Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2014
Review Comparative Study[Therapeutic Drug Monitoring of antiinfectives in intensive care medicine].
Therapeutic Drug Monitoring (TDM) is based on drug-level control in biological matrices and serves as a diagnostic approach for individualization of pharmacotherapy and drug safety. Drug levels of antibiotics are distinctly influenced by comorbidity, physiological changes and various concomitant drugs in patients on intensive care units. Several factors should be taken into account for calculation of relevant pharmacokinetic parameters (elimination half-life, bioavailability, and clearance) to deduce a recommendation for dosage. TDM is a diagnostic standard for the individualization of polypharmcotherapy based on validated analytical methods (in particular LC-MS/MS and HPLC-methods) in order to optimize dosing and drug safety.
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Dtsch. Med. Wochenschr. · Sep 2014
[Health care situation of patients with suspected sepsis in a German emergency department].
The in-hospital mortality of patients with severe sepsis and septic shock (ssss) is high. Of note, little is known about the health care situation of patients with sepsis in German emergency departments. The aim of the study was to analyze whether sepsis patients are treated according to current guidelines, to identify the treatment sites within the hospital and to evaluate the death rate of affected patients during index hospitalization. ⋯ Despite the high in-hospital mortality rate, more than two thirds of the patients with ssss were admitted to wards with usual care. We call for action 1) to early identify affected patients, 2) to provide adequate risk stratification tools and 3) to realize an early disposition of patients to the appropriate care units.
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Novel direct-acting oral anticoagulants (NOAC) represent an effective new familiy of drugs and an interesting alternative to optimise and simplify anticoagulation. Rates of bleeding complications by NOAC are comparabel to those of warfarin but a previously assumed increase in gastrointestinal bleeding complications was meanwhile confirmed. Therefore, indications and contraindications concerning the use of NOAC should be closely considered. ⋯ There are no recommendations on the basis of randomised studies. However, because of the short plasmatic half-life time of NOAC, their utilisation seems to be well controllable even in cases of high risk endoscopic interventions. More evidence based data about the periinterventional use of NOAC in endoscopic routine, in cases of endoscopic interventions with high bleeding risk or bleeding complications, bridging and the possibility of specific antidots in case of bleeding would be desirable.