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Challenge for highe...
Challenge for higher colistin dosage in critically ill patients receiving continuous venovenous haemodiafiltration
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- Karaiskos, Ilias (author)
- Hygeia Gen Hosp, Dept Internal Med 6, Athens, Greece.;Hygeia Gen Hosp, 4 Erythrou Stavrou Str & Kifisias, Athens 15123, Greece.
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- Friberg, Lena E (author)
- Uppsala universitet,Institutionen för farmaceutisk biovetenskap
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- Galani, Lambrini (author)
- Hygeia Gen Hosp, Dept Internal Med 6, Athens, Greece.
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- Ioannidis, Konstantinos (author)
- Hygeia Gen Hosp, 4 Erythrou Stavrou Str & Kifisias, Athens 15123, Greece.
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- Katsouda, Emmanouela (author)
- Hygeia Gen Hosp, Intens Care Unit, Athens, Greece.
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- Athanassa, Zoe (author)
- Hygeia Gen Hosp, Intens Care Unit, Athens, Greece.
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- Paskalis, Harris (author)
- Hygeia Gen Hosp, Intens Care Unit, Athens, Greece.
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- Giamarellou, Helen (author)
- Hygeia Gen Hosp, Dept Internal Med 6, Athens, Greece.
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Hygeia Gen Hosp, Dept Internal Med 6, Athens, Greece;Hygeia Gen Hosp, 4 Erythrou Stavrou Str & Kifisias, Athens 15123, Greece. Institutionen för farmaceutisk biovetenskap (creator_code:org_t)
- Elsevier BV, 2016
- 2016
- English.
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In: International Journal of Antimicrobial Agents. - : Elsevier BV. - 0924-8579 .- 1872-7913. ; 48:3, s. 337-341
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Traditionally, reduced daily doses of colistin methanesulphonate (CMS) in critically ill patients receiving continuous venovenous haemodiafiltration (CVVHDF) have resulted in suboptimal colistin concentrations. The necessity of a loading dose (LD) at treatment initiation has been proposed. A LD of 9 million IU (MU) [ca. 270 mg of colistin base activity (CBA)] was administrated with a maintenance dose of 4.5 MU (ca. 140 mg CBA) every 12 h (q12h) to eight critically ill patients receiving renal replacement therapy. Blood samples were collected immediately before and at different time intervals after the LD and the fourth dose, whilst pre-filter and post-filter blood samples were also collected. CMS and colistin concentrations were determined using an LC-MS/MS assay. Median maximum observed concentrations after the LD were 22.1 mg/L for CMS and 1.55 mg/L for colistin, whereas during maintenance dosing the corresponding values were 12.6 mg/L and 1.72 mg/L, respectively. CVVHDF clearance was determined as 2.98 L/h for colistin, equivalent to 62% of total apparent colistin clearance in CVVHDF patients. Both CMS and colistin were cleared by CVVHDF. Application of a LD of 9 MU CMS resulted in more rapid achievement of the target colistin concentration. Following implementation of a predicted pharmacokinetic model on plasma CMS/colistin concentrations, a LD of 12 MU CMS appears more appropriate, whilst a CMS maintenance dosage of at least 6.5-7.5 MU q12h is suggested in patients undergoing CVVHDF. However, further clinical studies are warranted to assess the safety of a LD of 12 MU CMS in patients receiving CVVHDF.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Medicinska och farmaceutiska grundvetenskaper -- Farmaceutiska vetenskaper (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Basic Medicine -- Pharmaceutical Sciences (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Infectious Medicine (hsv//eng)
Keyword
- Colistin
- CMS
- Loading dose
- Pharmacokinetics
- CVHHDF
Publication and Content Type
- ref (subject category)
- art (subject category)
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