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Objective To understand the changing characteristics of drug concentration in the serum and cerebrospinal fluid(CSF) after intravenous (IV) drip of norvancomycin in patients after neurosurgery procedure.Methods Patients with surgical cavity/ventricular drainages after neurosurgery procedure in a hospital in 2014 were selected, and they were divided into 2 groups according to the administration modes (12 in each group), conventional administration group: 0.8 g norvancomycin IV drip for 60 minutes, repeated every 12 hours;continuous administration group, 0.8 g norvancomycin, IV drip for 60 minutes, followed by 0.4 g of IV drip for 11 hours, then 0.4 g for 12 hours, serum and CSF specimens were collected at different time points after administration, concentration of norvancomycin was determined.Results Serum norvancomycin concentration reached a peak of (55.52±26.04) and (59.22±41.88) mg/L in conventional administration group and continuous administration group respectively, 24-hour serum concentration were (8.21±6.04) and (9.11±5.09)mg/L respectively;CSF norvancomycin concentration reached a peak of (16.31±11.15) and (8.82±8.91)mg/L in conventional administration group and continuous administration group respectively, 24-hour CSF concentration were (6.12±2.34)and (5.71±4.72)mg/L respectively;CSF penetration rate of conventional administration group was calculated by ratio of area under curve (AUCCSF/AUCserum), at 0-12 and 12-24 h hour were 63.3% and 59.0% respectively;in continuous administration group were 25.4% and 47.4% respectively.According to 95% of the minimum inhibitory concentration (MIC90) 2 mg/L of target bacteria methicillin-resistant Staphylococcus aureus (MRSA), AUC0-24/MIC90 in conventional administration group and continuous administration group were 192 and 184 respectively.Conclusion For patients who receives early use of standard dose of norvancomycin after neurosurgery procedure, CSF drug concentration after convention and continuous administration of norvancomycin can both reach MIC90 against target bacteria.
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Objective To observe vancomycin and vancomycin in elderly patients with renal toxicity.Methods 105 cases because of infection from March 2013 to October 2014 were collected and randomly divided into two groups, one had 52 patients and were given vancomycin for anti-infection treatment, another group had 53 patients and were given norvancomycin for anti-infective treatment.Changes of serum urea nitrogen and creatinine levels and adverse reactions were observed and compared between two groups.Results Creatinine levels of patients with vancomycin group after 10 days and 7 days after withdrawal were (97.86 ±8.27)μmoI/L, (82.03 ±5.72)μmoI/L, and the norvancomycin group were (98.67 ±8.34)μmoI/L, (83.47 ± 5.91)μmoI/L, the difference were not significant.Urea nitrogen levels of patients with vancomycin group after 10 days and 7 days after withdrawal were (6.71 ±1.15)mmoI/L,(6.09 ±1.09)mmoI/L, respectively, and the norvancomycin group were(6.75 ±1.17)mmoI/L,(6.15 ±1.12)mmoI/L, the difference were not statistically significant.The total effective rate of vancomycin group was 78.85%, and norvancomycin group was 75.47%, the difference was not statistically significant.Adverse reactions of vancomycin group during treatment was 13.46%, and norvancomycin group was 13.21%, the difference was not statistically significant.Conclusion Vancomycin and norvancomycinboth have anti-infective effect on renal function in patients with certain adverse effects, urea nitrogen, creatinine levels in two groups were elevated during treatment, but decreased after withdrawing medicine.
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OBJECTIVE:To establish the method for determining 10 residual organic solvents in norvancomycin hydrochloride raw material. METHODS:Headspace gas chromatography was performed on the column of nitro modified polyethylene terephthal-ate glycol as stationary phase capillary column;the oven temperature program started at 40 ℃ for 3 min and increased at a rate of 8 ℃/min up to 150 ℃ for 10 min;the temperature was 200 ℃ with carrier gas of high-purity nitrogen gas,the constant flow rate was 5 ml/min with split ratio of 15∶1;the headspace vial equilibrium temperature was 85 ℃ with equilibrium time of 40 min,and the volume was 1 ml. RESULTS:The concentration of n-pentane,acetone,ethanol,benzene,acrylonitrile,toluene,xylene,chlo-robenzene,styrene,divinylbenzene had good linear relationship with its peak area values(r=0.995 7-0.999 9);the RSDs of preci-sion,repeatability tests was ≤6.6%;average recovery was in the range of 94.3%-106.6%(RSD=0.5%-4.5%,n=9). CONCLU-SIONS:The method is fast,sensitive and accurate,and can be used for the determination of residual organic solvents in norvanco-mycin hydrochloride raw material.
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Objective To establish HPLC method for fast, effective, simultaneous determination of Vancomycin and Norvancomycin in serum. Methods The separation was achieved on the Hypersil ODS2(250 mm ×4.6 mm,5μm)with methanol-acetonitrile-a mixture of potassium phosphate (9.5:2.5:88) as the mobile phase.The flow rate was 1.0 mL/min.The UV detecting wavelength was 280 nm.The temperature of the column was 35 ℃. Vancomycin and Norvancomycin were used as the internal standard for each other .Results Vancomycin and Norvancomycin blood concentration were in well linearity in the range of 1.25-100μg/mL,R2 =0.9996.The average method recovery rate of three concentrations were 96.88%,99.50%,105.01%respectively, the average method recovery rate of three concentrations were 94.40%,103.90,103.81%respectively, the intra-day and inter-day RSD were less than 5%.Conclusion The HPLC method is proved to be simple,sensitive, accurate and precise in which little blood sample is taken, thus it is suitable for the therapeutic drug monitoring(TDM) and pharmacokinetic study of Vancomycin and Norvancomycin.
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OBJECTIVE:To explore the differences of plasma concentration of norvancomycin by HPLC and microbiological method. METHODS:Microbiological method and HPLC were used to detect the plasma concentration of norvancomycin,and clinical test result of both techniques was retrospectively analyzed. RESULTS:There were no significant differences in the plasma concentra-tion of norvancomycin by microbiological method and HPLC(y=0.992 7x+0.155 8,r=0.997 6)(P>0.05). CONCLUSIONS:Both microbiological method and HPLC are more effective and reliable for the plasma concentration detection of norvancomycin. The hospi-tals can choose corresponding method according to their condition when determining plasma concentration of norvancomycin.
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Objective To evaluate the clinical value of tube-sealing with norvancomycin and heparin saline mixture for prevention of central venous catheter-related infection (CRI).Methods A prospective randomized controlled trial was performed.120 patients who were admitted to department of critical care medicine from January 2012 to January 2014 were included,with their subclavian vein catheterization installation time longer than 48 hours,age over 18 years and younger than 80 years,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score reaching 10-29.The patients were divided into two groups using a random number table,and finally 116 patients were enrolled.Norvancomycin and heparin saline mixture were used for tube sealing in the intervention group (n=56),while only heparin saline was used in the control group (n=60).The incidence of CRI,catheter correlated spectrum of pathogens,adverse events,mortality,hospital day,catheter retention time,and hospital costs were compared between two groups.Results ① There was no significant difference in the incidence of CRI between intervention group and control group [7.14％ (4/56) vs.8.33％ (5/60),x2=0.058,P=1.000].There was no catheter pathogenic colonization in the intervention group,but there were 2 cases of catheter pathogenic colonization in control group.② A total of 7 pathogens were found in two groups.Three cases with pathogenic bacteria was found in the intervention group,with 1 case of Pseudomonas aeruginosa,1 case Acinetobacter baumannii,and 1 case fungi.Staphylococcus aureus,Staphylococcus epidermidis,fungi,and Acinetobacter baumannii was found in the control group,with 1 case of each.There was no significantly statistical difference between two groups (all P＞0.05),but there was a decreasing trend of Gram-positive cocci infection in the intervention group.③ There was no significant difference in the catheter thrombosis,local bleeding or hematoma,catheter dislocation and other adverse events between intervention group and control group [21.43％(12/56) vs.23.33％ (14/60),x2=0.060,P=0.806].④ There were no significant differences in mortality [7.14％(4/56) vs.8.33％ (5/60),x2=0.058,P=1.000],hospital day (days:35.9 ± 15.2 vs.34.1 ± 16.3,t=16.330,P=0.620),catheter retention time (days:25.0 ± 4.5 vs.24.5 ± 5.1,t=26.427,P=2.560) and cost of hospitalization (10 thousand Yuan:3.42 ± 1.22 vs.3.72 ± 1.30,t=13.215,P=1.560) between intervention group and control group.Conclusions For patients with central venous catheter,application norvancomycin with heparin saline mixture for tube sealing did not reduce the incidence of CRI,the incidence of adverse events and mortality,does not reduce hospitalization time,catheter retention time and hospital costs,but may reduce the catheter colonization and infection of Gram-positive bacteria.
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Objective: To discuss the role of clinical pharmacists played in the pharmaceutical care for osteomyelitis patients. Methods:Clinical pharmacists participated in the treatment for a special patient with osteomyelitis. Taking the disease features, medi-cal history, adverse drug reactions into account, clinical pharmacists provided consultant opinions for establishing and adjusting the ap-propriate therapeutic regimens and individualized pharmaceutical care. Results:The drug treatment regimens for the patient were safe, effective and rational. By the individualized pharmaceutical care, clinical pharmacists were able to find the problems in the drug treat-ment and implement the efficient solutions. Conclusion: Clinical pharmacists show their own advantages in individual pharmaceutical care, and play an important role in improving the rational drug use.
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Background The penetration of bacterial agents into the vitreous cavity is difficult because of the existence of blood-retina barrier.So conventional drug therapy is not enough effective on endophthalmitis.Drug delivery systems can decrease drug dose and reduce the drug toxicity.To construct nano controlled-release system of anti-bacterial agents is very important for the treatment of intraocular infectious diseases.Objective This study was to investigate the toxicology and intraocular pharmacoklnetics of intravitreal PNIPAAm-PEO loaded norvancomycin nanoparticles (NV-PNIPAAm-PEO) in normal rabbit eyes.Methods NV-PNIPAAm-PEO was constructed with the drug-loading rate about 22％,and then the drug gelatin solution (20 g/L) was prepared using normal saline solution.Forty-one New Zealand albino rabbits were randomized divided into experimental group and control group.20 g/L drug gelatin solution 0.1 ml was monocularly injected into the vitreous cavity in the experimental group,and the equal volume of sterilized normal saline solution was used in the control group.In 1 day,2,3,7,14,21 and 28 days after injection,ocular anterior and posterior segments were examined by slit lamp microscope and Bsonography,and electroretinogram (ERG) was recorded and the histopathological examination was performed to evaluate the biotoxicity of the drug.Norvancomycin contents in the cornea homogenate,aqueous humor,vitreous,retinochoroid homogenate were detected by high performance liquid chromatography (HPLC) system.Results The anterior and posterior segments were normal by the slit lamp microscope and B-sonography 1-28 days after injection of NV-PNIPAAm-PEO.In 7,14,21 and 28 days after injection,there were no statistically significant difference in the a-wave latency and amplitude of max-ERG between the two groups,as well as the b-wave amplitude(P＞0.05).The histopathological examination showed that the retinal structure was normal in both groups.HPLC assay showed that the norvancomycin level was gradually declined in different eye tissues from 1 day through 28 days after injection.Norvancomycin was undetectable in the cornea during the observing duration.The maximal norvancomycin content in the blood plasma was (0.34 ± 0.11) mg/L in the second day,and norvancomycin content ranged (0.08 ± 0.04)-(2.16±0.07) mg/L in the aqueous humor,(0.11 ±0.22)-(2.54 ±0.38) μg/g in the chorioretina,respectively.The drug concentration was (5.65 ± 1.14)-(406.69 ± 21.05) mg/L in the vitreous,which was higher than the minimal inhibitory concentration (MIC) to the most gram-positive bacteria.Conclusions The intravitreal injection of 22％ NV-PNIPAAm-PEO maintains the therapeutic drug concentration till 21 days in vitreous without the toxic effect on eye tissues,suggesting a great treating potential for intraocular infecting diseases.
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The medical records of 108 inpatients treated with vancomycin and norvancomycinin were collected and analyzed retrospectively.And 78.7% of all cases were used for therapy and 21.3% for prevention.The pathologic examination submission rate was 88.9% ( n=96 ).The drug utilization index ( DUI) of norvancomycin was 0.95 and vancomycin 0.92.The proportion of combination use was 86.1%and a maximum of 3 antibiotics were used.There were 6.5% cases of doubtful adverse drug reaction.The inpatient uses of vancomycin and norvancomycin are basically rational.Indications should be mastered strictly.Empirical and prophylactic uses should be minimized to prevent and delay drug resistance strain from spreading and prolong effectiveness.Necessary therapeutic drug monitoring is required.
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85 mL/min),CL=6.0?(WT/60)~(0.52).④The increased volume of peripheral distribution (V_2) was observed when norvancomycin was co-administered with diuretics;④Reduced drug clearance,prolonged t_(1/2),and increased values of AUC_(24) were found in elderly patients.Conclusions Renal function impairment and age have significant impact on PK parameters of norvancomycin.Dosing regimens of norvancomycin were finally established for different patients on the basis of important PPK parameters generated from different groups of patients.
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OBJECTIVE:To explore new therapy regimen for methicillin-resistance staphylococcus infection chronic osteomyelitis. METHODS:27 patients with methicillin-resistance staphylococcus infection chronic osteomyelitis were randomly divides into 2 groups. Both groups were injected with norvancomycin intravenously before operation to prevent infection. Norvancomycin chain bead (NCB) which were made from norvancomycin and bone cement was used to make up bone defect in NCB group(15 patients). Bone cement was used to make up bone defect in norvancomycin group(12 patients). The cure rates, the cost of infection therapy, the incidence of ADR and therapy duration were compared between 2 groups. RESULTS: Both NCB and intravenous administration of norvancomycin had sound effect on chronic osteomyelitis. The incidence of ADR and the cost of infection therapy of NCB regimen were close to low level. The infection was controlled effectively. CONCLUSION:Individual NCB regimen is superior to intravenous administration of norvancomycin in the treatment of methicillin-resistance staphylococcus infection chronic osteomyelitis.