Dosing Optimization of Ampicillin-Sulbactam Based on Cystatin C in Elderly Patients with Pneumonia.

Ampicillin-sulbactam is a first-line therapy for pneumonia and is mainly excreted by the kidney. It is important to optimize the dose and dosing interval of ampicillin-sulbactam because in patients with decreased renal function and low skeletal muscle mass, such as the elderly, excess drug may burden renal function. In this study, we evaluated indices of renal function and optimized the dose and dosing interval of ampicillin-sulbactam based on pharmacokinetics (PK) and pharmacodynamics theory in elderly patients. The serum concentrations of ampicillin and sulbactam were measured by HPLC, and PK parameters were calculated. Correlations between the clearance of ampicillin or sulbactam and renal function were evaluated, and dosing optimization was calculated based on PK parameters. The PK parameters of ampicillin were CL = 6.5 ± 4.0 L/h, Vd = 19.3 ± 0.2 L, Ke = 0.4 ± 0.2, and t1/2 = 2.7 ± 1.6 h. The most correlated renal function index was estimated glomerular filtration rate (eGFRcys-c) calculated by serum cystatin-c (r = 0.7374, correlation formula; CL of ampicillin = 0.1937 × eGFRcys-c-0.6726). Based on this formula, we calculated the clearance of ampicillin and developed dosing regimens for the elderly. Serum cystatin-c concentration is an ideal index to optimize ampicillin-sulbactam antimicrobial therapy in elderly patients with pneumonia.

Usability of PDF based Digital Textbooks to the Physically Disabled University Student.

Digital textbooks have been expected for providing multimedia information that the print textbooks could not handle. The original digital textbook can be fabricated relatively easily by using Epub or DAISY. Print textbooks are, however, employed as textbooks in the most of lectures in universities. Therefore, it is considered necessary to convert the content of the print textbook to the digital textbook simply and in a short time. In this paper, the digital textbook using PDF files of the print textbook was suggested as one of simple and practical solution to provide an alternative textbook for the physically disabled university student who has difficulty handling the print textbook. Then usability of the suggested method was evaluated experimentally from the point of workload. Result of the experiment indicates that the digital textbook fabricated as the alternative one for the print textbook by the suggested method has a potential to reduce workload for the physically disabled university students. In addition, the digital textbook with larger LCD display needs less workload than the print textbook. Then, there are not so much difference in the workload between the print book which is smaller than the print textbook and the digital book made from the print book.