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Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.
Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , China , Drug Monitoring/methods , Polymyxin B , Practice Guidelines as TopicABSTRACT
Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.
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Model informed precision dosing (MIPD) is a new concept to guide precision dosing for individual patient by modeling and simulation based on the available information about the individual patient, medications and the disease. Compared to the empirical dosing, MIPD could improve the efficacy, safety, economics and adherence of the pharmacotherapy according to the individual's pathophysiology, genotyping and disease progression. This consensus report provides a brief account of the concept, methodology and implementation of MIPD as well as clinical decision supporting systems for MIPD. The status and future advancing of MIPD was also discussed to facilitate the appropriate application and development of MIPD in China.
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OBJECTIVES@#Contrast-induced acute kidney injury (CI-AKI) is the third cause of hospital-acquired AKI, and existing clinical prevention and treatment measures such as hydration therapy and/or administration of antioxidants N-acetylcysteine treatment and other treatments still show little effect on the prevention and treatment of CI-AKI. This study aims to explore the effect of Danhong injection on prevention of CI-AKI.@*METHODS@#A total of 12 867 patients, who received coronary angiography, percutaneous coronary intervention, enhanced CT or vascular intervention in a tertiary hospital, were enrolled for this study. Among them, 423 in the treatment group received intravenous drip of Danhong injection, and 12 444 in the control group received routine medicine. Propensity score matching was conducted to balance confounding factors between the 2 groups and then the prevention effect of Danhong injection on CI-AKI was compared between them.@*RESULTS@#A total of 423 pairs of patients were matched successfully. The incidence of CI-AKI in the non-Danhong control group was higher than that in the Danhong treatment group (5.7% vs 2.4%). The difference between the 2 groups was statistically significant (@*CONCLUSIONS@#The results of this study support the use of Danhong injection in the prevention of the Stage 1 of CI-AKI.
Subject(s)
Humans , Acute Kidney Injury/prevention & control , Contrast Media/adverse effects , Drugs, Chinese Herbal , Injections , Percutaneous Coronary Intervention , Propensity Score , Risk Factors , Treatment OutcomeABSTRACT
High mobility group box 1 (HMGB1) is a nuclear protein that can bind to DNA and act as a co-factor for gene transcription. When released into extracellular fluid, it plays a proinflammatory role by acting as a damage-associated molecular pattern molecule (DAMP) (also known as an alarmin) to initiate innate immune responses by activating multiple cell surface receptors such as the receptor for advanced glycation end-products (RAGE) and toll-like receptors (TLRs), TLR2, TLR4 or TLR9. This proinflammatory role is now considered to be important in the pathogenesis of a wide range of kidney diseases whether they result from hemodynamic changes, renal tubular epithelial cell apoptosis, kidney tissue fibrosis or inflammation. This review summarizes our current understanding of the role of HMGB1 in kidney diseases and how the HMGB1-mediated signaling pathway may constitute a new strategy for the treatment of kidney diseases.
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<p><b>OBJECTIVE</b>Tacrolimus (FK506) is an immunosuppressive drug, which is widely used to prevent rejection of transplanted organs. However, chronic administration of FK506 leads to hypertension in solid organ transplantation patients, and its molecular mechanisms are much more complicated. In this review, we will discuss the above-mentioned molecular mechanisms of FK506-induced hypertension in solid organ transplantation subjects.</p><p><b>DATA SOURCES</b>The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed. The terms "FK506" or "tacrolimus" and "hypertension" were used for the literature search.</p><p><b>STUDY SELECTION</b>Original articles with no limitation of research design and critical reviews containing data relevant to FK506-induced hypertension and its molecular mechanisms were retrieved, reviewed and analyzed.</p><p><b>RESULTS</b>There are several molecular mechanisms attributed to FK506-induced hypertension in solid organ transplantation subjects. First, FK506 binds FK506 binding protein 12 and its related isoform 12.6 (FKBP12/12.6) and removes them from intracellular ryanodine receptors that induce a calcium ion leakage from the endoplasmic/sarcoplasmic reticulum. The conventional protein kinase C beta II (cPKCβII)-mediated phosphorylation of endothelial nitric oxide (NO) synthase at Thr495, which reduces the production of NO, was activated by calcium ion leakage. Second, transforming growth factor receptor/SMAD2/3 signaling activation plays an important role in Treg/Th17 cell imbalance in T cells which toget converge to cause inflammation, endothelial dysfunction, and hypertension following tacrolimus treatment. Third, the activation of with-no-K(Lys) kinases/STE20/SPS1-related proline/alanine-rich kinase/thiazide-sensitive sodium chloride co-transporter (WNKs/SPAK/NCC) pathway has a central role in tacrolimus-induced hypertension. Finally, the enhanced activity of renal renin-angiotensin-aldosterone system seems to play a crucial role in the pathophysiology of FK506-induced hypertension.</p><p><b>CONCLUSION</b>FK506 plays a predominant role in the pathophysiology of hypertension in solid organ transplantation subjects.</p>
Subject(s)
Humans , Hypertension , Immunosuppressive Agents , Therapeutic Uses , Organ Transplantation , Tacrolimus , Therapeutic UsesABSTRACT
OBJECTIVE:To find out the incidence and general patterns of drug-induced cardiovascular diseases and to guide rational use of drugs METHODS:By using literature metrological method 646 cases of drug-induced cardiovascular diseases which were reported in Chinese literatures in 1995～2000 were analysed RESULTS:Among those 646 cases,the incidence of arrhythmia was 59 8% The kinds of induced drugs were up to 155 and the most easily inducing one was cardiovascular system drug,which amounted to 37 2%(240/646) Propafenone had the highest incidence of all in inducing cardiovascular diseases(75 cases) There were 35(5 4%) fatal cases mainly caused by cardiovascular system drugs Most of the patients with drug-induced cardiovascular diseases were in middle-age and old age CONCLUSION:To reduce the rate of drug-induced diseases,cardiovascular system drugs should be rationally administrated and stictly supervised
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OBJECTIVE:To investigate the situation of opium analgesics used for advanced cancer patients in recent 3 years and its future trend METHODS:The sales volume of morphine,fentanyl and pethidine sold in four cities was analysed RESULTS:Morphine which conformed to the first treatment principle in late cancer ache recommended by WHO occupied the first place in amount of consumption The largest quantity of opium analgesics consumption was in Shanghai and Guangzhou,which represented the situation of these drugs used in the developed districts of China CONCLUSION:There arebroad prospects in opium analgesics in controlling cancer ache
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OBJECTIVE: To review the ARDs of ready-made Chinese drugs included in OTC list .METHODS: 160 cases of ARDs induced by ready-made Chinese drugs,reported in Chinese journals over 40 years(1960～2000),were analysed .RESULTS: 34 kinds of drugs were involved in inducing ARDs, of which, Huoxiang Zhengqi liquid was the most common one( 19 cases), essense of Fengyou and pseudo-ginseng tablet were the next(16 cases and 13 cases respectively).The ARDs in duced by above-mentioned 3 drugs accounted for 41.4% of total ARDs.Hypersensitive reaction was the most common ARD (67.2%) . 115 of 116 cases were cured, one died.CONCLUSION: Ready-made Chinese drugs can induce ARDs, so the consumers should pay attention to it, however,they need not feel frieghtened,so long as the drugs are used rationally, the incidence of ARDs is very low and the prognosis is good.
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To explore the rational use of antibiotics in patients undergoing laparoscopic cholecystectomy(LC).METHODS： The antibiotic use in the selected operation patients was retrospectively studied.230 patients were divided into four groups.A group： Perioperative administration of drug； B group： Preoperative administration for 3 to 7 days and perioperative administration； C group： Perioperative administration and postoperative administration for 2 to 7 days； D group： Preoperative administration for 2 to 7 days， perioperative administration and postoperative administration for 2 to 7 days.Four groups were compared about the efficacy， length of hospital stay and hospitalization expenses.RESULTS： There were no significant differences in efficacy among A， B， C， D and in average length of hospital stay and hospitalization expenses between A and D groups.A group was the lowest in two indices and had the best cost-effectiveness ratio.CONCLUSION： There is clinical significance of preventive antibiotic application in LC patients； perioperative use is the best choice； Cefazolin is the first choice.
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OBJECTIVE:To explore the rational use of antibiotics in patients undergoing laparoscopic cholecystectomy(LC) METHODS:The antibiotic use in the selected operation patients was retrospectively studied 230 patients were divided into four groups A group:Perioperative administration of drug;B group:Preoperative administration for 3 to 7 days and perioperative administration;C group:Perioperative administration and postoperative administration for 2 to 7 days;D group:Preoperative administration for 2 to 7 days,perioperative administration and postoperative administration for 2 to 7 days Four groups were compared about the efficacy,length of hospital stay and hospitalization expenses RESULTS:There were no significant differences in efficacy among A,B,C,D and in average length of hospital stay and hospitalization expenses between A and D groups A group was the lowest in two indices and had the best cost-effectiveness ratio CONCLUSION:There is clinical significance of preventive antibiotic application in LC patients;perioperative use is the best choice;Cefazolin is the first choice