Vancomycin

Objectives: The aim of this study was to assess the ability of a vancomycin nomogram to effectively predict vancomycin serum trough concentrations within the desired 15-20 mg/L therapeutic range. Methods: A retrospective chart review was performed on a randomized sample of trough concentrations from adult patients at HVMC (Holston Valley Medical Center) receiving intravenous vancomycin dosing regimens determined by the vancomycin nomogram over an eight-month span. Key findings: 102 patients were included in the study. Trough concentrations ranged from 3.5 mg/L to 40.8 mg/L with 36 (35.2%) patients having trough levels within the desired range of 15-20 mg/L. In addition, 75 (73.5%) patients had trough levels within the range of 10-25 mg/L. Conclusion: This study demonstrated that the vancomycin nomogram at HVMC is an effective dosing tool that provides consistency among multiple pharmacists and predictable serum trough concentrations.

Vancomycin-resistant enterococci (VRE) have emerged as important nosocomial pathogens. This study was conducted to clarify the clinical features and outcome of patients with vancomycin-resistant enterococcal bacteremia. Patients with vancomycin-resistant enterococcal bacteremia treated at a medical center in northern Taiwan between November 1998 and July 2006 were reviewed. Clinical and bacteriological characteristics of Enterococcus faecium and Enterococcus faecalis were compared. Twelve patients (6 males and 6 females) were included for analyses. The mean age was 69.3 years (range, 40 to 86 years), and 8 cases (66.7%) were older than 65 years. All patients had underlying disease. Two patients received total hip replacement before development of VRE bacteremia. Twelve patients had prior exposure to broad-spectrum antimicrobial therapy. Ten patients had prior intensive care unit stay and prior mechanical ventilation before VRE bacteremia. All of the patients (n = 12) had an intravas...

Probiotics are commonly defined as viable microorganisms (bacteria or yeasts) that exhibit a beneficial effect on the health of the host when they are ingested. They are used in foods, especially in fermented dairy products, but also in pharmaceutical preparations. The development of new probiotic strains aims at more active beneficial organisms. In the case of novel microorganisms and modified organisms the question of their safety and the risk to benefit ratio have to be assessed. Lactic acid bacteria (LAB) in foods have a long history of safe use. Members of the genera Lactococcus and Lactobacillus are most commonly given generally-recognised-as-safe (GRAS) status whilst members of the genera Streptococcus and Enterococcus and some other genera of LAB contain some opportunistic pathogens. Lactic acid bacteria are intrinsically resistant to many antibiotics. In many cases resistances are not, however, transmissible, and the species are also sensitive to many clinically used antibiotics even in the case of a lactic acid bacteria- associated opportunistic infection. Therefore no particular safety concern is associated with intrinsic type of resistance. Plasmid-associated antibiotic resistance, which occasionally occurs, is another matter because of the possibility of the resistance spreading to other, more harmful species and genera. The transmissible enterococcal resistance against glycopeptide antibiotics (vancomycin and teicoplanin) is particularly noteworthy, as vancomycin is one of the last effective antibiotics left in the treatment of certain multidrug-resistant pathogens. New species and more specific strains of probiotic bacteria are constantly identified. Prior to incorporating new strains into products their efficacy should be carefully assessed, and a case by case evaluation as to whether they share the safety status of traditional food-grade organisms should be made. The current documentation of adverse effects in the literature is reviewed. Future recommendations for the safety of already existing and new probiotics will be given.

Because of the recent awareness that vancomycin doses should aim to meet target Area Under the Curve (AUC) instead of trough concentrations, more aggressive dosing regimens are warranted, also in the pediatric population. In this study, both a neonatal and pediatric pharmacokinetic model for vancomycin were externally evaluated, and subsequently used to derive model-based dosing algorithms for neonates, infants and children. For the external validation, predictions from previously published pharmacokinetic models were compared to new data. Simulations were performed in order to evaluate current dosing regimens and to propose a model-based dosing algorithm. AUC24h/MIC was evaluated for all investigated dosing schedules (target >400), without any concentration exceeding 40 mg/L. Both the neonatal and pediatric model of vancomycin performed well in the external datasets resulting in concentrations that were predicted correctly and without bias. For neonates, a dosing algorithm based...