BackgroundVancomycin is a widely used antibiotic in nosocomial infections due to methicillin-resistant staphylococcal aureus, a major cause of death, justifying the strict controls on its use as well as serum drug level monitoring (SDLM).PurposeTo evaluate pharmaceutical interventions regarding their impact on the initial regimen and adjustment of serum vancomycin levels.Material and methodsA retrospective observational study of patients for whom pharmacokinetic monitoring of vancomycin was requested in the year 2013. The parameters evaluated were obtained from the computer applications Kinetidex, Clinidata Net and the pharmacotherapeutic profile: creatinine, dose, first dosed serum drug level and suggested dose.Results433 serum drug levels of vancomycin were determined. Of the total 159 patients, 63.5% were subjected to pharmacokinetic monitoring, averaging 4.29 serum drug levels per patient.61.4% patients received vancomycin, in an intermittent regimen (IR), 38.6% received it by continuous infusion (CI), of these only 46.2% had a loading dose.The average trough serum drug level was 14.07 μg/ml and the intermediate serum drug level in the CI regimen was 23.14 µg/ml.It was found that 40% of the trough serum drug levels in the IR were within the reference values?? (RV) (10–15 µg/ml), 30% of serum drug levels were above and 30% were below.In CI, 13.9% of intermediate serum drug levels were within the RV (20–25 µg/ml), 33.3% were above and 52.7% were below.Most pharmaceutical interventions were aimed at maintaining the dosing interval, reflecting the interventions in increasing doses (31.68%) or decreasing doses (20.79%).ConclusionIt was concluded that many patients required an adjustment to the initial treatment regimen, maintaining the dosing interval, but with dose modifications.A serum drug level lower than the RV is not effective in controlling the infection with the potential emergence of resistant strains. High serum drug levels above the RV may cause toxic effects.This differentiated pharmaceutical intervention contributed to improved health outcomes and strengthened the regulatory framework in multidisciplinary health teams.ReferenceMurphy JE, Clinical pharmacokinetics. American Society of Health-System Pharmacists, 3rd ed. 2005:349–64No conflict of interest.

Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em criançasRevisión sistemática del uso de la dexametasona como terapia adyuvante en la meningitis bacteriana en niños João Antonio G. G ABSTRACTObjective: To analyze the best available evidence from the last 15 years on the benefits of adjuvant therapy with dexamethasone for bacterial meningitis in children.Data sources: Randomized controlled trials comparing dexamethasone to placebo and/or other adjuvant therapies in patients with bacterial meningitis diagnosed by biochemical, cytological and/or microbiological data. Studies with patients from 29 days to 18 years of age, from 1996 to 2011, were searched at Medline, Lilacs and SciELO databases. The evaluated outcomes were mortality and development of neurological and/or hearing impairment. Studies related to tuberculous meningitis were excluded.Data synthesis: With the specified criteria, five published studies were identified corresponding to four study protocols. None of the studies showed differences between dexamethasone and placebo for the evaluated outcomes. All analyzed studies had high methodological quality (Jadad et al score=5).Conclusions: Current evidence is insufficient to support routine adjuvant therapy with dexamethasone to reduce mortality, hearing impairment, or neurological sequelae in pediatric patients with non-tuberculous bacterial meningitis.Key-words: meningitis, bacterial; dexamethasone; deafness; mortality. RESUMOObjetivo: Analisar a melhor evidência disponível nos últimos 15 anos com relação aos benefícios da terapia adjuvante com dexametasona na meningite bacteriana em população pediátrica.Fontes de dados: Das bases de dados Medline, Lilacs e SciELO, foram analisados ensaios clínicos randomizados de 1996 a 2011, os quais comparavam a dexametasona ao placebo e/ou a outra terapia adjuvante em pacientes com meningite bacteriana diagnosticada laboratorialmente por critérios quimiocitológicos e/ou bacteriológicos, na faixa etária de 29 dias aos 18 anos. Os desfechos avaliados foram mortalidade e ocorrência de sequelas neurológicas e/ou auditivas. Foram excluídos estudos relacionados à meningite tuberculosa.Síntese dos dados: Com os critérios utilizados, foram identificadas cinco publicações correspondentes a quatro protocolos de estudo. Nenhum dos estudos mostrou diferenças entre a dexametasona e o placebo para os desfechos avaliados. Os estudos analisados tiveram alta qualidade (escore de Jadad et al=5).Conclusões: As evidências encontradas na literatura são insuficientes para indicar de forma rotineira o uso da dexametasona como terapia adjuvante para redução de mortalidade, perda auditiva e sequelas neurológicas em pacientes pediátricos com meningite bacteriana não tuberculosa.Palavras-chave: meningite bacteriana; dexametasona; surdez; mortalidade. João Antonio G. G. Prats et al RESUMEN Objetivo:El presente estudio tiene por objetivo el análisis de la mejor evidencia disponible los últimos 15 años respecto a los beneficios de la terapia adyuvant...