Investigation of the clinical efficacy and dosage of intravenous ciprofloxacin in patients with respiratory infection.

PURPOSE: Infection control is particularly vital in hospitals, and proper use of antimicrobial drugs is one of the most important roles of hospital pharmacists. In this study, we surveyed patients who had been prescribed single-use ciprofloxacin (CPFX), and evaluated the blood concentration of CPFX from the predictive AUC (area under the concentration curve). METHODS: This study was performed retrospectively to 112 adult patients diagnosed as having respiratory infections who had been treated as inpatients with intravenous CPFX for more than 3 days at Toho University Omori Hospital in Tokyo. The predictive AUC of each patient was obtained from the modified formulae reported by Forrest et al. (1993) [1]. The relation between the antimicrobial activity of CPFX and pharmacokinetic/pharmacodynamic (Cmax, AUC and AUC/MIC (minimum inhibitory concentration)) was studied. RESULTS: Although CPFX is excreted from the kidney, standard treatment with this drug does not take renal function into consideration. Our results indicated that CPFX was effective in less than 50% of the patients who received it. Moreover, the AUC/MIC ratio in both the effective group and the failure group was less than 125 when the clinical target was gram-negative bacteria. CONCLUSION: These results suggest that the clinical use of CPFX for the treatment of infectious diseases does not reach the target AUC/MIC ratio, and that the concentration of CPFX is not within the range to which many pathogens are susceptible in a large proportion of patients. To ensure the effective treatment of patients with infectious diseases and to prevent the development of resistance in bacteria, we recommend therapeutic drug monitoring (TDM) of CPFX in hospitals.

[Study of the predictive method of 24-hour creatinine clearance in calculating the appropriate dosage of Carboplatin].

BACKGROUND: The carboplatin (CBDCA) dosage is usually calculated using the formula of Calvert. Instead of the glomerular filtration rate (GFR), 24-h creatinine clearance (24 CLcr) is often used in this formula, which is calculated based on 24-h urine collection in clinical practice. OBJECTIVE: We studied the adequacy of 24 CLcr in calculating the appropriate dosage of CBDCA using the formula of Calvert and compared CLcr and GFR using various substitutable predictive formulas (the formulae of Cockcroft and Gault, Yasuda, Orita, Jellife, Mawer, MDRD, and modified MDRD) when we were not able to use 24 CLcr. METHODOLOGY: We retrospectively studied 193 patients who received CBDCA as chemotherapy during the period April 2004 through November 2006. We evaluated the adequacy of 24-h urine collection for measurement of creatinine production and excretion. We also evaluated the appropriate urine collection within a 15% range of the difference. The correlation between the appropriate 24 CLcr resulting in the urine collection and the CLcr or GFR was examined using past predictive formulae in the patients with appropriate urine collection. RESULTS: The accuracy of 24 CLcr was evaluated in 83 patients (43%). There was a significant correlation between CLcr or GFR using various predictive formulas and the appropriate 24 CLcr. There was an especially close and significant correlation with the formulae of Cockcroft and Gault and Yasuda (r>0.950, p<0.001). CONCLUSION: When using the Calvert formula, the accuracy of 24 CLcr should be evaluated. Patients evaluated as having inaccurate urinary collection should use the formulae of Cockcroft and Gault and Yasuda.

[Case of serious renal failure induced by ingesting large volume of MAKIRON].

A 23-year-old male patient ingested 150 mL of MAKIRON in a suicide attempt and was transferred to the hospital emergency room approximately 30 hours after ingestion. Upon admission, components of MAKIRON, including naphazoline (1.4 microg/mL), chlorpheniramine (0.81 microg/mL), dibucaine (3.2 microg/mL) and benzethonium (5.5 microg/mL) were detected in the patient's plasma. Direct hemoperfusion and hemodiafiltration enforcement were carried out and the chemical components of MAKIRON were not detected the following day. At the time of hospitalization, the patient presented with serious hepatopathy, pneumonia and acute renal failure. The hepatopathy and pneumonia resolved several days later; however, the patient required continuation of dialysis three times per week for seventeen days due to persistence of anuria. Few case reports on renal failure induced by MAKIRON have been published, whereas there are occasional reports of MAKIRON poisoning. Serious renal dysfunction in this case is thought to be due to both the large volume of MAKIRON ingested and the time delay between ingestion and treatment.