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Translating PK-PD principles into improved methodology for clinical trials which compare intermittent with prolonged infusion of beta-lactam antibiotics.
Clin Infect Dis
January 2025
Professor of Medicine, Director, Institute for Therapeutic Innovation at University of Florida, Orlando, FL, USA.
Based on the fact that beta-lactam antibiotics demonstrate time-dependent killing, different dosing strategies have been implemented to increase the time that free (f) (unbound) antibiotic concentrations remain above the Minimal Inhibitory Concentration (MIC), including prolonged and continuous infusion. Multiple studies have been performed that compared continuous with traditional intermittent infusion to improve outcomes in patients with severe sepsis and/or septic shock. These studies have yielded inconsistent results for patients as measured by clinical response to treatment and mortality due to heterogeneity of included patients, pathogens, dosing strategies and the absence of Therapeutic Drug Monitoring (TDM).
View Article and Find Full Text PDFTherapeutic drug monitoring versus Bayesian AUC-based dosing for vancomycin in routine practice: a cost-benefit analysis.
J Antimicrob Chemother
January 2025
Pharmacy Department, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
Background: AUC-based dosing with validated Bayesian software is recommended as a good approach to guide bedside vancomycin dosing.
Objectives: To compare treatment and vancomycin-associated acute kidney injury (AKI) costs between Bayesian AUC-based dosing and conventional therapeutic drug monitoring (TDM) using steady-state plasma concentrations of vancomycin administered as continuous infusion in hospitalized non-critically ill patients with severe Gram-positive infection.
Methods: A cost-benefit analysis presented as a return on investment (ROI) analysis from a hospital perspective was conducted using a decision tree model (TDM versus AUC-based dosing) to simulate treatment cost (personnel, serum sampling and drug cost), vancomycin-associated AKI risk and cost up to 14 days.
Maintenance of prehospital anaesthesia in trauma patients: inconsistencies and variability in practice.
BJA Open
March 2025
Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
Background: Literature on prehospital anaesthesia predominantly focuses on preparation and induction, while there is limited guidance on anaesthesia maintenance. The hypothesis of this study was that for prehospital trauma patients, protocols and practice for anaesthesia maintenance may vary considerably between services. Hence, we sought to describe the practice of prehospital anaesthesia maintenance for trauma patients in Australia, New Zealand, and the UK.
View Article and Find Full Text PDFTachycardia-Induced Cardiomyopathy Following Prolonged Ritodrine Infusion During Pregnancy: A Case Report.
Cureus
December 2024
Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Fuchu, JPN.
Preterm birth remains a leading cause of neurodevelopmental disability in offspring, prompting various preventive measures. However, controversies persist surrounding these approaches, particularly regarding beta-mimetic drugs. In Japan, it remains a concerning reality that ritodrine infusion continues to be used for long-term tocolysis in preterm labor, despite the warning issued by the US Food and Drug Administration.
View Article and Find Full Text PDFMetastatic Insulinoma Managed With Continuous Glucose Monitoring in a Young Female Patient.
JCEM Case Rep
February 2025
Division of Endocrinology, Diabetes & Metabolic Diseases, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Insulinomas are rare neuroendocrine neoplasms and causes of hypoglycemia. They present with neuroglycopenic symptoms, including confusion and seizures. Suspected diagnosis must be confirmed through bloodwork and imaging.
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