Drug Pharmacokinetics Following Administration by Intermittent Intravenous Infusion
N. F. Gray in Basic Pharmacokinetics, 2012
Drug administration by intermittent IV infusion involves administration of short IV infusion repeatedly every xed dosing interval. Following repeated administration of these short IV infusions, the drug accumulates in the body until steady state is achieved. At steady state, the maximum and minimum plasma drug concentrations will be constant if the dose, infusion duration, and dosing interval are kept constant. This route of administration is usually used when bolus IV drug administration produces high plasma drug concentration that can produce serious adverse effects. Examples of drugs administered by this route of administration are vancomycin and aminoglycosides.
Tn
Adam P. Roberts, Peter Mullany in Bacterial Integrative Mobile Genetic Elements, 2022
Tn 1549 and closely related elements are largely responsible for VanB-type resistance in enterococci. The presence on these elements of three functional modules involved in vancomycin resistance, transposition, and intercellular transfer is indicative of conjugative transposons. Their transposition module is very similar to that of Tn 916 and leads to formation of detectable circular intermediate. However, En 1549 -type. elements are passively transferred between Enterococcus spp. by plasmid or large chromosomal fragments. They have been also detected in anaerobes, and their capacity to transfer to Enterococcus was established. They possess a functional mobilization structure composed by an origin of transfer and mobilization proteins, which enable the conjugation process. Detection of vanB gene in stool samples in the absence of cultivable vancomycin-resistant enterococci suggests that anaerobes constitute the reservoir for Van-B type resistance and that Tn 1549 is the vehicle involved for its mobilization.
Aspergillosis
Meera Chand, John Holton in Case Studies in Infection Control, 2018
This chapter presents a case study of a 31-year-old patient with acute myeloid leukemia (AML) who is persistendy pyrexial despite 5 days of meropenem and vancomycin. It provides a discussion on clinical management, prevention, epidemiology, biology, and pathology of this case. Aspergillus species may provoke an allergic response in the host, most commonly as allergic bronchopulmonary aspergillosis. Early diagnosis and treatment are essential in cases of invasive aspergillosis. Treatment options for invasive aspergillosis include voriconazole and liposomal amphotericin B, and some units employ both agents or add in an echinocandin in refractory cases. General measures to reduce the incidence of invasive aspergillosis in at risk patients fall into three main groups: strict adherence to infection control precautions, provision of an appropriate patient environment, and antifungal prophylaxis for higher-risk patients. Antifungal agents with activity against Aspergillus include voriconazole, itraconazole, and posaconazole.
Does nephrotoxicity develop less frequently when vancomycin is combined with imipenem-cilastatin than with meropenem? A comparative study
Published in Infectious Diseases, 2019
Hakeam A. Hakeam, Lina AlAnazi, Reem Mansour, Shahad AlFudail, Filwah AlMarzouq
Introduction: Nephrotoxicity is a frequent complication of vancomycin therapy. Experimental studies in different animal species have demonstrated the attenuation of vancomycin-associated nephrotoxicity with cilastatin administration. This study aimed to evaluate if imipenem-cilastatin attenuates vancomycin-associated nephrotoxicity, in patients treated with combinations of vancomycin and carbapenems. Methods: This retrospective, propensity-score matched study was conducted at King Faisal Specialist Hospital and Research Centre, Riyadh and Jeddah. Nephrotoxicity was compared in patients who received imipenem-cilastatin + vancomycin or meropenem + vancomycin. Patients with no history of renal disease who received imipenem-cilastatin + vancomycin or meropenem + vancomycin for a minimum of 72 h, from 1 January 2017 to 31 December 2017, were included. Nephrotoxicity was defined according to the RIFLE criteria (Risk, Injury, Failure, Loss, End-stage renal disease) if sustained for least 72 h. Results: A total of 227 patients were included in the analysis, consisting of 121 patients in the imipenem-cilastatin + vancomycin group, and 106 patients in the meropenem + vancomycin group. In the unmatched data set the rate of nephrotoxicity was 8.2% in imipenem-cilastatin + vancomycin group and 20.7% in the meropenem + vancomycin group (p = .007). Logistic regression analysis showed that imipenem-cilastatin + vancomycin therapy was associated with a 56% lower rate of nephrotoxicity compared to meropenem + vancomycin therapy. Propensity-score matching resulted in rates of nephrotoxicity of 6.2% and 17.1% in the imipenem-cilastatin + vancomycin group and the meropenem + vancomycin groups, respectively (p = .034). Conclusion: Vancomycin-associated nephrotoxicity developed less frequently when vancomycin was combined with imipenem-cilastatin than when combined with meropenem.
Vancomycin Therapy for Serious Staphylococcal Infections in Chronic Hemodialysis Patients
Published in Journal of Dialysis, 1980
M. H. Bierman, C. A. Needham-Walker, M. Hammeke, J. D. Egan
Vancomycin therapy during 7 episodes of serious staphylococcal infections in chronic hemodialysis patients was monitored by a sensitive bioassay technique. One gm of vancomycin was given during dialysis at a mean dosage interval of 7 days for a mean duration of 48 days. Serum peak and trough vancomycin levels were monitored during therapy. Accumulation of vancomycin occurred in 1 patient on prolonged therapy; progressive rising trough levels required a reduction in vancomycin dosage. Pre and post-dialysis vancomycin levels in one patient were unchanged. Vancomycin was effective in erradication of all staphylococcal infections and bacteremias. Three A-V shunt infections required surgical revision; 2 A-V fistula infections were salvaged with vancomycin therapy alone. We conclude that 1 gm vancomycin every 7 days is an effective regimen for serious staphylococcal infections in chronic hemodialysis patients. Monitoring of vancomycin levels insures maintenance of adequate levels and prevents toxic accumulation.
CHEMICAL STABILITY AND COMPATIBILITY STUDY OF VANCOMYCIN FOR ADMINISTRATION BY CONTINUOUS INFUSION IN INTENSIVE CARE UNITS
Published in Journal of Liquid Chromatography & Related Technologies, 2011
Jochen Pauwels, Isabel Spriet, Xuebin Fu, Sandrina von Winckelmann, Ludo Willems, Jos Hoogmartens, Ann Van Schepdael
In this study, various analytical techniques were applied in order to investigate the feasibility of continuously infusing vancomycin in intensive care units. First, the chemical stability of a 40 mg/mL vancomycin solution in normal saline was studied. The stability study included pH measurement, visual inspection, UV spectrophotometry, and assay by capillary electrophoresis. Subsequently, physical and chemical compatibility of vancomycin with five commonly co-administered drugs was evaluated. Physical compatibility tests consisted of pH measurement, visual inspection, and nephelometry. Physically compatible drugs were further assessed for chemical compatibility with vancomycin, by determining the vancomycin content in mixed samples using capillary electrophoresis. No changes in physical characteristics of the vancomycin solution were observed during 24 hours. The content of vancomycin remained higher than 90% of the nominal concentration throughout the stability study. Addition of sodium valproate and dipotassium clorazepate to the vancomycin solution resulted in precipitation. Vancomycin was physically compatible with amiodarone, piritramide and midazolam, respectively. Furthermore, capillary electrophoretic analysis revealed no decrease in vancomycin content upon mixing with physically compatible drugs. In conclusion, a 40 mg/mL vancomycin solution was proven to be stable and compatible with midazolam, piritramide, and amiodarone. Sodium valproate and dipotassium clorazepate, however, were physically incompatible with vancomycin.
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