Archive for March, 2012
TOXOPLASMOSIS OCULAR
Arch Soc Esp Oftalmol Madrid oct. 2003 V.78 N.10
Propósito
Realizar una actualización sobre los aspectos más salientes de la toxoplasmosis ocular.
Métodos
En base a publicaciones recientes, reuniones científicas e interpretación de la literatura se intenta clarificar los conceptos sobre distintos aspectos de la toxoplasmosis ocular.
Resultados
Se pone un especial énfasis en la transmisión de la parasitosis y en la enfermedad ocular con sus presentaciones clínicas. Se mencionan además algunas actualizaciones en cuanto al diagnóstico y tratamiento de la enfermedad.
Conclusión
El conocimiento de la epidemiología permitirá limitar la enfermedad ocular y la correcta interpretación permitirá un mejor diagnóstico clínico. Con estos elementos se podrán aplicar las diferentes alternativas de tratamiento que poco han evolucionado en los últimos años.
FULL TEXT
http://scielo.isciii.es/scielo.php?pid=s0365-66912003001000004&script=sci_arttext
2009 – HIDATIDOSIS – Norma Técnica y Manual de Procedimientos para su control
Ministerio de Salud de la Nación – Rep. Argentina
INDICE
Introducción
Diagnóstico de Situación en Argentina
Objetivo General
Objetivos específicos
Base legal
Normas para Diagnóstico y Vigilancia
Normas de Control
Atención en el hombre
Referencias
Anexos
http://www.msal.gov.ar/images/stories/epidemiologia/pdf/NormasHidatidosis.pdf
Vancomycin Dosing in Critically Ill Patients: Robust Methods for Improved Continuous-Infusion Regimens
Antimicrobial Agents and Chemotherapy June 2011 V.55 N.6 P.2704-2709
Jason A. Roberts1,*, Fabio Silvio Taccone2, Andrew A. Udy1, Jean-Louis Vincent2, Frédérique Jacobs3 and Jeffrey Lipman1
1Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
2Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
3Department of Infectious Diseases, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
ABSTRACT
Despite the development of novel antibiotics active against Gram-positive bacteria, vancomycin generally remains the first treatment, although rapidly achieving concentrations associated with maximal efficacy provides an unresolved challenge. The objective of this study was to conduct a population pharmacokinetic analysis of vancomycin in a large population of critically ill patients. This was a retrospective data collection of 206 adult septic critically ill patients who were administered vancomycin as a loading dose followed by continuous infusion. The concentration-versus-time data for vancomycin in serum was analyzed by a nonlinear mixed-effects modeling approach using NONMEM.Monte Carlosimulations were performed using the final covariate model. We found that the best population pharmacokinetic model consisted of a one-compartment linear model with combined proportional and additive residual unknown variability. The volume of distribution of vancomycin (1.5 liters/kg) was described by total body weight and clearance (4.6 liters/h) by 24-hour urinary creatinine clearance (CrCl), normalized to body surface area. Simulation data showed that a 35-mg/kg loading dose was necessary to rapidly achieve vancomycin concentrations of 20 mg/liter. Daily vancomycin requirements were dependent on CrCl, such that a patient with a CrCl of 100 ml/min/1.73 m2 would require at least 35 mg/kg per day by continuous infusion to maintain target concentrations. In conclusion, we have found that higher-than-recommended loading and daily doses of vancomycin seem to be necessary to rapidly achieve therapeutic serum concentrations in these patients.
http://aac.asm.org/content/55/6/2704.full.pdf+html
Optimization of Aminoglycoside Therapy
Antimicrobial Agents and Chemotherapy June 2011 V.55 N.6 P.2528-2531
G. L. Drusano* and Arnold Louie
Ordway Research Institute, 150 New Scotland Avenue, Albany, New York 12208
ABSTRACT
Aminoglycosides are experiencing a resurgence in use because of the spread of multiresistant Gram-negative pathogens. Use of these agents is attended by the occurrence of nephrotoxicity. Aminoglycoside optimization of dose can be defined as the dose having the highest likelihood of a good outcome and the lowest likelihood of toxicity. We have defined the metric Δ as the difference between the likelihoods of good outcome and toxicity, with higher values being better. We developed a method for explicitly evaluating Δ for different daily doses of drug and different schedules of administration. In the empirical therapy setting, when aminoglycosides are administered every 12 h, treatment of infections caused by microbes with MIC values greater than 1 mg/liter cannot attain a high enough likelihood of a good outcome without engendering an unacceptable toxicity likelihood. Daily administration, by decrementing the likelihood of toxicity, allows higher doses to be employed with more acceptable probabilities of toxicity. Obtaining patient-specific information (concentration-time data) allows better identification of the patient’s specific pharmacokinetic parameters and dispersion. As these become better identified, optimal doses become rapidly identified so that optimal outcomes are attained. Optimization of therapy for aminoglycosides requires understanding the relationship between exposure and response as well as that between exposure and toxicity. Furthermore, daily administration is much preferred, and stopping therapy as quickly as possible (a week or less may be optimal) will contribute to the ability to optimize therapy.
Case Report of a Successful Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia and MRSA/Vancomycin-Resistant Enterococcus faecium Cholecystitis by Daptomycin▿
Antimicrobial Agents and Chemotherapy 1 May 2011 V.55 N.5 P.2458-2459
Carlo Tascini1,†, Antonello Di Paolo2,†,*, Marialuisa Polillo2, Mauro Ferrari3, Paola Lambelet4, Romano Danesi2 and Francesco Menichetti1
1Infectious Diseases Unit, Santa Chiara University Hospital, Pisa, Italy
2Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa, Italy
3Division of Vascular Surgery, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy
4Division of Medicine, Versilia Hospital, Camaiore, Italy
ABSTRACT
A 72-year-old man, receiving 8 mg daptomycin/kg body weight/day for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, was diagnosed with MRSA/vancomycin-resistant Enterococcus faecium (VRE) cholecystitis (daptomycin MIC values, 1 and 2 mg/liter, respectively). After the fifth drug dose, the bile concentration of daptomycin was 66 mg/liter 5 min after drug administration, with the biliary concentration/MIC values higher than 30 for both bacterial strains. Therefore, daptomycin achieved therapeutic levels in bile, hence suggesting a role for the drug in the treatment of MRSA/VRE cholecystitis.