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M P Glauser - One of the best experts on this subject based on the ideXlab platform.

  • piperacillin tazobactam plus Amikacin versus ceftazidime plus Amikacin as empiric therapy for fever in granulocytopenic patients with cancer the international antimicrobial therapy cooperative group of the european organization for research and treat
    Antimicrobial Agents and Chemotherapy, 1995
    Co-Authors: A Cometta, Jean Klastersky, Thierry Calandra, H Gaya, Stephen H Zinner, R De Bock, J Langenaeken, Marianne Paesmans, C Viscoli, M P Glauser
    Abstract:

    Gram-positive bacteria have become the predominant infecting organisms in granulocytopenic cancer patients. Empiric antibiotic regimens used in febrile neutropenic patients often include an extended-spectrum cephalosporin, but the response to therapy in gram-positive coccal bacteremia has been unsatisfactory. Thus, new antibiotics with better activity against gram-positive bacteria should be tested. The objective of this prospective randomized controlled study was to evaluate and compare the efficacy and tolerance of piperacillintazobactam plus Amikacin with that of ceftazidime plus Amikacin, the standard regimen of the International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer, in the empiric treatment of febrile granulocytopenic cancer patients. A total of 858 episodes were eligible for this study, and 706 episodes were assessable for efficacy. The antibiotic treatment was successful in 210 (61%) of 342 episodes in the piperacillin-tazobactam-Amikacin group compared with 196 (54%) of 364 episodes treated with ceftazidime plus Amikacin (P = 0.05). The time to defervescence was significantly shorter (P = 0.01) and the time to failure was significantly longer (P = 0.02) in the piperacillin-tazobactam-Amikacin group. A significant difference in response to bacteremic infections between the two patient groups was found: piperacillin-tazobactam plus Amikacin was successful in 40 of 80 episodes (50%), and ceftazidime plus Amikacin was successful in 35 of 101 episodes (35%) (P = 0.05). A multivariate analysis showed that the probability of failure was significantly greater with ceftazidime plus Amikacin than with piperacillin-tazobactam plus Amikacin (P = 0.02). This trial suggests that piperacillin-tazobactam plus Amikacin is more effective than ceftazidime plus Amikacin for the empiric treatment of fever and bacteremia in granulocytopenic cancer patients. Although cutaneous reaction was more frequently associated with piperacillin-tazobactam plus Amikacin than with ceftazidime-Amikacin, this unwanted effect was relatively mild and its incidence was comparable to that of other penicillin compounds.

Jason A Roberts - One of the best experts on this subject based on the ideXlab platform.

Martin Gutierrez - One of the best experts on this subject based on the ideXlab platform.

  • cefepime plus Amikacin versus piperacillin tazobactam plus Amikacin for initial antibiotic therapy in haematology patients with febrile neutropenia results of an open randomized multicentre trial
    Journal of Antimicrobial Chemotherapy, 2002
    Co-Authors: Miguel A Sanz, Javier Lopez, Juan J Lahuerta, Montserrat Rovira, Montserrat Batlle, Cristina Fernandez Perez, L Vazquez, Antonio Julia, Javier Palau, Martin Gutierrez
    Abstract:

    BACKGROUND Standard therapy for suspected infections in patients with profound neutropenia is the combination of a beta-lactam antibiotic plus an aminoglycoside. Cefepime's broad-spectrum activity makes it an option for initial empirical therapy in neutropenic patients. The aim of this study is to evaluate the efficacy and safety of cefepime plus Amikacin compared with piperacillin-tazobactam plus Amikacin for initial empirical treatment of fever in adult haematology patients with severe neutropenia. METHODS In this prospective multicentre trial, 969 patients with 984 febrile neutropenic episodes were randomized to receive iv Amikacin (20 mg/kg every 24 h) combined with either cefepime (2 g every 8 h) or piperacillin-tazobactam (4 g/500 mg every 6 h). Clinical response was determined at 72 h and at completion of therapy. RESULTS Eight hundred and sixty-seven episodes were assessable for efficacy (432 cefepime, 435 piperacillin-tazobactam). The frequency of success without modification of the empirical therapy was nearly identical for cefepime plus Amikacin (49%) compared with piperacillin-tazobactam plus Amikacin (51%). Similar rates of success were found for microbiologically documented infection: 40% versus 39%, respectively. Antibiotic modification was necessary in 49% of cefepime and 44% of piperacillin-tazobactam patients. The overall response rate, with or without modification of the assigned treatment, was 94% in both groups. Drug-related adverse events were reported in 10% of cefepime plus Amikacin versus 11% of piperacillin-tazobactam plus Amikacin patients. Mortality due to infection occurred in a total of 10 patients (two cefepime, eight piperacillin-tazobactam). CONCLUSION The empirical regimen of cefepime plus Amikacin is equivalent to piperacillin-tazobactam plus Amikacin in febrile adult haematology patients with severe neutropenia. KEYWORDS cefepime, piperacillin-tazobactam, Amikacin, empirical antibiotic therapy, febrile neutropenia, haematological malignancy

Clinton K Murray - One of the best experts on this subject based on the ideXlab platform.

  • once daily Amikacin dosing in burn patients treated with continuous venovenous hemofiltration
    Antimicrobial Agents and Chemotherapy, 2011
    Co-Authors: Kevin S Akers, Jason M Cota, Christopher R Frei, Kevin K Chung, Katrin Mende, Clinton K Murray
    Abstract:

    Amikacin clearance can be increased in burn injury, which is often complicated by renal insufficiency. Little is known about the impact of renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), on Amikacin pharmacokinetics. We retrospectively examined the clinical pharmacokinetics, bacteriology, and clinical outcomes of 60 burn patients given 15 mg/kg of body weight of Amikacin in single daily doses. Twelve were treated with concurrent CVVH therapy, and 48 were not. The pharmacodynamic target of ≥10 for the maximum concentration of drug in serum divided by the MIC (C(max)/MIC) was achieved in only 8.5% of patients, with a small reduction of C(max) in patients receiving CVVH and no difference in Amikacin clearance. Mortality and burn size were greater in patients who received CVVH. Overall, 172 Gram-negative isolates were recovered from the blood cultures of 39 patients, with Amikacin MIC data available for 82 isolates from 24 patients. A 10,000-patient Monte Carlo simulation was conducted incorporating pharmacokinetic and MIC data from these patients. The cumulative fraction of response (CFR) was similar in CVVH and non-CVVH patients. The CFR rates were not significantly improved by a theoretical 20 mg/kg Amikacin dose. Overall, CVVH did not appear to have a major impact on Amikacin serum concentrations. The low pharmacodynamic target attainment appears to be primarily due to higher Amikacin MICs rather than more rapid clearance of Amikacin related to CVVH therapy.

Pedreira, Mavilde Da Luz Gonçalves - One of the best experts on this subject based on the ideXlab platform.

  • Potencial hidrogeniônico de soluções de antibióticos submetidas a condições ambientais: ensaio preliminar
    Universidade de São Paulo. Escola de Enfermagem, 2012
    Co-Authors: Monteiro Cintia, Crepaldi, Renata Maria Coelho, Avelar, Ariane Ferreira Machado, Peterlini, Maria Angélica Sorgini, Pedreira, Mavilde Da Luz Gonçalves
    Abstract:

    This experimental study was performed to assess the hydrogen potential (pH) of the antimicrobials ceftriaxone sodium, vancomycin hydrochloride, metronidazole, penicillin G potassium, and Amikacin sulphate, following reconstitution, diluted with NaCl 0.9% (SF) and glucose solution 5% (GS), at eight different time intervals and under the normal daily conditions of lighting and temperature within the hospital unit (no air conditioning). The objective of this study was to verify the changes in the acid-base behavior of the solutions, which indicate chemical instability and can be associated with complications during intravenous therapy. Of the 186 analyzed pH values, there were no variations greater than 1.0 and no physical alterations visible to the naked eye. All solutions had a pH less than 7, and there were no significant differences for clinical practice regarding the diluent. The mean pH values after dilution with SF and GS for vancomycin hydrochloride, metronidazole, and Amikacin sulphate are a risk factor for the development of intravenous complications due to their extreme acidity.Estudio experimental de contraste del potencial de hidrógeno (pH) de antimicrobianos ceftriaxona sódica, clorhidrato de vancomicina, metronidazol, penicilina G potásica y sulfato de Amikacina, luego de reconstitución, dilución con NaCl 0,9% (SF) y suero glucosado 5% (SG), en ocho momentos distintos, bajo condiciones normales de luminosidad y temperatura de unidad hospitalaria no climatizada. Objetivó verificar alteraciones del comportamiento ácido-básico de las soluciones, indicativas de inestabilidades químicas o relacionadas a complicaciones de terapia intravenosa. En 186 pH analizados, no se identificaron variaciones mayores a 1,0 valor, ni alteraciones físicas a simple vista. Todas las soluciones tuvieron pH menor a 7, no hubo diferencia considerable para la práctica clínica según el diluyente. Los promedios de valor de pH luego de dilución en SF y SG para clorhidrato de vancomicina, metronidazol y sulfato de Amikacina constituyen factor de riesgo para desarrollo de complicaciones intravenosas debido a su extrema acidez.Estudo experimental para aferição do potencial hidrogeniônico (pH) dos antimicrobianos ceftriaxona sódica, cloridrato de vancomicina, metronidazol, penicilina G potássica e sulfato de amicacina, após reconstituição, diluição com NaCl 0,9% (SF) e soro glicosado 5% (SG), em oito momentos distintos e sob condições cotidianas de luminosidade e temperatura ambiente de unidade hospitalar não climatizada. O objetivo deste estudo foi verificar alterações no comportamento ácido-básico das soluções, indicativas de instabilidade química ou relacionadas a complicações da terapia intravenosa. Nos 186 valores de pH analisados, não foram identificadas variações maiores que 1,0 valor nem alterações físicas visíveis a olho nu. Todas as soluções tiveram pH menor que 7 e não houve diferença considerável para a prática clínica segundo o diluente. As médias dos valores de pH após a diluição em SF e SG, do cloridrato de vancomicina, metronidazol e sulfato de amicacina constituem fator de risco para o desenvolvimento de complicações intravenosas devido a sua extrema acidez

  • Potencial de hidrógeno de soluciones de antibióticos sometidas a condiciones ambientales: ensayo preliminar
    'FapUNIFESP (SciELO)', 2012
    Co-Authors: Monteiro Cintia, Crepaldi, Renata Maria Coelho, Avelar, Ariane Ferreira Machado, Peterlini, Maria Angélica Sorgini, Pedreira, Mavilde Da Luz Gonçalves
    Abstract:

    This experimental study was performed to assess the hydrogen potential (pH) of the antimicrobials ceftriaxone sodium, vancomycin hydrochloride, metronidazole, penicillin G potassium, and Amikacin sulphate, following reconstitution, diluted with NaCl 0.9% (SF) and glucose solution 5% (GS), at eight different time intervals and under the normal daily conditions of lighting and temperature within the hospital unit (no air conditioning). The objective of this study was to verify the changes in the acid-base behavior of the solutions, which indicate chemical instability and can be associated with complications during intravenous therapy. Of the 186 analyzed pH values, there were no variations greater than 1.0 and no physical alterations visible to the naked eye. All solutions had a pH less than 7, and there were no significant differences for clinical practice regarding the diluent. The mean pH values after dilution with SF and GS for vancomycin hydrochloride, metronidazole, and Amikacin sulphate are a risk factor for the development of intravenous complications due to their extreme acidity.Estudio experimental de contraste del potencial de hidrógeno (pH) de antimicrobianos ceftriaxona sódica, clorhidrato de vancomicina, metronidazol, penicilina G potásica y sulfato de Amikacina, luego de reconstitución, dilución con NaCl 0,9% (SF) y suero glucosado 5% (SG), en ocho momentos distintos, bajo condiciones normales de luminosidad y temperatura de unidad hospitalaria no climatizada. Objetivó verificar alteraciones del comportamiento ácido-básico de las soluciones, indicativas de inestabilidades químicas o relacionadas a complicaciones de terapia intravenosa. En 186 pH analizados, no se identificaron variaciones mayores a 1,0 valor, ni alteraciones físicas a simple vista. Todas las soluciones tuvieron pH menor a 7, no hubo diferencia considerable para la práctica clínica según el diluyente. Los promedios de valor de pH luego de dilución en SF y SG para clorhidrato de vancomicina, metronidazol y sulfato de Amikacina constituyen factor de riesgo para desarrollo de complicaciones intravenosas debido a su extrema acidez.Estudo experimental para aferição do potencial hidrogeniônico (pH) dos antimicrobianos ceftriaxona sódica, cloridrato de vancomicina, metronidazol, penicilina G potássica e sulfato de amicacina, após reconstituição, diluição com NaCl 0,9% (SF) e soro glicosado 5% (SG), em oito momentos distintos e sob condições cotidianas de luminosidade e temperatura ambiente de unidade hospitalar não climatizada. O objetivo deste estudo foi verificar alterações no comportamento ácido-básico das soluções, indicativas de instabilidade química ou relacionadas a complicações da terapia intravenosa. Nos 186 valores de pH analisados, não foram identificadas variações maiores que 1,0 valor nem alterações físicas visíveis a olho nu. Todas as soluções tiveram pH menor que 7 e não houve diferença considerável para a prática clínica segundo o diluente. As médias dos valores de pH após a diluição em SF e SG, do cloridrato de vancomicina, metronidazol e sulfato de amicacina constituem fator de risco para o desenvolvimento de complicações intravenosas devido a sua extrema acidez.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de EnfermagemUNIFESP, EPESciEL