Search

Background Continuous renal replacement therapy (CRRT) is common practice in critical care patients with acute renal failure. Objectives To evaluate the adequacy of antimicrobial doses calculated based on the total drug clearance and dose recommended by different guides in critically ill patients undergoing CRRT. Methods Retrospective observational study. Patients admitted to a critical care unit during May 2014 to May 2016 and subjected to CRRT were included. The recommended dose was established as the product of the usual dose of the drug by total drug clearance. Results 177 antimicrobial agents, used in 64 patients were analysed; 45 (25.4%) antimicrobials were given in an insufficient dose (

Background Cytomegalovirus disease is an important cause of morbidity and mortality in haematopoietic stem cell transplantation (HSCT) recipients. Foscarnet, an intravenous drug active against cytomegalovirus, represents an increasingly widespread alternative when there is resistance or intolerance to conventional treatments (ganciclovir/valganciclovir, acyclovir). More data about its use, effectiveness and safety in the clinical practice are necessary. Purpose To analyse the effectiveness and safety of the use of foscarnet against cytomegalovirus in HSCT recipients, and its adaptation to clinical practice guidelines and expert recommendations in order to optimise future treatment strategies. Material and methods Observational, retrospective, single centre study including all adult HSCT recipients treated with foscarnet for pre-emptive therapy or treatment of cytomegalovirus in a tertiary hospital between January 2013 and June 2015. Demographic, effectiveness and safety data about the treatment were collected and analysed using Access and Excel. After a literature search, results were compared with clinical trials and retrospective studies published, as well as with clinical practice guidelines and expert recommendations. Results 43 episodes in 34 patients were included (50% women) with a median age of 52 years (range 47–57). In 9 cases (31%) of pre-emptive therapy, no patient experienced reactivation of cytomegalovirus. In 34 cases of treatment after reactivation, 85.7% (n = 29) started with a positive cytomegalovirus viral load. Of them, 72.4% reach negative viral load, 20.7% died and 6.9% were considered resistant. The remaining 14.3% (n = 5) maintained negative for viral load during treatment. All patients experienced at least one adverse effect but only 3% discontinued treatment. There were electrolytic disorders (100%), creatinine alterations (32.6%) and gastrointestinal disturbances (9%). Concomitant drugs causing electrolyte alterations or renal toxicity were not registered. Conclusion Foscarnet was shown to be effective with acceptable toxicity in cytomegalovirus treatment in HSCT recipients. The results are not entirely comparable with other published studies1,2 due to differences between populations and therapeutic regimens. The use of foscarnet (indications, dosage and treatment duration) in hospital mainly follows recommendations of experts and guidelines. More studies should be carried out in order to get the most beneficial treatment regimen with the minimum adverse effects. References and/or Acknowledgements Reusser P, et al. Randomised multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood 2002;99:1159–64 Asakura M, et al. Use of foscarnet for cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation from a related donor. Int J Hematol 2010;92:351–9 No conflict of interest.

Background The increasing prevalence, morbidity and mortality rates of Clostridium difficile infection (CDI) turn its treatment into a challenge for researchers. Fidaxomicin is a new treatment option which has been shown to be effective for treating both primary and recurrent CDI in clinical trials but there is limited clinical experience. Purpose To evaluate the use and outcome in patients with CDI treated with fidaxomicin in a tertiary hospital. Material and methods Between May 2013 and September 2014 patients undergoing treatment with fidaxomicin were assessed. Demographic and clinical data were collected from the patient electronic medical record. The outcome measure was Symptom-Free Interval (SFI), calculated in patients who were monitored for at least 1 month. Results Thirteen patients were analysed (n = 13), 53.8% male, median age 54 years (range 27–83) and all had baseline disease which increased the risk of recurrent CDI, so fidaxomicin treatment was indicated by current clinical guidelines. Seven had a history of recurrent CDI and eleven had received previous treatment with vancomycin and/or metronidazole. Treatments with fidaxomicin were 200 mg twice daily for 10 days. Recurrence was found in 30.8% patients after the first treatment with fidaxomicin, but 6 patients were lost to follow-up (died). SFI varied with number of courses received. After the first treatment, the median SFI was 75 days (range 15–395). After the second course (2 patients) SFI was 66 and 180 days and following the third treatment (2 patients) SFI was 133 and 64 days. Conclusion Use of fidaxomicin is more common in patients with recurrence or non-responders to standard treatment (84.6%); the recurrence rate was high (30.8%). This study was limited by the number lost to follow-up and high inter-individual variability in SFI. More clinical experience is needed to determinate which patients may benefit most. Alternative dose regimens should be considered to improve treatment outcomes. References and/or Acknowledgements No conflict of interest

Background Sinusoidal obstruction syndrome (SOS) is an important non-haematological toxicity in patients who have received chemotherapy for haematopoietic stem cell transplantation (HSCT). In March 2013, European Medicines Agency refused marketing authorisation for the orphan drug defibrotide to prevent and treat SOS. In July 2013, after re-examination, defibrotide had a new positive opinion for marketing authorisation but only for treatment. Purpose To investigate the effectiveness, safety and cost of defibrotide for SOS. Materials and methods Retrospective observational study (Period: January 2009–September 2013). We analysed patients with SOS treated with defibrotide. Response criteria were defined as total serum bilirubin Results Eleven patients (five adults (mean age: 55.7(SD = 4.3) years) and four children (3.1(SD = 1.3)) received defibrotide at a dose of 6.25 mg/kg every 6 h (two patients received 10 mg/kg/6 h). Median duration of treatment was 9 days (range: 5–25). Overall complete response was achieved in seven patients (63.6%), all four children and only three adults. 45.5% of patients had completely recovered from hepatomegaly at the end of defibrotide administration. Six of the eight patients with ascites and one patient with encephalopathy recovered their normal status. All patients reduced their weight gain after defibrotide treatment. 100 day post-HSCT survival was 72.7%. Three patients presented haemorrhagic episodes during defibrotide treatment (two gastrointestinal episodes and one nasal bleeding). Median cost per patient was 19,180 € (range 5,480–41,100 €). Conclusions According to our limited results, defibrotide is an effective option for SOS treatment in children, although cost per patient is high. Cost-effectiveness studies comparing treatment for SOS with and without defibrotide are needed. No conflict of interest.