Background: It is recommended to adjust the dosage of lithium carbonate, primarily used in the treatment of mania, based on the serum lithium concentration at steady-state (Css). It has been suggested that factors associated with renal function should be included in the estimation of lithium clearance (Li-CL) due to its elimination via renal excretion. In the present study, parameters affecting Li-CL were investigated in Japanese patients. Methods: Retrospective analysis was performed in patients who had chronically received lithium carbonate, by stepwise regression analysis, with Li-CL as the dependent variable and gender, age, weight and creatinine clearance (Ccr) as independent variables. Ccr was calculated using the Cockcroft-Gault equation, and Li-CL was calculated as the reciprocal value of Css per daily dose. Results: Seventy-two patients were enrolled in this study. Regression analysis revealed that only Ccr was an independent variable (P<0.001), and the following equation was obtained: Li-CL (mL/min) = 0.161 × Ccr (mL/min) + 6.47. This equation was then validated by comparison with previously reported methods using a separate population of patients. The bias and precision of the equation's predictions were evaluated by calculating the mean prediction error, mean absolute error and root mean squared prediction error. Although the Jermain method had the least bias, no significant differences were observed between the present and Jermain methods. Conclusion: Because the equation of the present study includes Ccr as a parameter of renal function, this may better provide appropriate dosing and safety of lithium therapy in Japanese patients.

Infections caused by multiple-drug-resistant Pseudomonas aeruginosa (MDRP) are a clinically signiˆcant problem. We reported here the eŠective use of combination therapy in a patient with infection caused by MDRP according to an interventional treatment strategy suggested by a pharmacist. The patient was a 70-year-old male who underwent allogeneic hematopoietic stem cell transplantation. On day 45 after transplant, MDRP was newly isolated from urine, but the diagnosis at that time was colonization. On day 61, the patient developed a fever ( 38.0°C). In addition, laboratory data showed that C-reactive protein (CRP) was also increased. At the medical team conference, the pharmacist proposed the following treatment strategy for this infection. Aztreonam and amikacin were intravenously administered at doses of 2 g/day and 800 mg/day, respectively. The subsequent clinical course was well controlled, but the infection recurred and was aggravated. Aztreonam and cipro‰oxacin were then intravenously administered at doses of 4 g/day and 600 mg/day, respectively, resulting in the alleviation of fever in the patient as well as a decrease in CRP and disappearance of MDRP isolates from urine on day 67; that is, MDRP infection was consequently well controlled. In conclusion, the combination therapy between aztreonam and amikacin, or cipro‰oxacin may be clinically useful for severe infections of MDRP in compromised hosts.

Bendamustine is an anti-cancer drug approved for relapse or refractory indolent B cell lymphoma. Although it is a promising drug because it shows a different activity pattern from other alkylating agents and a lack of crossresistance with them, there is insufficient evidence to standardize the regimen including supportive care, particularly at outpatient cancer chemotherapy. In our hospital, bendamustine (120 mg/m 2) was administered to a patient with follicular lymphoma. Cycle 1 treatment was performed under hospitalization, followed by cycles 2 to 4 under outpatient cancer chemotherapy. For prophylaxis of nausea and vomiting, azasetron, dexamethasone and aprepitant were used. At outpatient cancer chemotherapy, dexamethasone was orally administered on days after bendamustine injection. No nausea or vomiting was observed throughout all cycles. However, on cycle 1, myelosuppression including grade 4 leukopenia and grade 2 thrombocytopenia were observed. Therefore, the dosage of bendamustine on cycles 2 to 4 was reduced to 90 mg/m 2. During outpatient cancer chemotherapy, mild myelosuppression was observed, but chemotherapy could be achieved without delay by treatment with granulocyte-colony stimulating factor (G-CSF) or antibiotics. In this case, the bendamustine regimen could be safely performed without severe adverse events except myelosuppression, indicating that this report may be a good reference in the management of supportive care for safe administration of bendamustine.