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  • ISSN: 2379-089X
    Volume 4, Issue 7
    Mini Review
    Bhise SB*
    Pharmacokinetic characteristics of INH are presented. Adverse effects and toxicity caused by INH has been reviewed under the headings of neuropathy and seizures, hepatotoxicity, rhabdomyolysis, agranulocytosis, acidosis and other adverse drug reactions. Cases of poisoning by INH have been mentioned independently. Few case reports indicating symptoms of intoxication and the mechanism of toxicity have been described. Relevant treatment for INH toxicity has been indicated. Due to structural similarity, pyridoxine is the only antidote for INH toxicity. References indicating use of pyridoxine in the treatment of INH toxicity have been mentioned.
    Short Communication
    Mary K. La, Alvin Ong, Kathryn Morbitzer, Dedrick J. Jordan, Denise H. Rhoney*
    Central nervous system (CNS) infection in neurocritically ill patients is associated with poor clinical outcomes. Therapeutic drug monitoring is recommended for dose optimization, which is routinely performed for antimicrobials such as vancomycin. The study objective was to quantify vancomycin pharmacokinetics in this population, and compare them with those predicted from population pharmacokinetic models.
    Thirty adult critically ill patients with CNS infections admitted between May 1, 2010 - June 1, 2016 to UNC Medical Center’s Neurosciences ICU who received vancomycin for a CNS infection were included. The primary outcome was the difference between actual vs. predicted serum trough concentrations, elimination rate constant (ke), and elimination half-life (t1/2), evaluated using paired t-tests or Wilcoxon signed-rank tests at α = 0.05.
    Two-thirds of the patients had developed meningitis or ventriculitis. The median admission estimated CrCl was 102.7mL/min. Median vancomycin regimens ranged from 16.6 - 21.3mg/kg/dose IV Q8H between first and second trough levels. The first vancomycin trough was sub therapeutic for predicted and measured values. There were no differences between predicted vs. measured ke (at first level: 0.103 vs. 0.121 hr-1, p = 0.59; at second level: 0.107 vs. 0.112 hr-1, p = 0.71), or t1/2 (at first level: 6.7 vs. 5.7 hr, p = 0.57; at second level: 6.5 vs. 6.2 hr, p = 0.80).
    In this study, no differences were observed between population-predicted and measured vancomycin pharmacokinetic parameters. Given the sub therapeutic initial troughs and concern for early under dosing in serious CNS infections, first-dose pharmacokinetic monitoring or obtaining measured CrCl may be beneficial.
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