Monitoring of tobramycin serum concentrations in selected critically ill patients receiving selective decontamination of the digestive tract: a retrospective evaluation

Möhlmann, Julia E; Luin, Matthijs van; Mascini, Ellen M.; Leeuwen, Henk J. van; Maat, M R de

doi:10.1007/s00228-019-02644-x

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Though historically, TDM was mostly implemented to prevent toxic adverse effects, mainly for glycopeptides and aminoglycosides, the assessment of trough and peak concentrations is considered diagnostically and therapeutically important and strongly recommended for patients using the aforementioned antibiotics. Since the treatment of serious infections can imply the administration of high doses of antibiotics, an accumulation of these drugs in plasma is recurrent, often leading to toxic effects, and the value of TDM of these antibiotics has been demonstrated [73,74,[78][79][80][81][82][83][84][85][86]. Although TDM has been recommended for these antibiotics, it is still not a routine clinical practice for reasons still not systematically reviewed.…”

Section: Antibiotics and The Need For Tdm And Dosage Adjustmentmentioning

confidence: 99%

PBPK Modeling and Simulation and Therapeutic Drug Monitoring: Possible Ways for Antibiotic Dose Adjustment

2021

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Pharmacokinetics (PK) is a branch of pharmacology present and of vital importance for the research and development (R&D) of new drugs, post-market monitoring, and continued optimizations in clinical contexts. Ultimately, pharmacokinetics can contribute to improving patients’ clinical outcomes, helping enhance the efficacy of treatments, and reducing possible adverse side effects while also contributing to precision medicine. This article discusses the methods used to predict and study human pharmacokinetics and their evolution to the current physiologically based pharmacokinetic (PBPK) modeling and simulation methods. The importance of therapeutic drug monitoring (TDM) and PBPK as valuable tools for Model-Informed Precision Dosing (MIPD) are highlighted, with particular emphasis on antibiotic therapy since dosage adjustment of antibiotics can be vital to ensure successful clinical outcomes and to prevent the spread of resistant bacterial strains.

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Section: Antibiotics and The Need For Tdm And Dosage Adjustmentmentioning

confidence: 99%

PBPK Modeling and Simulation and Therapeutic Drug Monitoring: Possible Ways for Antibiotic Dose Adjustment

2021

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“…However, concentration of some drugs administered orally as part of SID can be quite high in critically ill patients. Monitoring of tobramycin concentration in blood serum of such patients showed that it could reach toxic values (>2.0 mg/L) in some cases, which is likely to be associated with increased permeability of the intestinal barrier and decreased liver and kidney function [ 80 – 82 ]. There are few reports of antibiotic-associated diarrhea due to SID.…”

Section: The Safety Of Using Selective Intestinal Decontaminationmentioning

confidence: 99%

Selective Intestinal Decontamination as a Method for Preventing Infectious Complications (Review)

Барсук¹,

Nekaeva²,

Ловцова³

et al. 2020

Sovrem Tehnol Med

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Infectious complications are the most common cause of death in patients with severe burns. To date, there is no generally accepted method for preventing such complications in burn injury. One of the possible prevention options is selective intestinal decontamination (SID). This method is based on the enteral administration of non-absorbable antimicrobial agents. The preventive effect of SID involves inhibition of intestinal microflora translocation through the mucous membranes, inasmuch as studies demonstrate that endogenous opportunistic microorganisms are a common cause of infectious complications in various critical conditions. The SID method was originally developed in the Netherlands for patients suffering from mechanical injury. Antimicrobial drugs were selected based on their high activity in relation to the main endogenous opportunistic pathogens and minimal activity against normal intestinal microflora components. The combination of polymyxin (B or E), tobramycin, and amphotericin B with intravenous cefotaxime was chosen as the first SID regimen. Other regimens were proposed afterwards, and the application field of the method was expanded. In particular, it became the method of choice for prevention of infectious complications in patients with severe burn injury. Clinical studies demonstrate efficacy of some SID regimens for preventing infectious complications in patients with thermal injury. Concomitant administration of SID and systemic preventive antibiotics and addition of oropharyngeal decontamination increases the method efficacy. SID is generally well-tolerated, but some studies show an increased risk of diarrhea with this preventive option. In addition, SID increases the risk of developing antibiotic resistance like any other antibiotic regimens.

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“…The four antibiotics studied here, amikacin, gentamicin, tobramycin, and vancomycin, are the most frequently monitored in inpatients, which can be explained by their narrow therapeutic indexes and potential to cause adverse effects, namely nephrotoxicity, particularly in prolonged treatments [15][16][17]. The value of TDM of these antibiotics has been extensively demonstrated [13,14,[18][19][20][21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

PBPK Modeling and Simulation of Antibiotics Amikacin, Gentamicin, Tobramycin, and Vancomycin Used in Hospital Practice

Ferreira

Martins

Oliveira

et al. 2021

Life

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The importance of closely observing patients receiving antibiotic therapy, performing therapeutic drug monitoring (TDM), and regularly adjusting dosing regimens has been extensively demonstrated. Additionally, antibiotic resistance is a contemporary concerningly dangerous issue. Optimizing the use of antibiotics is crucial to ensure treatment efficacy and prevent toxicity caused by overdosing, as well as to combat the prevalence and wide spread of resistant strains. Some antibiotics have been selected and reserved for the treatment of severe infections, including amikacin, gentamicin, tobramycin, and vancomycin. Critically ill patients often require long treatments, hospitalization, and require particular attention regarding TDM and dosing adjustments. As these antibiotics are eliminated by the kidneys, critical deterioration of renal function and toxic effects must be prevented. In this work, clinical data from a Portuguese cohort of 82 inpatients was analyzed and physiologically based pharmacokinetic (PBPK) modeling and simulation was used to study the influence of different therapeutic regimens and parameters as biological sex, body weight, and renal function on the biodistribution and pharmacokinetic (PK) profile of these four antibiotics. Renal function demonstrated the greatest impact on plasma concentration of these antibiotics, and vancomycin had the most considerable accumulation in plasma over time, particularly in patients with impaired renal function. Thus, through a PBPK study, it is possible to understand which pharmacokinetic parameters will have the greatest variation in a given population receiving antibiotic administrations in hospital context.

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Monitoring of tobramycin serum concentrations in selected critically ill patients receiving selective decontamination of the digestive tract: a retrospective evaluation

Cited by 5 publications

References 11 publications

PBPK Modeling and Simulation and Therapeutic Drug Monitoring: Possible Ways for Antibiotic Dose Adjustment

PBPK Modeling and Simulation and Therapeutic Drug Monitoring: Possible Ways for Antibiotic Dose Adjustment

Selective Intestinal Decontamination as a Method for Preventing Infectious Complications (Review)

PBPK Modeling and Simulation of Antibiotics Amikacin, Gentamicin, Tobramycin, and Vancomycin Used in Hospital Practice

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