9 results on '"Roberts J.A."'
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2. Advances in antibiotic therapy in the critically ill
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Vincent, J.L., Bassetti, M., François, B., Karam, G., Chastre, J., Torres, A., Roberts, J.A., Taccone, F.S., Rello, J., Calandra, T., De Backer, D., Welte, T., and Antonelli, M.
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Anti-Bacterial Agents/pharmacology ,Anti-Bacterial Agents/therapeutic use ,Critical Illness ,Humans - Abstract
Infections occur frequently in critically ill patients and their management can be challenging for various reasons, including delayed diagnosis, difficulties identifying causative microorganisms, and the high prevalence of antibiotic-resistant strains. In this review, we briefly discuss the importance of early infection diagnosis, before considering in more detail some of the key issues related to antibiotic management in these patients, including controversies surrounding use of combination or monotherapy, duration of therapy, and de-escalation. Antibiotic pharmacodynamics and pharmacokinetics, notably volumes of distribution and clearance, can be altered by critical illness and can influence dosing regimens. Dosing decisions in different subgroups of patients, e.g., the obese, are also covered. We also briefly consider ventilator-associated pneumonia and the role of inhaled antibiotics. Finally, we mention antibiotics that are currently being developed and show promise for the future.
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- 2016
3. Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort
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Abdul-Aziz, Mohd H., Lipman, Jeffrey, Akova, Murat, Bassetti, Matteo, De Waele, Jan J., Dimopoulos, George, Dulhunty, Joel, Kaukonen, Kirsi-Maija, Koulenti, Despoina, Martin, Claude, Montravers, Philippe, Rello, Jordi, Rhodes, Andrew, Starr, Therese, Wallis, Steven C., Roberts, Jason A., Paul, Sanjoy, Ribas, Antonio Margarit, De Crop, Luc, Spapen, Herbert, Wauters, Joost, Dugernier, Thierry, Jorens, Philippe, Dapper, Ilse, De Backer, Daniel, Taccone, Fabio S., Ruano, Laura, Afonso, Elsa, Alvarez-Lerma, Francisco, Gracia-Arnillas, Maria Pilar, Fernández, Francisco, Feijoo, Neus, Bardolet, Neus, Rovira, Assumpta, Garro, Pau, Colon, Diana, Castillo, Carlos, Fernado, Juan, Lopez, Maria Jesus, Fernandez, Jose Luis, Arribas, Ana Maria, Teja, Jose Luis, Ots, Elsa, Montejo, Juan Carlos, Catalan, Mercedes, Prieto, Isidro, Gonzalo, Gloria, Galvan, Beatriz, Blasco, Miguel Angel, Meyer, Estibaliz, Nogal, Frutos Del, Vidaur, Loreto, Sebastian, Rosa, Garde, Pila Marco, Velasco, Maria del Mar Martin, Crespo, Rafael Zaragoza, Esperatti, Mariano, Torres, Antoni, Baldesi, Olivier, Dupont, Herve, Mahjoub, Yazine, Lasocki, Sigismond, Constantin, Jean Michel, Payen, Jean François, Albanese, Jacques, Malledant, Yannick, Pottecher, Julien, Lefrant, Jean-Yves, Jaber, Samir, Joannes-Boyau, Olivier, Orban, Christophe, Ostermann, Marlies, Mckenzie, Catherine, Berry, Willaim, Smith, John, Lei, Katie, Rubulotta, Francesca, Gordon, Anthony, Brett, Stephen, Stotz, Martin, Templeton, Maie, Ebm, Claudia, Moran, Carl, Pettilä, Ville, Xristodoulou, Aglaia, Theodorou, Vassiliki, Kouliatsis, Georgios, Sertaridou, Eleni, Anthopoulos, Georgios, Choutas, George, Rantis, Thanos, Karatzas, Stylianos, Balla, Margarita, Papanikolaou, Metaxia, Myrianthefs, Pavlos, Gavala, Alexandra, Fildisis, Georgios, Koutsoukou, Antonia, Kyriakopoulou, Magdalini, Petrochilou, Kalomoira, Kompoti, Maria, Michalia, Martha, Clouva-Molyvdas, Fillis-Maria, Gkiokas, Georgios, Nikolakopoulos, Fotios, Psychogiou, Vasiliki, Malliotakis, Polychronis, Akoumianaki, Evangelia, Lilitsis, Emmanouil, Koulouras, Vassilios, Nakos, George, Kalogirou, Mihalis, Komnos, Apostolos, Zafeiridis, Tilemachos, Chaintoutis, Christos, Arvaniti, Kostoula, Matamis, Dimitrios, Kydona, Christina, Gritsi-Gerogianni, Nikoleta, Giasnetsova, Tatiana, Giannakou, Maria, Soultati, Ioanna, Chytas, Ilias, Antoniadou, Eleni, Antipa, Elli, Lathyris, Dimitrios, Koukoubani, Triantafyllia, Paraforou, Theoniki, Spiropoulou, Kyriaki, Bekos, Vasileios, Spring, Anna, Kalatzi, Theodora, Nikolaou, Hara, Laskou, Maria, Strouvalis, Ioannis, Aloizos, Stavros, Kapogiannis, Spyridon, Soldatou, Ourania, Adembri, Chiara, Villa, Gianluca, Giarratano, Antonio, Raineri, Santi Maurizio, Cortegiani, Andrea, Montalto, Francesca, Strano, Maria Teresa, Marco Ranieri, V., Sandroni, Claudio, De Pascale, Gennaro, Molin, Alexandre, Pelosi, Paolo, Montagnani, Luca, Urbino, Rosario, Mastromauro, Ilaria, De Rosa, Francesco G., Cardoso, Teresa, Afonso, Susana, Gonçalves-Pereira, João, Baptista, João Pedro, Özveren, Arife, Abdul-Aziz, M.H., Lipman, J., Akova, M., Bassetti, M., De Waele, J.J., Dimopoulos, G., Dulhunty, J., Kaukonen, K.-M., Koulenti, D., Martin, C., Montravers, P., Rello, J., Rhodes, A., Starr, T., Wallis, S.C., Roberts, J.A., Paul, S., Ribas, A.M., De Crop, L.D., Spapen, H., Wauters, J., Dugernier, T., Jorens, P., Dapper, I., De Backer, D.D., Taccone, F.S., Ruano, L., Afonso, E., Alvarez-Lerma, F., Gracia-Arnillas, M.P., Fernández, F., Feijoo, N., Bardolet, N., Rovira, A., Garro, P., Colon, D., Castillo, C., Fernado, J., Lopez, M.J., Fernandez, J.L., Arribas, A.M., Teja, J.L., Ots, E., Montejo, J.C., Catalan, M., Prieto, I., Gonzalo, G., Galvan, B., Blasco, M.A., Meyer, E., Nogal, F.D., Vidaur, L., Sebastian, R., Garde, P.M., Velasco, M.M.M., Crespo, R.Z., Esperatti, M., Torres, A., Baldesi, O., Dupont, H., Mahjoub, Y., Lasocki, S., Constantin, J.M., Payen, J.C., Albanese, J., Malledant, Y., Pottecher, J., Lefrant, J.-Y., Jaber, S., Joannes-Boyau, O., Orban, C., Ostermann, M., McKenzie, C., Berry, W., Smith, J., Lei, K., Rubulotta, F., Gordon, A., Brett, S., Stotz, M., Templeton, M., Ebm, C., Moran, C., Pettilä, V., Xristodoulou, A., Theodorou, V., Kouliatsis, G., Sertaridou, E., Anthopoulos, G., Choutas, G., Rantis, T., Karatzas, S., Balla, M., Papanikolaou, M., Myrianthefs, P., Gavala, A., Fildisis, G., Koutsoukou, A., Kyriakopoulou, M., Petrochilou, K., Kompoti, M., Michalia, M., Clouva-Molyvdas, F.-M., Gkiokas, G., Nikolakopoulos, F., Psychogiou, V., Malliotakis, P., Akoumianaki, E., Lilitsis, E., Koulouras, V., Nakos, G., Kalogirou, M., Komnos, A., Zafeiridis, T., Chaintoutis, C., Arvaniti, K., Matamis, D., Kydona, C., Gritsi-Gerogianni, N., Giasnetsova, T., Giannakou, M., Soultati, I., Chytas, I., Antoniadou, E., Antipa, E., Lathyris, D., Koukoubani, T., Paraforou, T., Spiropoulou, K., Bekos, V., Spring, A., Kalatzi, T., Nikolaou, H., Laskou, M., Strouvalis, I., Aloizos, S., Kapogiannis, S., Soldatou, O., Adembri, C., Villa, G., Giarratano, A., Raineri, S.M., Cortegiani, A., Montalto, F., Strano, M.T., Marco Ranieri, V., Sandroni, C., De Pascale, G.D., Molin, A., Pelosi, P., Montagnani, L., Urbino, R., Mastromauro, I., De Rosa, F.G., Cardoso, T., Afonso, S., Gonçalves-Pereira, J., Baptista, J.P., Özveren, A., University of Queensland [Brisbane], Service Anesthésie et Réanimation [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Service d'anesthésie - réanimation chirurgicale [CHU Bichat], Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Abdul-Aziz M.H., Lipman J., Akova M., Bassetti M., De Waele J.J., Dimopoulos G., Dulhunty J., Kaukonen K.-M., Koulenti D., Martin C., Montravers P., Rello J., Rhodes A., Starr T., Wallis S.C., Roberts J.A., Paul S., Ribas A.M., De Crop L.D., Spapen H., Wauters J., Dugernier T., Jorens P., Dapper I., De Backer D.D., Taccone F.S., Ruano L., Afonso E., Alvarez-Lerma F., Gracia-Arnillas M.P., Fernandez F., Feijoo N., Bardolet N., Rovira A., Garro P., Colon D., Castillo C., Fernado J., Lopez M.J., Fernandez J.L., Arribas A.M., Teja J.L., Ots E., Montejo J.C., Catalan M., Prieto I., Gonzalo G., Galvan B., Blasco M.A., Meyer E., Nogal F.D., Vidaur L., Sebastian R., Garde P.M., Velasco M.M.M., Crespo R.Z., Esperatti M., Torres A., Baldesi O., Dupont H., Mahjoub Y., Lasocki S., Constantin J.M., Payen J.C., Albanese J., Malledant Y., Pottecher J., Lefrant J.-Y., Jaber S., Joannes-Boyau O., Orban C., Ostermann M., McKenzie C., Berry W., Smith J., Lei K., Rubulotta F., Gordon A., Brett S., Stotz M., Templeton M., Ebm C., Moran C., Pettila V., Xristodoulou A., Theodorou V., Kouliatsis G., Sertaridou E., Anthopoulos G., Choutas G., Rantis T., Karatzas S., Balla M., Papanikolaou M., Myrianthefs P., Gavala A., Fildisis G., Koutsoukou A., Kyriakopoulou M., Petrochilou K., Kompoti M., Michalia M., Clouva-Molyvdas F.-M., Gkiokas G., Nikolakopoulos F., Psychogiou V., Malliotakis P., Akoumianaki E., Lilitsis E., Koulouras V., Nakos G., Kalogirou M., Komnos A., Zafeiridis T., Chaintoutis C., Arvaniti K., Matamis D., Kydona C., Gritsi-Gerogianni N., Giasnetsova T., Giannakou M., Soultati I., Chytas I., Antoniadou E., Antipa E., Lathyris D., Koukoubani T., Paraforou T., Spiropoulou K., Bekos V., Spring A., Kalatzi T., Nikolaou H., Laskou M., Strouvalis I., Aloizos S., Kapogiannis S., Soldatou O., Adembri C., Villa G., Giarratano A., Raineri S.M., Cortegiani A., Montalto F., Strano M.T., Marco Ranieri V., Sandroni C., De Pascale G.D., Molin A., Pelosi P., Montagnani L., Urbino R., Mastromauro I., De Rosa F.G., Cardoso T., Afonso S., Goncalves-Pereira J., Baptista J.P., Ozveren A., Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)
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0301 basic medicine ,Male ,Penicillanic Acid ,intensive care unit ,law.invention ,thienamycin derivative, abdominal infection ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,law ,central nervous system infection ,creatinine clearance ,Pharmacology (medical) ,Infusions, Intravenou ,Prospective Studies ,Infusions, Intravenous ,Prospective cohort study ,Tazobactam Drug Combination ,Aged ,Anti-Bacterial Agents ,Blood Chemical Analysis ,Critical Illness ,Female ,Humans ,Intensive Care Units ,Meropenem ,Microbial Sensitivity Tests ,Middle Aged ,Piperacillin ,Piperacillin, Tazobactam Drug Combination ,Thienamycins ,Treatment Outcome ,Pharmacology ,Microbiology (medical) ,Infectious Diseases ,critical illne ,Microbial Sensitivity Test ,adult ,Respiratory infection ,clinical trial ,continuous infusion ,analogs and derivative ,Intensive care unit ,3. Good health ,antiinfective agent ,intravenous drug administration ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Piperacillin/tazobactam ,multicenter study (topic) ,SOFA score ,treatment outcome, Aged ,Intravenous ,prospective study ,Human ,medicine.drug ,survival rate ,medicine.medical_specialty ,Infusions ,post hoc analysi ,respiratory tract infection ,030106 microbiology ,bloodstream infection ,minimum inhibitory concentration ,piperacillin plus tazobactam ,Tazobactam ,Article ,03 medical and health sciences ,critically ill patient ,Internal medicine ,Anti-Bacterial Agent ,medicine ,Sequential Organ Failure Assessment Score ,Thienamycin ,survival time ,blood analysi ,business.industry ,Blood Chemical Analysi ,major clinical study ,Surgery ,Prospective Studie ,multicenter study ,[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology ,piperacillin, tazobactam drug combination ,urinary tract infection ,business - Abstract
Objectives: We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged- infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies. Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries. Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT≥MIC (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving β-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of ≥ 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025]. Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
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- 2016
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4. Antimicrobial therapeutic drug monitoring in critically ill adult patients: a Position Paper#
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Fredrik Sjövall, Sebastian G. Wicha, Matteo Bassetti, Mohd H. Abdul-Aziz, Pharmacokinetic, José Artur Paiva, Deborah Marriott, Jason A. Roberts, George Dimopoulos, Hendrik Bracht, Jan J. De Waele, Federico Pea, Michael Neely, pharmacodynamic, Jean F. Timsit, Markus Zeitlinger, Andrew A. Udy, Jan-Willem C. Alffenaar, Abdul-Aziz M.H., Alffenaar J.-W.C., Bassetti M., Bracht H., Dimopoulos G., Marriott D., Neely M.N., Paiva J.-A., Pea F., Sjovall F., Timsit J.F., Udy A.A., Wicha S.G., Zeitlinger M., De Waele J.J., and Roberts J.A.
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Adult ,medicine.medical_specialty ,Critical Illness ,Pharmacokinetic ,Antifungal ,beta-Lactams ,Critical Care and Intensive Care Medicine ,law.invention ,Conference Report and Expert Panel ,03 medical and health sciences ,0302 clinical medicine ,Anti-Infective Agents ,law ,Sepsis ,Antimicrobial chemotherapy ,Humans ,Medicine ,Pharmacokinetics ,Dosing ,Antiviral ,Intensive care medicine ,Voriconazole ,Antifungals ,Pharmacodynamic ,Antibacterials ,Antivirals ,Pharmacodynamics ,medicine.diagnostic_test ,business.industry ,030208 emergency & critical care medicine ,Intensive care unit ,Anti-Bacterial Agents ,Antibacterial ,Transplantation ,030228 respiratory system ,Therapeutic drug monitoring ,Position paper ,Vancomycin ,Drug Monitoring ,business ,medicine.drug - Abstract
Purpose This Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and antivirals in critically ill adult patients in the intensive care unit (ICU). This Position Paper also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients. Methods Literature review and analysis were performed by Panel Members nominated by the endorsing organisations, European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) and International Society of Antimicrobial Chemotherapy (ISAC). Panel members made recommendations for whether TDM should be applied clinically for different antimicrobials/classes. Results TDM-guided dosing has been shown to be clinically beneficial for aminoglycosides, voriconazole and ribavirin. For most common antibiotics and antifungals in the ICU, a clear therapeutic range has been established, and for these agents, routine TDM in critically ill patients appears meritorious. For the antivirals, research is needed to identify therapeutic targets and determine whether antiviral TDM is indeed meritorious in this patient population. The Panel Members recommend routine TDM to be performed for aminoglycosides, beta-lactam antibiotics, linezolid, teicoplanin, vancomycin and voriconazole in critically ill patients. Conclusion Although TDM should be the standard of care for most antimicrobials in every ICU, important barriers need to be addressed before routine TDM can be widely employed worldwide. Electronic supplementary material The online version of this article (10.1007/s00134-020-06050-1) contains supplementary material, which is available to authorized users.
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- 2020
5. Valganciclovir Pharmacokinetics in Patients Receiving Oral Prophylaxis Following Kidney Transplantation and Model-Based Predictions of Optimal Dosing Regimens
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Jason A. Roberts, Piergiorgio Cojutti, Federico Pea, Thomas Tängdén, Tangden T., Cojutti P.G., Roberts J.A., and Pea F.
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0301 basic medicine ,Ganciclovir ,Cytomegalovirus Infection ,Adult ,Male ,medicine.medical_specialty ,030106 microbiology ,Urology ,Renal function ,Administration, Oral ,030226 pharmacology & pharmacy ,Antiviral Agents ,Models, Biological ,Drug Administration Schedule ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Pharmacokinetics ,Retrospective Studie ,Medicine ,Humans ,Valganciclovir ,Pharmacology (medical) ,Prodrugs ,Dosing ,Pharmacology ,Prodrug ,Kidney transplantation ,Aged ,Retrospective Studies ,Antiviral Agent ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Therapeutic drug monitoring ,Cytomegalovirus Infections ,Female ,Drug Monitoring ,business ,Monte Carlo Method ,medicine.drug ,Human - Abstract
Background and Objectives: Valganciclovir is used as oral prophylaxis for cytomegalovirus (CMV) infection in kidney transplant recipients. However, limited pharmacokinetic data exist to guide dosing in this patient group. This study aimed to describe the population pharmacokinetics of valganciclovir in a large sample of kidney transplant recipients and predict optimal dosing based on Monte Carlo simulations. Methods: Therapeutic drug monitoring (TDM) data from adult kidney transplant recipients who received valganciclovir prophylaxis during a 10-year study period were collected retrospectively. A non-parametric pharmacokinetic analysis and Monte Carlo simulations to determine the probabilities of reaching an area under the drug concentration–time curve (AUC) target of 40–50mg·h/L with various dosing regimens at different levels of renal function were conducted using the Pmetrics™ package for R. Results: This study included 792 ganciclovir concentration measurements derived from 97 patients. A one-compartment oral absorption model best described the data. The final covariate model was as follows: CL(ganciclovir)=TVCL×(CLCR/51)0.75, where CL is the clearance, TVCL is the typical value of ganciclovir clearance, creatinine clearance (CLCR) according to the Cockcroft-Gaultt equation and 51 is the mean CLCR determined in the study. In the simulations, the probability of reaching the targeted AUC was insufficient when using the recommended dosing regimens for prophylaxis, especially in patients with impaired renal function at CLCR 
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- 2018
6. An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units
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Otto R Frey, Russell J Benefield, Federico Pea, Jeffrey Lipman, Michael S. Roberts, Jacobus P.J. Ungerer, Anka C Roehr, Jason A. Roberts, Judit Preisenberger, Fabio Silvio Taccone, Thomas Robertson, Angela Huttner, Alexander Brinkman, Brett McWhinney, Gloria Wong, Stéphan Juergen Harbarth, Najoua El Helali, Fekade B. Sime, Mieke Carlier, Jan J. De Waele, Benoit Misset, Wong G., Brinkman A., Benefield R.J., Carlier M., De Waele J.J., Helali N.E., Frey O., Harbarth S., Huttner A., McWhinney B., Misset B., Pea F., Preisenberger J., Roberts M.S., Robertson T.A., Roehr A., Sime F.B., Taccone F.S., Ungerer J.P.J., Lipman J., Roberts J.A., Wong, Gloria, Brinkman, Alexander, Benefield, Russell J, Carlier, Mieke, Roberts, Michael S, Robertson, Thomas A, Sime, Fekade Bruck, and Roberts, Jason A
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Microbiology (medical) ,Drug ,medicine.medical_specialty ,Internationality ,medicine.drug_class ,Continuous infusion ,media_common.quotation_subject ,Antibiotics ,Intensive Care Unit ,Pharmacokinetic ,beta-Lactams ,law.invention ,TDM ,law ,Surveys and Questionnaires ,Intensive care ,Anti-Bacterial Agent ,medicine ,Antimicrobial ,Critical care ,Dosing ,Pharmacokinetics ,Pharmacology ,Pharmacology (medical) ,Infectious Diseases ,Medicine (all) ,polycyclic compounds ,Humans ,Surveys and Questionnaire ,Intensive care medicine ,media_common ,ddc:616 ,medicine.diagnostic_test ,business.industry ,Survey research ,Intensive care unit ,dosing ,Anti-Bacterial Agents ,critical care ,Intensive Care Units ,Therapeutic drug monitoring ,antimicrobial ,Drug Monitoring ,business ,pharmacokinetics ,Human - Abstract
Objectives: Emerging evidence supports the use of therapeutic drug monitoring (TDM) of β-lactams for intensive care unit (ICU) patients to optimize drug exposure, although limited detail is available on how sites run this service in practice. This multicentre survey study was performed to describe the various approaches used for β-lactam TDM in ICUs. Methods: A questionnaire survey was developed to describe various aspects relating to the conduct of β-lactam TDM in an ICU setting. Data sought included: β-lactams chosen for TDM, inclusion criteria for selecting patients, blood sampling strategy, analytical methods, pharmacokinetic (PK)/pharmacodynamic (PD) targets and dose adjustment strategies. Results: Nine ICUs were included in this survey. Respondents were either ICU or infectious disease physicians, pharmacists or clinical pharmacologists. Piperacillin (co-formulated with tazobactam) and meropenem (100% of units surveyed) were the β-lactams most commonly subject to TDM, followed by ceftazidime (78%), ceftriaxone (43%) and cefazolin (43%). Different chromatographic and microbiological methods were used for assay of β-lactam concentrations in blood and other biological fluids (e.g. CSF). There was significant variation in the PK/PD targets (100% fT>MIC up to 100% fT>4×MIC) and dose adjustment strategies used by each of the sites. Conclusions: Large variations were found in the type of β-lactams tested, the patients selected for TDM and drug assay methods. Significant variation observed in the PK/PD targets and dose adjustment strategies used supports the need for further studies that robustly define PK/PD targets for ICU patients to ensure a greater consistency of practice for dose adjustment strategies for optimizing β-lactam dosing with TDM. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
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- 2017
7. The Clinical Relevance of Plasma Protein Binding Changes
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Jeffrey Lipman, Jason A. Roberts, Federico Pea, Roberts J.A., Pea F., and Lipman J.
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Drug ,Metabolic Clearance Rate ,media_common.quotation_subject ,Context (language use) ,Pharmacology ,Kidney Function Tests ,Kidney ,Body Temperature ,Blood Protein ,Pharmacokinetics ,Intensive care ,Anti-Bacterial Agent ,Humans ,Medicine ,Pharmacology (medical) ,Dosing ,media_common ,Volume of distribution ,Kidney Function Test ,business.industry ,Kidney metabolism ,Blood Proteins ,Hydrogen-Ion Concentration ,Anti-Bacterial Agents ,Pharmacodynamics ,Drug Monitoring ,business ,Human ,Protein Binding - Abstract
Controversy reigns as to how protein binding changes alter the time course of unbound drug concentrations in patients. Given that the unbound concentration is responsible for drug efficacy and potential drug toxicity, this area is of significant interest to clinicians and academics worldwide. The present uncertainty means that many questions relating to this area exist, including "How important is protein binding?", "Is protein binding always constant?", "Do pH and temperature changes alter binding?" and "How do protein binding changes affect dosing requirements?". In this paper, we seek to address these questions and consider the data associated with altered pharmacokinetics in the presence of changes in protein binding and the clinical consequences that these may have on therapy, using examples from the critical care area. The published literature consistently indicates that a change in the protein binding and unbound concentrations of some drugs are common in certain specific patient groups such as the critically ill. Changes in pharmacokinetic parameters, including clearance and apparent volume of distribution (Vd), may be dramatic. Drugs with high protein binding, high intrinsic clearance (e.g. clearance by glomerular filtration) and where dosing is not titrated to effect are most likely to be affected in a clinical context. Drugs such as highly protein bound antibacterials with multiple half-lives within a dosing interval and that have some level of renal clearance, such as ertapenem, teicoplanin, ceftriaxone and flucloxacillin, are commonly affected. In response to these challenges, clinicians need to adapt dosing regimens rationally based on the pharmacokinetic/pharmacodynamic characteristics of the drug. We propose that further pharmacokinetic modelling-based research is required to enable the design of robust dosing regimens for drugs affected by altered protein binding. © 2012 Springer International Publishing Switzerland.
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- 2012
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8. DALI: Defining Antibiotic Levels in Intensive Care Unit Patients: Are Current -Lactam Antibiotic Doses Sufficient for Critically Ill Patients?
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Roberts JA, Lipman J, Starr T, Wallis SC, Paul SK, Margarit Ribas A, De Waele JJ, De Crop L, Spapen H, Wauters J, Dugernier T, Jorens P, Dapper I, De Backer D, Taccone FS, Rello J, Ruano L, Afonso E, Alvarez Lerma F, Gracia Arnillas MP, Fernández F, Feijoo N, Bardolet N, Rovira A, Garro P, Colon D, Castillo C, Fernado J, Lopez MJ, Fernandez JL, Arribas AM, Teja JL, Ots E, Carlos Montejo J, Catalan M, Prieto I, Gonzalo G, Galvan B, Blasco MA, Meyer E, Del Nogal F, Vidaur L, Sebastian R, Garde PM, Martin Velasco Mdel M, Zaragoza Crespo R, Esperatti M, Torres A, Montravers P, Baldesi O, Dupont H, Mahjoub Y, Lasocki S, Constantin JM, Payen JF, Martin C, Albanese J, Malledant Y, Pottecher J, Lefrant JY, Jaber S, Joannes Boyau O, Orban C, Ostermann M, McKenzie C, Berry W, Smith J, Lei K, Rubulotta F, Gordon A, Brett S, Stotz M, Templeton M, Rhodes A, Ebm C, Moran C, Kaukonen KM, Pettilä V, Dimopoulos G, Koulenti D, Xristodoulou A, Theodorou V, Kouliatsis G, Sertaridou E, Anthopoulos G, Choutas G, Rantis T, Karatzas S, Balla M, Papanikolaou M, Myrianthefs P, Gavala A, Fildisis G, Koutsoukou A, Kyriakopoulou M, Petrochilou K, Kompoti M, Michalia M, Clouva Molyvdas FM, Gkiokas G, Nikolakopoulos F, Psychogiou V, Malliotakis P, Akoumianaki E, Lilitsis E, Koulouras V, Nakos G, Kalogirou M, Komnos A, Zafeiridis T, Chaintoutis C, Arvaniti K, Matamis D, Kydona C, Gritsi Gerogianni N, Giasnetsova T, Giannakou M, Soultati I, Chytas I, Antoniadou E, Antipa E, Lathyris D, Koukoubani T, Paraforou T, Spiropoulou K, Bekos V, Spring A, Kalatzi T, Nikolaou H, Laskou M, Strouvalis I, Aloizos S, Kapogiannis S, Soldatou O, Bassetti M, Adembri C, Villa G, Montalto F, Strano MT, Ranieri VM, Sandroni C, De Pascale G, Molin A, Pelosi P, Montagnani L, Urbino R, Mastromauro I, De Rosa FG, Cardoso T, Afonso S, Gonçalves Pereira J, Baptista JP, Akova M, Ozveren A., GIARRATANO, Antonino, RAINERI, Santi Maurizio, CORTEGIANI, Andrea, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Roberts JA, Lipman J, Starr T, Wallis SC, Paul SK, Margarit Ribas A, De Waele JJ, De Crop L, Spapen H, Wauters J, Dugernier T, Jorens P, Dapper I, De Backer D, Taccone FS, Rello J, Ruano L, Afonso E, Alvarez-Lerma F, Gracia-Arnillas MP, Fernández F, Feijoo N, Bardolet N, Rovira A, Garro P, Colon D, Castillo C, Fernado J, Lopez MJ, Fernandez JL, Arribas AM, Teja JL, Ots E, Carlos Montejo J, Catalan M, Prieto I, Gonzalo G, Galvan B, Blasco MA, Meyer E, Del Nogal F, Vidaur L, Sebastian R, Garde PM, Martin Velasco Mdel M, Zaragoza Crespo R, Esperatti M, Torres A, Montravers P, Baldesi O, Dupont H, Mahjoub Y, Lasocki S, Constantin JM, Payen JF, Martin C, Albanese J, Malledant Y, Pottecher J, Lefrant JY, Jaber S, Joannes-Boyau O, Orban C, Ostermann M, McKenzie C, Berry W, Smith J, Lei K, Rubulotta F, Gordon A, Brett S, Stotz M, Templeton M, Rhodes A, Ebm C, Moran C, Kaukonen KM, Pettilä V, Dimopoulos G, Koulenti D, Xristodoulou A, Theodorou V, Kouliatsis G, Sertaridou E, Anthopoulos G, Choutas G, Rantis T, Karatzas S, Balla M, Papanikolaou M, Myrianthefs P, Gavala A, Fildisis G, Koutsoukou A, Kyriakopoulou M, Petrochilou K, Kompoti M, Michalia M, Clouva-Molyvdas FM, Gkiokas G, Nikolakopoulos F, Psychogiou V, Malliotakis P, Akoumianaki E, Lilitsis E, Koulouras V, Nakos G, Kalogirou M, Komnos A, Zafeiridis T, Chaintoutis C, Arvaniti K, Matamis D, Kydona C, Gritsi-Gerogianni N, Giasnetsova T, Giannakou M, Soultati I, Chytas I, Antoniadou E, Antipa E, Lathyris D, Koukoubani T, Paraforou T, Spiropoulou K, Bekos V, Spring A, Kalatzi T, Nikolaou H, Laskou M, Strouvalis I, Aloizos S, Kapogiannis S, Soldatou O, Bassetti M, Adembri C, Villa G, Giarratano A, Raineri SM, Cortegiani A, Montalto F, Strano MT, Ranieri VM, Sandroni C, De Pascale G, Molin A, Pelosi P, Montagnani L, Urbino R, Mastromauro I, De Rosa FG, Cardoso T, Afonso S, Gonçalves-Pereira J, Baptista JP, Akova M, Ozveren A, Roberts, J.A., Paul, S.K., Akova, M., Bassetti, M., De Waele, J.J., Dimopoulos, G., Kaukonen, K.-M., Koulenti, D., Martin, C., Montravers, P., Rello, J., Rhodes, A., Starr, T., Wallis, S.C., Lipman, J., Margarit Ribas, A., De Crop, L., Spapen, H., Wauters, J., Dugernier, T., Jorens, P., Dapper, I., De Backer, D., Taccone, F.S., Ruano, L., Afonso, E., Alvarez-Lerma, F., Gracia-Arnillas, M.P., Fernández, F., Feijoo, N., Bardolet, N., Rovira, A., Garro, P., Colon, D., Castillo, C., Fernado, J., Lopez, M.J., Fernandez, J.L., Arribas, A.M., Teja, J.L., Ots, E., Carlos Montejo, J., Catalan, M., Prieto, I., Gonzalo, G., Galvan, B., Blasco, M.A., Meyer, E., Del Nogal, F., Vidaur, L., Sebastian, R., Garde, P.M., Martin Velasco, M.D.M., Zaragoza Crespo, R., Esperatti, M., Torres, A., Baldesi, O., Dupont, H., Mahjoub, Y., Lasocki, S., Constantin, J.M., Payen, J.F., Albanese, J., Malledant, Y., Pottecher, J., Lefrant, J.-Y., Jaber, S., Joannes-Boyau, O., Orban, C., Ostermann, M., McKenzie, C., Berry, W., Smith, J., Lei, K., Rubulotta, F., Gordon, A., Brett, S., Stotz, M., Templeton, M., Ebm, C., Moran, C., Pettilä, V., Xristodoulou, A., Theodorou, V., Kouliatsis, G., Sertaridou, E., Anthopoulos, G., Choutas, G., Rantis, T., Karatzas, S., Balla, M., Papanikolaou, M., Myrianthefs, P., Gavala, A., Fildisis, G., Koutsoukou, A., Kyriakopoulou, M., Petrochilou, K., Kompoti, M., Michalia, M., Clouva-Molyvdas, F.-M., Gkiokas, G., Nikolakopoulos, F., Psychogiou, V., Malliotakis, P., Akoumianaki, E., Lilitsis, E., Koulouras, V., Nakos, G., Kalogirou, M., Komnos, A., Zafeiridis, T., Chaintoutis, C., Arvaniti, K., Matamis, D., Kydona, C., Gritsi-Gerogianni, N., Giasnetsova, T., Giannakou, M., Soultati, I., Chytas, I., Antoniadou, E., Antipa, E., Lathyris, D., Koukoubani, T., Paraforou, T., Spiropoulou, K., Bekos, V., Spring, A., Kalatzi, T., Nikolaou, H., Laskou, M., Strouvalis, I., Aloizos, S., Kapogiannis, S., Soldatou, O., Adembri, C., Villa, G., Giarratano, A., Maurizio Raineri, S., Cortegiani, A., Montalto, F., Strano, M.T., Ranieri, V.M., Sandroni, C., De Pascale, G., Molin, A., Pelosi, P., Montagnani, L., Urbino, R., Mastromauro, I., De Rosa, F.G., Cardoso, T., Afonso, S., Gonçalves-Pereira, J., Baptista, J.P., Özveren, A., İç Hastalıkları, and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
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Male ,International Cooperation ,Antibiotics ,adverse event ,intensive care unit ,law.invention ,0302 clinical medicine ,meropenem ,Models ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,adverse events ,continuous infusion ,extended infusion ,pharmacodynamics ,pharmacokinetics ,Aged ,Anti-Bacterial Agents ,Bacterial Infections ,Blood Chemical Analysis ,Female ,Humans ,Intensive Care Units ,Microbial Sensitivity Tests ,Middle Aged ,Models, Statistical ,Prospective Studies ,Treatment Outcome ,beta-Lactams ,Critical Illness ,antibiotic therapy ,amoxicillin plus clavulanic acid ,ComputingMilieux_MISCELLANEOUS ,beta lactam antibiotic ,APACHE ,0303 health sciences ,critical illne ,adult ,clinical trial ,3. Good health ,antiinfective agent ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,priority journal ,disease severity ,beta-Lactam ,statistical model, Aged ,prospective study ,Human ,Microbiology (medical) ,medicine.medical_specialty ,drug exposure ,Immunology ,bloodstream infection ,piperacillin plus tazobactam ,Microbiology ,beta lactam, abdominal infection ,03 medical and health sciences ,critically ill patient ,Intensive care ,Anti-Bacterial Agent ,cefepime ,Dosing ,Adverse effect ,030306 microbiology ,Odds ratio ,major clinical study ,mortality ,antibiotic sensitivity ,ceftriaxone ,Prospective Studie ,multicenter study ,ampicillin ,Ceftazidime ,Settore MED/41 - Anestesiologia ,Interquartile range ,law ,030212 general & internal medicine ,pharmacokinetic ,lung infection ,Microbial Sensitivity Test ,article ,Statistical ,Intensive care unit ,Infectious Diseases ,cefazolin ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,blood sampling ,medicine.drug ,medicine.drug_class ,prevalence ,doripenem ,minimum inhibitory concentration ,Bacterial Infection ,Internal medicine ,medicine ,controlled study ,blood analysi ,business.industry ,Blood Chemical Analysi ,Surgery ,pharmacodynamic ,drug blood level ,business - Abstract
Background. Morbidity and mortality for critically ill patients with infections remains a global healthcare problem. We aimed to determine whether α-lactam antibiotic dosing in critically ill patients achieves concentrations associated with maximal activity and whether antibiotic concentrations affect patient outcome.Methods. This was a prospective, multinational pharmacokinetic point-prevalence study including 8 α-lactam antibiotics. Two blood samples were taken from each patient during a single dosing interval. The primary pharmacokinetic/pharmacodynamic targets were free antibiotic concentrations above the minimum inhibitory concentration (MIC) of the pathogen at both 50% (50% f TMIC) and 100% (100% f T MIC) of the dosing interval. We used skewed logistic regression to describe the effect of antibiotic exposure on patient outcome.Results. We included 384 patients (361 evaluable patients) across 68 hospitals. The median age was 61 (interquartile range [IQR], 48-73) years, the median Acute Physiology and Chronic Health Evaluation II score was 18 (IQR, 14-24), and 65% of patients were male. Of the 248 patients treated for infection, 16% did not achieve 50% f TMIC and these patients were 32% less likely to have a positive clinical outcome (odds ratio [OR], 0.68; P =. 009). Positive clinical outcome was associated with increasing 50% f TMIC and 100% f TMIC ratios (OR, 1.02 and 1.56, respectively; P
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- 2014
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9. Variability in protein binding of teicoplanin and achievement of therapeutic drug monitoring targets in critically ill patients: Lessons from the DALI Study
- Author
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Roberts, J. A., Stove, V., De Waele, J. J., Sipinkoski, B., McWhinney, B., Ungerer, J. P. J., Akova, M., Bassetti, M., Dimopoulos, G., Kaukonen, K. -M., Koulenti, D., Martin, C., Montravers, P., Rello, J., Rhodes, A., Starr, T., Wallis, S. C., Lipman, J., Paul, S., Ribas, A. M., DeCrop, L., Spapen, H., Wauters, J., Dugernier, T., Jorens, P., Dapper, I., De Backer, D., Taccone, F. S., Ruano, L., Afonso, E., Alvarez-Lerma, F., Gracia-Arnillas, M. P., Fernández, F., Feijoo, N., Bardolet, N., Rovira, A., Garro, P., Colon, D., Castillo, C., Fernado, J., Lopez, M. J., Fernandez, J. L., Arribas, A. M., Teja, J. L., Ots, E., Montejo, J. C., Catalan, M., Prieto, I., Gonzalo, G., Galvan, B., Blasco, M. A., Meyer, E., Nogal, F. D., Vidaur, L., Sebastian, R., Garde, P. M., Velasco Mdel, M., Crespo, R. Z., Esperatti, M., Torres, A., Baldesi, O., Dupont, H., Mahjoub, Y., Lasocki, S., Constantin, J. M., Payen, J. F., Albanese, J., Malledant, Y., Pottecher, J., Lefrant, J. Y., Jaber, S., Joannes-Boyau, O., Orban, C., Ostermann, M., McKenzie, C., Berry, W., Smith, J., Lei, K., Rubulotta, F., Gordon, A., Brett, S., Stotz, M., Templeton, M., Ebm, C., Moran, C., Pettilä, V., Xristodoulou, A., Theodorou, V., Kouliatsis, G., Sertaridou, E., Anthopoulos, G., Choutas, G., Rantis, T., Karatzas, S., Balla, M., Papanikolaou, M., Myrianthefs, P., Gavala, A., Fildisis, G., Koutsoukou, A., Kyriakopoulou, M., Petrochilou, K., Kompoti, M., Michalia, M., Clouva-Molyvdas, F. M., Gkiokas, G., Nikolakopoulos, F., Psychogiou, V., Malliotakis, P., Akoumianaki, E., Lilitsis, E., Koulouras, V., Nakos, G., Kalogirou, M., Komnos, A., Zafeiridis, T., Chaintoutis, C., Arvaniti, K., Matamis, D., Kydona, C., Gritsi-Gerogianni, N., Giasnetsova, T., Giannakou, M., Soultati, I., Chytas, I., Antoniadou, E., Antipa, E., Lathyris, D., Koukoubani, T., Paraforou, T., Spiropoulou, K., Bekos, V., Spring, A., Kalatzi, T., Nikolaou, H., Laskou, M., Strouvalis, I., Aloizos, S., Kapogiannis, S., Soldatou, O., Adembri, C., Villa, G., Giarratano, A., Raineri, S. M., Cortegiani, A., Montalto, F., Strano, M. T., Ranieri, V. M., Sandroni, C., De Pascale, G., Molin, A., Pelosi, P., Montagnani, L., Urbino, R., Mastromauro, I., DeRosa, F. G., Cardoso, T., Afonso, S., Gonçalves-Pereira, J., Baptista, J. P., Özveren, A., Roberts JA, Lipman J, Starr T, Wallis SC, Paul S, Ribas AM, De Waele JJ, DeCrop L, Spapen H, Wauters J, Dugernier T, Jorens P, Dapper I, De Backer D, Taccone FS, Rello J, Ruano L, Afonso E, Alvarez-Lerma F, Gracia-Arnillas MP, Fernández F, Feijoo N, Bardolet N, Rovira A, Garro P, Colon D, Castillo C, Fernado J, Lopez MJ, Fernandez JL, Arribas AM, Teja JL, Ots E, Montejo JC, Catalan M, Prieto I, Gonzalo G, Galvan B, Blasco MA, Meyer E, Nogal FD, Vidaur L, Sebastian R, Garde PM, Velasco Mdel M, Crespo RZ, Esperatti M, Torres A, Montravers P, Baldesi O, Dupont H, Mahjoub Y, Lasocki S, Constantin JM, Payen JF, Martin C, Albanese J, Malledant Y, Pottecher J, Lefrant JY, Jaber S, Joannes-Boyau O, Orban C, Ostermann M, McKenzie C, Berry W, Smith J, Lei K, Rubulotta F, Gordon A, Brett S, Stotz M, Templeton M, Rhodes A, Ebm C, Moran C, Kaukonen KM, Pettilä V, Dimopoulos G, Koulenti D, Xristodoulou A, Theodorou V, Kouliatsis G, Sertaridou E, Anthopoulos G, Choutas G, Rantis T, Karatzas S, Balla M, Papanikolaou M, Myrianthefs P, Gavala A, Fildisis G, Koutsoukou A, Kyriakopoulou M, Petrochilou K, Kompoti M, Michalia M, Clouva-Molyvdas FM, Gkiokas G, Nikolakopoulos F, Psychogiou V, Malliotakis P, Akoumianaki E, Lilitsis E, Koulouras V, Nakos G, Kalogirou M, Komnos A, Zafeiridis T, Chaintoutis C, Arvaniti K, Matamis D, Kydona C, Gritsi-Gerogianni N, Giasnetsova T, Giannakou M, Soultati I, Chytas I, Antoniadou E, Antipa E, Lathyris D, Koukoubani T, Paraforou T, Spiropoulou K, Bekos V, Spring A, Kalatzi T, Nikolaou H, Laskou M, Strouvalis I, Aloizos S, Kapogiannis S, Soldatou O, Bassetti M, Adembri C, Villa G, Giarratano A, Raineri SM, Cortegiani A, Montalto F, Strano MT, Ranieri VM, Sandroni C, De Pascale G, Molin A, Pelosi P, Montagnani L, Urbino R, Mastromauro I, DeRosa FG, Cardoso T, Afonso S, Gonçalves-Pereira J, Baptista JP, Akova M, Özveren A, Hôpital Nord [CHU - APHM], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Roberts, J.A., Stove, V., De Waele, J.J., Sipinkoski, B., McWhinney, B., Ungerer, J.P.J., Akova, M., Bassetti, M., Dimopoulos, G., Kaukonen, K.-M., Koulenti, D., Martin, C., Montravers, P., Rello, J., Rhodes, A., Starr, T., Wallis, S.C., Lipman, J., Paul, S., Ribas, A.M., DeCrop, L., Spapen, H., Wauters, J., Dugernier, T., Jorens, P., Dapper, I., De Backer, D., Taccone, F.S., Ruano, L., Afonso, E., Alvarez-Lerma, F., Gracia-Arnillas, M.P., Fernández, F., Feijoo, N., Bardolet, N., Rovira, A., Garro, P., Colon, D., Castillo, C., Fernado, J., Lopez, M.J., Fernandez, J.L., Arribas, A.M., Teja, J.L., Ots, E., Montejo, J.C., Catalan, M., Prieto, I., Gonzalo, G., Galvan, B., Blasco, M.A., Meyer, E., Nogal, F.D., Vidaur, L., Sebastian, R., Garde, P.M., Velasco Mdel, M., Crespo, R.Z., Esperatti, M., Torres, A., Baldesi, O., Dupont, H., Mahjoub, Y., Lasocki, S., Constantin, J.M., Payen, J.F., Albanese, J., Malledant, Y., Pottecher, J., Lefrant, J.Y., Jaber, S., Joannes-Boyau, O., Orban, C., Ostermann, M., McKenzie, C., Berry, W., Smith, J., Lei, K., Rubulotta, F., Gordon, A., Brett, S., Stotz, M., Templeton, M., Ebm, C., Moran, C., Pettilä, V., Xristodoulou, A., Theodorou, V., Kouliatsis, G., Sertaridou, E., Anthopoulos, G., Choutas, G., Rantis, T., Karatzas, S., Balla, M., Papanikolaou, M., Myrianthefs, P., Gavala, A., Fildisis, G., Koutsoukou, A., Kyriakopoulou, M., Petrochilou, K., Kompoti, M., Michalia, M., Clouva-Molyvdas, F.M., Gkiokas, G., Nikolakopoulos, F., Psychogiou, V., Malliotakis, P., Akoumianaki, E., Lilitsis, E., Koulouras, V., Nakos, G., Kalogirou, M., Komnos, A., Zafeiridis, T., Chaintoutis, C., Arvaniti, K., Matamis, D., Kydona, C., Gritsi-Gerogianni, N., Giasnetsova, T., Giannakou, M., Soultati, I., Chytas, I., Antoniadou, E., Antipa, E., Lathyris, D., Koukoubani, T., Paraforou, T., Spiropoulou, K., Bekos, V., Spring, A., Kalatzi, T., Nikolaou, H., Laskou, M., Strouvalis, I., Aloizos, S., Kapogiannis, S., Soldatou, O., Adembri, C., Villa, G., Giarratano, A., Raineri, S.M., Cortegiani, A., Montalto, F., Strano, M.T., Ranieri, V.M., Sandroni, C., De Pascale, G., Molin, A., Pelosi, P., Montagnani, L., Urbino, R., Mastromauro, I., DeRosa, F.G., Cardoso, T., Afonso, S., Gonçalves-Pereira, J., Baptista, J.P., Özveren, A., and İç Hastalıkları
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Male ,validity ,validation proce ,International Cooperation ,Settore MED/41 - Anestesiologia ,drug protein binding ,Gastroenterology ,law.invention ,Plasma ,Staphylococcus infection ,Critically ill patients ,Interquartile range ,law ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Antibiotics ,antibiotic therapy ,Pharmacology (medical) ,Pharmacology & Pharmacy ,Glycopeptides ,Hypoalbuminaemia ,ICU ,Pharmacokinetics ,Adult ,Aged ,Anti-Bacterial Agents ,Chromatography ,Critical Illness ,Female ,Humans ,Middle Aged ,Protein Binding ,Teicoplanin ,Young Adult ,Drug Monitoring ,Microbiology (medical) ,Infectious Diseases ,clinical article ,medicine.diagnostic_test ,drug dose regimen ,critical illne ,Medicine (all) ,article ,clinical trial ,General Medicine ,trough time concentration ,drug protein binding variability ,Intensive care unit ,Glycopeptides, Antibiotics, Critically ill patients, Pharmacokinetics, Hypoalbuminaemia, ICU ,3. Good health ,antiinfective agent ,drug distribution ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,priority journal ,multicenter study (topic) ,Vancomycin ,blood sampling ,Critically ill patient ,Human ,medicine.drug ,medicine.medical_specialty ,high performance liquid chromatography ,area under the curve ,ultraviolet spectroscopy ,mid dose concentration ,chemistry ,Glycopeptide ,Microbiology ,teicoplanin, adult ,enterococcal infection ,young adult, Adult ,drug clearance ,Therapeutic index ,Internal medicine ,Anti-Bacterial Agent ,medicine ,steady state ,Dosing ,business.industry ,drug half life ,Antibiotic ,recommended drug dose ,calibration ,Surgery ,multicenter study ,Therapeutic drug monitoring ,drug blood level ,[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology ,free plasma drug concentration ,business ,metabolism - Abstract
The aims of this study were to describe the variability in protein binding of teicoplanin in critically ill patients as well as the number of patients achieving therapeutic target concentrations. This report is part of the multinational pharmacokinetic DALI Study. Patients were sampled on a single day, with blood samples taken both at the midpoint and the end of the dosing interval. Total and unbound teicoplanin concentrations were assayed using validated chromatographic methods. The lower therapeutic range of teicoplanin was defined as total trough concentrations from 10 to 20 mg/L and the higher range as 10-30 mg/L. Thirteen critically ill patients were available for analysis. The following are the median (interquartile range) total and free concentrations (mg/L): midpoint, total 13.6(11.2-26.0) and free 1.5 (0.7-2.5); trough, total 11.9 (10.2-22.7) and free 1.8 (0.6-2.6). The percentage free teicoplanin for the mid-dose and trough time points was 6.9% (4.5-15.6%) and 8.2% (5.5-16.4%), respectively. The correlation between total and free antibiotic concentrations was moderate for both the midpoint (rho=0.79, P = 0.0021) and trough (rho = 0.63, P = 0.027). Only 42% and 58% of patients were in the lower and higher therapeutic ranges, respectively. In conclusion, use of standard dosing for teicoplanin leads to inappropriate concentrations in a high proportion of critically ill patients. Variability in teicoplanin protein binding is very high, placing significant doubt on the validity of total concentrations for therapeutic drug monitoring in critically ill patients. (C) 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
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- 2014
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