International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Oct 2015
ReviewAssays for therapeutic drug monitoring of β-lactam antibiotics: A structured review.
In some patient groups, including critically ill patients, the pharmacokinetics of β-lactam antibiotics may be profoundly disturbed due to pathophysiological changes in distribution and elimination. Therapeutic drug monitoring (TDM) is a strategy that may help to optimise dosing. The aim of this review was to identify and analyse the published literature on the methods used for β-lactam quantification in TDM programmes. ⋯ The median run time was 8 min (IQR 5.9-21.3 min). There is also a growing number of methods measuring free concentrations. An assay that measures antibiotics without any sample preparation would be the next step towards real-time monitoring; no such method is currently available.
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Int. J. Antimicrob. Agents · Oct 2015
Comparative StudyInfluence of mould-active antifungal treatment on the performance of the Aspergillus-specific bronchoalveolar lavage fluid lateral-flow device test.
The effect of mould-active antifungal (AF) therapy/prophylaxis on the performance of the Aspergillus-specific lateral-flow device (LFD) test for diagnosing invasive pulmonary aspergillosis (IPA) was evaluated. This was a retrospective analysis of patients diagnosed with probable or proven IPA (according to revised EORTC/MSG criteria) at the Medical University of Graz (Austria) and the University Hospital of Mannheim (Germany) between February 2011 and December 2014. In total, 60 patients with 63 bronchoalveolar lavage fluid (BALF) samples were included in the analysis. ⋯ Similar results were found for BALF GM, with sensitivities decreasing under systemic AFs (71% vs. 95%, P=0.013 with the 0.5 ODI cut-off; 52% vs. 81%, P=0.036 with the 1.0 cut-off). These results suggest that the sensitivity of the BALF LFD and BALF GM assays may be reduced in the presence of mould-active AF treatment. Negative results in patients on AFs should therefore be interpreted with caution.
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Int. J. Antimicrob. Agents · Oct 2015
Earlier switching from intravenous to oral antibiotics owing to electronic reminders.
Paper-based interventions have been shown to stimulate switching from intravenous (i.v.) to oral (p.o.) antibiotic therapies. Shorter i.v. durations are associated with a lower risk of iatrogenic infections as well as reduced workload and costs. The purpose of this study was to determine whether automated electronic reminders are able to promote earlier switching. In this controlled before-and-after study, an algorithm identified patients who were eligible for i.v.-to-p.o. switch 60 h after starting i.v. antimicrobials. Reminders offering guidance on the re-assessment of initial i.v. therapy were displayed within the electronic health records in 12 units during the intervention period (year 2012). In contrast, no reminders were visible during the baseline period (2011) and in the control group (17 units). A total of 22863 i.v. antibiotic therapies were analysed; 6082 (26.6%) were switched to p.o. ⋯ In the intervention group, 757 courses of i.v. antibiotics were administered for a mean ± standard deviation duration of 5.4 ± 8.1 days before switching to p.o. antibiotics in the baseline period, and 794 courses for 4.5 ± 5.5 days in the intervention period (P = 0.004), corresponding to a 17.5% reduction of i.v. administration time. In contrast, in the control group the duration increased; 2240 i.v. antibiotics were administered for a mean duration of 4.0 ± 5.9 days in the baseline period, and 2291 for 4.3 ± 5.8 days in the intervention period (P = 0.03). Electronic reminders fostered earlier i.v.-to-p.o. switches, thereby reducing the duration of initial i.v. therapies by nearly a day.
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Int. J. Antimicrob. Agents · Sep 2015
Review Meta Analysis Comparative StudyFluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: Systematic review and meta-analysis.
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. This review compared two of the main treatment alternatives: quinolone or macrolide monotherapy versus their combination with β-lactams. A systematic review and meta-analysis of randomised controlled trials (RCTs) including adult inpatients and outpatients with CAP that compared treatment with any respiratory fluoroquinolone or macrolide administered as single agent with combination therapy of a β-lactam plus either a fluoroquinolone or a macrolide (four separate comparisons) were conducted. ⋯ In all comparisons, treatment discontinuation and diarrhoea were more frequent in patients receiving combination therapy with a β-lactam. Overall, there is no evidence for a benefit of β-lactam/macrolide or β-lactam/quinolone combination therapies over monotherapy with a respiratory fluoroquinolone. The ecological implications of selecting fluoroquinolone or β-lactam monotherapy as the preferred regimen for hospitalised CAP among adults should be further investigated.
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Int. J. Antimicrob. Agents · Sep 2015
Review Meta AnalysisVancomycin-associated nephrotoxicity: A meta-analysis of administration by continuous versus intermittent infusion.
Vancomycin is a glycopeptide antibiotic widely used in the management of meticillin-resistant Staphylococcus aureus (MRSA). Guidelines currently recommend vancomycin be administered by intermittent infusion, despite recent research suggesting that continuous infusion (CI) may be associated with lower rates of vancomycin-associated nephrotoxicity. In 2012, Cataldo et al. presented a meta-analysis supporting the use of CI. ⋯ Seven studies were included in the final analysis. Using a random-effects model, a non-significant trend of reduced nephrotoxicity in those who received vancomycin by CI (risk ratio=0.799, 95% confidence interval 0.523-1.220; P=0.299) was identified. A large, randomised controlled trial is necessary to confirm these results.