Introduction. Vitamin D insufficiency is highly prevalent and is a negative predictor for survival in ischemic stroke patients. We evaluated the effect of a high dose of vitamin D3 on the Neuron-Specific Enolase (NSE) level, National Institute of Health Stroke Scale (NIHSS), and Barthel Index (BI) scoring system in moderate ischemic stroke patients. Methods. This prospective, double-blind, randomized clinical trial (RCT) study was conducted from April 2020 to March 2021. Patients with moderate ischemic stroke (NIHSS 5 to 15) who had vitamin D deficiency (serum 25-OH vitamin D ≤30 ng/mL) were recruited and randomized into intervention and control groups. Subjects in the intervention group received a single dose, intramuscular (IM) injection of 600000 international unit (IU) vitamin D3, in addition to the standard treatment. NSE level and NIHSS were evaluated at baseline and 48 hours after the intervention. The BI was monitored three months after discharge. Results. During the study period, 570 patients were assessed; finally, forty-one patients completed the study. Except for the age which was higher in the control group ( p = 0.04 ), there were no statistically significant differences in other baseline characteristics between the two groups. After 48 hours, the NIHSS score was significantly lower in the intervention group (median 8 vs. 6.5, p = 0.008 in the control and intervention groups, respectively), but there was no significant difference in the NSE level ( p = 0.80 ). Three months after discharge, the BI was significantly higher in the intervention group (median 8 vs. 9, p = 0.03 in the control and intervention groups, respectively). Conclusions. Administration of a single 600000 IU of vitamin D3 could have neuroprotective effects in patients with moderate ischemic stroke, according to its significantly positive effects on functional clinical outcomes (NIHSS and BI), but this effect on the biomarker related to neural damage (NSE) was not significant.
Aims. Augmented renal clearance (ARC), which is commonly defined as increased renal clearance above 130 ml/min/1.73 m2, is a common phenomenon among critically ill patients. The increased elimination rate of drugs through the kidneys in patients with ARC can increase the risk of treatment failure due to the exposure to subtherapeutic serum concentrations of medications and affect the optimal management of infections, length of hospital stay, and outcomes. The main goal of this review article is to summarize the recommendations for appropriate dosing of antibiotics in patients with ARC. Methods. This article is a narrative review of the articles that evaluated different dosing regimens of antibiotics in patients with ARC. The keywords “Augmented Renal Clearance,” “Critically ill patients,” “Drug dosing,” “Serum concentration,” “Beta-lactams,” “Meropenem,” “Imipenem,” “Glycopeptide,” “Vancomycin,” “Teicoplanin,” “Linezolid,” “Colistin,” “Aminoglycosides,” “Amikacin,” “Gentamycin,” “Fluoroquinolones,” “Ciprofloxacin,” and “Levofloxacin” were searched in Scopus, Medline, PubMed, and Google Scholar databases, and pediatric, nonhuman, and non-English studies were excluded. Results. PK properties of antibiotics including lipophilicity or hydrophilicity, protein binding, the volume of distribution, and elimination rate that affect drug concentration should be considered along with PD parameters for drug dosing in critically ill patients with ARC. Conclusion. This review recommends a dosing protocol for some antibiotics to help the appropriate dosing of antibiotics in ARC and decrease the risk of subtherapeutic exposure that may be observed while receiving conventional dosing regimens in critically ill patients with ARC.
Because of an increased prevalence of infections with resistant Gram-negative bacteria, finding optimal treatment regimens for these cases is one of the major healthcare concerns. Providencia is a Gram-negative bacteria belonging to the Enterobacteriaceae family. This article aims to describe an effective antibacterial regimen used for treating ventilator-associated pneumonia (VAP) with species of Providencia that are resistant to all antimicrobial classes. We present the case of a 74-year-old woman suffering from VAP caused by pandrug-resistant Providencia. The patient received high-dose intravenous meropenem (1 g every 12 h, infused over 4 h), intravenous amikacin (1,500 mg every 48 h) and nebulised amikacin (250 mg every 6 h). The dosages were calculated based on weight and renal function (GFR = 13.69 ml/min/1.73). After 23 days of treatment, following improvement in clinical signs (including fever), a drop in leucocytes counts, a higher than 80% reduction in procalcitonin levels (0.12), together with confirmed microbial eradication (negative sputum cultures), the antibacterial regimen was discontinued. In conclusion, when dealing with an infection with a pan-resistant microorganism, using combinations of antibiotics in high doses can be an option. These treatment regimens have the potential of overcoming in vitro resistance, leading to clinical improvement and microbial eradication.
Aims and Scope Eurasian Journal of Medicine (Eurasian J Med) is an international, scientific, open access periodical published by independent, unbiased, and tripleblinded peer-review principles. The journal is the official publication of
Background: Irrational use of antibiotics is a healthcare problem which can lead to antibiotic resistance. Vancomycin resistance is developing worldwide and is a huge financial burden to healthcare systems. Antimicrobial control programs are an essential component of educational programs in ensuring the optimal use of antibiotics. This study aimed to evaluate the effects of an educational program implemented at an Educational Medical Center on vancomycin prescription patterns. Methods: This was a cross-sectional, pre-post interventional study carried out at Imam Hussein Hospital affiliated with Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran, between 2014 to 2016. Vancomycin protocol was prepared, then all physicians and assistants were trained through workshops and instructed to order vancomycin based on the approved protocol. The primary objective of this study was to determine the change in vancomycin usage – calculated based on the Defined Daily Dose (DDD) per 100 patient-days in each ward – collected in three phases: at baseline, during the educational program and post-intervention phase. Results: The data revealed that total vancomycin consumption significantly decreased at the baseline and post-intervention phases in comparison with during the educational program (p=0.007, p= 0.105, respectively). Conclusion: The educational programs in this study were effective at optimizing antibiotics usage and the study results showed that antimicrobial training programs can be successfully implemented for the management of vancomycin usage at our university-affiliated hospital.
Aim: Augmented Renal Clearance (ARC) is a common phenomenon among critically ill patients and create sub-therapeutic concentrations of antibiotics, due to an increase in renal clearance of them. We evaluated the Pharmacokinetic and Pharmacodynamic (PK/PD) properties of recommended doses of meropenem in critically ill patients with ARC. Methods: Adult critically ill patients with confirmed ARC, based on 12-hour Creatinine Clearance (CrCl) ([?]130 ml/min/1.73 m2), who received standard doses of meropenem enrolled. Two blood samples were gathered from each participant, at the steady-state time, to determination of peak and trough concentrations. Serum concentrations of meropenem were measured by High-Performance Liquid Chromatography (HPLC) with UltraViolet (UV) detector. Results: From eighteen paired samples (peak and trough concentrations) that were obtained from 16 critically ill patients, peak concentrations were significantly lower in group 1 (received meropenem 1g every 8 hours) than group 2 (received meropenem 2g every 8 hours) (mean ±SD, 5.95 ±3.39 μg/mL vs. 11.93± 4.18 μg/mL, respectively, p= 0.005). Trough concentration were sub-threshold (< 2 μg/mL) in 10 patients of group 1 (83.3%) and 3 patients of group 2 (50%). ft > MIC [?] 50% was achieved in 83.3% of patients in both groups whereas 16.6% of patients of group 1 and 33.3% of patients of group 2 had ft> MIC= 100%. Conclusion: ARC is an essential cause of sub-therapeutic concentrations of meropenem in critically ill patients, and higher than the recommended doses of meropenem administered as an intermittent infusion may be necessary to achieve the PD targets and improve efficacy.
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