2 research outputs found
Pantoprazole intraveineux aux soins intensifs pédiatriques: un modÚle de pharmacocinétique de population
Objectifs : DĂ©finir les paramĂštres pharmacocinĂ©tiques du pantoprazole intraveineux en soins intensifs pĂ©diatriques et dĂ©terminer lâinfluence quâexercent sur ceux-ci les facteurs dĂ©mographiques, le syndrome de rĂ©ponse inflammatoire systĂ©mique (SRIS), la dysfonction hĂ©patique et lâadministration dâun inhibiteur du cytochrome (CYP) 2C19.
MĂ©thode : Cent cinquante-six concentrations plasmatiques de pantoprazole provenant dâune population de 20 patients (ĂągĂ©s de 10 jours Ă 16.4 ans) Ă risque ou atteints dâune hĂ©morragie gastroduodĂ©nale de stress, ayant reçu des doses quotidiennes de pantoprazole de 19.9 Ă 140.6 mg/1.73m2, ont Ă©tĂ© analysĂ©es selon les mĂ©thodes non compartimentale et de modĂ©lisation non linĂ©aire Ă effets mixtes.
RĂ©sultats : Une clairance mĂ©diane (CL) de 0.14 L/h/kg, un volume apparent de distribution de 0.20 L/kg et une demi-vie dâĂ©limination de 1.7 h ont Ă©tĂ© dĂ©terminĂ©s via lâapproche non compartimentale. Le modĂšle populationnel Ă deux compartiments avec une infusion dâordre zĂ©ro et une Ă©limination dâordre un reprĂ©sentait fidĂšlement la cinĂ©tique du pantoprazole. Le poids, le SRIS, la dysfonction hĂ©patique et lâadministration dâun inhibiteur du CYP2C19 constituaient les covariables significatives rendant compte de 75 % de la variabilitĂ© interindividuelle observĂ©e pour la CL. Seul le poids influençait significativement le volume central de distribution (Vc). Selon les estimations du modĂšle final, un enfant de cinq ans pesant 20 kg avait une CL de 5.28 L/h et un Vc de 2.22 L. La CL du pantoprazole augmentait selon lâĂąge et le poids tandis quâelle diminuait respectivement de 62.3%, 65.8% et 50.5% en prĂ©sence dâun SRIS, dâun inhibiteur du CYP2C19 ou dâune dysfonction hĂ©patique.
Conclusion : Ces rĂ©sultats permettront de guider les cliniciens dans le choix dâune dose de charge et dans lâajustement des posologies du pantoprazole en soins intensifs pĂ©diatriques dĂ©pendamment de facteurs frĂ©quemment rencontrĂ©s dans cette population.Aims : To characterize the pharmacokinetics of intravenous pantoprazole in a paediatric intensive care population and to determine the influence of demographic factors, systemic inflammatory response syndrome (SIRS), hepatic dysfunction and concomitantly used cytochrome (CYP) 2C19 inhibitors on the drugâs pharmacokinetics.
Methods : A total of 156 pantoprazole concentrations from 20 patients (aged from 10 days to 16.4 years) at risk for or with upper gastrointestinal bleeding, who received pantoprazole doses ranging from 19.9 to 140.6 mg/1.73m2/day, were analyzed using non compartmental and non linear mixed effects modelling (NONMEM) approaches.
Results : The non compartmental results showed that median clearance (CL), apparent volume of distribution and elimination half-life were 0.14 L/h/kg, 0.20 L/kg and 1.7 h, respectively. The best structural model for pantoprazole was a two-compartment model with zero order infusion and first order elimination. Body weight, SIRS, age, hepatic dysfunction and presence of CYP2C19 inhibitors were the significant covariates affecting CL, accounting for 75% of interindividual variability. Only body weight significantly influenced central volume of distribution (Vc). In the final population model, the estimated CL and Vc were 5.28 L/h and 2.22 L, respectively, for a typical five year old child weighing 20 kg. Pantoprazole CL increased with weight and age whereas the presence of SIRS, CYP2C19 inhibitors and hepatic dysfunction, when present separately, significantly decreased pantoprazole CL by 62.3%, 65.8% and 50.5%, respectively.
Conclusion : These results provide important information to physicians regarding selection of a starting dose and dosing regimen of pantoprazole for paediatric intensive care patients based on various factors frequently encountered in this population
Group A Streptococcal Meningitis in a Pediatric Patient following Cochlear Implantation: Report of the First Case and Review of the Literature
The Food and Drug Administration published a public health warning on the association of bacterial meningitis and cochlear implants in June 2002. This article reports the first case of group A streptococcal (GAS) meningitis in a cochlear-implanted patient, followed by a review on cochlear implantation and GAS meningitis