Monitorización terapéutica de antimicrobianos en pediatría. Revisión de la experiencia latinoamericana

Zylbersztajn, Brenda; Barraza, Marlon; Torres, Juan Pablo; Morales, Jorge

doi:10.4067/s0716-10182018000100022

Cited by 2 publications

(1 citation statement)

References 18 publications

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“…Therapeutic drug monitoring involves measuring the concentration of drugs or their metabolites and interpreting them by a doctor with appropriate education (clinical pharmacologist or clinical pharmacist). The drugs being monitored have a narrow therapeutic index, which represents the ratio between the toxic and effective dose of the drug [1,2,3,4].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Drug Monitoring and Evaluation of Safety of Intravenous Infusion of Amikacin in Patients With Cystic Fibrosis

Nikodinovski,

Naceva Fushtikj,

Trojacanec

et al. 2023

JMS

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Therapeutic drug monitoring (TDM) involves measuring drug concentrations in plasma, serum or blood. This information is used to individualize dosage so that drug concentrations can be maintained within a target range and to make dose adjustments. Amikacin is a kanamycin-derived semisynthetic aminoglycoside antibiotic and one of the important antimicrobial agent against Gram-negative pathogens. Aminoglycoside antibiotics have a small therapeutic index and therapeutic range due to monitoring of amikacin concentrations is necessary. For optimal antimicrobial effect of amikacin therapy and prevent toxicity, it is recommended monitoring of amikacin concentrations during therapy with this drug.The study for evaluation of safety of the therapy with amikacin intravenous infusion included 12 patients (7 male and 5 female) with cystic fibrosis. Amikacin was infused over 1 h in the dose of 30 mg/kg (maximum 1.5 g) one time daily during 10-14 days. Blood samples for determination concentrations of amikacin were obtained at the following times: immediately before administration of third dose of amikacin, at the end of infusion, 30 min. and 6 h after infusion. The concentrations of amikacin in the sample before administration of third dose of amikacin was <2 µg/ml in all treated patients. Safety of the therapy was evaluated from the results of laboratory analyses, creatinine clearance (estimated according to the Cockroft-Gault equation), anamnestic symptoms of ototoxicity or vestibular toxicity, evaluation of the whisper test and other adverse events.From the results of our study, we suggest that the dose of 30 mg/kg once daily amikacin infusion administered for 10-14 days is safety in patients with cystic fibrosis.

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Section: Introductionmentioning

confidence: 99%

Therapeutic Drug Monitoring and Evaluation of Safety of Intravenous Infusion of Amikacin in Patients With Cystic Fibrosis

Nikodinovski,

Naceva Fushtikj,

Trojacanec

et al. 2023

JMS

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Use of Drug Sensitisers to Improve Therapeutic Index in Cancer

Chen,

Jin,

Day

2024

Pharmaceutics

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The clinical management of malignant tumours is challenging, often leading to severe adverse effects and death. Drug resistance (DR) antagonises the effectiveness of treatments, and increasing drug dosage can worsen the therapeutic index (TI). Current efforts to overcome DR predominantly involve the use of drug combinations, including applying multiple anti-cancerous drugs, employing drug sensitisers, which are chemical agents that enhance pharmacokinetics (PK), including the targeting of cellular pathways and regulating pertinent membrane transporters. While combining multiple compounds may lead to drug–drug interactions (DDI) or polypharmacy effect, the use of drug sensitisers permits rapid attainment of effective treatment dosages at the disease site to prevent early DR and minimise side effects and will reduce the chance of DDI as lower drug doses are required. This review highlights the essential use of TI in evaluating drug dosage for cancer treatment and discusses the lack of a unified standard for TI within the field. Commonly used benefit–risk assessment criteria are summarised, and the critical exploration of the current use of TI in the pharmaceutical industrial sector is included. Specifically, this review leads to the discussion of drug sensitisers to facilitate improved ratios of effective dose to toxic dose directly in humans. The combination of drug and sensitiser molecules might see additional benefits to rekindle those drugs that failed late-stage clinical trials by the removal of detrimental off-target activities through the use of lower drug doses. Drug combinations and employing drug sensitisers are potential means to combat DR. The evolution of drug combinations and polypharmacy on TI are reviewed. Notably, the novel binary weapon approach is introduced as a new opportunity to improve TI. This review emphasises the urgent need for a criterion to systematically evaluate drug safety and efficiency for practical implementation in the field.

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Monitorización terapéutica de antimicrobianos en pediatría. Revisión de la experiencia latinoamericana

Cited by 2 publications

References 18 publications

Therapeutic Drug Monitoring and Evaluation of Safety of Intravenous Infusion of Amikacin in Patients With Cystic Fibrosis

Therapeutic Drug Monitoring and Evaluation of Safety of Intravenous Infusion of Amikacin in Patients With Cystic Fibrosis

Use of Drug Sensitisers to Improve Therapeutic Index in Cancer

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