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Albano M, Fleischmann WA, Greenwood-Quaintance KE, Patel R. In vitro activity of arbekacin against multidrug-resistant gram-negative bacilli. J Microbiol Immunol Infect 2020; 54:1118-1121. [PMID: 32962921 DOI: 10.1016/j.jmii.2020.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arbekacin is a broad-spectrum aminoglycoside with activity against some Gram-positive and Gram-negative bacteria. METHODS Arbekacin minimum inhibitory concentration (MIC) values were determined for 296 drug-resistant Gram-negative bacilli, and compared to previously determined plazomicin, amikacin, gentamicin, and tobramycin MIC values. RESULTS The MIC values required to inhibit 50% and 90% of isolates (MIC50 and MIC90, respectively) were 16 and >128 μg/ml, respectively. CONCLUSIONS Arbekacin showed similar MIC50 values to amikacin and gentamicin, a lower MIC50 value than tobramycin, and a higher MIC50 value than plazomicin.
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Affiliation(s)
- Mariana Albano
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Wim Alexander Fleischmann
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Paracelsus Medical University, Salzburg, Austria
| | | | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Oda K, Fujii S, Yamamoto T, Mayumi T, Takesue Y. Evaluation of once-daily dosing and target concentrations in therapeutic drug monitoring for arbekacin: A meta-analysis. J Infect Chemother 2020; 27:26-31. [PMID: 32828677 DOI: 10.1016/j.jiac.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/05/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Arbekacin is the first aminoglycoside antibacterial agent approved for treating methicillin-resistant Staphylococcus aureus infection in Japan. Although therapeutic drug monitoring (TDM) is recommended during arbekacin treatment, little evidence for the target exposure and once-daily dosing has been reported. This study aimed to clarify the target peak/trough concentrations and the effectiveness of once-daily dosing of arbekacin against nephrotoxicity or treatment failure via meta-analysis. METHODS A literature search was performed using MEDLINE, Cochrane Library, and Ichushi-Web. RESULTS Nine observational cohort studies met the inclusion criteria. A peak arbekacin concentration of ≥15-16 μg/mL did not exhibit a statistically significant lower risk of treatment failure (risk ratio [RR] = 0.61, 95% confidence interval [CI] = 0.30-1.24). A trough arbekacin concentration of <2 μg/mL resulted in a significantly lower risk of nephrotoxicity (RR = 0.30, 95% CI = 0.15-0.61). Once-daily dosing significantly reduced the risk of treatment failure (RR = 0.61, 95% CI = 0.39-0.97) but not nephrotoxicity (RR = 0.54, 95% CI = 0.16-1.75). CONCLUSIONS Once-daily dosing can improve the therapeutic efficacy of arbekacin, and a trough arbekacin concentration of <2 μg/mL can reduce the risk of nephrotoxicity. A peak arbekacin concentration of ≥15-16 μg/mL did not exhibit the significant lower risk of treatment failure. Additional clinical trials are required to confirm these findings.
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Affiliation(s)
- Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan; Department of Infection Control, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Takehito Yamamoto
- Department of Pharmacy, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Hagihara M, Kato H, Hamada Y, Hirai J, Sakanashi D, Suematsu H, Nishiyama N, Koizumi Y, Yamagishi Y, Matsuura K, Mikamo H. Population pharmacokinetics of arbekacin in different infectious disease settings and evaluation of dosing regimens. J Infect Chemother 2016; 22:436-43. [PMID: 27260679 DOI: 10.1016/j.jiac.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/04/2015] [Revised: 02/05/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022]
Abstract
The efficacy of arbekacin in patients with MRSA infections is influenced by the peak concentration (Cpeak)/MIC ratio (≧8). A daily arbekacin dose of 4-6 mg/kg is primarily used for the treatment of MRSA infection. However, clinical pharmacokinetic studies of arbekacin that evaluate changes in patients with different infectious diseases have been limited. This study was to evaluate the pharmacokinetics of arbekacin in different infectious diseases and to evaluate its dosing regimens. This work describes a single-centre, retrospective study. The pharmacokinetic parameters of arbekacin were calculated from individual serum-concentration data using WinNonlin ver. 6.3. A total of 331 serum samples were obtained from 170 patients. Our drug concentration-time data were well described by a two-compartment open model. The final model showed that drug clearance was related to creatinine clearance and that the total distribution volume (Vd) was related to actual body weight and the presence of bacteremia. The individual Vd in bacteremia patients was significantly higher than those of other patients (bacteremia: 29.7 ± 0.5 L, pneumonia: 20.8 ± 0.4 L, other infections: 21.4 ± 0.4 L; p < 0.05). Additionally, Monte Carlo simulation showed that target (Cpeak/MIC ≧ 8) attainment was only 10.1%, even at a dose of 6 mg/kg, especially for MRSA bacteremia patients with an arbekacin MIC = 2 μg/mL. In conclusion, our study revealed that the Vd may be higher in bacteremia patients than in patients with other infectious diseases. Therefore, an increase in the daily dose of arbekacin should be considered for bacteremia patients.
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Affiliation(s)
- Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Yukihiro Hamada
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Naoya Nishiyama
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Katsuhiko Matsuura
- Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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Abstract
Arbekacin is a broad-spectrum aminoglycoside used to treat methicillin-resistant Staphylococcus aureus (MRSA). Arbekacin has antibacterial activities against high-level gentamicin-resistant Enterococci, multidrug-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii et al. Here, we reviewed in vitro data on arbekacin in Staphylococci and Gram-negative microorganisms. We also reviewed clinical studies for clinical efficacy and microbiologic efficacy data in patients with identified MRSA and suspected MRSA infections. The overall clinical efficacy ranged from 66.7% to 89.7%. The microbiologic efficacy rate ranged from 46.2% to 83%. In comparative studies between arbekacin and glycopeptides, arbekacin was similar to other glycopeptides with respect to clinical and microbiological efficacy rates. Combination trials with other antibiotics suggest that arbekacin will be a promising strategy to control Enterococcus spp. multi-drug resistant P. aeruginosa. The major adverse reaction was nephrotoxicity/hepatotoxicity, but patients recovered from most adverse reactions without any severe complications. Based on these results, arbekacin could be a good alternative to vancomycin/teicoplanin in MRSA treatment. Finally, therapeutic drug monitoring is recommended to maximize clinical efficacy and decrease nephrotoxicity.
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Affiliation(s)
- Jae Hoon Lee
- Department of Internal Medicine, Wonkwang University Medical School, Iksan, Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University, Jeonju, Korea.; Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea.; Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Miura K, Nakagawa M, Takahashi H, Uchino Y, Kodaira H, Iriyama N, Sakagami M, Ohtake S, Kobayashi S, Hojo A, Kurita D, Kobayashi Y, Kusuda M, Hirabayashi Y, Hatta Y, Takei M. Clinical efficacy and safety of arbekacin for high-risk infections in patients with hematological malignancies. Int J Hematol 2016; 103:334-40. [PMID: 26715149 DOI: 10.1007/s12185-015-1926-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/07/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
We performed a clinical trial to investigate the efficacy and safety of arbekacin (ABK), a unique aminoglycoside with activity against methicillin-resistant Staphylococcus aureus (MRSA), in patients with hematological malignancies complicated by high-risk infections. ABK was administered intravenously at a dose of approximately 5 mg/kg with various broad-spectrum β-lactams, followed by therapeutic drug monitoring (TDM). A total of 54 febrile or infectious episodes were registered, and TDM was performed in 44 (81%) cases. The absolute neutrophil count was below 500/μl in 49 (91%) cases, and cytotoxic chemotherapy was being administered in 47 (87%) cases. Before initiation of ABK, 52 (96%) patients had received fluoroquinolones (n = 37) and/or broad-spectrum β-lactams (n = 34). There were 10 cases of documented infections including one of MRSA pneumonia, and 44 cases of febrile neutropenia. The efficacy at the end of treatment was 80% for all patients, and efficacy was significantly higher in patients attaining maximum concentrations ≥ 16 µg/ml or receiving TDM-guided dose-adjustment of ABK (n = 19, 95 vs. 71%, P = 0.039). Renal toxicity was observed in six cases (11%) but was generally acceptable. This study demonstrated that TDM-guided ABK administration may be applicable under limited conditions for patients with hematological malignancies.
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Hwang JH, Lee JH, Hwang JH, Chung KM, Lee EJ, Yoon YJ, Moon MK, Kim JS, Won KS, Lee CS. Comparison of Arbekacin and Vancomycin in Treatment of Chronic Suppurative Otitis Media by Methicillin Resistant Staphylococcus aureus. J Korean Med Sci 2015; 30:688-93. [PMID: 26028918 PMCID: PMC4444466 DOI: 10.3346/jkms.2015.30.6.688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/18/2015] [Indexed: 11/25/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of ear infections. We attempted to evaluate the clinical usefulness of arbekacin in treating chronic suppurative otitis media (CSOM) by comparing its clinical efficacy and toxicity with those of vancomycin. Efficacy was classified according to bacterial elimination or bacteriologic failure and improved or failed clinical efficacy response. Ninety-five subjects were diagnosed with CSOM caused by MRSA. Twenty of these subjects were treated with arbekacin, and 36 with vancomycin. The bacteriological efficacy (bacterial elimination, arbekacin vs. vancomycin: 85.0% vs. 97.2%) and improved clinical efficacy (arbekacin vs. vancomycin; 90.0% vs. 97.2%) were not different between the two groups. However, the rate of complications was higher in the vancomycin group (33.3%) than in the arbekacin group (5.0%) (P=0.020). In addition, a total of 12 adverse reactions were observed in the vancomycin group; two for hepatotoxicity, one for nephrotoxicity, eight for leukopenia, two for skin rash, and one for drug fever. It is suggested that arbekacin be a good alternative drug to vancomycin in treatment of CSOM caused by MRSA.
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Affiliation(s)
- Ji-Hee Hwang
- Department of Pharmacy, Chonbuk National University Hospital, Jeonju, Korea
| | - Ju-Hyung Lee
- Department of Preventive Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Min Chung
- Department of Microbiology & Immunology, Chonbuk National University Medical School, Jeonju, Korea
| | - Eun-Jung Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Yong-Joo Yoon
- Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Korea
- Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Mi-Kyoung Moon
- Department of Pharmacy, Chonbuk National University Hospital, Jeonju, Korea
| | - Ju-Sin Kim
- Department of Pharmacy, Chonbuk National University Hospital, Jeonju, Korea
| | - Kyoung-Suk Won
- Department of Pharmacy, Chonbuk National University Hospital, Jeonju, Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Chonbuk National University Hospital, Jeonju, Korea
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Funatsu Y, Hasegawa N, Fujiwara H, Namkoong H, Asami T, Tasaka S, Kimizuka Y, Kamata H, Ishii M, Iketani O, Ogata H, Iwata S, Betsuyaku T. Pharmacokinetics of arbekacin in bronchial epithelial lining fluid of healthy volunteers. J Infect Chemother 2014; 20:607-11. [PMID: 24973909 DOI: 10.1016/j.jiac.2014.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Arbekacin is a unique aminoglycoside antibiotic with anti-methicillin-resistant Staphylococcus aureus activity. The efficacy of aminoglycosides is related to their serum maximum concentration. Local concentration of antibiotics in pulmonary epithelial lining fluid, rather than its serum concentration, can help determine its clinical efficacy more precisely for treatment of respiratory infectious disease. The objective of this study was to sequentially measure arbekacin concentration in epithelial lining fluid after infusion of a single clinically available dose. METHOD After the initial blood sampling, arbekacin was intravenously infused into 6 healthy volunteers over 1 h. Epithelial lining fluid and serum samples were collected by bronchoscopic microsampling 1, 1.5, 2, 2.5, 3, 4, 5, and 6 h after the start of 200 mg arbekacin infusion. RESULTS Each probe sampled 10.1 ± 5.2 μl bronchial epithelial lining fluid. The sample dilution factor was 266.7 ± 157.1. Drug concentration was successfully measured in all but 2 of the epithelial lining fluid samples. The maximum concentration of arbekacin in epithelial lining fluid and serum was 10.4 ± 1.9 μg/ml and 26.0 ± 12.2 μg/ml, respectively. The ratio of the maximum drug concentration in the epithelial lining fluid to that in the serum was 0.47 ± 0.19. CONCLUSIONS The maximum concentration of epithelial lining fluid reached levels that would effectively treat most clinical strains of methicillin-resistant S. aureus.
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Okada K, Kimura T, Mikamo H, Kasahara K, Seki M, Takakura S, Tokimatsu I, Ohmagari N, Takahashi Y, Matsumoto K, Igarashi M, Kobayashi M, Hamada Y, Mochizuki T, Kimura M, Nishi Y, Tanigawara Y, Takesue Y. Clinical practice guidelines for therapeutic drug monitoring of arbekacin: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Infect Chemother 2013; 20:1-5. [PMID: 24486168 DOI: 10.1016/j.jiac.2013.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 06/10/2013] [Revised: 08/02/2013] [Accepted: 08/07/2013] [Indexed: 11/27/2022]
Abstract
Arbekacin (ABK) was approved and widely used in Japan for treatment of patients infected with MRSA, and TDM was introduced in clinical practice. The Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring decided to develop a clinical practice guidelines for TDM of ABK for the following reasons. First, although the daily dose of 150-200 mg was approved in Japan, recent PK-PD studies revealed that higher serum concentration is required to achieve better clinical efficacy and several findings concerning the usefulness of higher dosage regimen have obtained recently. Second, although maximal concentrations that obtained immediately after the end of administration (Cmax) was generally adopted, the serum concentration at 1 h after initiation of administration [peak serum concentration (Cpeak)] proved to be more suitable as an efficacy indicator of aminoglycosides. Lastly, as ABK is approved only in Japan, no international practice guideline for TDM has not been available in ABK to date. This guideline evaluated the scientific data associated with serum ABK monitoring and provided recommendations based on the available evidence. Potential limitations of this guideline, however, include the findings that few prospective clinical trials of TDM of ABK are available in the treatment of MRSA infections and that most of the published literature describes observational studies.
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Affiliation(s)
- Kenji Okada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Hiroshige Mikamo
- Department of Infection Control and Prevention, Aichi Medical University, Graduate School of Medicine, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Masafumi Seki
- Division of Infection Control and Prevention, Osaka University Medical Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Shunji Takakura
- Department of Infection Control and Prevention, Kyoto University Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Issei Tokimatsu
- Internal Medicine II, Oita University Faculty of Medicine, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo Medical College Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Kazuaki Matsumoto
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Masahiro Igarashi
- Department of Pharmacy, Toranomon Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Masahiro Kobayashi
- Department of Pharmacy, Kitasato University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yukihiro Hamada
- Department of Infection Control and Prevention, Aichi Medical University, Graduate School of Medicine, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Takahiro Mochizuki
- Department of Pharmacy, Shizuoka Cancer Center, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Masao Kimura
- Department of Pharmacy, Aichi Medical University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yoshifumi Nishi
- Department of Pharmacy, Kyorin University School of Medicine, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yusuke Tanigawara
- Keio University, School of Medicine, Department of Clinical Pharmacokinetics and Pharmacodynamics, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo Medical College Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan.
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Iwashita Y, Enokiya T, Suzuki K, Yokoyama K, Yamamoto A, Ishikura K, Okuda M, Imai H. Arbekacin treatment of a patient infected with a Pseudomonas putida producing a metallo-beta-lactamase. J Intensive Care 2013; 1:3. [PMID: 25705398 PMCID: PMC4336246 DOI: 10.1186/2052-0492-1-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/13/2013] [Indexed: 11/10/2022] Open
Abstract
Treatment of infections caused by multidrug-resistant Pseudomonas species is difficult because few antibiotics active against such organisms are available. Arbekacin, a relatively new aminoglycoside, is effective against Pseudomonas spp. in vitro. However, no clinical report on arbekacin treatment of a human infection with a multidrug-resistant Pseudomonas has appeared to date. We encountered a case of pneumonia caused by a Pseudomonas strain producing a metallo-beta-lactamase; the patient was successfully treated with arbekacin. A 69-year-old male presented to our hospital experiencing cardiac arrest after rescue from water. Spontaneous circulation had earlier resumed after brief application of cardiopulmonary resuscitation. The patient was subjected to induced hypothermia. He experienced severe acute respiratory distress syndrome. The patient regained consciousness on day 8 post-admission. Episodes of ventilator-associated pneumonia were recorded on days 5 and 12. The causative organism was a strain of Pseudomonas putida that produced a metallo-beta-lactamase. Combination therapy with arbekacin and levofloxacin successfully resolved the pneumonia. The patient was transferred to another hospital on day 37 to undergo further rehabilitation. Strains of P. putida producing metallo-beta-lactamases have become more widespread in recent years. Colistin is traditionally the drug of last resort to treat infections with multidrug-resistant Pseudomonas. However, colistin use is associated with a very high frequency of adverse effects, and the costs of such therapy are not covered by the Japanese health insurance system. Our results indicate that arbekacin is an efficient alternative to multidrug-resistant Pseudomonas.
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Affiliation(s)
- Yoshiaki Iwashita
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
| | - Tomoyuki Enokiya
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
| | - Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
| | - Kazuto Yokoyama
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
| | - Akitaka Yamamoto
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
| | - Ken Ishikura
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
| | - Masahiro Okuda
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie, 514-8507 Japan
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Hwang JH, Lee JH, Moon MK, Kim JS, Won KS, Lee CS. The efficacy and safety of arbekacin and vancomycin for the treatment in skin and soft tissue MRSA infection: preliminary study. Infect Chemother 2013; 45:62-8. [PMID: 24265951 PMCID: PMC3780940 DOI: 10.3947/ic.2013.45.1.62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 05/21/2012] [Accepted: 05/30/2012] [Indexed: 11/24/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) has become a one of the most important causes of nosocomial infections, and use of vancomycin for the treatment of MRSA infection has increased. Unfortunately, vancomycin-resistant enterococcus have been reported, as well as vancomycin-resistant S. aureus. Arbekacin is an antibacterial agent and belongs to the aminoglycoside family of antibiotics. It was introduced to treat MRSA infection. We studied the clinical and bacteriological efficacy and safety of arbekacin compared to vancomycin in the treatment of infections caused by MRSA. Materials and Methods This was a retrospective case-control study of patients who were admitted to tertiary Hospital from January 1st, 2009 to December 31st, 2010, and received the antibiotics arbekacin or vancomycin. All the skin and soft tissue MRSA infected patients who received arbekacin or vancomycin were enrolled during the study period. The bacteriological efficacy response (BER) was classified with improved and failure. The improved BER was defined as no growth of MRSA, where failure was defined as growth of MRSA, culture at the end of therapy or during treatment. Clinical efficacy response (CER) was classified as improved and failure. Improved CER was defined as resolution or reduction of the majority of signs and symptoms related to the original infection. Failure was defined as no resolution and no reduction of majority of the signs and symptoms, or worsening of one or more signs and symptoms, or new symptoms or signs associated with the original infection or a new infection. Results Totally, 122 patients (63/99 in arbekacin, 59/168 in vancomycin group) with skin and soft tissue infection who recieved arbekacin or vancomcyin at least 4 days were enrolled and analysed. The bacteriological efficacy response [improved, arbekacin vs vancomycin; 73.0% (46/63), 95% confidence interval (CI) 60.3 to 83.4% vs 83.1% (49/59), 95% CI 71.0 to 91.6%] and clinical efficacy response [improved, arbekacin vs vancomycin; 67.2% (41/61), 95% CI 52.0 to 76.7% vs 78.0% (46/59), 95% CI 65.3 to 87.7%] were similar between the two groups (P=0.264, 0.265). The complication rate was significantly higher in the vancomycin group [29/59(49.2%), 95% CI 35.9 to 62.5%] than arbekacin [10/63(15.9%), 95% CI 8.4 to 29.0%] (P<0.001). Conclusions Arbekacin could be considered as an alternative antibiotics for vancomycin in skin and soft tissue infection with MRSA. However, further prospective randomized trials are needed to confirm this finding.
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Affiliation(s)
- Ji-Hee Hwang
- Department of Pharmacy, Chonbuk National University Hospital, Jeonju, Korea
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