Pharmacotherapy
-
Disseminated Mycobacterium avium complex (MAC) infection is a common opportunistic disease in patients with acquired immunodeficiency syndrome and is associated with significant morbidity and mortality. Macrolides effectively prevented and treated the disease in clinical trials. In general, prophylaxis with clarithromycin or azithromycin is indicated for patients with CD4 cell counts below 50 cells/mm3. ⋯ Clarithromycin plus ethambutol is considered the standard regimen. Potential alternatives are azithromycin, rifabutin, ciprofloxacin, clofazamine, and amikacin. Several factors influence drug selection, such as the patient's immune status, evidence of treatment safety and efficacy, drug interactions, and potential for resistance.
-
Sedation in children poses a great challenge, with the main concern one of safety. The importance of providing adequate sedation to children was realized only in the last decade and a half, and relevant data are severely lacking. ⋯ Children are given sedative agents in a wide variety of settings by practitioners with different degrees of experience with the drugs and management of adverse effects. Controversial issues must be addressed in this area, and appropriate tools developed to measure sedation and individualize treatment based on the drugs' pharmacokinetic and pharmacodynamic properties.
-
Hepatic drug metabolism is altered in critically ill patients. The etiology and mechanisms of the alterations are not clearly understood and are difficult to address in clinical studies. ⋯ Specifically, those with sepsis, septic shock, hemorrhagic shock, trauma, neurotrauma, and burns are populations that have been studied. Most of this research, however, has not led to established guidelines for the administration of drugs in these populations.
-
Case Reports
Hyperkalemia associated with rapid infusion of conventional and lipid complex formulations of amphotericin B.
A child developed hyperkalemia and cardiac arrest with infusion of an amphotericin B lipid complex 5.0 mg/kg over 1 hour. Another child, with chronic renal failure, developed hyperkalemia after infusion of conventional amphotericin B deoxycholate 1.0 mg/kg over 2 hours. Rapid infusion of the agent causes hyperkalemia in dogs and humans that is exacerbated in the setting of renal failure. A lipid formulation of amphotericin B is commercially available, and no reports of hyperkalemia are associated with its administration.