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- ItemSomente MetadadadosAntimicrobial activity of daptomycin in comparison to glycopeptides and other antimicrobials when tested against numerous species of coagulase-negative Staphylococcus(Elsevier B.V., 2012-06-01) Sader, Hello S. [UNIFESP]; Jones, Ronald N.; JMI Labs Inc; Universidade Federal de São Paulo (UNIFESP); Tufts UnivCoagulase-negative Staphylococcus spp. (CoNS) represent a major cause of bloodstream infections, especially in patients with prosthetic devices and intravenous catheters. We evaluated the activity of daptomycin in comparison to vancomycin and teicoplanin against a large collection of 22,024 CoNS isolates causing clinically significant infections from 283 medical centers over 9 years (2002-2010) and tested for susceptibility by broth microdilution methods against daptomycin and numerous comparators. Overall, daptomycin (MIC50/90, 0.25/0.5 mu g/mL) inhibited 99.8% of CoNS at the susceptible breakpoint of <= 1 mu g/mL and was 4- to 16-fold more active than vancomycin (MIC50/90, 1/2 mu g/mL; >99.9% susceptible). All species showed >= 99.6% susceptibility to daptomycin, except Staphylococcus auricularis (95.1%), S. capitis (99.0%), S. warneri (98.8%), and S. sciuri. S. sciuri represented only 0.2% of the collection (46 strains) and exhibited decreased susceptibility to daptomycin (MIC50/90, 1/2 mu g/mL; 71.7% susceptible). in contrast, S. sciuri exhibited high susceptibility to vancomycin and teicoplanin (highest MIC at 2 mu g/mL for both drugs). in summary, daptomycin exhibited species-specific activity among CoNS, especially versus S. sciuri. No correlation between decreased susceptibility to daptomycin and the glycopeptides tested was observed. (C) 2012 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Avaliação do nível sérico de vancomicina em pacientes internados em centro de terapia intensiva pediátrica em um hospital terciário(Universidade Federal de São Paulo (UNIFESP), 2017-11-20) Maloni, Talita Muniz [UNIFESP]; Furtado, Guilherme Henrique Campos [UNIFESP]; http://lattes.cnpq.br/0879763986599914; http://lattes.cnpq.br/2269069832558641; Universidade Federal de São Paulo (UNIFESP)Infecções por Staphylococcus aureus resistente a oxacilina estão associadas com significativa morbidade e custos hospitalares. A vancomicina é um antibiótico glicopeptídeo, amplamente utilizado para o tratamento de infecções graves por microorganismos gram-positivos, principalmente Staphylococcus aureus resistente a oxacilina. Recomenda-se que os níveis séricos de vancomicina variem entre 10mg/L-20mg/L para otimizar sua eficácia e evitar o desenvolvimento de resistência bacteriana. Manter o nível sérico alvo de 15-20mg/L é recomendado para tratamento de infecções mais graves, em adultos, a concentração mínima de vancomicina de 15-20mg/L foi correlacionado com ASC/CIM>400, alvo farmacodinâmico que melhor prediz a eficácia da vancomicina. Apesar do extenso uso, informações ideais sobre posologia na população pediátrica permanecem limitadas. Dado o risco de prejuízo ao tratamento com vancomicina quando o paciente não atinge o nível sérico alvo, avaliamos a prevalência de pacientes pediátricos que não atingiram os níveis séricos de vancomicina adequados após administração da posologia recomendada. Além disso, investigamos a influência da idade, balanço hidrico positivo e uso de drogas vasoativas na capacidade destes pacientes atingirem os níveis alvo. Usamos um delineamento retrospectivo, observacional, em pacientes internados na Unidade de Terapia Intensiva Pediátrica do Hospital Israelita Albert Einstein no período de 1 de janeiro de 2008 a 31 de dezembro de 2014, para avaliar se o nível sérico da vancomicina coletado no vale estava dentro da faixa terapêutica (10-20mg/L). O perfil dos pacientes que utilizaram vancomicina também foi avaliado. Nosso estudo mostrou que na primeira coleta de vancocinemia 71,9% dos pacientes apresentaram nível sérico abaixo de 10mg/L, e somente 27,1% atingiram o nível 10-20mg/L. Considerando o tratamento completo, com todas as doses utlizadas, o nível sérico alvo também não foi atingido na maioria dos pacientes, 69% dos pacientes apresentaram nível sérico <10mg/L, ainda que 84% das coletas tenham sido realizadas no vale, conforme preconizado, a mediana da posologia tanto na primeira dose quanto no tratamento completo foi 40mg/kg/dia. Estes resultados enfatizam a necessidade de revisão das doses propostas e revisão do nível sérico alvo para atingir ASC/CIM>400 na população pediátrica.
- ItemAcesso aberto (Open Access)Efeito de fármacos ototóxicos na audição de recém-nascidos de alto risco(Sociedade Brasileira de Fonoaudiologia, 2010-01-01) Camara, Marília Fontenele e Silva; Azevedo, Marisa Frasson de [UNIFESP]; Lima, José Wellington de Oliveira; Sartorato, Edi Lúcia; Universidade de Fortaleza; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual do Ceará; Universidade Estadual de Campinas (UNICAMP)PURPOSE: To calculate the incidence of sensorineural hearing loss (SNHL), to verify if there is a causal association between the use of ototoxic drugs and SNHL, and to establish the frequency of genetic mutations related to SNHL in high risk newborns. METHODS: The study was a retrospective and prospective cohort research with 250 children. Data was gathered from subjects' charts and with their caregivers. Moreover, subjects were submitted to auditory evaluation with distortion product otoacoustic emissions, timpanometry, visual reinforcement audiometry, auditory brainstem response and transient otoacoustic emissions. The study of the genetic mutation 35delG, and the mitochondrial mutations A1555G and A7445G was essential to evaluate the possibility that SNHL had a non-syndromic genetic origin. The association between the medicine use and the occurrence of hearing loss had been analyzed. RESULTS: The incidence of SNHL in high risk newborns was 11.6%, and causal associations between SNHL and the drugs administered were: amikacin and cefotaxime (OR=5.35), cefotaxime and furosemide (OR=7.02), ceftazidime and vancomycin (OR=9.12). The frequencies of the mutation 35deIG and mitochondrial mutations A1555G and A7445G were, respectively, 0.8% and 0%. CONCLUSION: The incidence of SNHL in high risk newborns was high, showing an important causal relation with the use of ototoxic drugs and a small relation with genetic mutations.
- ItemAcesso aberto (Open Access)Endothelial, renal and hepatic variables in wistar rats treated with Vancomycin(Academia Brasileira de Ciências, 2014-12-01) Bruniera, Felipe R.; Ferreira, Felipe M.; Savioli, Luiz R.m.; Bacci, Marcelo R.; Feder, David; Pereira, Edimar Cristiano [UNIFESP]; Pedreira, Mavilde da Luz Gonçalves [UNIFESP]; Peterlini, Maria Angélica Sorgini [UNIFESP]; Perazzo, Fábio Ferreira [UNIFESP]; Azzalis, Ligia Ajaime [UNIFESP]; Rosa, Paulo César Pires [UNIFESP]; Junqueira, Virginia Berlanga Campos [UNIFESP]; Sato, Monica A.; Fonseca, Fernando Luiz Affonso [UNIFESP]; Faculdade de Medicina do ABC Departamento de Morfologia Disciplina de Farmacologia; Universidade Federal de São Paulo (UNIFESP)Vancomycin (VCM) is indicated in combat against Gram-positive infections, but it is not considered a first-choice drug because of its adverse effects. It is believed that oxidative stress is the primary mechanism of endothelial injury and the consequent VCM toxicity, which varies from phlebitis to nephrotoxicity. Moreover, dose recommendations, dilution, rates and types of infusion are still controversial. The aim of this study was to determine the effect of different VCM dilutions in endothelial, liver and kidney injuries by biochemical parameters and histopathological analysis. Wistar rats were randomly divided into six groups and subjected to femoral vein cannulation for drug administration. Control groups received 0.9 ml of saline and the others received VCM (10mg/Kg/day) at dilutions of 5.0 and 10.0 mg/mL for 3 and 7 days. Homocysteine, hs-CRP, AST, ALT, GGT, urea, creatinine, lycopene, alpha-tocopherol, beta-carotene and retinol were analyzed. Kidney, liver and cannulated femoral vein fragments were collected.This study showed alterations in ALT which featured hepatotoxicity. However, drug dilutions were not able to show changes in other biochemical parameters. In contrast, kidney and endothelium pathological changes were observed. More studies are needed to characterize VCM induced kidney and endothelium toxicity and biochemical markers able to show such morphological modifications.
- ItemAcesso aberto (Open Access)Estabilidade de soluções de cloridrato de vancomicina segundo concentração, tempo de infusão e temperatura(Universidade Federal de São Paulo (UNIFESP), 2014-12-17) Barbosa, Ana Paula Soares [UNIFESP]; Peterlini, Maria Angelica Sorgini Peterlini [UNIFESP]; http://lattes.cnpq.br/1599622257763420; Universidade Federal de São Paulo (UNIFESP)Estudo experimental que teve como objetivos validar metodologia analítica em cromatografia líquida de alta eficiência (HPLC) para determinar a concentração de cloridrato de vancomicina e analisar a estabilidade de soluções de cloridrato de vancomicina por meio de HPLC e pH, segundo concentração, tempo de exposição e temperatura. A separação cromatográfica foi realizada em colunas C-18 Phenosphere® (150 x 4,6mm, 5?m) e Kinetex® (100 x 4,6mm, 2,6?m), usando como fase móvel mistura de tampão fosfato monobásico de amônio 50mM e acetonitrila (92:8v/v), pH 4,0 (±1), em fluxo de 1 mL/min, com detecção no ultravioleta, ?=220nm em sistema isocrático de eluição. Os dados foram analisados segundo média e desvios padrão (m±dp). O método demonstrou linearidade para as faixas compreendidas entre 0,005 e 0,25mg/mL para a coluna Phenosphere® e 0,015625 - 0,25mg/mL para a coluna Kinetex®. O limite de quantificação para o método foi de 0,0005mg/mL e os coeficientes de variação no ensaio de repetitividade e precisão intermediária apresentaram valores entre 2,92% e 8,75%. Os tempos de retenção médios em coluna Phenosphere® foram de 7,446(±0,045), 7,524(±0,035) e 7,407(±0,159) minutos, com tempo de corrida cromatográfica de 10 minutos e na Kinetex® de 4,133(±0,127), 4,081(±0,106) e 3,978(±0,081) minutos, com tempo de corrida de cinco minutos. Boa exatidão (variações entre 86,2% e 111,9%) e alta seletividade foram verificadas. A análise da estabilidade foi realizada pela mensuração do pH e da concentração do fármaco após reconstituição com água para injetáveis e diluição com solução fisiológica (SF) em concentrações de 5 mg/mL e 10mg/mL, expostas às temperaturas de 22ºC(±1) e 37ºC(±1), administradas em bomba de infusão por período de 60 e 120 minutos. As amostras foram coletadas em triplicatas. Controlou-se o pH dos solventes, diluentes, soluções reconstituídas e soluções diluídas. A análise da concentração aconteceu no início e no final da infusão, cada triplicata foi analisada em quintuplicata. Os dados foram analisados segundo média e desvio padrão (m±dp). Foram verificados 120 valores de pH. Não foram observadas alterações importantes nos valores de pH das soluções em nenhuma das situações estudadas. Mensurou-se 240 valores de concentração. Na comparação das concentrações iniciais e finais das soluções a 5mg/mL, expostas à 22ºC(±1) em 60 e 120 minutos, houve aumento de 0,17% e 0,35%, respectivamente. As soluções na mesma concentração expostas à 37ºC(±1), nos mesmos intervalos de tempo, resultaram em redução da concentração de 1,20% em 60 minutos e de 16,3% em 120 minutos. Nas soluções a 10 mg/mL, expostas à 22ºC (±1) em 60 e 120 minutos, houve aumento de 4,03% e 21,11%, respectivamente. As soluções na mesma concentração expostas à 37ºC(±1), nos mesmos intervalos de tempo, resultaram em aumento da concentração de 4,59% em 60 minutos e diminuição de 10,28% em 120 minutos. Soluções de cloridrato de vancomicina diluídas a 5mg/mL e 10mg/mL quando expostas às temperaturas elevadas e infundidas em 120 minutos parece sofrer degradação.
- ItemSomente MetadadadosEstabilidade do cloridrato de vancomicina empregado na técnica de selo com antimicrobianos para descontaminação de cateteres intravenosos centrais(Universidade Federal de São Paulo (UNIFESP), 2019-08-29) Barros, Daniele Porto [UNIFESP]; Peterlini, Maria Angelica Sorgini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Bloodstream infection related to central lines catheter is a frequent complication in children undergoing bone marrow transplantation, and the use of an antimicrobial lock technique, such as vancomycin hydrochloride in combination with sodium heparin is recommended as an adjunct to treatment. However, there is little evidence of the stability of the drugs used. Objectives: To verify the concentration and stability of vancomycin hydrochloride and sodium heparin solutions similar to those used in the antimicrobial lock technique, according to the influence of time and temperature. Methods: Experimental research developed under controlled environmental conditions. The hydrogen potential (pH), the osmolality and the concentration of vancomycin hydrochloride (500 mg), saline solution and sodium heparin (5,000 U.I.) were analized separately and in association, resulting in 282 analyzes. The concentration was verified by means of high performance liquid chromatography, the method being validated following the recommended guidelines for selectivity, linearity, precision and accuracy parameters. Vancomycin hydrochloride was reconstituted in distilled water (AD), diluted in saline solution and associated with sodium heparin, resulting in a concentration of 5 mg/mL of the antimicrobial and 100 U.I./mL of the anticoagulant. The solutions were conditioned in bottles of amber glass, at temperatures of 22° C and 37° C and the analyzes performed at the initial moment (T0), three (T3), eight (T8) and 24 hours (T24) after preparation. The data were analyzed according to mean and standard deviation, and one-way ANOVA, Kolmogorov-Smirnov, with Bonferroni correction (p≤0.05) was used. Results: Descriptive analysis of pH and osmolality of the solutions evidenced variation without statistically significant difference, except for osmolality of SF (p=0.022). The pH values of dilute vancomycin hydrochloride solutions, as well as in combination with sodium heparin at 22° C, showed statistically significant variation (p<0.001). The diluted antimicrobial solutions at 37° C resulted in a pH of 3,73 (± 0.02) in T0 at 3,68 (± 0.02) in T24 (p=0.004), and in the association 3,80 (±0.02) in T0 at 3,78 (±0.01) in T24 (p=0.389). The concentration of the diluted vancomycin hydrochloride at 22° C resulted in 5,10 (±0,08) in T0 at 5,12 (±0,07) mg/mL in T24 (p<0.001); and associated heparin sodium from 5,09 (±0.19) in T0 to 4,82 (±0.08) mg/mL in T24 (p<0.001). The diluted antimicrobial solutions at 37° C resulted in a concentration of 4,89 (±0.03) in T0 at 4,92 (±0.14) in T24 (p<0.001); the association of the drugs in 4,75 (±0.09) in T0 at 4,85 (±0.06) mg/mL in T24 (p=0.001). By analyzing the physical aspect of the solutions containing vancomycin hydrochloride and sodium heparin, precipitate formation was observed in T3, both at 22º C and 37º C. Conclusion: Vancomycin hydrochloride presented significant changes in the experimental situations studied, however. , the concentration variation was less than 10% in all experimental situations. The association of the antimicrobial with the anticoagulant resulted in pharmaceutical stability, but with physical incompatibility.
- ItemSomente MetadadadosInfluência da concentração, tempo de exposição e temperatura na estabilidade de soluções de cloridrato de vancomicina(Universidade Federal de São Paulo (UNIFESP), 2019-09-26) Onofre, Priscilla Sete De Carvalho [UNIFESP]; Peterlini, Maria Angelica Sorgini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Vancomycin hydrochloride is an antimicrobial widely used in the treatment of children with severe infections. Clinical practice has verified different methods of administration of drug solutions, with different diluents and concentrations, infusion period over one hour and exposure to environmental conditions, such as temperature and luminosity. These conditions raise the question about the possible impairment the stability of the medication, and scientific support is required to ensure proper administration practices, and safe nursing interventions. Objectives: To develop and validate analytical methodology to determine vancomycin hydrochloride content using High Performance Liquid Chromatography (HPLC); to analyze the stability of vancomycin hydrochloride solutions by verification of hydrogenic potential (pH) and content by HPLC based in concentration, infusion time, and exposure to high temperatures. Materials and Methods: The experimental study was developed in the Laboratory of Nursing Experiments of the Federal University of São Paulo. To validate the analytical methodology the selectivity parameters, linearity, work range, matrix effect, robustness, precision, and accuracy were determined. The sample was composed of 12 solutions. Chemical stability was analyzed using the pH and content of vancomycin hydrochloride at 5 and 10 mg/mL diluted in 0.9% sodium chloride and exposed to temperatures of 22 ± 2° C and 37 ± 2° C. The analyses were conducted immediately after preparation (T0), and after two (T2), and four (T4) h of exposure. The content analyzed was collected in three aliquots of each solution in all experimental situations, for a total of 108 analyses. For the pH, an aliquot of each solution was collected at all studied times, completing 36 measurements. The results were analyzed based on the mean (± standard deviation) and using ANOVA Variance and the multilevel linear regression model. Data normality was verified by Kolmogorov-Smirnov and Bonferroni correction tests (p ≤ 0.05). Results: The method was validated for the separation and quantification of vancomycin hydrochloride, and proved selective, linear, precise, accurate and robust. The pH did not vary during the 4 h exposure to the solution in all proposed situations, keeping its acid characteristic. In the diluted vancomycin hydrochloride solutions, to obtain 5 mg/mL and submitted to a temperature of 22 ℃. The men who did this were similar; however, there was a reduction at T4 (T0 = 101.93% ± 1.66; T2 = 101.45% ± 1.46; T4 = 100.31% ± 0.87; p < 0.001); the same situation was observed in the experiment at 37 ℃ (T0 = 106.12% ± 2.60; T2 = 106.02 ± 1.43; T4 = 104.83% ± 1.66; p < 0.001). The drug diluted to 10 mg/mL and exposed to a temperature of 22 °C resulted in an increase in T0 to T2 content, with a consecutive decrease in T4 (T0 = 92.96% ± 1.38; T2 = 94.39% ± 3.69; T4 = 91.86% ± 1.12; p = 0.006). For the 10 mg/mL vancomycin hydrochloride solution exposed at 37 ℃, the mean at T0 was lower when compared to other analysis times (T0 = 96.17% ± 2.25; T2 = 97.70% ± 1.50; T4 = 97.47% ± 0.68; p < 0.001). Despite the identified variations in drug content, the pharmacological stability of the solutions was observed due to changes of less than 10%. Conclusions: The chromatographic method for content analyses of vancomycin hydrochloride was considered valid. In the four-hour interval vancomycin hydrochloride diluted to 5 or 10 mg/mL showed statistically significant differences but remained stable according to the proportion of variability accepted to maintain pharmacological stability.
- ItemAcesso aberto (Open Access)Interação do glicopeptídeo Vancomicina em monocamadas de Langmuir como modelos de membrana celular(Universidade Federal de São Paulo, 2022-11-25) Santana, Heung Jin Alves [UNIFESP]; Caseli, Luciano [UNIFESP]; https://lattes.cnpq.br/8929162910172931Fármacos com atividade microbicida, responsáveis por tratar adversidades causadas por infecções bacterianas, são amplamente utilizados no meio médico e clínico e devem envolver em seu mecanismo de ação interações com as membranas que limitam a bactéria. Este trabalho teve como objetivo analisar a interação do fármaco vancomicina (VC), utilizado amplamente para tratar infecções bacterianas, com modelos de membrana utilizando monocamadas de Langmuir constituídas de lipídios. Estes filmes foram formados pelos fosfolipídios dipalmitoilfosfatidilcolina (DPPC) e dipalmitoilfosfatidilserina (DPPS) para estudar os efeitos da vancomicina com modelo de membrana de eritrócitos, e os fosfolipídios dipalmitoilfosfatiletalonamina (DPPE) para estudar os efeitos do fármaco em modelos de camada externa de membranas citoplasmáticas de bactérias. VC foi incorporada à monocamada lipídica a partir da subfase aquosa, e a interação fármaco-lipídio foi analisada por isotermas de pressão e potencial de superfície-área, microscopia no ângulo de Brewster e espectroscopia no infravermelho. Para efeitos de comparação, realizou-se ensaios com o bioativo puro, com cada lipídio puro e com os filmes mistos de VC-DPPC, VC-DPPE e VC-DPPS. Para o DPPC, a VC condensou a monocamada, a deixando menos estável quando previamente comprimidas até altas pressões. Para o DPPE, a VC deixou o filme mais estável, sinalizando uma expansão da monocamada, além da formação de agregados. Por fim, a vancomicina condensou a monocamada de DPPS, interagindo com suas regiões hidrofílicas. Concluímos que a interação da vancomicina com os modelos de membrana na interface ar-água é modulada pela composição lipídica, e depende das interações intermoleculares com o grupo polar das moléculas formadoras da monocamada.
- ItemSomente MetadadadosRisk factors for enterococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients(Wiley-Blackwell, 2010-12-01) Mikulska, Malgorzata; Del Bono, V.; Prinapori, R.; Boni, L.; Raiola, A. M.; Gualandi, F.; Van Lint, Maria Teresa; Dominietto, A.; Lamparelli, T.; Cappellano, Paola [UNIFESP]; Bacigalupo, Andrea; Viscoli, Claudio; San Martino Univ Hosp; Ist Toscano AOU Tumori Careggi; Universidade Federal de São Paulo (UNIFESP)P>Bacteremia is a well known cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients and enterococci are among the most frequently isolated pathogens. the aim of this study was to identify risk factors for enterococcal bacteremia during the first 30 days after allogeneic HSCT. A retrospective case-control study was performed; for each case, 3 controls were randomly selected among 306 patients transplanted during the study period (January 1, 2004 to December 31, 2007). Odds ratios (OR) with 95% confidence intervals (CI) were calculated for variables influencing the risk for bacteremia. Overall, 33 patients developed enterococcal bacteremia, within a median of 9 days after HSCT (range, 2-24). the cumulative incidence was 10.8%. Multivariate analysis identified the following variables as risk factors for enterococcal bacteremia: donor and transplant type (greater risk for mismatched related or cord blood) (OR=8.98, 95% CI, 1.65-48.99 and OR=7.52, 95% CI, 1.56-36.31, respectively, P=0.047); severe (grades 3-4) mucositis (OR=9.04, 95% CI, 1.97-41.52, P=0.018); pharyngeal enterococcal colonization (OR=4.48, 95% CI, 1.11-18.03, P=0.035); and previous empirical therapy with cephalosporins (OR=4.16, 95% CI, 0.93-18.66 for 1-7 days of therapy, and OR=7.31, 95% CI, 1.78-30.12 for 8-23 days, P=0.018). Higher Karnofsky score (>= 50) and previous empirical therapy with glycopeptides were associated with a decreased risk (OR=0.25, 95% CI, 0.06-0.97, P=0.045 and OR=0.11, 95% CI, 0.02-0.59, P=0.010, respectively). the crude mortality at 7 and 30 days was 12% (4/33) and 24% (8/33), respectively. Enterococcal bacteremia is frequent after allogeneic HSCT. the factors associated with this infection are type of transplant, pharyngeal colonization, severe mucositis, and use of cephalosporins. Good general conditions and the use of vancomycin were associated with lower risk of enterococcal bacteremia.
- ItemAcesso aberto (Open Access)Successful treatment of vancomycin-resistant enterococcus ventriculitis in a child(Brazilian Society of Infectious Diseases, 2007-04-01) Silva, Paulo Sérgio Lucas da [UNIFESP]; Monteiro Neto, Henrique [UNIFESP]; Sejas, Lílian Márcia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.
- ItemSomente MetadadadosThe use of vancomycin with its therapeutic and adverse effects: a review(Verduci Publisher, 2015-01-01) Bruniera, F. R.; Ferreira, F. M.; Saviolli, L. R. M. [UNIFESP]; Bacci, M. R.; Feder, D.; Luz Goncalves Pedreira, M. da [UNIFESP]; Peterlini, M. A. Sorgini [UNIFESP]; Azzalis, L. A. [UNIFESP]; Junqueira, V. B. Campos [UNIFESP]; Fonseca, F. L. A. [UNIFESP]; Fac Med ABC; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Vancomycin (VCM) is a tricyclic glycopeptide antibiotic produced by Streptococcus orientalis. Widely used in hospitals, it is indicated to fight severe infections caused by Gram-positive bacteria, especially with the advent of MRSA (methicillin-resistant Staphylococcus aureus), penicillin-resistant pneumococci among others. Furthermore, it is indicated for the treatment of patients allergic to penicillins and cephalosporins. Dose recommendations, dilution rates and types of infusion are controversial and also result in toxic effects. Aim of this paper was to perform a literature review showing the therapeutic and adverse effects of vancomycin.MATERIALS AND METHODS: This is a literature review of recent articles published on MEDLINE and SciELO databases in English, Portuguese and Spanish.RESULTS: The main adverse effects of vancomycin are: hypotension, phlebitis, nephrotoxicity, ototoxicity, hypersensitivity reactions, red man syndrome, neutropenia, chills, fever, interstitial nephritis.CONCLUSIONS: The use of vancomycin is still very common; however, inadequate doses and prolonged therapy pose a risk of increasing minimum inhibitory concentrations (MICs), resulting in subtherapeutic levels, treatment failures and toxicity. Therefore, further studies should be conducted to optimize the administration of vancomycin, monitoring treatments from the beginning in order to ensure a safe and effective use of the drug.
- ItemSomente MetadadadosVancomycin-associated linear IgA disease mimicking toxic epidermal necrolysis(Soc Brasileira Dermatologia, 2016) Pereira, Amanda Regio [UNIFESP]; Siqueira Pinheiro, Jhonatan Rafael [UNIFESP]; Enokihara, Mílvia Maria Simões e Silva [UNIFESP]; Moura, Luis Henrique Barbizan de [UNIFESP]; Pasin, Victor Pavan [UNIFESP]; Porro, Adriana Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Linear IgA dermatosis is a rare subepidermal autoimmune blistering disease characterized by linear deposition of IgA along the basement membrane zone. In the last three decades, many different drugs have been associated with the druginduced form of the disease, especially vancomycin. We report a case of vancomycin-induced linear IgA disease mimicking toxic epidermal necrolysis. The aim of this work is to emphasize the need to include this differential diagnosis in cases of epidermal detachment and to review the literature on the subject and this specific clinical presentation.