Marc Pfister, Ped Pharmacology, UKBB

Dimarts, 10 gener 2017 · 4:20 p.m. · 09m 04s

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and it's a pleasure to be here are some

of you participated in this initiative

actual many of you and I want to thank

you for collecting data for us we're

collecting data on closing strategies in

the different clinics and a goal is to

harmonize some of these dozing

strategies the name is spit those i'm

involved

heading up the focus group on dozing in

neonates and we have a couple of folks

already participating thanks to eric and

offers to universities are but it

represented here and it would like to

have someone from Bern and Zurich so if

you're interested in participating in

this I think interesting and important

national project come to me or Eric

today or send an email so this project

is supported by the government by all

states by universities in fact it's

co-sponsored by the Department of of

health park and the goal is to analyze

what is done now and to come off a

process to harmonize dozing in neonates

and we learned that it is so complex to

understand just in terms of branding

buildings when to start how long to give

antibiotics how to combine these drugs

this project is focusing just on those

in so it's not about indication or how

long is just about those in and several

steps involved so far we collected those

information from all major clinics for

the most frequently used most important

tracks 35 trucks and V started with the

harmonization process for a trucks and a

goal is within the next 2-3 years

basically agree on a harmonized dozing

strategy on all these 35 trucks i give

an example

amoxicillin

we see that clicks are using this in a

different way some are using it all

frequently and others not

it's fascinating that in the tents miss

clinics we found almost every

combination of those in strategy

everything was different in terms of

dozing the given time in terms of those

intervals and at different toes total

doses daily doses and even how you

calculate those is different clinics use

just body weight and others have very

complex calculations with PMA of PNA

orchestration HR combination and we did

some investigation and just to give you

first finding it doesn't help to cover

complex calculation so there's no

evidence to us that the complex way of

calculating closing forever Sicilian

helps and i will show it's more

important to get those into all correct

and todos this is the result if you have

these different approaches and you the

x-axis is basically the time after birth

and told those is on the y-axis we took

the two extremely extremely preterm and

the term and you can see that those

things not only different at the given

time after above their way it's switched

its stepwise function is different and

in fact it's so different that at

certain time points they said threefold

difference in till today those so

1-click would give 70 milligrams and

another what give 200 program and this

is a simulation study in 1,000 children

actual neonates and you can see that

each clinic has a different color a

color represent 1000 approach is not

there to clinics actual similar two and

three but other than that there's no

consistency in fact in one clinic for

the two approaches within one clinic

now we did some investigation simulation

study ins wanted to know what's the

impact of these differences and if you

have a certain target let's say and I'm

a sea of 84 e coli and we can discuss

whatever this is an important target but

what you can see is that if you want to

stay above that concentration level some

dozing approaches will do well and

others not

and here's simulation and what we

learned is that for our mock Celine it's

more important to have the doesn't world

correct so you can give green means you

have well above these concentrations

target potential target considerations

and you can give it every 6 hours 25

become or hi jose AV eight to 12 hours

some Kleenex give 25 million per

kilogram every eight to 12 hours and we

have some evidence that this may result

in too low concentrations

so what we learned is that it's a

combination of different factors that

may help to achieve top conservation

this is just an example that we have to

think in a more quantitative way if you

want to look at building stretches for

some antibiotics so conclusion is yes if

it's just a goal to stay fifty percent

above a certain target consideration for

books it is just an example all

guidelines all those instructions you're

using may be fine but if you have a

different target if you want to treat

equal I in combination with another to a

drug then you may have to think about a

harmonized optimized dozing strategy now

we are going through all these trucks

and give you another example

caffeine is the most frequently used

drug we did a snapshot in Switzerland

and it was the most frequently you

struggle to give a day in n seals and

typical doesn't strategy is to give a

loading dose of 20 milligrams and then

five minutes per day

now what we can see

in a simulation study given the fact

that clearance of the truck is

increasing on time due to moderation is

that the concentration of this truck is

going on

victory is decreasing 34% different 2

months so don't think it gives the same

maintenance those that the concentration

levels stay consistent they actually

decrease now if you want to maintain

concentrations you may need to increase

the dozing everyone at two weeks so we

did an optimization study in a

simulation study and we showed that if

you increase their maintenance those by

one gram per Coulomb per day every 12

weeks you're able to maintain the levels

some clinics give actually 10 grand

because there's some evidence that it

may be safe up to 20 30 milligram per

liter concentration if you give 10

become you may be above certain target

so we have published is and hopefully we

can do even study together to see ever

more complex those adjustment will you

know bring some benefit or whatever as

simple increase or Target or at

maintenance intimidate me actually

maintain that concentration levels so

different approaches another example how

we can maybe do some simulation studies

to better understand how those things

strategy we are using have an impact on

exposure and efficacy

so in summary we would like to work for

field first we have this expertise and

you like to have a person from Bern and

Zurich helping us to think about

harmonization for these different drugs

and we also want to work closely with

the society here with Matthias and

others to have a smooth process in terms

of harmonizing these treatments and I'm

very much open for your feet

back and after my presentation as want

to thank Christophe Berra who is heading

up the entire project in Switzerland for

spearheading such an important national

effort thank you

M. Roth-Kleiner, R. Arlettaz Mieth

10 gen. 2017 · 9:33 a.m.

E. Giannoni, T. Karen, Resp. Lausanne, Zürich

10 gen. 2017 · 9:38 a.m.

Katrina Evers, Neonatology UKBB

10 gen. 2017 · 9:39 a.m.

Katrina Evers, Neonatology UKBB

10 gen. 2017 · 9:44 a.m.

Roland Gerull, Bern

10 gen. 2017 · 9:47 a.m.

Roland Gerull, Bern

10 gen. 2017 · 9:54 a.m.

Dr Truant AS, Cheffe de clinique, Néonatologie, CHUV, Lausanne

10 gen. 2017 · 9:59 a.m.

Dr Truant AS, Cheffe de clinique, Néonatologie, CHUV, Lausanne

10 gen. 2017 · 10:04 a.m.

Severin Kasser, Dr. med. UKBB

10 gen. 2017 · 10:10 a.m.

Severin Kasser, Dr. med. UKBB

10 gen. 2017 · 10:14 a.m.

Alessandro Borghesi, Fellay lab, EPFL

10 gen. 2017 · 10:17 a.m.

Alessandro Borghesi, Fellay lab, EPFL

10 gen. 2017 · 10:25 a.m.

G. Grand-Guillaume-Perrenoud, Pediatrics, Children's University Hospital Geneva

10 gen. 2017 · 10:27 a.m.

G. Grand-Guillaume-Perrenoud, Pediatrics, Children's University Hospital Geneva

10 gen. 2017 · 10:34 a.m.

C. Kind, R. Gerull, Resp. St.Gallen, Bern

10 gen. 2017 · 10:37 a.m.

Christoph Berger, Zürich

10 gen. 2017 · 10:40 a.m.

Christoph Berger, Zürich

10 gen. 2017 · 11:15 a.m.

R. Pfister, S. Kämpfen, Resp. Geneva, Basel

10 gen. 2017 · 11:44 a.m.

Eric Giannoni, Lausanne

10 gen. 2017 · 11:45 a.m.

Eric Giannoni, Lausanne

10 gen. 2017 · 11:58 a.m.

Christoph Bührer, Berlin

10 gen. 2017 · 2:21 p.m.

Martin Stocker, Lucerne

10 gen. 2017 · 2:50 p.m.

Martin Stocker, Christoph Berger, Eric Giannoni, Christoph Bührer

10 gen. 2017 · 3:10 p.m.

Romaine Arlettaz Mieth , Neonatologist, Zürich, President of the Organizing Committee

10 gen. 2017 · 3:47 p.m.

Christoph Bührer, Berlin

10 gen. 2017 · 3:48 p.m.

Christoph Bührer, Berlin

10 gen. 2017 · 4:16 p.m.

Marc Pfister, Ped Pharmacology, UKBB

10 gen. 2017 · 4:20 p.m.

Matthias Roth-Kleiner, CHUV, President of the SSN

10 gen. 2017 · 4:30 p.m.

Philippe Fischer, FSRM

16 mar. 2017 · 12:21 p.m.

Jakob Weber, BÜHLMANN Laboratories

26 oct. 2017 · 11:47 a.m.