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Prolonged antibiotics infusion

Chau-Chyun Sheu, Ya-Ting Chang, Shang-Yi Lin, Yen-Hsu Chen, Po-Ren Hsueh
Carbapenems are considered as last-resort antibiotics for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. With the increasing use of carbapenems in clinical practice, the emergence of carbapenem-resistant pathogens now poses a great threat to human health. Currently, antibiotic options for the treatment of carbapenem-resistant Enterobacteriaceae (CRE) are very limited, with polymyxins, tigecycline, fosfomycin, and aminoglycosides as the mainstays of therapy. The need for new and effective anti-CRE therapies is urgent...
2019: Frontiers in Microbiology
Yanqiu Liu, Hong Gao, Guilong Wang, Li An, Jing Yi, Xiaokui Fu, Chunlei Wen, Zijun Wang
The aim of this study is to investigate the changes in QT, QTc, and Tp-e intervals and Tp-e/QT ratio on surface electrocardiogram (ECG) signals during anaesthesia induction using propofol or sevoflurane after preoperative cefuroxime infusion. Some 120 cases of gynaecological patients are randomly divided into propofol (P) and sevoflurane (S) groups (n=60). After cefuroxime (1.5 g) was infused in the two groups of patients, propofol target controlled infusion (TCI) was conducted in the P group for 5 min to realise a plasma concentration of 4  μ g/ml while patients in the S group inhaled anaesthesia by infusing 1...
2019: BioMed Research International
X J Bi, X F Jin, H F Zhang, Z X Su, B Shen
In March 2017, a severely burned male patient aged 36 years with hypovolemic shock was admitted to our hospital. The patient received large quantities of antibiotics and blood products and repeated skin graft after admission, and then he suffered wound errhysis and throat congestion. The patient was healthy before without family history of bleeding or thrombosis disease. Laboratory tests showed that prothrombin time and activated partial coagulation time were remarkably prolonged, blood coagulation factor Ⅴ activity was extremely low, and the result of qualitative test of coagulation factor inhibitor was positive...
January 20, 2019: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Keso Skhirtladze-Dworschak, Doris Hutschala, Georg Reining, Peter Dittrich, Anna Bartunek, Martin Dworschak, Edda M Tschernko
AIM: Surgical site infections contribute to morbidity and mortality after surgery. The authors hypothesized that higher antibiotic tissue concentrations can be reached for a prolonged time span by continuous administration of prophylactic cefuroxime compared to bolus administration. METHODS: Twelve patients undergoing elective cardiac surgery were investigated. Group A received 1.5 g cefuroxime as bolus infusions before surgery, and 12 and 24 hours thereafter. In group B, a continuous infusion of 3...
January 12, 2019: British Journal of Clinical Pharmacology
Daniel B Chastain, Anthony Davis
Osteomyelitis remains difficult to treat, typically requiring a prolonged course of intravenous (IV) antibiotics. The optimal route and duration of antibiotics remains ill-defined due to limited prospective clinical trials. Oritavancin is a long acting, semisynthetic, lipoglycopeptide antibiotic with rapid, concentration-dependent bactericidal activity against many Gram-positive organisms. Favorable pharmacokinetics makes oritavancin an appealing alternative for currently available antibiotics requiring daily infusions to decrease the risk of vascular access complications associated with outpatient antimicrobial therapy...
December 8, 2018: International Journal of Antimicrobial Agents
C Addy, G Doran, A L Jones, G Wright, S Caskey, D G Downey
BACKGROUND: Non-Tuberculous Mycobacterial-pulmonary disease (NTM-PD) is increasing in incidence and prevalence. Mycobacterium abscessus (M.abscessus) is a rapid growing multi-resistant NTM associated with severe NTM-PD requiring prolonged antibiotic therapy. Complications of therapy are common but reports on direct complications of active NTM-PD are rare. Vasculitis has been described as a rare complication of NTM-PD, most often in individuals with inherited immune defects. This case is the first to describe an ANCA positive vasculitide (Microscopic Polyangiitis) secondary to M...
November 19, 2018: BMC Pulmonary Medicine
Ester Steffens, Charlotte Quintens, Inge Derdelinckx, Willy E Peetermans, Johan Van Eldere, Isabel Spriet, Annette Schuermans
PURPOSE: This narrative review aims to describe barriers of outpatient parenteral antimicrobial therapy at home (OPAT), potentially compromising general standards of antibiotic stewardship (ABS) and facilitators of OPAT for ABS. METHODS: After a literature review, five authors determined the barriers and facilitators to discuss in this review. RESULTS: Sixty-six publications were included in the narrative review and seven barriers and five facilitators are discussed in this article...
November 15, 2018: Infection
Ai Goto, Mihoko Hagiwara-Nagasawa, Hiroko Izumi-Nakaseko, Kumiko Kitta, Kiyotaka Hoshiai, Koki Chiba, Kentaro Ando, Yasuki Akie, Atsuhiko T Naito, Atsushi Sugiyama
Although azithromycin can suppress cardiac INa , IKr , IKs , ICa,L and IK1 , its onset mechanisms for cardiovascular death have not been fully investigated. We examined electropharmacological effects of azithromycin in intravenous doses of 0.3, 3 and 30 mg/kg using microminipigs under the halothane anesthesia (n = 4), which provided plasma concentrations of 3.1, 11.2 and 120.4 μg/mL, respectively. The low dose did not alter any of the cardiohemodynamic or electrocardiographic variables. The middle dose significantly shortened QT interval for 10-20 min and QTc for 10-30 min...
November 2018: Journal of Pharmacological Sciences
Katharina Olbrisch, Tobias Kisch, Julia Thern, Evelyn Kramme, Jan Rupp, Tobias Graf, Sebastian G Wicha, Peter Mailänder, Walter Raasch
Infections are a major problem in patients with burn diseases. Mortality is high despite antibiotic therapy as studies are controversial concerning drug underdosing. The aims of this prospective, observational study were to monitor plasma concentrations of piperacillin during standard piperacillin/tazobactam treatment in 20 burn patients and 16 controls from the intensive care unit (ICU) and to optimize doses by in silico analyses. Piperacillin/tazobactam (4/0.5 g, tid) was administered over 0.5 h. Blood samples were taken at 1, 4, and 7...
October 27, 2018: Naunyn-Schmiedeberg's Archives of Pharmacology
James R Gregory, June C Smith, Sarah M Brown-Riley, Alexis M Elward, Scott J Luhmann
STUDY DESIGN: Prospective consecutively enrolled cohort. OBJECTIVES: To evaluate paraspinal muscle concentration of intravenously administered vancomycin, at predetermined time points, during posterior spinal fusion (PSF) with instrumentation in neuromuscular scoliosis (NMS). SUMMARY: Surgical site infection (SSI) after PSF for NMS can be a devastating complication, which may lead to prolonged antibiotic use, multiple additional surgical procedures, pseudarthroses, and sepsis...
November 2018: Spine Deformity
Tze-Peng Lim, Reyna Wang, Gang Quan Poh, Tse-Hsien Koh, Thean-Yen Tan, Winnie Lee, Jocelyn Qi-Min Teo, Yiying Cai, Thuan-Tong Tan, Pui Lai Rachel Ee, Andrea L Kwa
Objectives: Treatment for nosocomial bloodstream infections (BSI) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) is challenging. Rising antimicrobial resistance, especially in extended spectrum beta-lactamase production, inadvertently increases empiric carbapenem consumption. Three antipseudomonal carbapenems (imipenem, meropenem [MER], and doripenem [DOR]) are available commercially against MDR GNB in Singapore. The study aims to determine the most optimal empiric carbapenem dosing regimens (CDR) and evaluate their cost-effectiveness for GNB-BSI in the face of increasing MDR GNB...
2018: Infection and Drug Resistance
A V Sazhin, T V Nechay, S M Titkova, A E Tyagunov, M V Anurov, K Yu Melnikov-Makarchuk, A A Tyagunov, I V Ermakov, N S Glagolev, L S Kurashinova, E A Ivanova, V S Nechay, A V Karpov, A T Mirzoyan, G B Ivakhov, Yu S Balakirev
AIM: To analyze outcomes of fast track rehabilitation in patients with acute appendicitis. MATERIAL AND METHODS: Prospective, randomized multi-center trial including 86 patients was conducted. There were 38 patients in the main group and 48 in the control group. All patients underwent laparoscopic appendectomy under endotracheal anesthesia. Protocol included informing, no premedication, glucose infusion prior to surgery, antibiotics administration, mesoappendix excision, limited deployment of drainage tubes, intraabdominal prolonged anesthesia, minimal pneumoperitoneum, limited irrigation, minimum power monopolar electrocautery, antiemetics, early activation and eating (2 and 6 hours after surgery)...
2018: Khirurgiia
Katherine Kohari, Krista Mehlhaff, Audrey Merriam, Sonya Abdel-Razeq, Olga Grechukhina, Daisy Leon-Martinez, Mert Ozan Bahtiyar
Prelabor rupture of the membranes (PROM) near the limit of viability is associated with significant risks for both mother and fetus. Preterm labor, intra-amniotic infection, and placental abruption are the immediate risks to the pregnancy; however, the fetus incurs additional risks related to the sequela of persistent oligohydramnios. Transabdominal intra-amniotic infusions have been studied. Results, suggesting that this intervention may prolong the latency period, and potentially, decrease pulmonary hypoplasia in surviving neonates without evidence of increasing risk of intra-amniotic infection...
July 2018: American Journal of Perinatology Reports
Rui Pedro Veiga, José-Artur Paiva
Antimicrobials are among the most important and commonly prescribed drugs in the management of critically ill patients and beta-lactams are the most common antibiotic class used. Critically ill patient's pathophysiological factors lead to altered pharmacokinetics and pharmacodynamics of beta-lactams.A comprehensive bibliographic search in PubMed database of all English language articles published from January 2000 to December 2017 was performed, allowing the selection of articles addressing the pharmacokinetics or pharmacodynamics of beta-lactam antibiotics in critically ill patients...
September 24, 2018: Critical Care: the Official Journal of the Critical Care Forum
XiangQing Song, MingHui Long
Background Continual evolution of resistance among bacteria against methods of surgical prophylaxis may make currently used beta-lactam regimens inadequate. Objective To re-evaluate beta-lactam regimens in surgical prophylaxis. Setting A pharmacodynamic Monte Carlo simulation (MCS) model based on a number of patients in China. Methods Pharmacodynamic profiling using Monte Carlo simulation up to 4 hours postinfusion was conducted for standard-dose, short-term (0.5 h) and prolonged (2 to 4 h) infusions of ampicillin, cefazolin, cefotaxime, cefoxitin, cefuroxime, ertapenem, and piperacillin/tazobactam in adult patients with normal renal function...
October 2018: International Journal of Clinical Pharmacy
Glenn E Dale, Atef Halabi, Marc Petersen-Sylla, Achim Wach, Christian Zwingelstein
This open-label, nonrandomized, single-dose, phase 1 study evaluated the pharmacokinetics and safety of murepavadin, a novel peptide antibiotic for the treatment of serious Pseudomonas aeruginosa infections. The study was conducted in 32 subjects of either sex in 4 groups (up to 8 per group) with mild (group 1), moderate (group 2), and severe (group 3) renal function impairment or with normal renal function (group 4). The degree of renal impairment of the subjects was classified at screening according to the estimated creatinine clearance (CLCr ) according to the Cockcroft-Gault equation...
September 2018: Antimicrobial Agents and Chemotherapy
Sofie A M Dhaese, Magalie De Kezel, Maxime Callant, Jerina Boelens, Liesbet De Bus, Pieter Depuydt, Jan J De Waele
BACKGROUND: Prolonged infusion of beta-lactam antibiotics is broadly recognized as a strategy to optimize antibiotic therapy by achieving a higher percentage of time that concentrations remain above the minimal inhibitory concentration (% fT>MIC ), i.e. the pharmacokinetic/pharmacodynamic (PK/PD) index. However, %fT>MIC may not be the PK/PD index of choice for inhibition of resistance emergence and it is therefore unsure what impact prolonged infusion of beta-lactam antibiotics may have on the emergence of resistance...
October 2018: Journal of Critical Care
Kiyoshi Kinoshita
Clostridium difficile (C. difficile), an enterobacteria, flourishes and produces potent toxins, toxin A (TcdA) and toxin B (TcdB), after the disruption of the normal colonic microbiota by antibiotic therapy. C. difficile infection (CDI) may induce life-threatening complications such as fulminant colitis through damage of the intestinal wall by the toxins, therefore the prevention of CDI recurrence is the most important in CDI treatment. Bezlotoxumab is a human monoclonal antibody that neutralizes the activity of TcdB directly...
2018: Nihon Yakurigaku Zasshi. Folia Pharmacologica Japonica
Sotiria C Apostolopoulou, George A Vagenakis, Alexandros Tsoutsinos, Felicia Kakava, Spyridon Rammos
End-stage heart failure (HF) frequently needs continuous inotropic support in hospital and has high morbidity and mortality in absence of heart transplantation. This study reports outcome, efficacy, and safety of continuous ambulatory inotropes (AI) and/or periodic levosimendan (LS) infusions in pediatric HF patients. The study included 27 patients, median age 9.4 (0.1-26.1) years, with severe HF (6 myocarditis, 13 dilated cardiomyopathy, 2 restrictive cardiomyopathy, 6 repaired congenital heart disease). Dobutamine and milrinone AI were administered in 21 patients through a permanent central catheter for median duration 1...
October 2018: Pediatric Cardiology
A Brinkmann, A C Röhr, A Köberer, T Fuchs, W A Krüger, C König, D Richter, M A Weigand, O R Frey
Sepsis-induced changes in pharmacokinetic parameters are a well-known problem in intensive care medicine. Dosing of antibiotics in this setting is therefore challenging. Alterations to the substance-specific kinetics of anti-infective substances have an effect on the distribution and excretion processes in the body. Increased clearance and an increased distribution volume (Vd ) and particularly compromized organ function with reduced antibiotic elimination are often encountered in patients with sepsis. Renal replacement treatment, which is frequently used in intensive care medicine, represents a substantial intervention in this system...
June 2018: Der Anaesthesist
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