ABSTRACT
The scientific potential of bacteriophage (phage) therapy is gaining recognition in the global fight against antimicrobial resistance (AMR). However, phages are not well understood by the general population in the West and this is a major barrier to phage therapy. This piece takes an interdisciplinary approach to public "acceptability," highlighting the significant impact that human behavior has had on the development of bacteriophage science to date, before addressing what current human factors might impact on the future exploitation of this scientific field. It argues that the history and status of phage therapy are not identical across the world, and that more understanding of different cultural attitudes in different places is essential. In addition, it argues that from a Western perspective, human issues relating to phage therapy make this science particularly susceptible to media hype and misunderstanding. Further study of the human dimensions is, therefore, crucial in any future development of phage therapy as a response to AMR.
ABSTRACT
Two healthy research cats involved in a randomized, blinded prospective pharmacodynamics study evaluating midazolam continuous-rate infusion as a means to decrease sevoflurane concentrations experienced unexpectedly prolonged recoveries. Midazolam loading doses, infusion rates, and the targeted plasma midazolam concentrations at steady-state were determined by pharmacokinetic modeling based on the results of a preliminary pharmacokinetic study using a single dose of midazolam. In the pharmacodynamics study, cats remained oversedated after recovery from anesthesia, and plasma concentrations of midazolam and its primary metabolite (1-hydroxymidazolam) remained elevated. The use of flumazenil was unsuccessful in timely treatment of oversedation. Administration of intravenous lipid emulsion was used in one of the cats to facilitate recovery and appeared to be effective in both reducing the depth of midazolam-induced oversedation and significantly reducing the plasma concentration of 1-hydroxymidazolam. The effects after the administration of both treatment modalities on clinical signs and plasma drug concentrations in cats are discussed. The observations suggest that cats may eliminate 1-hydroxymidazolam more slowly than expected; consequently dose adjustments may be required when continuous infusion of midazolam is intended. In addition, intravenous lipid emulsion may facilitate recovery from midazolam oversedation, particularly in cases unresponsive to traditional treatment modalities. However, further investigations are warranted to delineate the efficacy of this modality in the treatment of midazolam oversedation.
