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Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Many clinicians recommend that combined treatment is given with two anti-pseudomonal antibiotics to discourage the emergence of resistance [16]. A commonly used combination is the aminoglycoside antibiotic tobramycin, given intravenously, combined with ceftazidime. For each drug, a pharmacological strategy has been proposed to allow more effective bacterial killing. Tobramycin shows concentration dependent killing and a post antibiotic effect, and therefore, a once daily regimen with high peaks and low troughs should give better bacterial killing. In practice, a once daily regimen appears to be equally effective and less nephrotoxic than the traditional three times daily approach [18]. The reduced nephrotoxicity is likely to be due to the pharmacokinetics of aminoglycoside uptake into the proximal tubule, which are saturable at high serum concentration. In the case of ceftazidime, bacterial killing is enhanced if the concentration of the antibiotic exceeds the minimum inhibitory concentration of ceftazidime for P. aeruginosa for most of the time. A continuous infusion should therefore be more effective [19]. However, a controlled trial of continuous ceftazidime, with sufficient statistical power to detect a clinically important difference in outcome, has not yet been undertaken.
Calculation Skills
Published in Vilius Savickas, Reem Kayyali, Neel Sharma, Student Success in the Prescribing Safety Assessment (PSA), 2020
Vilius Savickas, Reem Kayyali, Neel Sharma
Newly born baby Jerome (38 weeks) is suspected to have developed neonatal sepsis. The microbiology team have advised to initiate the extended interval IV tobramycin infusion. You are asked to prescribe the dose as appropriate. Tobramycin (available as 40 mg/mL vials) is to be diluted with sodium chloride 0.9% to 50 mL and is to be given over 60 minutes. The ideal body weight is 3.5 kg.
Tobramycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Juan Gálvez-Acebal, Jesús Rodríguez-Baño
Tobramycin is an aminoglycoside aminocyclitol antibiotic, which is one of several compounds in an antibiotic complex (nebramycin) produced by Streptomyces tenebrarius. The molecular formula for tobramycin is C18H37N5O9; the corresponding molecular weight is 467.5, and the molecular structure is shown in Figure 53.1. Tobramycin is used clinically both as a sulfate salt and in a nebulizer solution in sodium chloride and without preservatives for inhalation. It is a drug similar to gentamicin (see Chapter 52, Gentamicin), but its advantages include greater intrinsic activity against Pseudomonas aeruginosa, activity against some gentamicin-resistant P. aeruginosa and Acinetobacter baumannii strains, and lesser nephrotoxicity.
Therapeutic drug monitoring-guided dosing for pediatric cystic fibrosis patients: recent advances and future outlooks
Published in Expert Review of Clinical Pharmacology, 2023
Siân Bentley, Jamie Cheong, Nikesh Gudka, Sukeshi Makhecha, Simone Hadjisymeou-Andreou, Joseph F Standing
Traditionally TDM for aminoglycosides in all people with CF has focused on measurement of trough concentrations and peak concentrations to ascertain safety and efficacy, respectively [25,26]. This method is still used by many centers, likely due to the ease of measurement and interpretation, and was utilized in the multicenter study by Smyth et al, evaluating the clinical outcomes in people with CF, including children, of once-daily vs. thrice-daily tobramycin [27]. Target concentrations of tobramycin for the once-daily regimen were trough concentrations of ≤1 mg/L and peak concentrations of 20–30 mg/L. The primary endpoint was a mean change in FEV1 % predicted, and once daily dosing resulted in a mean change in FEV1 (% predicted) over 14 days of 10·4%. Conversely, the use of alternative TDM methods encompassing the PK/PD target AUC24/MIC have been used for many years in some regions including Australia [28]. Mouton et al. demonstrated a significant relationship between Cmax/MIC and AUC24/MIC of tobramycin and efficacy parameters (increase in FEV1 and FVC) in children and young adults with CF [29].
Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)Following Acute COVID-19 Infection
Published in Ocular Immunology and Inflammation, 2023
Cigdem Altan, Berna Basarir, Serife Bayraktar, Ilknur Tugal-Tutkun
In patients who had resolution of pigment dispersion during follow-up, resolution time was recorded. Retinal nerve fiber layer (RNFL) thickness via spectral-domain optical coherence tomography (Spectralis; Heidelberg Engineering, Dossenheim, Heidelberg, Germany) and visual field static automated perimetry, using the 30–2 Swedish Interactive Threshold Algorithm (SITA) standard program (Humphrey Visual Field Analyzer; Carl Zeiss-Meditec Inc., Dublin, CA) findings were recorded. Patients were treated with topical prednisolone acetate 1% when they had acute symptoms or ongoing high-grade pigment dispersion in the anterior chamber and the dose was reduced according to the severity of the signs. In patients with an IOP equal or higher than 24 mmHg, topical antiglaucomatous medications (Dorzolamide/timolol fixed combination or brinzolamide/timolol fixed combination and/or topical brimonidine twice a day and prostaglandin analogs as a last option) and oral asetazolamid were used if needed. The highest IOP during follow-up and total follow-up time were recorded. Glaucoma surgery was carried out in patients with high IOP under maximum antiglaucomatous medication and/or progressive optic nerve head cupping. Topical tobramycin was used in the postoperative one-week period. Clinical findings after glaucoma surgery were also recorded.
Clinical Analysis of Central Islands after Small Incision Lenticule Extraction (SMILE)
Published in Current Eye Research, 2021
Joaquín Fernández, Javier García-Montesinos, Javier Martínez, David P. Piñero, Manuel Rodríguez-Vallejo
All the procedures were conducted by the same surgeon (JF) with the VisuMax 500-kHz femtosecond laser (Carl Zeiss Meditec, Jena, Germany). Two drops of topical anesthesia (oxybuprocaine hydrochloride 0.4%) were instilled 5 minutes before surgery and two further drops 1 minute before surgery. Laser settings were configured for an optical zone of 6.5 mm and cap thickness of 120 μm. The incision length and location for extracting the lenticule were 2.0 mm and 70°, respectively. The cut energy index used was 32 (corresponding to approximately 160 nJ) and the spot spacing 4.5 µm. A personalized nomogram was used derived from previous analyzed data. Cyclotorsion was manually corrected in eyes with astigmatism equal or higher to 1.50 D by means of marking 2 mm from the limbus and manually rotating the sucking cone to match the corneal marks (the ones along the 0° to 180° line) with the reticle.6 Finally, two drops of tobramycin (3 mg/ml) and dexamethasone (1 mg/ml) combination were instilled in all cases immediately at the end of the procedure. Postoperative treatment included ofloxacin (3 mg/ml) for 2 days, dexamethasone drops 5, 3, 2 and 1 per day tapered each 7 days, and sodium hyaluronate 0.15% for 1 month.