ABSTRACT
Vancomycin remains a useful agent in the infection doctor's toolkit, particularly for Staphylococcus aureus and MRSA infections. Therapeutic drug monitoring (TDM) is essential to maintain efficacy and avoid toxicity. Until recently, trough-based dosing has been the recommended method but in recent years the reliability of this has been questioned. The 2020 Infectious Diseases Society of America (IDSA) vancomycin guideline update has sent a clear message that trough-based dosing is not to be relied on, instead recommending dosing via 24 h AUC/MIC. The UK, however, has yet to follow suit in this, despite the wealth of evidence showing that trough-based dosing puts patients at higher risk of nephrotoxicity. Clearly, it is time to incorporate AUC/MIC-based dosing to utilize this effective antibiotic safely.
Subject(s)
Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Adult , Anti-Bacterial Agents/adverse effects , Area Under Curve , Drug Monitoring , Humans , Microbial Sensitivity Tests , Reproducibility of Results , Staphylococcal Infections/drug therapy , United Kingdom , Vancomycin/adverse effectsABSTRACT
Various instrumentation techniques have been proposed and examined with conflicting results. They include hand and ultrasonic techniques and combinations of the two. In the present study we assessed the effectiveness of four preparation methods for cleaning small, curved root canals, using backscattered-imaging scanning electron microscopy (SEM). The methods were: (i) step-back without initial coronal flaring; (ii) step-back with coronal flaring; (iii) step-back with initial coronal flaring and finished by ultrasonic irrigation; and (iv) ultrasonics only. Eighty freshly extracted maxillary and mandibular molars were randomly placed into four treatment groups of 20 teeth each. After preparation, roots were sectioned longitudinally and examined wet by SEM. Each canal was qualitatively evaluated and the groups compared for removal of debris and smear layer, both overall and at each level (apical, middle and coronal). There were no statistically significant differences between the techniques, either overall or within any of the regions. When comparing regions (regardless of technique) the middle level was cleaner than the apical or coronal levels. In conclusion, efficacy differed little among the techniques; none of them completely removed smear layer and all left debris.
