ABSTRACT
We administered tocilizumab into 13 severe-to-critically ill patients with coronavirus disease 2019 (COVID-19) for compassionate use in combination with potential anti-viral agents in those who required an oxygen supply and showed increased laboratory inflammatory markers such as C-reactive protein (CRP) and ferritin. One injection of tocilizumab led to rapid improvements in clinical features, inflammatory findings, and oxygen supply in seven patients with severe COVID-19 and substantial amelioration in two patients who were critically ill, whereas four patients, who exhibited rapidly worsened respiratory function, required artificial ventilatory support even after tocilizumab treatment. Three of these four patients ultimately recovered from deterioration after methylprednisolone treatment. Administration of tocilizumab did not affect viral elimination nor IgG production specific for the virus. Compared with well-responding patients, rapidly-worsened patients showed a significantly higher ratio of ferritin vs. CRP. These findings suggest that tocilizumab has beneficial effects in severe-to-critically ill patients with COVID-19; however, in some cases, addition of methylprednisolone is required for disease rescue.
ABSTRACT
<b>Objective: </b>To determine the factors affecting the antimicrobial effect of VCM on MRSA.<br><b>Study Design: </b>Case series study.<br><b>Methods: </b>This study was conducted on pneumonia patients admitted to a university-affiliated hospital between January 2000 and December 2008 and had MRSA in their sputum culture. From seven days prior to the starting VCM administration through the end of the administration, detailed information such as underlying diseases, VCM serum concentration and quantity of MRSA were recorded. Logistic regression analysis was carried out on current diseases, trough concentration, surgery experience, and the detection of Gram-negative bacteria to verify the antimicrobial effect of VCM.<br><b>Results: </b>The number of subjects investigated this study was 55 subjects. Multiple logistic regression analysis did not yield any significant factors when carried out using the factors affecting the antimicrobial effect of VCM on MRSA as independent variables.<br><b>Conclusions: </b>Multivariable analysis yielded no factors as being significant in affecting the antimicrobial effect of VCM, but did indicate in that patients aged 70 and older, the antimicrobial effect of VCM was poor for MRSA. This suggests that when pharmacists intervene in antimicrobial treatment for improved effects, it is important to consider not only the serum concentration of VCM, but also the background of the patient.
