Articles: vancomycin-administration-dosage.
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This study investigated the use of liquid gentamicin, a much less costly antibiotic (<1/20 the price of tobramycin) with a broad antimicrobial spectrum, alone and in combination with vancomycin in bone cement. Standardized cement specimens loaded with 480 mg of liquid gentamicin, 4 g of powdered vancomycin, or both antibiotics were tested for elution characteristics, bioactivity, compressive strength, and porosity. Vancomycin elution was enhanced by 146% with the addition of gentamicin liquid, and gentamicin elution was enhanced by 45% when combined with vancomycin. ⋯ Adding liquid gentamicin increased porosity, whereas adding vancomycin did not. Compressive strength decreased by 13%, 37%, and 45% in specimens containing vancomycin, liquid gentamicin, and both antibiotics, respectively. Despite inferior mechanical properties, the temporary nature of cement beads and spacers makes the liquid gentamicin-vancomycin mixture a potentially more cost-effective regimen in bone cement to treat musculoskeletal infections.
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Antibiotic-loaded bone cement is extensively used in joint arthroplasty, but increasing bacteria resistance against common antibiotics has lead to a demand for alternative drugs. However, bone cement containing new additives must be characterized both biologically and mechanically. ⋯ The mechanical properties were negatively affected by 1.0 g of vancomycin, but these detrimental effects were acceptable when only 0.5 g of vancomycin were added to a cement containing 0.5 g of meropenem. Further investigations on this formulation with adjusted antibiotic amounts are, however, necessary to reach the optimal compromise between the antibacterial and the mechanical properties of the bone cement.
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Multicenter Study
Multicenter evaluation of vancomycin dosing: emphasis on obesity.
There is a paucity of data available regarding the dosing of antimicrobials in obesity. However, data are available demonstrating that vancomycin should be dosed on the basis of actual body weight. ⋯ In this multicenter pilot study, obese patients routinely received inadequate empiric vancomycin using a lenient assessment of dosing. Greater efforts should be undertaken to ensure patients receive weight-based dosing because inadequate dosing can lead to subtherapeutic concentrations and potentially worse clinical outcomes.
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Hepato Gastroenterol · May 2008
Case ReportsCombination therapy with direct hemoperfusion using polymyxin B-immobilized fiber and oral vancomycin improves fulminant pseudomembranous colitis by reducing the elevated endogenous cannabinoids and inflammatory cytokines: report of a case.
This paper reports a case of fulminant pseudo-membranous colitis which did not lead to septic shock. The case was improved by combination therapy with direct hemoperfusion using polymyxin B-immobilized fiber and oral vancomycin. ⋯ The clinical improvement occurred in parallel with a decrease in APACHE II score (from 20 to 14 points), serum levels of endogenous cannabinoids (anandamide and 2-arachidonylglycerol), and inflammatory cytokine (interleukin-6). Thus, direct hemoperfusion is strongly recommended in cases of fulminant pseudomembranous colitis, because direct hemoperfusion using polymyxin B-immobilized fiber reduces inflammatory cytokines by absorbing endogenous cannabinoids and, thereby, improves the patient's condition.
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Implantation of antibiotic-loaded beads is used for orthopedic infections. However, recent in vitro reports have emphasized that bacteria can persist on-or even colonize-antibiotic-impregnated bone cement. We therefore assessed whether bacterial adherence and growth could be determined on gentami-cin- and gentamicin-vancomycin-loaded beads that had been removed after eradication of infection. ⋯ Persistence of bacterial growth on bone cement remains a hazardous problem in orthopedic surgery. Adherence of bacteria to cement can lead to emergence of bacterial resistance to antibiotics and might result in clinical recurrence of infection.