Class of 2013 Abstract / Specific Aims: The purpose of this study was to retrospectively evaluate sulfamethoxazole concentrations obtained in adult patients with varying degrees of renal function. The first study aim was to identify sulfamethoxazole serum concentrations obtained from patients who received high-dose trimethoprim/sulfamethoxazole. The second aim is to examine the relationship between sulfamethoxazole concentrations, trimethoprim/sulfamethoxazole doses prescribed, and subjects' estimated renal function. Methods: This institutional review board approved study examined sulfamethoxazole serum concentrations in adult patients with varying renal function. Subjects selected had recorded sulfamethoxazole blood concentrations while receiving high-dose sulfamethoxazole/trimethoprim between June 2006 and May 2012 while admitted to an academic medical center. For the first study aim, patients were grouped by renal function with estimated creatinine clearance exceeding 30 ml/min, creatinine clearance of 15 to 30 ml/min, and creatinine clearance of less than 15 ml/min. For the last group, dosing practices were described since few recommendations for this degree of renal function exist. For the first two groups, adherence to literature recommendations was evaluated. The second aim was addressed with a population pharmacokinetic analysis. A one compartment model was used with first-order elimination. Oral dosing was incorporate a separate administration compartment with first order transfer to compartment 1. Intravenous dosing was handled as a rate input into compartment 1. For patients with estimated creatinine clearance greater than 60 ml/min, all doses within the prior 48 hours were entered while those with estimated creatinine clearance less than 60 ml/min only the prior 96 hours of doses before a concentration were entered. Sulfamethoxazole concentrations were assessed in context of trimethoprim/sulfamethoxazole dose and renal function. Main Results: A total of 77 subjects who had a total of 206 sulfamethoxazole concentration(s) obtained while receiving high-dose sulfamethoxazole/trimethoprim. The sulfamethoxazole concentrations ranged from undetectable to 316.8 mcg/mL with a median value of 79.6 mcg/mL. The number of sulfamethoxazole concentrations obtained per subject ranged from 1 to 8 concentrations. The pharmacokinetic analysis of these sulfamethoxazole concentrations based on subjects’ estimated renal function and doses prescribed is in progress. Conclusion: To be determined.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Vancomycin has been considered first-line treatment for bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) despite treatment failures in up to 20% of patients with MRSA bacteremia secondary to endocarditis. However, trimethoprim-sulfamethoxazole (TMP-SMX) is as effective as vancomycin for the management of MRSA bacteremia. secondary to endocarditis in injection drug users. We report the successful management of a left ventricular assist device-related MRSA infection with persistent MRSA bacteremia that failed to respond to vancomycin, linezolid, and quinupristin/dalfopristin but did respond to TMP-SMX.

No description available.

A recent systematic literature and meta-analysis reported relative efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of toxoplasmic encephalitis (TE) in HIV-infected adults. Here, we estimated relapse rates during secondary prophylaxis with TMP-SMX, and further explored differences in relapse rates prior to introduction of highly active antiretroviral therapy (HAART) and the widespread adoption of HAART. A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials yielded 707 studies whereby 663 were excluded after abstract screening, and 38 were excluded after full review leaving 6 studies for extraction. We performed double data extraction with a third-party adjudicator. Study designs varied with only one randomized study, four prospective cohorts and one retrospective cohort. Relapse rates were transformed using the Freeman-Tukey method and pooled using both fixed-effect and random-effects meta-analysis models. The TMP-SMX relapse rate was 16.4% (95% CI = 6.2% to 30.3%) based on random-effects models. When the disaggregated pre-HAART studies (n = 4) were included, the relapse rate was 14.9% (random effects; 95% CI = 3.7% to 31.9%). Analysis of two post-HAART studies indicated a relapse rate of 19.2% (random effects; 95% CI = 2.8% to 45.6%). Comparing the relapse rates between pre- and post-HAART studies were contrary to what might be expected based on known benefits of HAART therapy in this population. Nevertheless, cautious interpretation is necessary considering the heterogeneity of the included studies and a limited number of subjects receiving TMP-SMX reported in the post-HAART era.

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology and Toxicology Student: Veronika Ackermannová Supervisor: prof. Radomír Hrdina, MD, CSc. Title of diploma thesis: Topic and systemic treatment of acne vulgaris Acne vulgaris is a skin disease affecting the hair follicles and sebaceous glands. The disease manifests itself by increased sebum production, non-inflammatory (comedones) and inflammatory lesions (papules, pustules, nodules, cysts). It occurs predominantly in adolescents, but may persist into adulthood. It is a multifactorial disease, which is caused by several factors (internal and external stimuli). The major pathogenetic factors include increased sebum production, hyperkeratosis, P. acnes colonization and inflammation present. First, it is necessary to diagnose the type of acne in order to choose the right and effective therapy, because there is not only one type of acne. There are many types and variants of acne, and although they show similar symptoms (affecting the follicles of sebaceous glands), their cause often differs. There is no uniform classification system for acne vulgaris and it varies between authors. Some authors classify acne vulgaris according to severity into mild, moderate and severe, others into comedonic, papulopustular, nodulocystic...