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      Pharmacokinetic monitoring in ambulatory treatment with teicoplanin for chronic knee prosthetic infection Translated title: Monitorización farmacocinética ambulatoria de teicoplanina por infección crónica de prótesis de rodilla

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          Abstract

          SUMMARY We report a patient with chronic knee prosthetic infection, underwent multiple surgical procedures and previous antibiotic treatments. Traumatologist indicated chronic suppressive antibiotic treatment and no further surgery was indicated due to the patient´s high comorbidity. A microbiology examination revealed the presence of hetero-resistant Staphylococcus epidermidis strains, which meant the possibility of being treated only with linezolid or glycopeptides. It was discarded a chronic use of linezolid due to reasons of hematological toxicity and optical and peripheral neuropathy described in treatments over 28 days. Teicoplanin was proposed for good pharmacokinetic profile, which makes it optimal for outpatient management regimes. Monitoring of treatment was based on the pharmacokinetics monitoring teicoplanin trough levels, and dose adjustment based on them. Monitoring inflammation parameters, hematology and renal function was performed to monitor the effectiveness and toxicity of treatment. During the follow-up period (18 months) patient presented a satisfactory clinical evolution without notable toxicity. In this sense, in selected patients, teicoplanin with outpatient management may be useful in treating chronic infections of joint prosthesis.

          Translated abstract

          RESUMEN Presentamos el caso de un paciente con infección crónica de prótesis de rodilla, sometido a múltiples intervenciones quirúrgicas y tratamientos antibióticos previos. La indicación de Traumatología es tratamiento antibiótico de supresión crónico, contraindicando nueva intervención quirúrgica. En esta situación, se constata que la infección está causada por una mezcla de cepas de Staphylococus epidermidis con heterorresistencia con sensibilidad únicamente a linezolid y a glupopéptidos. Se descartó el uso crónico de linezolid por razones de toxicidad hematológica y neuropatía óptica y periférica descritos en tratamientos superiores a 28 días. Se propuso teicoplanina por su buen perfil farmacocinético, que la hace óptima para regímenes de administración ambulatoria. El seguimiento del tratamiento se basó en la monitorización farmacocinética de los niveles valle de teicoplanina, y ajuste de dosis en función de los mismos. Se realizó seguimiento de parámetros de inflamación, hematológicos y de función renal para monitorizar la efectividad y toxicidad del tratamiento. El paciente presentó durante el periodo de seguimiento (18 meses) una evolución clínica satisfactoria sin toxicidad destacable. En este sentido, en pacientes seleccionados, teicoplanina administrada por unidades ambulatorias de administración de antibióticos puede resultar útil en el tratamiento de infecciones crónicas de prótesis articulares.

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          Linezolid plasma concentrations and occurrence of drug-related haematological toxicity in patients with gram-positive infections.

          Retrospective studies have documented a significant association between linezolid (LNZ) plasma concentrations and drug-related haematological toxicity. However, the safe upper threshold level for LNZ plasma trough concentrations (Cmin values) has not been defined with certainty. A prospective observational study was performed aimed at comparing LNZ Cmin values in patients developing drug-related side effects with those measured in patients not experiencing LNZ toxicity. LNZ Cmin values were measured from the first week after starting therapy and were repeated periodically up to the end of treatment. Fifty patients, for a total of 210 LNZ Cmin evaluations, were considered. All patients (n=9) who developed drug-related haematological toxicity also had significantly higher plasma LNZ Cmin values during the first week of therapy (9.0±6.4 mg/L vs. 4.9±3.7 mg/L; P<0.01) and thereafter (9.3±5.4 mg/L vs. 4.4±3.4 mg/L; P<0.01). The significant association between LNZ plasma concentrations and haematological toxicity was also confirmed by multivariate logistic regression analysis including age, serum creatinine and concomitant medications as independent variables. A causal relationship between LNZ concentrations and the risk of developing drug-related haematological toxicity was observed. Accordingly, application of therapeutic drug monitoring may improve the safety outcome of patients receiving LNZ therapy. Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
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            Peripheral neuropathy associated with prolonged use of linezolid.

            We present a case of a woman who developed severe, painful peripheral neuropathy while receiving linezolid therapy for 6 months. Nerve conduction studies indicated a sensory-motor axonal neuropathy. Extensive assessment did not show alternative explanations for her neuropathy. At the time of death 1 month after discontinuing linezolid, the neuropathy had not resolved. A review of published material shows a growing body of evidence that long-term use of linezolid may be associated with severe peripheral and optic neuropathy. 21 cases have been reported. In most cases, optic neuropathies resolved after stopping linezolid but peripheral neuropathies did not. The duration of therapy rather than indication for treatment seems to be the most important factor. The mechanism of toxicity is unknown but certain pharmacological properties of linezolid that may play a part are proposed. This report highlights the importance of post-approval surveillance and reporting of serious adverse drug effects, and potential consequences of off-label use of pharmaceuticals. It further demonstrates the critical role clinicians have in communicating awareness of emerging drug toxicities.
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              Population pharmacokinetic and pharmacodynamic analyses of teicoplanin in Japanese patients with systemic MRSA infection.

              Teicoplanin is a glycopeptide antibiotic used for the treatment of MRSA infection. An initial loading dose of 400 mg every 12 hours for three doses is the standard dosing regimen. This study aimed to assess whether this regimen was appropriate based on the pharmacokinetic/pharmacodynamic (PK/PD) analyses in Japanese patients.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                2020
                : 30
                : 3
                : 253-255
                Affiliations
                [2] Valencia orgnameManises Hospital orgdiv1Department of Internal Medicine orgdiv2Geriatric Unit Spain
                [1] Valencia orgnameManises Hospital orgdiv1Pharmacy Department Spain
                [4] Valencia orgnameManises Hospital orgdiv1Orthopedic Surgery Department Spain
                [3] Alicante orgnameQuirón Torrevieja Hospital orgdiv1Pharmacy Department Spain
                Article
                S1699-714X2020000300253 S1699-714X(20)03000300253
                10.4321/s1699-714x2020000300017
                c12779b0-c4c8-4fe6-bbcd-109dd103b019

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 02 June 2019
                : 23 April 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 5, Pages: 3
                Product

                SciELO Spain

                Categories
                Clinical Cases

                prosthetic infection,Teicoplanin,Teicoplanina,niveles valle,monitorización,infeccion prótesis articular,pharmacokinetic monitoring

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