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Biomedical subjects

M L Job

Publications and source records attributed to M L Job.

13 recordsLinked to original sources
PubMed1997

Drug-induced Clostridium difficile-associated disease.

Clostridium difficile is a spore-forming anaerobe that resides in the colon and is capable of producing gastrointestinal disease in humans. Factors such as previous exposure to antibacterials and some antineoplastic agents have been reported to promote the overgrowth of C. difficile, with subsequent liberation of potent exotoxins that induce inflammation in the colonic mucosa. Colonisation rates vary, and are higher during infancy and hospitalisation, compared with healthy adults. Although many antibacterials have been reported to induce disease, those agents that achieve high concentrations in the intestinal lumen and are active against bowel flora are more likely to promote overgrowth of C. difficile. Agents with a high potential to induce C. difficile-associated disease (CDAD) include aminopenicillins, cephalosporins and clindamycin. These antibacterials are capable of reducing normal colonisation resistance within the colon. The exact incidence of CDAD is unknown. Some reports suggest an incidence of 1 to 3 infections per 100,000 courses of outpatient oral therapy. The spectrum of illness of CDAD can range from mild diarrhoeal disease to severe colitis, toxic megacolon and sepsis. Fatalities have occurred in some cases. Discontinuation of the offending antibacterial in patients with mild disease is often sufficient to alleviate symptoms. For those with moderate to severe illness, metronidazole and vancomycin are reported to be equally efficacious. Increasing resistance of enterococci to vancomycin limits its use to patients with severe life-threatening infections. Patients with recurrent disease usually respond well to the same course of therapy as was used to treat the initial infection. CDAD is potentially preventable when appropriate antibacterial selection and infection control measures are implemented.

Adult↗
PubMed1994

Effect of ciprofloxacin on the pharmacokinetics of multiple-dose phenytoin serum concentrations.

We performed this study to determine if an interaction exists during the co-administration of ciprofloxacin with phenytoin. Seven healthy volunteers received oral phenytoin, 200 mg/day, as a single dose for 10 days. On day 9, phenytoin blood sampling was performed at times 0, 1, 2, 4, 6, 8, 10, 12, and 24 h. On day 10, oral ciprofloxacin, 500 mg, b.i.d. was initiated. On day 14, blood samples were collected as previously described. Pharmacokinetic analysis was performed to determine if there were differences between the area under the concentration time curve (AUC), maximum serum concentration, Cmax, and time of maximum serum concentration, Tmax, of phenytoin before and during co-administration of ciprofloxacin. Four subjects completed the study. Results of the analysis showed no significant differences between AUC, Cmax, and Tmax of phenytoin before and during ciprofloxacin administration. However, one subject showed marked reductions in both AUC and Cmax. Similar reductions in plasma concentrations have also been reported, resulting in breakthrough seizures. In conclusion, ciprofloxacin was not shown to increase phenytoin plasma concentrations or AUC in healthy volunteers. The potential for decreasing plasma phenytoin concentrations may exist and warrants close monitoring of levels when these two agents are given simultaneously.

Adult↗
PubMed1992

Use of theophylline in neonates as an aid to ventilator weaning.

Respiratory diseases are major causes of morbidity and mortality in premature neonates. Theophylline has been utilized as an adjunct in facilitating ventilator weaning and in the management of apnea with or without bradycardia. Patient characteristics associated with improved outcome from theophylline have not been determined. The purpose of this study was to evaluate parameters associated with improved outcome in neonates with respiratory diseases receiving theophylline. The study population consisted of premature neonates that were studied retrospectively. Criteria for entry into the study were (1) less than 40 weeks gestation, (2) a diagnosis of respiratory distress syndrome (RDS), apnea of prematurity, hyaline membrane disease (HMD), or bronchopulmonary dysplasia (BPD), (3) dependence on intermittent mandatory ventilation, (4) failure to wean from the ventilator 24 h or more before the study, or (5) receiving theophylline. In this study, we found no correlations between time to wean from the ventilator and postnatal age at the time theophylline was initiated, 5-min APGAR score, and final theophylline serum concentration before complete weaning from the ventilator. However, there were significant negative correlations between birthweight and gestational age with respect to time to wean from the ventilator. The average theophylline serum concentration before weaning from the ventilator for this population of neonates was approximately 5-10 micrograms/ml, indicating that theophylline is not beneficial as an aid to ventilator weaning at serum concentrations < 10 micrograms/ml.

Apgar Score↗
PubMed1992

Teicoplanin nephrotoxicity: first case report.

A 71-year-old man with type I diabetes mellitus was admitted to the hospital for the treatment of osteomyelitis of the left great toe secondary to methicillin-resistant Staphylococcus aureus. The patient was enrolled in an investigational protocol and was treated with teicoplanin 1200 mg/day. Following 40 days of treatment, the patient developed both markedly elevated serum creatinine and blood urea nitrogen. Urine analysis also showed the presence of protein. The eosinophils were markedly elevated in the blood. The patient was subsequently diagnosed with a probable drug-induced acute interstitial nephritis. Treatment with furosemide and hemodialysis over the next two weeks failed to produce improvement in renal function. The patient was referred for long-term dialysis. The data presented in this report suggest the possible relationship of teicoplanin and the development of renal failure in this patient. Periodic monitoring of renal function and follow-up are probably warranted in patients receiving long-term teicoplanin therapy.

Aged↗
PubMed1990

Seizure activity with imipenem therapy: incidence and risk factors.

Two elderly patients with a history of either cerebral vascular accident (CVA) or head trauma and no evidence of renal disease developed seizures while receiving maximum doses of imipenem/cilastatin. Neither patient had reported previous seizures or seizure-like activity nor was receiving anticonvulsant agents. All seizures were controlled with therapeutic doses of phenytoin. Both patients had received maximum doses of other beta-lactam antibiotics without evidence of seizure activity.

Aged↗
PubMed1990

Implementing and maintaining a private pharmacokinetics practice.

The development and maintenance of a private-practice pharmacokinetics service is described. A contracted pharmacokinetics service has been in place at Georgia Baptist Medical Center, a 525-bed hospital, for the past eight years. Physician support, inhouse study results, and literature documentation of the benefits of scheduling drug concentration determinations were used to convince hospital administrators of the value of a pharmacokinetics service. Services were reimbursed by increasing the fee charged for each drug concentration determination, with payment made to the pharmacokinetics service on a monthly basis. The service is associated with the pathology department for administrative purposes. Each member of the pharmacokinetics service is credentialed by the medical staff. The group trains part-time personnel to provide services when needed. Services provided by the group but not required by the contract include collecting quality assurance data, conducting research, serving on hospital committees, writing newsletter articles, conducting inservice-education programs, and providing clinical interventions for nonconsultation patients. This private-practice pharmacokinetics service provides high-quality services and is well accepted within the institution.

Drug Information Services↗
PubMed1989

Seven years of experience with a pharmacokinetic service.

There have been several reports describing the impact of pharmacokinetic services on cost containment. The purposes of this report are to describe seven years of experience with the operation of a pharmacokinetic service, and the processes used to implement and maintain the service along with a discussion of the impact of the service on hospital cost and patient charge containment. The major functions of the pharmacokinetic service are to; 1) provide clinical pharmacokinetic and pharmacology consultation upon physician request, 2) coordinate the scheduling of serum drug levels (SDLs), and 3) provide quality assurance and utilization review reports related to the service. Data gathered from the service are reported to the medical staff monthly and are incorporated into the hospital's on-going drug usage evaluation. The results of continuous review demonstrate that direct intervention of a pharmacokineticist and a systematic approach to drug level scheduling yielded less than 1% of inappropriately collected SDLs, and in the latest year, a yearly patient charge savings of +116,304. In another study evaluating the service, it was demonstrated that when aminoglycoside dosages are adjusted by a pharmacokineticist, a patient charge savings of +491 per patient is realized. This review of seven years of experience with a pharmacokinetic service supports the conclusion that these services can have a beneficial impact on hospital costs. Furthermore, data gathered from the service can be utilized for the hospital's overall quality assurance program.

Cost Control↗
PubMed1987

Aminoglycoside monitoring: use of a pharmacokinetic service versus physician recommendations.

Two patient populations were evaluated regarding the monitoring of aminoglycoside serum concentrations by either a pharmacokinetic service (PKS) or staff physicians. Both groups were evenly matched by demographic characteristics, underlying disease state(s), and indication for aminoglycoside therapy. Patients in the PKS group showed increased incidence of clinical improvement after therapy when compared with the physicians' group; a decreased length of stay and duration of treatment were also observed in this group. Aminoglycoside dosing and monitoring by the PKS provided an estimated average cost savings of $491,00 per patient. The results indicate that the PKS may provide cost savings and benefit in aminoglycoside monitoring for the patient and/or the hospital.

Adolescent↗
PubMed1986

Correlation of pharmacokinetic indices with therapeutic outcome in patients receiving aminoglycosides.

The influence of five pharmacokinetic indices on therapeutic response was retrospectively studied in 45 adult patients treated with aminoglycosides for bacterial infections. Subjects were treated for a minimum of five days, had culture and sensitivity reports, and had at least one set of steady-state peak and trough serum aminoglycoside concentrations. Serum drug concentrations were determined by enzyme-multiplied immunoassay or by fluorescence polarization assay. Minimum inhibitory concentrations (MICs) for the drugs were determined by microdilution assays. Cure was determined by negative cultures or absence of clinical evidence of infection. Values for five pharmacokinetic indices were determined for each patient: ratio of steady-state peak serum concentration to MIC (Cssmax/MIC); time that the serum concentration remained above the MIC during a 72-hour period (tsupra-MIC(72)); the intensity index for a 72-hour period (II(72)), which is related but not identical to the area under the curve (AUC), reflecting the contributions of Cssmax/MIC and tsupra-MIC(72); time that the serum concentration was greater than four times the MIC during a 72-hour period (tsupra-(4 X MIC)(72)), and the intensity index related but not identical to AUC greater than four times the MIC (II4 X MIC(72)), which reflects the contribution of Cssmax/(4 X MIC) and tsupra-(4 X MIC)(72). Statistical analysis revealed significant correlations between each of the five indices and the patients' therapeutic responses. The following index values were associated with cures: Cssmax/MIC greater than 4 (and ideally greater than 8); tsupra-MIC(72) of at least 40 hours; tsupra-(4 X MIC)(72) of at least 10 hours; (4) II(72) greater than 400; and II4 X MIC(72) greater than 50. All five pharmacokinetic indices were good predictors of patient outcome. The ratio of maximum steady-state serum aminoglycoside concentration to minimum inhibitory concentration is the index most easily monitored and interpreted.

Adult↗