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Relief for Haiti, update

Good morning! It looks like yesterday's Indie+Relief effort was a huge success! Even though we blew it and didn't get in on the official program we decided to do what we could. We're sending $50.00 to Doctors without Borders in the name of our users. We'd like to extend our whole hearted thanks to everyone that participated in the various efforts around the Mac Indie scene yesterday.

We're very small, and the dollar amount we're sending seems small, but every little bit helps.

THANK YOU!

Relief for Haiti

The Mac and iPhone Indie community have put together a relief effort for Haiti called Indie+Relief, brought to you by Second Gear Software and Garrett Murray. Apple Core Labs tried to participate but we were just too late due to an overwhelming response, and our lateness to join the effort. Fear not! We're going to join the effort, just not through Indie Relief.

What does that mean?

Quite simply this. Apple Core Labs will donate all proceeds from sales of RxCalc on January 20, 2010 to Doctors Without Borders to help the people of Haiti.

If you've ever considered purchasing RxCalc now would be a great time to give it a try and in the process you'll help people in need.

Also, while you're here, take a look at all the great software being offered by Indie Relief, and pick something else up to help fight the good fight!

Thank You.

Evaluation of once-daily gentamicin dosing in children with febrile neutropenia

Once-Daily Gentamicin Dosing in Children with Febrile Neutropenia Resulting from Antineoplastic Therapy

Miriam Inparajah, B.Sc.Phm. | Cecile Wong, B.Sc.Phm. | Cathryn Sibbald, B.Sc.Phm. | Sabrina Boodhan, B.Sc.Phm. | Eshetu G. Atenafu, M.Sc. | Ahmed Naqvi, M.B.B.S., MCPS, MRCP | L. Lee Dupuis, M.Sc.Phm., FCSHP

Pharmacotherapy. 2010 Jan;30(1):43-51

Abstract

Study Objectives. To evaluate an existing once-daily gentamicin dosing guideline in children with febrile neutropenia resulting from antineoplastic therapy and, if necessary, to develop a new simulated dosing guideline that would achieve pharmacokinetic targets more reliably after the first dose.

Design. Pharmacokinetic analysis of data froma retrospective medical record review.

Setting. Hematology-oncology unit of a university-affiliated pediatric hospital in Canada.

Patients. One hundred eleven patients aged 1–18 years who received once-daily gentamicin between April 2006 and January 2008 for the treatment of febrile neutropenia resulting from antineoplastic therapy, and who had plasma gentamicin concentrations determined after their first dose.

Measurements and Main Results. Demographic data, gentamicin dosing information, blood sampling times, and plasma gentamicin concentrations were noted. Plasma gentamicin concentrations were determined at approximately 3 and 6 hours after the start of the 30-minute infusion of the first dose. Pharmacokinetic parameters were calculated according to standard first-order, one-compartment equations. The proportion of children who achieved pharmacokinetic targets after the first gentamicin dose was used as a measure of dosing guideline performance; the guideline achieved maximum concentration (Cmax) values below the target range (20–25mg/L) in 51% of patients. Ideal dosing guidelines were then developed using the mean dose required to achieved a Cmax of 23 mg/L for each patient. Univariate analysis or the Student t test was used to determine the existence of significant relationships between pharmacokinetic parameters and patient age and sex. The recursive binary partitioningmethod was used to determine critical values of age for dosage guideline development; analysis of variance was then used to compare the different levels obtained after use of this technique. Simulated administration of once-daily gentamicin in the following doses achieved a Cmax within or above target in 73% of patients: 1 year to 6 years, 10.5mg/kg/dose; girls ≥ 6 years, 9.5mg/kg/dose; and boys ≥ 6 years, 7.5mg/kg/dose. Doses were based on actual body weight for children who weighed less than 125% of ideal body weight or based on effective body weight for children 125%ormore of ideal body weight.

Conclusion. The initial gentamicin dosing guidelines were not effective in achieving Cmax. The new proposed dosing guidelines are predicted to achieve a Cmax within or above the target range in almost three quarters of patients. Subsequent dosing should be tailored according to plasma gentamicin concentrations.

Got Pharmacokinetics?

The year is coming to an end, so why not celebrate by purchasing a copy of RxCalc for your iPhone? There's still time to buy before the end of the year and at $0.99 it's a real bargain! At least we think it is.

So, what do you get for less than a buck?

• New Start - Vancomycin and Aminoglycoside.


• Adjustment with Levels - Vancomycin and Aminoglycoside.


• Ideal Body Weight


• Creatinine Clearance (CG)

That's just the 1.0 release. We have more features planned for the next release and we'd LOVE to hear from our users, just drop us an e-mail at support@applecorelabs.com, it's that easy.

If you'd like more information on RxCalc, just visit the RxCalc product page. If you'd like to purchase RxCalc, visit the iPhone App Store.

Best iPhone Apps for Pharmacists

Online Education Blog: "This application is said to be the only pharmacokinetics calculator made available on the iPhone. The handy interface helps the end user enjoy a hassle free way of going about information collection." - Thanks for mentioning us!

Summary of Consensus Recommendations for Vancomycin Monitoring in Adults

A recent article in November 2009 issue Pharmacotherapy summarizes the recommendations from the American Society of Health-System Pharmacists, the Infections Diseases Society of America, and the Society of Infectious Diseases Pharmacists on the monitoring of vancomycin in adults.

“The American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists published a consensus statement on therapeutic monitoring of serum vancomycin levels in adults. These organizations established an expert panel to review the scientific data and controversies associated with vancomycin monitoring and to make recommendations based on the available evidence. As the members of this panel, we summarize the conclusions and highlight the recommendations from the consensus statement. We determined that the area under the concentration-time curve (AUC):minimum inhibitory concentration (MIC) ratio is the most useful pharmacodynamic parameter to predict vancomycin effectiveness and suggested a target ratio of 400 or greater to eradicate S. aureus. In addition, trough serum concentration monitoring is the most accurate and practical method to monitor vancomycin serum levels. Increasing trough concentrations to 15–20 mg/L to attain the target AUC:MIC ratio may be desirable but is currently not supported by clinical trials. Alternative therapies should be considered in patients with S. aureus infections that demonstrate a vancomycin MIC of 2 mg/L or greater because the target AUC:MIC ratio ( 400) is unlikely to be achieved in this setting. Increasing the dosage to result in higher trough concentrations may increase the potential for toxicity; however additional clinical experience is required to determine the extent.”

While the article contains nothing new in terms of vancomycin monitoring and kinetics, the recommendation to consider alternate therapy for S. aureus infections with an MIC >/= 2 mg/L is important to note.