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Biomedical subjects

G R Bailie

Publications and source records attributed to G R Bailie.

At least 19 recordsLinked to original sources
PubMed1995

Severe accidental dapsone overdose.

Acute poisoning from excessive dapsone (4,4-diaminodiphenylsulfone) intake in uncommon in the United States; no cases were reported during 1992. However, with the increasing use of dapsone for diseases other than leprosy and dermatitis herpetiformis, such as acne vulgaris, psoriasis, and Pneumocystis carinii pneumonia infection in acquired immunodeficiency syndrome, clinicians should be aware of potential toxicities. This report describes a case of accidental dapsone intoxication resulting in severe cyanosis with a modest elevation in methemoglobin concentration.

Charcoal↗
PubMed1995

Absorption interactions with fluoroquinolones. 1995 update.

The utility of the fluoroquinolone class of antibiotics is rapidly expanding due to their favourable pharmacokinetic profile and the continuing development of new compounds. These agents are often used for indications not successfully treated with other orally available antimicrobials in the past, or for 'step-down' therapy in patients originally treated with intravenous agents. As the usage of these agents expands for serious systemic infections, knowledge of absorptive interactions with fluoroquinolones becomes paramount. Fluoroquinolones are often utilised in dosages and against modestly susceptible pathogens which allow a narrow margin for acceptable decreases in bioavailability. Chelation interactions with multivalent cations can result in inactivation of the fluoroquinolone with ramifications in vitro and in vivo. Chelation interactions have been reported to occur in between 22 and 76% of patients prescribed fluoroquinolones. Concurrent administration of magnesium-aluminum antacids and sucralfate has the greatest effect on the bioavailability of quinolones followed by iron, calcium and zinc. Spacing doses of fluoroquinolones and interactants has been suggested as a method of ensuring adequate quinolone absorption, but this can make optimal administration of the cation interactant difficult, if not impossible.

Absorption↗
PubMed1992

Pharmacokinetics of propofol during and after long-term continuous infusion for maintenance of sedation in ICU patients.

The pharmacokinetics of propofol administered as long term infusions were determined in 12 intensive care unit patients (two female; mean age 58 yr, mean weight 66.9 kg) requiring sedation during mechanical ventilation. Patients were recruited after having been administered propofol for 24 h. Blood samples for analysis of propofol were taken during the infusion (mean duration 85.6 h; mean rate 2.58 mg kg-1 h-1) and for up to about 42 h after its termination. The median propofol total body clearance, derived from the apparent steady state propofol blood concentrations during infusion, was 2.11 litre min-1. One patient died during the infusion, from multi-organ failure secondary to a pre-existing septicaemia, and in one other patient no sampling was possible during the first 30 min after infusion; full elimination data were obtained for 10 patients. After termination of the infusion, propofol blood concentrations declined rapidly, with an overall mean decrease of 50% over the first 10 min; thereafter the decline was more gradual. The elimination profile was triphasic in seven patients and biphasic in three patients. Mean half-lives for the three phases were 1.81 (n = 10) min, 70.9 (n = 7) min and 1411 (n = 11) min. There was no apparent trend in the terminal phase half-life with the duration of sampling after infusion.

Adult↗
PubMed1992

Continuous ambulatory peritoneal dialysis: a review of its mechanics, advantages, complications, and areas of controversy.

OBJECTIVE: The primary objective of this article is to review the mechanics, advantages, complications, pharmacokinetics, and future trends of continuous ambulatory peritoneal dialysis (CAPD) as they pertain to pharmacotherapy. DATA SOURCES: Pertinent articles were obtained from an English-language literature search using MEDLINE (1980-1991), Index Medicus (1987-1990), and bibliographic reviews of review articles. Indexing terms included peritoneal dialysis, pharmacokinetics, peritonitis, vancomycin, and fluoroquinolones. DATA SYNTHESIS: All clinical studies comparing organism recovery methods and treatment of peritonitis have methodologic limitations (e.g., comparison of disparate patient groups, different definitions of peritonitis, lack of follow-up, lack of control for sterile cultures) that may affect the reported results. CONCLUSIONS: CAPD is an alternative to hemodialysis for the treatment of endstage renal disease and has many complications, leading to significant morbidity. This indicates that CAPD is not appropriate for all patients. Using blood-culturing techniques to culture for dialysate is most productive, but also the most costly. There are few data to indicate exactly the drugs, doses, and durations of choice for peritonitis. Both intraperitoneal and oral administration appear to be appropriate.

Anti-Infective Agents↗
PubMed1992

Prediction of serum vancomycin concentrations following intraperitoneal loading doses in continuous ambulatory peritoneal dialysis patients with peritonitis.

The pharmacokinetics of vancomycin were studied in continuous ambulatory peritoneal dialysis patients with peritonitis. Six patients received an intraperitoneal loading dose of 15 mg/kg and 4 received an intraperitoneal dose of 25 mg/L. The ability of 2 methods to predict serum concentrations during the loading dose exchange was determined. The mean serum concentration after the exchange was 17.8 +/- 2.2 mg/L in patients receiving the loading dose. The mean dialysis clearance in all patients was 0.94 +/- 0.34 L/h. 66.6 +/- 13.4% of a dose was absorbed into the circulation in 4 h. The volume of distribution was 0.61 +/- 0.46 L/kg, and the half-life for equilibration of vancomycin into the circulation from dialysate was 2.76 +/- 0.94 h. Two methods of predicting serum vancomycin concentrations were tested, with 1 method predicting values significantly different from measured concentrations while the other did not. Serum vancomycin concentrations can be accurately predicted during a loading dose exchange.

Adolescent↗
PubMed1992

Relationship between peritonitis and exit site infections in CAPD.

This study was designed to retrospectively review the experience in this center with oral ciprofloxacin 500 mg bid and ip vancomycin 25 mg/L in the treatment of CAPD-related exit site infections and to determine the relationship between exit site infections and peritonitis. There were 48 patients with 172 episodes of infection (23 had both infections, 22 had peritonitis only, 3 had exit site infections only). Thus, exit site infections occur infrequently in the absence of peritonitis (23% of occasions). Of the 35 patients who had peritonitis as the first infection, 13 (37%) subsequently developed an exit site infection. The mean +/- SD period from an initial peritonitis to a subsequent exit site infection in these patients was 8.2 +/- 8.0 (range 1-28) months. Of the 22 patients with 34 exit site infections, there were 15 (44%) treatment failures, of which 10 (67%) were relapses or possible relapses. S. aureus was the most common isolate. 5% of exit site infections were culture negative. Follow-up was incomplete for many patients resulting in many instances of no further cultures, and compliance could not be assured. This combination was associated with a high incidence of treatment failures in this setting.

Ciprofloxacin↗
PubMed1992

Erythropoietin in continuous ambulatory peritoneal dialysis: experience with subcutaneous administration.

Experience in the use of subcutaneous erythropoietin (EPO) in 32 continuous ambulatory peritoneal dialysis (CAPD) patients is presented. All patients were treated with oral iron supplements. The total and mean +/- SD durations of EPO treatment were 466 weeks and 14.6 +/- 10.1 weeks respectively. Twenty-two patients started treatment with normal or elevated iron stores; 10 had an initial iron saturation less than 20%. The initial hematocrit was 23.8 +/- 3.7%. Thirteen patients reached a steady-state hematocrit by the end of the study period, when the mean +/- SD hematocrit for all 32 patients was 34.1 +/- 3.6%. All patients responded to EPO. The initial dose of EPO was 147.1 +/- 53.8 U/kg/week. Maintenance dose was 72 +/- 36 U/kg/week.

Anemia↗
PubMed1991

Effect of staggered dose of calcium on the bioavailability of ciprofloxacin.

The effect on ciprofloxacin's bioavailability (F) of calcium carbonate given 2 h before ciprofloxacin administration in 12 male volunteers was studied. The relative F with calcium was 0.98, maximum concentration of drug in serum increased significantly from 1.98 to 2.42 mg/liter (P = 0.039), and time to maximum concentration of drug in serum decreased from 1.82 to 1.26 h (P = 0.038). Thus, a single calcium carbonate dose, administered 2 h before ciprofloxacin, does not alter the F of this quinolone.

Adult↗
PubMed1991

Chemical peritonitis associated with intraperitoneal vancomycin.

A case of chemical peritonitis associated with intraperitoneal vancomycin is reported. A 23-year-old woman presented with signs and symptoms consistent with a chronic ambulatory peritoneal dialysis catheter exit-site infection. Intraperitoneal vancomycin (Vancoled) 1 g was given, followed by 25 mg/L into each subsequent exchange. On day 4 the patient developed abdominal pain and cloudy dialysis effluent. The vancomycin was discontinued, and the dialysate cleared by day 8. Fluid cultures were negative, and Staphylococcus aureus was isolated from the exit site. Subsequent intravenous vancomycin, and smaller intraperitoneal doses, failed to repeat the event. Fluid and serum white blood cell count, serum immunoglobulins and complement, culture results, and the temporal relationship are strongly suggestive of a vancomycin-induced chemical peritonitis.

Adult↗
PubMed1991

Pentamidine-associated nephrotoxicity and hyperkalemia in patients with AIDS.

The incidences of pentamidine-associated nephrotoxicity and hyperkalemia were determined from a retrospective review of records in AIDS patients using standard definitions for both toxicities. There were 37 patients, mean age 35.6 +/- 7.7 years and mean initial creatinine clearance (Clcr) 96 mL/min (1.6 mL/s). The mean pentamidine dose was 255 +/- 60 mg/d (3.87 +/- 0.33 mg/kg/d). The mean total dose was 2900 +/- 1600 mg given over 11.6 +/- 5.9 days (range 3-21 d). In 28 patients who were nephrotoxic (8 mild, 6 moderate, 14 severe), 27 episodes were possibly or probably pentamidine-associated. Total dose and days to nephrotoxicity onset were 1570 +/- 710 mg and 6.4 +/- 2.8 days (range 2-15 d), respectively. Nine patients became hyperkalemic (one required countermeasures) and all cases were pentamidine-associated. Total dose and days to hyperkalemia onset were 2510 +/- 1460 mg and 9.2 +/- 4.9 days (range 3-16 d), respectively. Mean baseline potassium increased and Clcr decreased significantly during therapy (from 4.2 to 4.9 mEq/L and from 96 to 70 mL/min, respectively). No correlation between nephrotoxicity or hyperkalemia and initial renal function was found, but significant correlations were found between the total pentamidine dose or duration and the percent of renal function remaining. AIDS patients have a high incidence of pentamidine-associated nephrotoxicity (up to 73 percent) and hyperkalemia (24 percent) with a trend to earlier onset of the former.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Quinolone-cation interactions: a review.

The quinolone class of antibiotics is enjoying a recent resurgence in interest and use due to the development of improved compounds. Norfloxacin, ciprofloxacin, and, most recently, ofloxacin have been marketed. Enoxacin and other agents are in various stages of investigation. These newer compounds are often used for indications not successfully treated by the original quinolones, or in some cases, not optimally treated with any previously available oral antibiotic. A potential problem with the increasing use of quinolone-type antibiotics for systemic illness is the chelation and inactivation of these compounds by several cations. One outcome of these potential interactions is a possible reduction in bioavailability and effectiveness of quinolone compounds. A review of the literature on quinolone-cation interactions, in vivo and in vitro significance, and recommendations to avoid potential problems are provided.

4-Quinolones↗
PubMed1991

Experience with subcutaneous erythropoietin in CAPD patients.

Experience in the use of subcutaneous erythropoietin in 18 CAPD patients is presented. The total and mean (SD) durations on CAPD were 419 and 23.3 (20.5) months, respectively. Eleven patients started treatment with normal or elevated iron stores, 7 had an initial iron saturation less than 20%. The initial hematocrit was 22.0 (3.1%). Eleven patients reached a steady state hematocrit (34.1 +/- 3.5%) by the end of the study period, and the mean percentage increase in hematocrit for all 18 patients was 47% over the initial hematocrit. All patients responded to EPO. The initial dose of EPO was 157.6 U/kg/wk, and all patients received oral iron supplements. There was no significant change in the means of any iron parameters. Transfusion requirements decreased from a mean of 0.42 transfusions per month per patient during the 12 months, prior to EPO, to 0.22 during the study. There were no significant changes in blood pressure or other measured parameters. Transient pain at the site of injection was noted infrequently.

Anemia↗