Recurrent Body Rash Warranted Second Desensitization With Acyclovir in a Myeloma Patient: A Case Report.

A 75-year-old woman developed a moderately severe rash about a week and a half after the start of bortezomib (Btb)-based chemotherapy for IgG lambda multiple myeloma; at the time, she was also receiving acyclovir as antiviral prophylaxis in addition to herpes zoster (HZ) vaccination. HZ reactivation rate is high in Btb recipients; therefore, the timing of antiviral prevention is critical in relation to Btb. Attempts were made to identify the offending agent based on the timing of drugs administered and the appearance of skin lesions in relation to other drugs. Both Btb and acyclovir were potential culprits. However, the timing of rash presented on days 9 - 10 revealed the offending agent when the corticosteroid was weaned off while acyclovir continued. A decision was made to administer acyclovir rapid desensitization program (RDP) for our patient.

Pharmacokinetic modelling of a once-daily dosing regimen for intravenous tobramycin in paediatric cystic fibrosis patients.

OBJECTIVES: This study was designed to determine an optimal dose range for the once-daily dosing (ODD) of tobramycin in the treatment of an acute pulmonary exacerbation in paediatric cystic fibrosis (CF) patients. In addition, we aimed to assess whether certain patient characteristics affect tobramycin pharmacokinetics and, therefore, dosing. METHODS: Patient characteristics and pharmacokinetic parameters of patients receiving tobramycin three times daily from 1 January 1992 to 31 October 2005 were analysed using univariate analysis and multiple linear regression to determine statistically significant relationships and to derive dosing models. The binary partitioning method was used to derive critical values to determine stratification within the chosen dosing model. RESULTS: Using multiple linear regression, age and sex were significantly associated with the volume of distribution divided by the body weight (V/kg). By the binary partitioning method, the critical value for age was 13.75 years. CONCLUSIONS: Age and sex were used to derive an ODD regimen for tobramycin in paediatric CF. Using a target peak concentration range of 25-35 mg/L, the initial dose for female CF patients at least 14 years of age was calculated to be 7 mg/kg/day given intravenously as a single daily dose. All other CF patients would receive an initial dose of 9 mg/kg/day given intravenously as a single daily dose. These dosing guidelines will require prospective evaluation for safety and efficacy.

ANG II-induced attenuation of duck salt gland secretion does not depend upon the release of adrenal catecholamines.

Pekin ducks (Anas platyrhynchos) were bilaterally adrenalectomized (ADX) using a two-stage procedure and given daily i.m. injections of 1 mg kg bw(-1) of dexamethasone (DEXA), a steroid lacking mineralocorticoid activity, and 0.9% saline drinking water ad libitum to counterbalance renal losses of salt and water. Mean arterial blood pressure (mmHg) fell from 161+/- 3.7 (intact controls) to 116 +/- 6.9 (bilateral ADX+DEXA), a decrease of 27%, but heart rates (HR) were unchanged. The nasal salt glands were fully active after ADX + DEXA. Rates of fluid secretion and electrolyte and osmolal concentrations were unchanged. Secretion stopped, then rebounded several minutes later if ADX + DEXA ducks were injected i.v. with 1 microg of [Asn(1),Val(5)]-angiotensin II (ANG II) kg bw(-1) which showed that attenuation was not adrenal catecholamine-dependent.