Pharmacokinetics/pharmacodynamics and therapeutic drug monitoring of ceftazidime/avibactam administered by continuous infusion in patients with MDR Gram-negative bacterial infections.

BACKGROUND: Therapeutic drug monitoring (TDM) of ß-lactams in critically ill patients has been correlated with better clinical outcomes. Evidence on TDM of newer ß-lactams such as ceftazidime/avibactam administered by continuous infusion (CI) is very limited. OBJECTIVES: To describe our experience with TDM of ceftazidime/avibactam and pharmacokinetic/pharmacodynamic (PK/PD) target attainment in patients with MDR bacterial infections. Clinical outcomes of ceftazidime/avibactam administered by CI were also assessed. METHODS: Patients treated with ceftazidime/avibactam administered by CI and undergoing TDM of ceftazidime plasma concentrations were included. Blood samples were obtained as part of the TDM program. The PK/PD therapeutic target of ceftazidime/avibactam was defined as 100%fT > 4 × MIC of the causative pathogen, and 100%fT > 10 × MIC was considered overexposure. Dose changes were made according to the TDM results. RESULTS: Thirty-one patients were included. Ceftazidime/avibactam total daily doses ranged from 1 g/0.25 g to 6 g/1.5 g. Twenty-six patients (83.9%) achieved a 100%fT > 4 × MIC, 15 (48.4%) of which were overexposed (100%fT > 10 × MIC). Dose reduction was suggested in 16/28 (57.1%) patients and dose maintenance in 12/28 (42.9%). Overall clinical cure was observed in 21 (67.7%) patients, and 18 of these (85.7%) achieved a 100%fT > 4 × MIC. CONCLUSIONS: Administering ceftazidime/avibactam by CI enabled the desired PK/PD target to be achieved in a large proportion of patients, even at lower doses than those recommended for a 2 h extended infusion. We suggest that the use of CI with TDM may be a useful tool for reducing initial doses, which could help to reduce antimicrobial-related adverse effects and treatment costs.

Hipnosis en niños: evidencias científicas de su aplicación clínica en la medicina y psiquiatría actual / No disponible

La hipnosis se puede definir como un estado alteradode la conciencia caracterizado por la relajación, la atenciónfocalizada y una especial receptibilidad a aceptarcambios en el comportamiento y en los patrones de pensamiento.Los niños son sujetos especialmente indicadospara la intervención hipnótica, debido a su altasugestionabilidad. Aunque los estudios publicados alrespecto tienen importantes limitaciones metodológicas,de la revisión de los mismos se apunta a la posible utilidadde la hipnosis en el tratamiento de niños con diversostrastornos: alteraciones emocionales, problemas delsueño, tics, descontrol de impulsos, duelo, enfermedadesmédicas crónicas y terminales y control del dolor(AU)

Hypnosis could be described as a state of relaxation,focalised atention and a special receptibility to acceptchanges in behaviour and thought patterns. Cihldren aresubjects specially indicated to hypnotic interventions,due to their high sugestionability. Althought publishedstudies in hypnosis have important methodologic limitations,their revision point to a posible application ofhypnosis in treatment of children with several disorders,such as emotional disorders, sleep alterations, tics,impulse discontrol, mourning, chronic and terminal diseasesand pain control(AU)