniel K Benjamin
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Corresponding author. Duke University Medical Center, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA. Tel:+1-919-668-7081; Fax: +1-919-668-7058; E-mail:
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31
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Catho G, Scheel D, Teira P, Renaud C, Kakinami L, Ovetchkine P, Autmizguine J. 1601. Effect of Preemptive Rituximab Therapy on Epstein–Barr Reactivation in Allogenic Hematopoietic Stem Cell Pediatric Transplants. Open Forum Infect Dis 2018. [PMCID: PMC6254397 DOI: 10.1093/ofid/ofy210.1429] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Children with Epstein–Barr virus (EBV) viremia after hematopoietic stem cell transplantation (HSCT) are at increased risk of post-transplant lymphoproliferative disease (PTLD). Our aim was to assess whether pre-emptive rituximab reduced EBV-viral load (EBV-VL) and the risk of developing PTLD. Methods We retrospectively included all children who had a positive EBV-VL within 12 months after an allogenic HSCT (2007–2015) in a single tertiary pediatric hospital. Whole blood EBV-VL was monitored weekly using a real-time PCR, during the first 100 days after HSCT and then monthly until 6 months post-HSCT or until EBV-VL became undetectable. EBV-VL clearance was defined as two negative EBV-VL at least 1 week apart. Pre-emptive rituximab was defined as a treatment administered before the occurrence of PTLD. We determined the impact of pre-emptive rituximab on EBV-VL clearance, using a marginal structural cox model, adjusting for age at transplant, time between transplant and first positive EBV-VL, in-vivo T-cell depletion at induction, value of EBV-VL at the first dose of rituximab, and the EBV-VL value at the current and previous time point. Results Of 214 children who underwent allogenic HSCT, EBV DNA was detected in 87 (41%) children. Children who received rituximab after diagnosis of PTLD were excluded, leading to a cohort of 78 children. Twenty-two (28%) children received pre-emptive rituximab. Mean (SD) age was similar in both groups (10 [5] year). First post-transplant positive EBV-VL was earlier in the pre-emptive rituximab group (mean of 55 [54] vs. 113 [96] days; P < 0.05) and first positive EBV-VL was higher in the pre-emptive rituximab group (mean of 3.4 [0.6] vs. 3.0 [0.6] log10/mL; P < 0.05). In adjusted analyses, pre-emptive rituximab was associated with a higher likelihood of EBV-VL clearance (hazard ratio 1.86; 95% confidence interval 1.10–3.14; Figure 1). Of the 10 children who developed PTLD, none had received pre-emptive rituximab. Conclusion EBV viremia is frequent in children with allogenic HSCT. Our results suggest that pre-emptive rituximab is associated with more rapid EBV-VL clearance. The effect of rituximab on the risk of PTLD needs to be better defined. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Gaud Catho
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
- Infectious Diseases, Geneva University Hospital-University of Geneva, Geneva, Switzerland
| | - Daniel Scheel
- Department of Mathematics and Statistics, Concordia University, Montreal, Montreal, QC, Canada
| | - Pierre Teira
- Onco-Hematology Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Christian Renaud
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
- Microbiology and Immunology, CHU Sainte-Justine- Université de Montréal, Montréal, QC, Canada
| | - Lisa Kakinami
- Department of Mathematics and Statistics, Concordia University, Montreal, Montreal, QC, Canada
| | - Philippe Ovetchkine
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Julie Autmizguine
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
- Research Center, CHU Sainte-Justine - Université de Montréal, Montreal, QC, Canada
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32
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Dionne A, Le CK, Poupart S, Autmizguine J, Meloche-Dumas L, Turgeon J, Fournier A, Dahdah N. Profile of resistance to IVIG treatment in patients with Kawasaki disease and concomitant infection. PLoS One 2018; 13:e0206001. [PMID: 30332473 PMCID: PMC6192641 DOI: 10.1371/journal.pone.0206001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Kawasaki disease (KD) can be associated with concomitant viral or bacterial infections. Children with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications. Although concomitant infection does not affect coronary outcome, it is unknown how it influences the response to IVIG treatment. METHODOLOGY Retrospective cohort study between 2008 and 2016 in a tertiary pediatric university hospital, including 154 children, of which 59 (38%) had concomitant infection. RESULTS Children with concomitant infection were more likely to have fever 48 hours after initial IVIG treatment (36% vs 20%, p = 0.05) and to be treated with a second dose (33% vs 18%, p = 0.04). Children with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p = 0.04), and 48 hours after IVIG administration (111 vs 59 mg/L, p = 0.003). Nevertheless, there was no statistically significant difference in the prevalence of coronary complications (Z-score > 2.5) between children with and without concomitant infection (36% vs 39%, p = 0.68). CONCLUSION Children with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment. This association increases the likelihood of receiving a second dose of IVIG but not the risk of coronary complication. Accordingly, prospective studies to distinguish true IVIG resistance from infection induced persistent fever is warranted.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, CHU Ste-Justine, Montreal, Canada
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Cathie-Kim Le
- Department of Cardiology, CHU Ste-Justine, Montreal, Canada
- Department of Pediatrics, Centre Hospitalier de l’Universite Laval, Quebec, Canada
| | | | - Julie Autmizguine
- Department of Pharmacology, University of Montreal, Montreal, Canada
- Research Center, CHU Ste-Justine, Montreal, Canada
- Department of pediatrics, CHU Ste-Justine, Montreal, Canada
| | | | - Jean Turgeon
- Department of pediatrics, CHU Ste-Justine, Montreal, Canada
| | - Anne Fournier
- Department of Cardiology, CHU Ste-Justine, Montreal, Canada
| | - Nagib Dahdah
- Department of Cardiology, CHU Ste-Justine, Montreal, Canada
- * E-mail:
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33
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Autmizguine J, Tan S, Cohen-Wolkowiez M, Cotten CM, Wiederhold N, Goldberg RN, Adams-Chapman I, Stoll BJ, Smith PB, Benjamin DK. Antifungal Susceptibility and Clinical Outcome in Neonatal Candidiasis. Pediatr Infect Dis J 2018; 37:923-929. [PMID: 29369937 PMCID: PMC6057841 DOI: 10.1097/inf.0000000000001913] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive candidiasis is an important cause of sepsis in extremely low birth weight infants (ELBW, < 1000 g), is often fatal, and frequently results in neurodevelopmental impairment (NDI) among survivors. We sought to assess the antifungal minimum inhibitory concentration (MIC) distribution for Candida in ELBW infants and evaluate the association between antifungal resistance and death or NDI. METHODS This was a secondary analysis of a National Institute of Child Health and Human Development Neonatal Research Network study. MIC values were determined for fluconazole, amphotericin B and micafungin. NDI was assessed at 18-22 months adjusted age using the Bayley Scales of Infant Development. An infant was defined as having a resistant Candida isolate if ≥ 1 positive cultures from normally sterile sites (blood, cerebrospinal fluid, or urine) were resistant to ≥ 1 antifungal agent. In addition to resistance status, we categorized fungal isolates according to MIC values (low and high). The association between death/NDI and MIC level was determined using logistic regression, controlling for gestational age and Bayley Scales of Infant Development (II or III). RESULTS Among 137 ELBW infants with IC, MICs were determined for 308 isolates from 110 (80%) infants. Three Candida isolates from 3 infants were resistant to fluconazole. None were resistant to amphotericin B or micafungin. No significant difference in death, NDI, or death/NDI between groups with low and high MICs was observed. CONCLUSIONS Antifungal resistance was rare among infecting Candida isolates, and MIC level was not associated with increased risk of death or NDI in this cohort of ELBW infants.
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MESH Headings
- Amphotericin B/pharmacology
- Antifungal Agents/pharmacology
- Antifungal Agents/therapeutic use
- Candida/drug effects
- Candida/isolation & purification
- Candidiasis, Invasive/complications
- Candidiasis, Invasive/drug therapy
- Candidiasis, Invasive/mortality
- Cohort Studies
- Drug Resistance, Fungal
- Female
- Fluconazole/pharmacology
- Gestational Age
- Humans
- Infant
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/microbiology
- Intensive Care Units, Neonatal/statistics & numerical data
- Male
- Micafungin/pharmacology
- Microbial Sensitivity Tests
- Neurodevelopmental Disorders/etiology
- Prospective Studies
- Sepsis/complications
- Sepsis/microbiology
- Sepsis/mortality
- Treatment Outcome
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Affiliation(s)
- Julie Autmizguine
- From the Department of Pharmacology and Physiology, Université de Montréal, Montréal, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Canada
- Department of Pediatrics, Duke University, Durham, NC
| | - Sylvia Tan
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | | | | | - Nathan Wiederhold
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | | | - Barbara J Stoll
- Department of Pediatrics, Emory University, Atlanta, GA
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
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Leveillee A, Lapointe A, Lachance C, Descarries M, Autmizguine J, Dubois J, Moussa A. Assessing effect of catheter type and position on central line-associated bloodstream infections in the NICU. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.149] [Citation(s) in RCA: 2] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Central venous catheter usage in NICU remains associated with serious complications such as bloodstream infection. Also, low position (underdiaphragmatic) of umbilical venous catheter (UVC) is tolerated despite not recommended. To our knowledge, no previous study assessed the effect of such a position on central line associated bloodstream infections (CLABSI) rates in the NICU.
OBJECTIVES
The primary objectives of this study were to assess global CLABSI rates for each central catheter subtype and position, and specific rates according to birth weight and gestational age. Dwell time before infection and microorganisms involved were also evaluated.
DESIGN/METHODS
For this retrospective cohort study, all neonates hospitalized in Level 3 NICU, from April 1st 2011 to March 31st 2016, in whom a central line was inserted, were included. Data about catheter insertion, demographic characteristics and bloodstream infections was extracted from local CVC database, local CLABSI database, patient medical record, post catheter insertion X-rays and Canadian Neonatal Network database. Difference in CLABSI rates and type of microorganisms involved were analyzed using Cox regression and Chi2. Difference in dwell time was analyzed using a one-way ANOVA and evolution in time of the proportion of each type of catheter presented as observational data.
RESULTS
A total of 1577 neonates were included and 2440 CVC were studied. Median gestational age (GA) was 30 2/7 [26 6/, 37] weeks and birth weight (BW) was 1310 [680, 2796] g. Of the 2440 neonates, 1308 were boys (53.6%). There was a total of 197 CLABSI. Total number of catheter days over the study period was 23 479 days. CLABSI rate for high UVC was 11.49 per 1000 catheter days compared to 6.92 for PICC line (p < 0.001) and 5.14 for femoral CVC (p = 0.008). CLABSI rate for low UVC was 17.31 per 1000 catheter days (p = 0.002 when compared to high UVC). Median dwell time before infection is 7 days for high UVC, 5 days for low UVC and 11 days for PICC (p < 0.001). Microorganism involved in CLABSI was a majority of Coagulase-negative Staphylococcus in 57.1–71.9% without a statistically significant difference between groups (p= 0.33).
CONCLUSION
Evolution of CVC usage over years remained stable. CLABSI rates are significantly higher with all UVC compared with PICC line and femoral CVC, particularly for newborn < 1500g and < 32 weeks of GA. Low UVC are associated to higher CLABSI rates than high UVC. Health professionals should be cautious with indwelling UVC, especially when in low position. They might conisder replacing low lines by a PICC as soon as possible.
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35
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Gilpin A, Autmizguine J, Allakhverdi Z, Tessier JE, Giroux D, Lebel D, Litalien C. A PAN-CANADIAN STUDY ON THE COMPOUNDED MEDICINES MOST IN NEED OF COMMERCIALIZED ORAL PEDIATRIC FORMULATIONS. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.133] [Citation(s) in RCA: 3] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
A large number of drugs administered to children have no commercially available formulations. As a result, health care providers and parents manipulate dosage forms designed for adults. Although compounding is essential to increase access to medicines for children, it can result in adverse events or therapeutic failure. There is an urgent need to undertake a mapping of the needs for child-friendly medicines in Canada.
OBJECTIVES
To determine: 1) the most frequently compounded medicines in Canadian paediatric hospitals; 2) the challenges associated with drug compounding; and 3) medicines most in need of commercialized oral paediatric formulations.
DESIGN/METHODS
Sixteen Canadian paediatric academic hospitals were contacted to participate in a telephone survey including 12 open-, close-ended or Likert-scale questions.
RESULTS
Thirteen centers participated in the survey (81.3%). Fifty-three drugs were identified as most in need of a commercialized oral paediatric formulation. Of those, 12 were reported by ≥4 hospitals as a priority (Table). The most frequently reported compounding challenges were: lack of standardization, bad taste, lack of awareness of prescribers, stability of the formulation, and availability of compounding pharmacies.
CONCLUSION
This study highlights which drugs are most needed for paediatric oral formulations in Canada. For compounded medicines with paediatric formulations available in other countries we are currently assessing their adequacy and partnering with pharmaceutical industry to bring them to the Canadian market. As for those medicines without paediatric formulations in Canada or abroad we are looking for partners interested in developing such formulations. Furthermore, harmonized regulations and data-sharing should be pursued to facilitate access to child-friendly medicines.
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Affiliation(s)
- Andrea Gilpin
- Department of Pediatrics, CHU Ste-Justine, University of Montreal
| | - Julie Autmizguine
- Department of Pediatrics, CHU Ste-Justine, University of Montreal
- Department of Pharmacology, University of Montreal
- Goodman Pediatric Formulations Centre
| | | | | | | | - Denis Lebel
- Goodman Pediatric Formulations Centre
- Department of Pharmacy, CHU Sainte-Justine
| | - Catherine Litalien
- Goodman Pediatric Formulations Centre
- Department of Pediatrics, CHU Ste-Justine, University of Montreal
- Department of Pharmacology, University of Montreal
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36
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Poupart S, Dionne A, Le CK, Meloche-Dumas L, Turgeon J, Autmizguine J, Dahdah N. PROFILE OF RESISTANCE TO IVIG TREATMENT IN PATIENT WITH KAWASAKI DISEASE AND CONCOMITANT INFECTION. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Kawasaki disease (KD) is a paediatric systemic vasculitis that can be associated with concomitant viral or bacterial infections. Patients with persistent or recurrent fever 36 hours after the end of intravenous immunoglobulin (IVIG) are considered to be resistant to treatment and are at increased risk for coronary complications.
OBJECTIVES
However, it is unknown how concomitant infection influences the response to IVIG treatment. The aim of this study was to determine the impact of concurrent infection on the prevalence of IVIG resistance and coronary outcome.
DESIGN/METHODS
Retrospective study of 154 children (mean age at diagnosis: 3.4 ± 2.8 years) diagnosed with KD, between 2008–2016 in a tertiary paediatric university hospital, of which 59 (38%) had concomitant infection.
RESULTS
Delay in diagnosis (>10 days of fever) was similar between patients with and without concomitant infection (7% vs 7%, p=0.89). Patients with concomitant infection were more likely to have fever 48 hours after initial treatment (36% vs 20%, p=0.05) and to be treated with a second dose of IVIG (33% vs 18%, p=0.04). Patients with infection had higher C-reactive protein at the time of diagnosis (148 vs 112 mg/L, p=0.04), which persisted after IVIG administration (111 vs 59 mg/L at 48 hours, p=0.003). However, there was no statistically significant difference in the prevalence of coronary artery (CA) complications (coronary artery Z-score > 2.5) between patients with and without concomitant infection (36% vs 39%, p=0.68).
CONCLUSION
Children with KD and concomitant infection are more likely to have persistent fever and elevated inflammatory markers after treatment requiring a second dose of IVIG. Nevertheless, this is not associated with an increased risk of CA complications. Larger scale studies are needed to help distinguish IVIG resistance from infection in children with persistent fever and guide management of this population.
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Autmizguine J, Melloni C, Hornik CP, Dallefeld S, Harper B, Yogev R, Sullivan JE, Atz AM, Al-Uzri A, Mendley S, Poindexter B, Mitchell J, Lewandowski A, Delmore P, Cohen-Wolkowiez M, Gonzalez D. Population Pharmacokinetics of Trimethoprim-Sulfamethoxazole in Infants and Children. Antimicrob Agents Chemother 2018; 62:e01813-17. [PMID: 29084742 PMCID: PMC5740321 DOI: 10.1128/aac.01813-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/07/2017] [Indexed: 11/20/2022] Open
Abstract
Trimethoprim (TMP)-sulfamethoxazole (SMX) is used to treat various types of infections, including community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and Pneumocystis jirovecii infections in children. Pharmacokinetic (PK) data for infants and children are limited, and the optimal dosing is not known. We performed a multicenter, prospective PK study of TMP-SMX in infants and children. Separate population PK models were developed for TMP and SMX administered by the enteral route using nonlinear mixed-effects modeling. Optimal dosing was determined on the basis of the matching adult TMP exposure and attainment of the surrogate pharmacodynamic (PD) target for efficacy, a free TMP concentration above the MIC over 50% of the dosing interval. Data for a total of 153 subjects (240 samples for PK analysis) with a median postnatal age of 8 years (range, 0.1 to 20 years) contributed to the analysis for both drugs. A one-compartment model with first-order absorption and elimination characterized the TMP and SMX PK data well. Weight was included in the base model for clearance (CL/F) and volume of distribution (V/F). Both TMP and SMX CL/F increased with age. In addition, TMP and SMX CL/F were inversely related to the serum creatinine and albumin concentrations, respectively. The exposure achieved in children after oral administration of TMP-SMX at 8/40 mg/kg of body weight/day divided into administration every 12 h matched the exposure achieved in adults after administration of TMP-SMX at 320/1,600 mg/day divided into administration every 12 h and achieved the PD target for bacteria with an MIC of 0.5 mg/liter in >90% of infants and children. The exposure achieved in children after oral administration of TMP-SMX at 12/60 and 15/75 mg/kg/day divided into administration every 12 h matched the exposure achieved in adults after administration of TMP-SMX at 640/3,200 mg/day divided into administration every 12 h in subjects 6 to <21 years and 0 to <6 years of age, respectively, and was optimal for bacteria with an MIC of up to 1 mg/liter.
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Affiliation(s)
- Julie Autmizguine
- Research Center, CHU Sainte-Justine, and Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Chiara Melloni
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | - Barrie Harper
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ram Yogev
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Janice E Sullivan
- University of Louisville, Norton Children's Hospital and Kosair Charities Pediatric Clinical Research Unit, Louisville, Kentucky, USA
| | - Andrew M Atz
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amira Al-Uzri
- Oregon Health and Science University, Portland, Oregon, USA
| | - Susan Mendley
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brenda Poindexter
- Perinatal Institute, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | | | | | | | - Daniel Gonzalez
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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McMahon J, Théorêt Y, Autmizguine J, Bittencourt H, Tapiéro B, Ovetchkine P. Posaconazole Plasma Monitoring in Immunocompromised Children. J Pediatric Infect Dis Soc 2017; 6:389-392. [PMID: 28186550 DOI: 10.1093/jpids/piw087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Received: 06/20/2016] [Accepted: 12/06/2016] [Indexed: 11/12/2022]
Abstract
Plasma posaconazole exposure was assessed in 13 children who underwent a hematopoietic stem cell transplant. The median dosage was 12.5 mg/kg per day, divided into 3 doses. Of these 13 patients, 46.2% (6) and 30.8% (4) achieved concentrations higher than 0.7 and 1.25 mg/L, respectively. In children at high risk, a higher dosage might be needed to achieve target concentrations.
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Affiliation(s)
| | - Yves Théorêt
- Research Centre.,Infectious Diseases Division, Department of Pediatrics.,Hemato-Oncology Division, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Québec, Canada
| | - Julie Autmizguine
- Research Centre.,Infectious Diseases Division, Department of Pediatrics.,Hemato-Oncology Division, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Québec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Montréal, Québec, Canada
| | | | - Bruce Tapiéro
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Philippe Ovetchkine
- Research Centre.,Clinical Pharmacology Unit, CHU Sainte-Justine, Montréal, Québec, Canada
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Blanchard AC, Fortin E, Laferrière C, Goyer I, Moussa A, Autmizguine J, Quach C. Comparative effectiveness of linezolid versus vancomycin as definitive antibiotic therapy for heterogeneously resistant vancomycin-intermediate coagulase-negative staphylococcal central-line-associated bloodstream infections in a neonatal intensive care unit. J Antimicrob Chemother 2017; 72:1812-1817. [PMID: 28333257 DOI: 10.1093/jac/dkx059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/04/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives Heterogeneously resistant vancomycin-intermediate coagulase-negative staphylococci (hVICoNS) are emerging pathogens causing central-line-associated bloodstream infections (CLABSIs) in neonatal intensive care unit (NICU) patients. Given the burden of disease associated with CLABSI and the current lack of therapeutic guidelines, we aimed to compare the effectiveness of linezolid versus vancomycin used as the definitive antibiotic therapy for hVICoNS CLABSI. Methods We performed a retrospective cohort study of infants with hVICoNS CLABSI from a single NICU between 2009 and 2014, treated with either linezolid or vancomycin as definitive antibiotic therapy. CLABSI duration, early and late recurrence and in-hospital mortality were compared using propensity score-adjusted proportional hazards and logistic regression models. Results Of 89 infants with hVICoNS CLABSI, 33 (37.1%) treated with linezolid were compared with 56 (62.9%) treated with vancomycin. The median duration of CLABSI was 5 (range 1-12) versus 4 days (range 0-14) ( P = 0.11), early recurrences were 3.0% versus 7.1% ( P = 0.42), late recurrences 0% versus 14.3% ( P = 0.02) and mortality 27.3% versus 28.6% ( P = 0.90), when treated with linezolid versus vancomycin, respectively. When adjusting using a continuous propensity score, linezolid had an HR of 0.78 (95% CI 0.48-1.27) for CLABSI duration, an OR of 0.23 (95% CI 0.02-2.56) for early recurrence and an OR of 0.9 (95% CI 0.3-2.67) for mortality, relative to vancomycin. Conclusions There was no statistically significant difference between linezolid and vancomycin when used as definitive treatment for hVICoNS CLABSI in NICU patients, in terms of CLABSI duration, recurrence or all-cause mortality.
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Affiliation(s)
- A C Blanchard
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - E Fortin
- Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Québec, Canada
| | - C Laferrière
- Department of Microbiology, Infection Control and Prevention Unit, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - I Goyer
- Department of Pharmacy, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - A Moussa
- Division of Neonatology, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - J Autmizguine
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.,Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada
| | - C Quach
- Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Québec, Canada
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40
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Schroeder T, Piantadosi CA, Natoli MJ, Autmizguine J, Cohen-Wolkowieczs M, Hamilton KL, Bell C, Klawitter J, Christians U, Irwin DC, Noveck RJ. Safety and Ergogenic Properties of Combined Aminophylline and Ambrisentan in Hypoxia. Clin Pharmacol Ther 2017; 103:888-898. [PMID: 28857147 PMCID: PMC5947522 DOI: 10.1002/cpt.860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 01/24/2023]
Abstract
We hypothesized that concomitant pharmacological inhibition of the endothelin and adenosine pathway is safe and improves exercise performance in hypoxic humans, via a mechanism that does not involve augmentation of blood oxygenation. To test this hypothesis, we established safety and drug interactions for aminophylline (500 mg) plus ambrisentan (5 mg) in normoxic volunteers. Subsequently, a placebo-controlled study was employed to test the combination in healthy resting and exercising volunteers at simulated altitude (4,267 m). No serious adverse events occurred. Drug interaction was minimal or absent. Aminophylline alleviated hypoxia-induced headaches. Aminophylline, ambrisentan, and their combination all significantly (P < 0.05 vs. placebo) improved submaximal hypoxic exercise performance (19.5, 20.6, and 19.1% >placebo). Single-dose ambrisentan increased blood oxygenation in resting, hypoxic subjects. We conclude that combined aminophylline and ambrisentan offer promise to safely increase exercise capacity in hypoxemic humans without relying on increasing blood oxygen availability.
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Affiliation(s)
| | - Claude A Piantadosi
- Hyperbaric Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael J Natoli
- Hyperbaric Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Julie Autmizguine
- Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada
| | - Michael Cohen-Wolkowieczs
- Duke Early Phase Clinical Research Unit, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Karyn L Hamilton
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA
| | - Christopher Bell
- Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA
| | - Jelena Klawitter
- iC42 Integrated Solutions in Clinical Research and Development, University of Colorado, Bioscience East, Aurora, Colorado, USA
| | - Uwe Christians
- iC42 Integrated Solutions in Clinical Research and Development, University of Colorado, Bioscience East, Aurora, Colorado, USA
| | - David C Irwin
- Department of Medicine, University of Colorado Denver Anschutz Campus, Aurora, Colorado, USA
| | - Robert J Noveck
- Hyperbaric Center, Duke University Medical Center, Durham, North Carolina, USA
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Thibault C, Kassir N, Théorêt Y, Varin F, Litalien C, Autmizguine J. Dose-Exposure Simulation for Piperacillin-Tazobactam Dosing Strategies in Infants and Young Children. J Popul Ther Clin Pharmacol 2017; 24:e33-344. [PMID: 28873292 DOI: 10.22374/1710-6222.24.1.3.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Extended piperacillin-tazobactam (TZP) infusions have been associated with favourable outcomes. There are currently no pediatric dosing recommendations. OBJECTIVES To determine appropriate TZP dosing strategies in children 2 months - 6 years according to age and different minimal inhibitory concentrations (MICs). METHODS Age and weight were simulated for 1000 children. Post-hoc pharmacokinetic parameter estimates were generated using published clearance and volume of distribution data. For different dosing regimens, we estimated the probability of target attainment (PTA) over a range of MICs from 4 to 128 mg/L. The pharmacodynamic (PD) target was defined as free piperacillin concentrations above the MIC for ≥ 50% of the dosing interval. A PTA ≥ 90% was defined as optimal. RESULTS PTA decreased as MIC and age increased. In all age groups, standard dosing regimens (240-300 mg/kg/day, 0.5h infusions) failed to reach PTAs ≥ 90% at MICs ≥ 16 mg/L. Standard 0.5h infusions reached PTAs ≥ 90% at MICs up to 8 mg/L in infants > 2 to 6m. No 0.5h infusion reached PTAs ≥ 90% for MICs ≥ 4 mg/L in children > 6m. While none of the tested regimens were optimal at MICs > 16 mg/L in children > 6m, 100 mg/kg/dose every 6h as a 3h infusion reached PD target at MICs of 32 mg/L in infants > 2 to 6m. CONCLUSIONS Up to MICs of 16 mg/L, 90 mg/kg/dose every 8h as a 2h infusion in infants > 2 to 6m and 100 mg/kg/dose every 8h as a 4h infusion in children > 6m-6y achieved PTAs ≥ 90%.
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Affiliation(s)
- Céline Thibault
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | | | - Yves Théorêt
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada.,Certara Strategic Consulting, Montreal, QC, Canada.,Department of Pharmacology and Physiology, University of Montreal, Montreal, QC, Canada
| | - France Varin
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
| | - Catherine Litalien
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada.,Certara Strategic Consulting, Montreal, QC, Canada.,Department of Pharmacology and Physiology, University of Montreal, Montreal, QC, Canada
| | - Julie Autmizguine
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada.,Certara Strategic Consulting, Montreal, QC, Canada.,Department of Pharmacology and Physiology, University of Montreal, Montreal, QC, Canada
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42
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Farley St-Amand B, DTrottier E, Autmizguine J, Tremblay S, Vincent M, Chevalier I, Gouin S. THE EFFICACY OF HIGH DOSE CEPHALEXIN IN THE OUTPATIENT MANAGEMENT OF MODERATE CELLULITIS FOR PEDIATRIC PATIENTS. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.086] [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: 11/13/2022] Open
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43
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Ericson JE, Gostelow M, Autmizguine J, Hornik CP, Clark RH, Benjamin DK, Smith PB. Safety of High-dose Acyclovir in Infants With Suspected and Confirmed Neonatal Herpes Simplex Virus Infections. Pediatr Infect Dis J 2017; 36:369-373. [PMID: 27977557 PMCID: PMC5348260 DOI: 10.1097/inf.0000000000001451] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acyclovir is used to treat herpes simplex virus disease in infants. Treatment with high-dose acyclovir, 60 mg/kg/d, is recommended; however, the safety of this dosage has not been assessed in the past 15 years, and this dosage is not currently approved for infants by the US Food and Drug Administration. METHODS We included infants with neonatal herpes simplex virus disease treated with ≥14 days of intravenous acyclovir starting in the first 120 days of life admitted to 1 of 42 neonatal intensive care units managed by the Pediatrix Medical Group between 2002 and 2012. We determined the frequency and proportion of infants with clinical and laboratory adverse events (AEs) as well as the number and proportion of infant days with laboratory AEs occurring during acyclovir exposure. RESULTS We identified 89 infants during the study period with 1658 days of acyclovir exposure. Almost all received high-dose acyclovir therapy (79/89, 89%). The most common clinical AEs were hypotension and seizure, both occurring in 9% of infants. Thrombocytopenia was the most common laboratory AE occurring in 25% of infants and on 9% of infant-days. Elevated creatinine occurred in 2% of infants and 0.2% of infant-days and no infants developed renal failure requiring dialysis. Overall, 45% of infants had ≥1 AE. CONCLUSIONS In this cohort of infants treated during the high-dose acyclovir era, AEs were common but usually not severe. Many of the AEs reported in this cohort may be related to the underlying infection rather than due to acyclovir exposure.
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Affiliation(s)
- Jessica E. Ericson
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA
| | | | - Julie Autmizguine
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, Quebec
- Department of Pharmacology, University of Montreal, Montreal, Quebec
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - 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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Dionne A, Meloche-Dumas L, Desjardins L, Turgeon J, Saint-Cyr C, Autmizguine J, Spigelblatt L, Fournier A, Dahdah N. N-terminal pro-B-type natriuretic peptide diagnostic algorithm versus American Heart Association algorithm for Kawasaki disease. Pediatr Int 2017; 59:265-270. [PMID: 27589358 DOI: 10.1111/ped.13154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Received: 12/08/2015] [Revised: 05/14/2016] [Accepted: 08/26/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnosis of Kawasaki disease (KD) can be challenging in the absence of a confirmatory test or pathognomonic finding, especially when clinical criteria are incomplete. We recently proposed serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) as an adjunctive diagnostic test. METHODS We retrospectively tested a new algorithm to help KD diagnosis based on NT-proBNP, coronary artery dilation (CAD) at onset, and abnormal serum albumin or C-reactive protein (CRP). The goal was to assess the performance of the algorithm and compare its performance with that of the 2004 American Heart Association (AHA)/American Academy of Pediatrics (AAP) algorithm. RESULTS The algorithm was tested on 124 KD patients with NT-proBNP measured on admission at the present institutions between 2007 and 2013. Age at diagnosis was 3.4 ± 3.0 years, with a median of five diagnostic criteria; and 55 of the 124 patients (44%) had incomplete KD. CA complications occurred in 64 (52%), with aneurysm in 14 (11%). Using this algorithm, 120/124 (97%) were to be treated, based on high NT-proBNP alone for 79 (64%); on onset CAD for 14 (11%); and on high CRP or low albumin for 27 (22%). Using the AHA/AAP algorithm, 22/47 (47%) of the eligible patients with incomplete KD would not have been referred for treatment, compared with 3/55 (5%) with the NT-proBNP algorithm (P < 0.001). CONCLUSION This NT-proBNP-based algorithm is efficient to identify and treat patients with KD, including those with incomplete KD. This study paves the way for a prospective validation trial of the algorithm.
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Affiliation(s)
- Audrey Dionne
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
| | - Léamarie Meloche-Dumas
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
| | - Laurent Desjardins
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada.,Division of Pediatrics, Laval University Hospital, Quebec, Canada
| | - Jean Turgeon
- Division of Pediatrics, Saint Justine University Hospital Center, Montreal, Canada
| | - Claire Saint-Cyr
- Division of Pediatric Rheumatology, Saint Justine University Hospital Center, Montreal, Canada
| | - Julie Autmizguine
- Division of Pediatric Infectious Disease, Saint Justine University Hospital Center, Montreal, Canada
| | - Linda Spigelblatt
- Division of Pediatrics, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Saint Justine University Hospital Center, Montreal, Canada
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Goyer I, Iseppon M, Thibault C, Abaji R, Krajinovic M, Autmizguine J. Lactic Acidosis with Chloramphenicol Treatment in a Child with Cystic Fibrosis. J Popul Ther Clin Pharmacol 2017; 24:40-45. [PMID: 28186714 DOI: 10.22374/1710-6222.24.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 11/24/2022]
Abstract
Children with cystic fibrosis are commonly colonized with multi-resistant bacteria. In such patients, infectious exacerbation may require salvage therapy with uncommonly used antimicrobials, including chloramphenicol. Chloramphenicol is rarely used nowadays because of the associated severe adverse events. We describe the case of a 15-year-old female with terminal cystic fibrosis who required intravenous (IV) chloramphenicol treatment for a Burkholderia cepacia (B. cepacia) exacerbation. The child subsequently developed lactic acidosis and secondary respiratory compensation adding to her baseline respiratory distress. Based on the Naranjo scale, the probability of chloramphenicol being the cause of the hyperlactatemia and associated respiratory distress was rated as probable, as the adverse effects resolved upon discontinuation of the drug. Subsequent genotyping for mitochondrial polymorphism (G3010A) confirmed a possible susceptibility to lactic acidosis from mitochondrial RNA-inhibiting agents such as chloramphenicol. Hyperlactatemia is a rare but life threatening adverse effect that has been previously reported with chloramphenicol exposure, but is not generally thought of. Clinicians should be aware of this potentially life threatening, but reversible adverse event. Lactate should be monitored under chloramphenicol and it should be discontinued as soon as this complication is suspected, especially in patients with low respiratory reserve.
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Affiliation(s)
| | | | - Céline Thibault
- 3Department of Pediatrics, University of Montreal.,Department of Pharmacology, University of Montreal
| | - Rachid Abaji
- Department of Pharmacology, University of Montreal.,5CHU Sainte-Justine Research Center
| | - Maja Krajinovic
- Department of Pediatrics, University of Montreal.,Department of Pharmacology, University of Montreal.,CHU Sainte-Justine Research Center
| | - Julie Autmizguine
- Department of Pediatrics, University of Montreal.,Department of Pharmacology, University of Montreal.,CHU Sainte-Justine Research Center
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46
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Thibault C, Kassir N, Theoret Y, Varin F, Litalien C, Autmizguine J. Dose-Exposure Simulation for Piperacillin-Tazobactam Dosing Strategies in Infants and Young Children. JPTCP 2017. [DOI: 10.22374/1710-6222.24.3.3] [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: 11/24/2022]
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47
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Abstract
BACKGROUND AND OBJECTIVES A new noninvasive bladder stimulation technique has been described to obtain clean-catch urine (CCU) in infants aged <30 days. Objectives were (1) to determine proportion and predictive factors for successful CCU collections using a stimulation maneuver technique among infants <6 months and (2) to determine the proportion of bacterial contamination with this method. METHODS A prospective cohort study was conducted in a tertiary pediatric emergency department among infants <6 months needing a urine sample. CCU samples were collected using a standardized stimulation technique. Invasive technique was performed after CCU for three specific conditions. Primary outcomes were proportions of successful CCU specimens and bacterial contamination. We determined associations between successful urine samples and 4 predictive factors (age, sex, low oral intake, and recent voiding). RESULTS A total of 126 infants were included (64 boys, median age: 55 days). The CCU procedure was effective in 62 infants (49%; median time: 45 seconds). Infants 0 to 29 days; 30 to 59 days, and 60 to 89 days had more successful procedures, compared with infants >89 days (odds ratios [95% confidence interval (CI)]: 4.3 [1.4 to 13.4]; 3.2 [1.2 to 8.4]; and 4.44 [1.5 to 13.3], respectively). The contamination proportion was 16% (95% CI: 8% to 27%) in the CCU group. This proportion was not statistically different compared with the invasive method group (6%, 95% CI: 3% to 15%). CONCLUSIONS The CCU procedure is a quick and effective noninvasive method in children aged <90 days. Contamination proportions were similar to those reported in the literature for urethral catheterization. Circumstances for which the CCU procedure could be performed are proposed.
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Affiliation(s)
| | | | - Julie Autmizguine
- Departments of Pediatrics, and Pharmacology, University of Montreal, Montreal, Canada
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48
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Le CK, Dionne A, Autmizguine J, Dahdah N. RELATIONSHIP BETWEEN KAWASAKI DISEASE, COMMON INFECTIONS AND MYOCARDIAL PROFILING. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30993-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Abstract
Staphylococci are common pathogens in the neonatal period. Increased survival of premature infants leads to prolonged hospital stay with associated risk factors for developing invasive staphylococcal disease. Challenges of diagnosing coagulase-negative staphylococcal infections result in conflicting definitions and inconsistent clinical practice. Resistance to methicillin influences the choice of empirical therapy.
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Affiliation(s)
- Ana C Blanchard
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Caroline Quach
- Division of Infectious Diseases, Department of Medical Microbiology, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Julie Autmizguine
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec H3T 1J4, Canada; Research Center CHU Sainte-Justine, 3175 Chemin Côte Sainte Catherine, Montreal, Quebec H3T 1C5, Canada.
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Autmizguine J, Hornik CP, Benjamin DK, Laughon MM, Clark RH, Cotten CM, Cohen-Wolkowiez M, Benjamin DK, Smith PB. Anaerobic antimicrobial therapy after necrotizing enterocolitis in VLBW infants. Pediatrics 2015; 135:e117-25. [PMID: 25511117 PMCID: PMC4279070 DOI: 10.1542/peds.2014-2141] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on clinical outcomes in very low birth weight (≤1500 g) infants. METHODS We identified very low birth weight infants with NEC from 348 US NICUs from 1997 to 2012. Anaerobic antimicrobial therapy was defined by antibiotic exposure on the first day of NEC. We matched (1:1) infants exposed to anaerobic antimicrobial therapy with infants who were not exposed by using a propensity score stratified by NEC severity (medical and surgical). The primary composite outcome was in-hospital death or intestinal stricture. We assessed the relationship between anaerobic antimicrobial therapy and outcome by using a conditional logistic regression on the matched cohort. RESULTS A total of 1390 infants exposed to anaerobic antimicrobial therapy were matched with 1390 infants not exposed. Mean gestational age and birth weight were 27 weeks and 946 g, respectively, and were similar in both groups. We found no significant difference in the combined outcome of death or strictures, but strictures as a single outcome were more common in the anaerobic antimicrobial therapy group (odds ratio 1.73; 95% confidence interval, 1.11-2.72). Among infants with surgical NEC, mortality was less common with anaerobic antimicrobial therapy (odds ratio 0.71; 95% confidence interval, 0.52-0.95). CONCLUSIONS Anaerobic antimicrobial therapy was not associated with the composite outcome of death or strictures but was associated with an increase in intestinal strictures. This higher incidence of intestinal strictures may be explained by the fact that death is a competing outcome for intestinal strictures, and mortality was slightly lower in the anaerobic cohort. Infants with surgical NEC who received anaerobic antimicrobial therapy had lower mortality.
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Affiliation(s)
| | - Christoph P Hornik
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Daniel K Benjamin
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Matthew M Laughon
- Division of Neonatal-Perinatal Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida; and
| | - C Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Daniel K Benjamin
- John E. Walker Department of Economics, Clemson University, Clemson, South Carolina
| | - P Brian Smith
- Duke Clinical Research Institute, and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina;
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