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Zobell J.T.,Intermountain Primary Childrens Medical Center | Zobell J.T.,Intermountain Cystic Fibrosis Pediatric Center | Ferdinand C.,Intermountain Primary Childrens Medical Center | Young D.C.,University of Utah | Young D.C.,Intermountain Cystic Fibrosis Adult Center
Pediatric Pulmonology | Year: 2014

Aztreonam, cefepime, and ceftazidime are anti-pseudomonal beta-lactam antibiotics which have been previously reported to be administered by continuous infusion (CI) in pediatric CF patients. We present two cases administering intravenous (IV) meropenem and ticarcillin-clavulanate by CI in pediatric CF patients. The delivery of beta-lactam antibiotics via CI should be considered in order to optimize the pharmacodynamics (PD) of beta-lactams in the treatment of acute pulmonary exacerbations (APE). © 2013 Wiley Periodicals, Inc. Source


Zobell J.T.,Intermountain Primary Childrens Medical Center | Zobell J.T.,Intermountain Cystic Fibrosis Pediatric Center | Kemper A.L.,Intermountain Primary Childrens Medical Center | Young D.C.,University of Utah | Young D.C.,Intermountain Cystic Fibrosis Adult Center
Pediatric Pulmonology | Year: 2014

Ceftazidime is the only anti-pseduomonal beta-lactam that has been reported to be administered by extended infusion in pediatric cystic fibrosis (CF) patients. A small pediatric pharmacokinetic/pharmacodynamic study has been published regarding the use of intermittent extended infusion doripenem in the treatment of an acute pulmonary exacerbation (APE) in pediatric CF patients; however, clinical use of intermittent extended infusion doripenem in pediatric CF patients has not been previously reported. We present three cases administering intermittent extended infusion doripenem in pediatric CF patients for the treatment of an APE in the case of replacing meropenem due to shortage. The delivery of beta-lactam antibiotics via intermittent extended infusion should be considered in order to optimize the pharmacodynamics of beta-lactams in the treatment of an APE. © 2013 Wiley Periodicals, Inc. Source


Stockmann C.,University of Utah | Spigarelli M.G.,University of Utah | Campbell S.C.,University of Utah | Constance J.E.,University of Utah | And 5 more authors.
Pediatric Drugs | Year: 2014

The management of neonatal sepsis is challenging owing to complex developmental and environmental factors that contribute to inter-individual variability in the pharmacokinetics and pharmacodynamics of many antimicrobial agents. In this review, we describe (i) the changing epidemiology of early- and late-onset neonatal sepsis; (ii) the pharmacologic considerations that influence the safety and efficacy of antibacterials, antifungals, and immunomodulatory adjuvants; and (iii) the recommended dosing regimens for pharmacologic agents commonly used in the treatment and prevention of neonatal sepsis. Neonatal sepsis is marked by highmorbidity andmortality, such that prompt initiation of antimicrobial therapy is essential following culture collection. Before culture results are available, combination therapy with ampicillin and an aminoglycoside is recommended. When meningitis is suspected, ampicillin and cefotaxime may be considered. Following identification of the causative organism and in vitro susceptibility testing, antimicrobial therapy may be narrowed to provide targeted coverage. Therapeutic drug monitoring should be considered for neonates receiving vancomycin or aminoglycoside therapies. For neonates with invasive fungal infections, the development of new antifungal agents has significantly improved therapeutic outcomes in recent years. Liposomal amphotericin B has been found to be safe and efficacious in patients with renal impairment or toxicity caused by conventional amphotericin B. Antifungal prophylaxis with fluconazole has also been reported to dramatically reduce rates of neonatal invasive fungal infections and to improve long-term neurodevelopmental outcomes among treated children. Additionally, several large multicenter studies are currently investigating the safety and efficacy of oral lactoferrin as an immunoprophylactic agent for the prevention of neonatal sepsis. © Springer International Publishing 2013. Source


Zobell J.T.,Intermountain Primary Childrens Medical Center | Zobell J.T.,Intermountain Cystic Fibrosis Pediatric Center | Ampofo K.,University of Utah | Cash J.,Intermountain Primary Childrens Medical Center | And 2 more authors.
Journal of Cystic Fibrosis | Year: 2010

Background: The Intermountain Cystic Fibrosis Pediatric Center utilizes ticarcillin-clavulanate 400. mg/kg/day divided every 6. h, (maximum 24. g/day). This dosing strategy is higher than the Cystic Fibrosis Foundation (CFF) recommendations and the Food and Drug Administration (FDA) approved package labeling. The purpose is to determine the safety of this dosing regimen. Methods: A retrospective study of pediatric cystic fibrosis (CF) patients admitted from January 1, 2005 to December 31, 2009 who received the dosing regimen for at least 7. days. Baseline and follow-up laboratory parameters were recorded. Statistical analysis was performed. Results: 127 patients met inclusion criteria. The mean (±SD) ticarcillin dose was 3.5. g (±2.16) every 6. h; while the mean (±SD) total ticarcillin dose was 13.5. g (±6.5) per day. No significant differences occurred in liver function tests, white blood count, and platelet count from baseline. Serum creatinine showed a statistically significant decrease from baseline. Conclusions: Higher than FDA approved doses of ticarcillin-clavulanate may be safely used in the treatment of exacerbations in pediatric cystic fibrosis patients. © 2010 European Cystic Fibrosis Society. Source


Stockmann C.,University of Utah | Sherwin C.M.T.,University of Utah | Zobell J.T.,Intermountain Primary Childrens Medical Center | Zobell J.T.,Intermountain Cystic Fibrosis Pediatric Center | And 5 more authors.
Pediatric Pulmonology | Year: 2013

This review is the third installment in a comprehensive State of the Art series and aims to evaluate the use of fluoroquinolones in the management of P. aeruginosa infection in both children and adults with cystic fibrosis (CF). Oral and intravenous ciprofloxacin have been shown to be well-tolerated in the treatment of acute pulmonary exacerbations (APE) secondary to P. aeruginosa. Older literature supports an oral dosing regimen of 40 mg/kg/day divided every 12 hr, up to 2 g/day, and intravenous (IV) ciprofloxacin 30 mg/kg/day divided every 8 hr, maximum 1.2 g/day in children, and 750 mg administered orally twice a day or 400 mg IV every 8 hr in adults. However, a recent pharmacodynamic (PD) modeling study shows that the literature, U.S. Food and Drug Administration (FDA)-approved, and Cystic Fibrosis Foundation (CFF) guideline dosing regimens may be suboptimal for the treatment of P. aeruginosa in APE. Further study is warranted to determine if higher doses of ciprofloxacin are needed. Limited pharmacokinetic (PK), PK/PD, and efficacy studies involving levofloxacin exist in adult patients with CF. No pediatric data exists for levofloxacin in CF patients. Further study is needed to determine the tolerability and efficacy of levofloxacin in APE. At this time, the routine use of levofloxacin in the treatment of APE in pediatric and adult patients cannot be recommended. Pediatr Pulmonol. 2013; 48:211-220. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc. Source

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