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B H Ackerman

Publications and source records attributed to B H Ackerman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Effect of age and renal function on cefonicid pharmacokinetics.

Cefonicid (15 mg/kg) was administered intravenously at a constant rate of infusion over 15 min to 10 geriatric patients (mean age, 77 years) and to 4 young subjects (mean age, 35 years). Model-dependent and noncompartmental pharmacokinetic parameters were calculated and found to be congruous; noncompartmental data are reported. Significant differences in the values for area under the curve, mean residence time, total body clearance, and renal clearance were observed between the geriatric and young groups. Mean elimination half-life values were 9.59 and 4.88 h for the geriatric and young groups, respectively. Total body and renal clearances were inversely correlated to age and directly correlated to creatinine clearance. Free fraction was not correlated to albumin concentration but was correlated exponentially to total cefonicid concentration. Despite the prolonged half-life values observed in our geriatric patients, the difference in mean trough concentrations was slight. Daily administration of a 15-mg/kg dose should provide adequate concentrations in serum and should not produce appreciable accumulation in geriatric patients.

Adult↗
PubMed1989

Evaluation of three methods for determining initial vancomycin doses.

Dosing methods proposed by Matzke et al., Moellering et al., and Lake and Peterson were used to predict initial doses of vancomycin for serum concentration simulation using a two-compartment open model. Previously reported pharmacokinetic data from 25 of 28 patients were used to simulate steady-state serum vancomycin concentrations for doses derived from the three methods. The Matzke method failed to provide simulated one-hour postinfusion levels less than 30 micrograms/mL in 48 percent and troughs greater than 5 micrograms/mL in more than 88 percent of the patients. The Moellering method succeeded in achieving this goal in 96 percent of the simulated one-hour levels, and in 72 percent of the troughs when a six-hour dosing interval was selected. For the 8 mg/kg Lake-Peterson doses, one-hour levels greater than 30 micrograms/mL occurred in 28 percent of the simulations, and for the 10 mg/kg doses this increased to 40 percent. The 8 mg/kg doses resulted in trough simulations less than 5 micrograms/mL in 28 percent and the 10 mg/kg reduced this to only 20 percent. These simulations indicated that the Moellering nomogram with the six-hour dosing interval was the most successful method for initial dose selection, but early serum concentration monitoring and adjustment of initial empirical and nomogram-derived doses is necessary to assure safe and effective vancomycin serum concentrations.

Analysis of Variance↗
PubMed1989

Disposition of 3-hydroxyquinidine in patients receiving initial intravenous quinidine gluconate for electrophysiology testing of ventricular tachycardia.

The formation rate constant and elimination rate constant for 3-hydroxyquinidine were determined in eight patients with ventricular tachycardia. These two parameters (mean +/- SD) were found to be 0.784 +/- 0.202 and 0.042 +/- 0.058 h-1, respectively. Coefficients of determination for the computer-generated line of best fit for serum concentration-time data were 0.986 +/- 0.008. Patients received two infusions of quinidine gluconate 5 mg/kg over 30 minutes separated by a 20-30 minute electrophysiologic testing period. Unbound and total 3-hydroxyquinidine concentrations were also determined. Among the eight patients, 3-hydroxyquinidine was 61.9 percent bound. Studies in healthy volunteers had shown 50 percent binding. Linear regression of unbound and total 3-hydroxyquinidine was described by the equation Y = 0.3814X-1.448, r = 0.813. Although half-lives of 3.5-12.4 hours had been reported in healthy volunteers, prolonged half-lives were observed in all but two of our arrhythmia patients.

Adult↗
PubMed1988

Vancomycin serum protein binding determination by ultrafiltration.

Sixty-two serum concentrations were obtained from 12 infected patients enrolled in a vancomycin pharmacokinetic study. Both unbound and total serum vancomycin concentrations were measured using ultrafiltration and a commercial fluorescent polarization immunoassay. Ultrafiltrates were obtained by centrifugation at 1000 X g for ten minutes at room temperature and their assay indicated a range in protein binding from 7.9 to 71 percent. The mean protein binding (mean +/- SD) was 41.95 +/- 14.15 percent. No measurable adsorption of vancomycin onto the ultrafiltration membrane was noted. Orthogonal regression of unbound versus total vancomycin concentrations was described by the equation y = 0.597x-0.362 with a correlation coefficient of 0.948.

Adult↗
PubMed1988

Pruritic rash with actinic keratosis and impending exfoliation in a patient with hypertension managed with minoxidil.

Dermatological toxicity has been reported following initiation of therapy with minoxidil, but no cases have been reported following prolonged use. We report the emergence of an erythematous weeping rash with impending exfoliation three years after the initiation of minoxidil therapy. Minoxidil was withdrawn and the patient responded to therapy with topical corticosteroids. Following minor surgery, the patient was inadvertently rechallenged with minoxidil. Within 24 hours of exposure bullous lesions reappeared in the extremities which again resolved with topical corticosteroids. Dermatological lesions observed on this patient were similar to those reported following acute minoxidil exposure and strongly implicate chronic minoxidil therapy.

Drug Eruptions↗
PubMed1988

Disposition of cefonicid in orthopedic surgery patients.

Ten patients undergoing hip reconstructive procedures were given a single prophylactic dose of cefonicid 15 mg/kg to evaluate intraoperative and perioperative drug disposition in the surgical setting. Timed postinfusion serum samples were collected over 24 hours and resulting concentration versus time data were subjected to noncompartmental pharmacokinetic analysis. Bone samples were obtained in eight of ten patients with mean bone concentrations of 13.3 micrograms/g (range 8.2-25.1). Postinfusion serum concentrations at five minutes postinfusion ranged from 200.8 to 316.7 micrograms/ml; the 12-hour mean was 19.1 micrograms/ml (range 4.0-48) and the 24-hour mean was 4.3 micrograms/ml (range 0.0-13.8). Protein binding at three sampling times ranged from 88 to 96.5 percent, increasing over time as total cefonicid concentrations fell. The mean half-life in our patients was 3.5 hours, compared with 4.8 hours in our four controls. These data indicate that altered protein binding and intraoperative events alter the disposition of cefonicid. Although differences in disposition parameters between patients and controls were not statistically significant, suboptimal serum cefonicid concentrations were observed in four orthopedic patients.

Adult↗
PubMed1987

Carbamazepine and erythroid arrest.

A patient who developed anemia with an isolated erythroid toxicity following chronic carbamazepine administration is reported. The anemia quickly resolved with discontinuation of this drug. Other hematologic toxicities of carbamazepine are well described; however, an isolated erythroid toxicity is unusual. In addition, the onset of this drug-induced toxicity developed later than is expected for carbamazepine-associated hematological toxicities. This case demonstrates the suddenness with which hematological toxicities can occur with carbamazepine, and affirms the need for regular monitoring of patients. Any significant decrease in the patient's hemoglobin or hematocrit level requires close monitoring for the sudden development of serious anemia.

Adult↗
PubMed1984

Aminoglycoside therapy. Improving patient response and safety.

The aminoglycosides have long been effective antibiotics in treatment of serious gram-negative infections. However, ototoxicity and nephrotoxicity have been of major concern because of the narrow therapeutic range of these agents and the wide variability in pharmacokinetics among patients. With recent advances in aminoglycoside monitoring techniques, the risk of toxicity has been greatly reduced. Automated methods are now available to quickly and precisely measure aminoglycoside concentration in serum, and by applying pharmacokinetic principles to serum concentration-time data, the clinician can readily calculate the correct dosage for each patient. Programs for computers and programmable calculators, also now available, can assist in these calculations.

Adult↗
PubMed1984

Effect of decreased renal function on the pharmacokinetics of ceftazidime.

The pharmacokinetics of ceftazidime after a 1-g bolus dose were studied in 11 subjects, with creatinine clearances ranging from 113 to 6 ml/min. Concentrations of ceftazidime in serum were determined by microbiological assay. These data were fitted to a two-compartment open model, and pharmacokinetic parameters were calculated. Correlation of ceftazidime clearance with creatinine clearance was excellent (r = 0.99).

Adult↗
PubMed1983

Comparison of radioimmunoassay and fluorescent polarization immunoassay for quantitative determination of vancomycin concentrations in serum.

A new fluorescent polarization immunoassay (Abbott Laboratories, Diagnostics Division, North Chicago, Ill.) was compared with a standard radioimmunoassay (American Diagnostics Corp., Newport Beach, Calif.) in 34 patients being treated with vancomycin. A total of 123 serum samples were divided and quantitatively analyzed for vancomycin by both assay methods. The results obtained indicated that the two assay methods are comparable (y = 1.01x - 0.81; r = 0.99).

Fluorescence Polarization↗
PubMedDate not supplied

Monitoring chronic outpatient infections: providing comprehensive home healthcare pharmacy services.

Management of acute illness has been increasingly shifted to community practitioners. Expansion of community pharmacy into home healthcare has brought new opportunities and responsibilities to community practitioners. These practitioners are gaining expertise in total parenteral nutrition, intravenous infusion systems, intravenous catheters, parenteral antibiotics, and clinical pharmacokinetics--areas historically managed by hospital and long-term care facility pharmacists. This shift to community pharmacy-based care has brought with it the need for community pharmacists to develop expertise in therapeutic monitoring of chronic disease states. Dose adjustment of medications based upon careful analysis of blood concentrations is no longer limited to institutional pharmacy practice. Community pharmacists now must master basic infectious disease principles and possess internal medicine knowledge to ensure appropriate monitoring of their patients. This article discusses several disease states currently managed with community pharmacy-based home healthcare, summarizing basic monitoring parameters for comprehensive patient care, and provides sample supply lists and documentation forms for home healthcare providers.

Anti-Bacterial Agents↗