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Ishiwada N, Kitajima H, Morioka I, Takeuchi N, Endo M, Watanabe A, Kamei K. Nationwide survey of neonatal invasive fungal infection in Japan. Med Mycol 2018; 56:679-686. [PMID: 29087483 DOI: 10.1093/mmy/myx096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Invasive fungal infection (IFI) is a life-threating infectious disease in high-risk neonates. Strategies for the treatment and prevention of IFI in neonates in Japan remain unclear. We conducted a nationwide retrospective survey to determine IFI incidence between January 2014 and October 2015. Primary survey questionnaires were submitted to 309 medical facilities that regularly treat high-risk neonates. The questionnaire assessed IFI incidence during the study period, methods for preventing fungal infection in early delivery neonates, and methods for preventing mother-to-child fungal transmission. The secondary questionnaire was for facilities that had IFI cases and replied to the primary questionnaire. In total, 128 medical facilities (41.4%) completed the primary questionnaire, 17/128 facilities recorded 23 proven or probable IFI cases. Estimated annual IFI incidence was 0.33/1000 live births of hospitalized neonates. Patient data at IFI onset were available for all 23 patients. Birth weight was < 1000 g in 18 patients. Causative microorganisms were identified in 22 patients. Candida species (n = 21) were the most common pathogens, and one patient had mucormycosis. The mortality rate was 17.4%. Regarding neonatal fungal prophylaxis, 55/128 facilities (43.0%) reported administering therapy. The most frequently used prophylactic drugs were fluconazole, then micafungin. Fungal prophylaxis for mothers who showed fungal colonization was performed in 30/128 facilities (23.4%). Oxiconazole vaginal tablets were most commonly used as prophylaxis for high-risk mothers. In Japan, the diagnosis, treatment, and prevention of neonatal IFI varied. Continuous surveillance and treatment regimen for neonatal IFI are required to improve outcomes in high-risk neonates.
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Affiliation(s)
- Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Japan
| | - Hiroyuki Kitajima
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Japan
| | - Noriko Takeuchi
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Japan
| | - Mamiko Endo
- Department of Pediatrics, Chiba University Hospital, Japan
| | - Akira Watanabe
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Japan
| | - Katsuhiko Kamei
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Japan
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Nunes BM, Xavier TC, Martins RR. Antimicrobial drug-related problems in a neonatal intensive care unit. Rev Bras Ter Intensiva 2017; 29:331-336. [PMID: 28876403 PMCID: PMC5632976 DOI: 10.5935/0103-507x.20170040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/24/2017] [Indexed: 12/17/2022] Open
Abstract
Objective The goal was to determine the main drug-related problems in neonates who were
using antimicrobials. Method This was an observational, prospective and longitudinal study. Drug-related
problems were classified according to version 6.2 of the Pharmaceutical Care
Network Europe Foundation classification. A descriptive analysis was
performed, in which the clinical and therapeutic variables were presented as
absolute and relative frequencies or as the mean and standard deviation, as
appropriate. Results In total, 152 neonates with a predominance of males (58.5%), gestational age
of 32.7 ± 4.2 weeks and weight of 1,903.1 ± 846.9g were
included. The main diagnostic hypothesis of infection was early sepsis
(66.5%), and 71.7% of the neonates had some risk factor for infection. Among
the neonates, 33.6% had at least one drug-related problem. Of these, 84.8%
were related to treatment effectiveness and 15.2% to adverse reactions. The
main cause of drug-related problems was the selected dose, particularly for
aminoglycosides and cephalosporins. Conclusion The use of antimicrobials in the neonatal intensive care is mainly associated
with problems related to medication effectiveness, predominantly the
prescription of subdoses of antimicrobials, especially aminoglycosides.
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Affiliation(s)
- Bruna Meirelly Nunes
- Residência Multiprofissional em Saúde, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | - Tatiana Costa Xavier
- Residência Multiprofissional em Saúde, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | - Rand Randall Martins
- Departamento de Farmácia, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
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Mulugeta Y, Barrett JS, Nelson R, Eshete AT, Mushtaq A, Yao L, Glasgow N, Mulberg AE, Gonzalez D, Green D, Florian J, Krudys K, Seo S, Kim I, Chilukuri D, Burckart GJ. Exposure Matching for Extrapolation of Efficacy in Pediatric Drug Development. J Clin Pharmacol 2017; 56:1326-1334. [PMID: 27040726 DOI: 10.1002/jcph.744] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/28/2016] [Indexed: 01/04/2023]
Abstract
During drug development, matching adult systemic exposures of drugs is a common approach for dose selection in pediatric patients when efficacy is partially or fully extrapolated. This is a systematic review of approaches used for matching adult systemic exposures as the basis for dose selection in pediatric trials submitted to the US Food and Drug Administration (FDA) between 1998 and 2012. The trial design of pediatric pharmacokinetic (PK) studies and the pediatric and adult systemic exposure data were obtained from FDA publicly available databases containing reviews of pediatric trials. Exposure-matching approaches that were used as the basis for pediatric dose selection were reviewed. The PK data from the adult and pediatric populations were used to quantify exposure agreement between the 2 patient populations. The main measures were the pediatric PK studies' trial design elements and drug systemic exposures (adult and pediatric). There were 31 products (86 trials) with full or partial extrapolation of efficacy with an available PK assessment. Pediatric exposures had a range of mean Cmax and AUC ratios (pediatric/adult) of 0.63 to 4.19 and 0.36 to 3.60, respectively. Seven of the 86 trials (8.1%) had a predefined acceptance boundary used to match adult exposures. The key PK parameter was consistently predefined for antiviral and anti-infective products. Approaches to match exposure in children and adults varied across products. A consistent approach for systemic exposure matching and evaluating pediatric PK studies is needed to guide future pediatric trials.
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Affiliation(s)
- Yeruk Mulugeta
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Jeffrey S Barrett
- Division of Clinical Pharmacology & Therapeutics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert Nelson
- Office of Pediatric Therapeutics, Office of the Commissioner, US Food and Drug Administration, Silver Spring, MD, USA
| | - Abel Tilahun Eshete
- Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Lynne Yao
- Pediatric and Maternal Health Staff, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Nicole Glasgow
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Andrew E Mulberg
- Division of Gastroenterology and Inborn Errors Products, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Dionna Green
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Jeffry Florian
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Kevin Krudys
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Shirley Seo
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Insook Kim
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Dakshina Chilukuri
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Gilbert J Burckart
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
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Dong WH, Zhang GZ, Li JX, Wang Y, Wang TT, Dong YL. Development of indicators for evaluating the appropriate use of triazoles for invasive fungal disease: A Delphi panel survey. J Clin Pharm Ther 2017; 42:720-732. [PMID: 28597467 DOI: 10.1111/jcpt.12570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/09/2017] [Indexed: 01/05/2023]
Affiliation(s)
- W. H. Dong
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - G. Z. Zhang
- Department of Pharmacy; Xi'an NO.4 Hospital; Xi'an China
| | - J. X. Li
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - Y. Wang
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - T. T. Wang
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
| | - Y. L. Dong
- Department of Pharmacy; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
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Delso I, Valero-González J, Marca E, Tejero T, Hurtado-Guerrero R, Merino P. Rational Design of Glycomimetic Compounds Targeting the Saccharomyces cerevisiae Transglycosylase Gas2. Chem Biol Drug Des 2015; 87:163-70. [PMID: 26280762 DOI: 10.1111/cbdd.12650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/01/2015] [Accepted: 08/11/2015] [Indexed: 12/27/2022]
Abstract
The transglycosylase Saccharomyces cerevisiae Gas2 (ScGas2) belongs to a large family of enzymes that are key players in yeast cell wall remodeling. Despite its biologic importance, no studies on the synthesis of substrate-based compounds as potential inhibitors have been reported. We have synthesized a series of docking-guided glycomimetics that were evaluated by fluorescence spectroscopy and saturation-transfer difference (STD) NMR experiments, revealing that a minimum of three glucose units linked via a β-(1,3) linkage are required for achieving molecular recognition at the binding donor site. The binding mode of our compounds is further supported by STD-NMR experiments using the active site-mutants Y107Q and Y244Q. Our results are important for both understanding of ScGas2-substrate interactions and setting up the basis for future design of glycomimetics as new antifungal agents.
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Affiliation(s)
- Ignacio Delso
- Laboratorio de Síntesis Asimétrica, Departamento de Síntesis y Estructura de Biomoléculas, Instituto de Síntesis Química y Catálisis Homogénea (ISQCH), CSIC, Universidad de Zaragoza, Zaragoza, Aragón, 50009, Spain.,Servicio de Resonancia Magnética Nuclear, Centro de Química y Materiales de Aragón (CEQMA), CSIC, Universidad de Zaragoza, Campus San Francisco, Zaragoza, Aragón, 50009, Spain
| | - Jessika Valero-González
- Instituto de Biocomputación y Fisica de Sistemas Complejos (BIFI), BIFI-IQFR (CSIC) Joint Unit, Universidad de Zaragoza, Zaragoza, Aragón, 50009, Spain
| | - Eduardo Marca
- Laboratorio de Síntesis Asimétrica, Departamento de Síntesis y Estructura de Biomoléculas, Instituto de Síntesis Química y Catálisis Homogénea (ISQCH), CSIC, Universidad de Zaragoza, Zaragoza, Aragón, 50009, Spain
| | - Tomás Tejero
- Laboratorio de Síntesis Asimétrica, Departamento de Síntesis y Estructura de Biomoléculas, Instituto de Síntesis Química y Catálisis Homogénea (ISQCH), CSIC, Universidad de Zaragoza, Zaragoza, Aragón, 50009, Spain
| | - Ramón Hurtado-Guerrero
- Instituto de Biocomputación y Fisica de Sistemas Complejos (BIFI), BIFI-IQFR (CSIC) Joint Unit, Universidad de Zaragoza, Zaragoza, Aragón, 50009, Spain.,Fundación ARAID, Gobierno de Aragón, Zaragoza, Aragón 50009, Spain
| | - Pedro Merino
- Laboratorio de Síntesis Asimétrica, Departamento de Síntesis y Estructura de Biomoléculas, Instituto de Síntesis Química y Catálisis Homogénea (ISQCH), CSIC, Universidad de Zaragoza, Zaragoza, Aragón, 50009, Spain
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Abstract
Understanding the tissue penetration of systemically administered antifungal agents is critical for a proper appreciation of their antifungal efficacy in animals and humans. Both the time course of an antifungal drug and its absolute concentrations within tissues may differ significantly from those observed in the bloodstream. In addition, tissue concentrations must also be interpreted within the context of the pathogenesis of the various invasive fungal infections, which differ significantly. There are major technical obstacles to the estimation of concentrations of antifungal agents in various tissue subcompartments, yet these agents, even those within the same class, may exhibit markedly different tissue distributions. This review explores these issues and provides a summary of tissue concentrations of 11 currently licensed systemic antifungal agents. It also explores the therapeutic implications of their distribution at various sites of infection.
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Fanni D, Ambu R, Gerosa C, Nemolato S, Castagnola M, Van Eyken P, Faa G, Fanos V. Cytochrome P450 genetic polymorphism in neonatal drug metabolism: role and practical consequences towards a new drug culture in neonatology. Int J Immunopathol Pharmacol 2014; 27:5-13. [PMID: 24674673 DOI: 10.1177/039463201402700102] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The cytochrome P450 superfamily (CYP450) in humans is formed by 57 functional monooxygenases critical for the metabolism of numerous endogenous and exogenous compounds. The superfamily is organized into 18 families and 44 subfamilies. CYP nomenclature is based on the identity of amino acids. The most important functions of the CYP450 are related to metabolism of endogenous compounds, detoxification of exogenous xenobiotics and decomposition of the vast majority of currently used drugs. The expression of CYP450 enzymes in the human body is characterized by a marked substrate and tissue specificity, the most important being localized in the liver, but also present in kidney, lung, brain, breast, prostate and in the small intestine. The human cytochrome P450 3A gene family (CYP3A) accounts for the largest portion of CYP450 proteins in human liver and includes 4 genes: CYP3A4, CYP3A5, CYP3A7, CYP3A43. Multiple and complex genetic variations, marked interindividual, interethnic and gender variability have been reported regarding CYP3A isoform expression and activity. Multiple factors may affect CYP3A expression and activity, such as inducers like rifampicin, phenobarbital, 3-methylcholantrene, beta-naphtoflavone, and dexamethasone. The maturation of organ systems, paralleled by ontogeny of drug-metabolizing enzymes during fetal life and in the first months of postnatal life, surely exerts profound effects on drug disposition, probably being the predominant factor accounting for age-associated changes in drug clearance. In fact, drug dosage in the perinatal period represents a continuous challenge for neonatologists. The purpose of this article is to provide a brief review of the pharmacokinetic differences between neonates and adults, showing the peculiarities of liver CYP450-related drug metabolism in the perinatal period and at birth, and to report the toxic mechanisms of liver injury in neonates, due to the most frequently utilized drugs in NICU centers.
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Affiliation(s)
- D Fanni
- University of Cagliari, Department of Pathology, Cagliari, Italy
| | - R Ambu
- University of Cagliari, Department of Pathology, Cagliari, Italy
| | - C Gerosa
- University of Cagliari, Department of Pathology, Cagliari, Italy
| | - S Nemolato
- University of Cagliari, Department of Pathology, Cagliari, Italy
| | - M Castagnola
- Catholic University, Faculty of Medicine, Institute of Biochemistry and Clinical Biochemistry, Rome, Italy
| | - P Van Eyken
- University Hospitals, KU Leuven, Department of Pathology, Leuven, Belgium
| | - G Faa
- University of Cagliari, Department of Pathology, Cagliari, Italy
| | - V Fanos
- University of Cagliari, Department of Pediatrics and Clinical Medicine, Cagliari, Italy
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Díaz A, Garcés C. Uso actual de los antifúngicos triazoles en niños. Infectio 2012; 16:82-93. [DOI: 10.1016/s0123-9392(12)70031-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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