, since a fungal infection was ruled out, but the patient continued to present severe neutropenia.
Treatment was started with IV infusion combined with lactated Ringer's solution in 5% dextrose (90 mL), 0.45% sodium chloride solution (80 ml), ampicillin sulbactame (10 mg/kg, q12h
, IM), ranitidine (0.5 mg/kg, q12h
, IM), metoclopramide (0.2 mg/kg, q12h
, IM), erythropoietin (100 Units/kg 3 times weekly SC), aluminium hydroxide (30 mg/kg, q12h
, PO) and force feeding with commercial food for kidney failure (Hills[R] K/D).
Imipenem-cilastatin (1 g q6h) and ceftazidime (2g q8h) combined with tigecycline (100 mg q12h
) were started.
The owner declined hospitalization for amphotericin B but elected to start voriconazole (Glenmark, Mahwah, New Jersey, USA), at 2.7mg/kg, PO, q12h
, on an empty stomach.
He was started on vancomycin (15 mg/kg IV q8h) and ceftriaxone (50 mg/kg IV q12h
Dose fractionation studies with the neutropenic mouse disseminated candidiasis (NMDC) model, confirmed that the fungicidal efficacy of AMBd correlated with large, infrequent doses; for instance, dosing [AMB.sub.d] every 72 h (q72h) achieved maximal efficacy with doses 5-7 times lower than q6h or q12h
Cephalexin (Lixen (b)) at the dose 30 mg/kg q12h
was given to group B, while Cefpodoxime (Cefpet (a))at the dose of 5 mg/ kg q24h was given to group A.
1) Five-day antimicrobial prophylaxis (oral ciprofloxacin 500 mg q12h+ornidazole 1 g q12h
started two days before the biopsy and lasted until the third day and amikacin 500 mg once during the biopsy) was changed to single-day prophylaxis (oral ciprofloxacin 500 mg q12h
+ ornidazole 1 g q12h
given 2 h before the biopsy) ([7,8]).
He was treated with vancomycin IV at 15mg/kg/dose q12h
to obtain a serum trough concentration of 15 to 20mcg/mL and rifampin 300 mg PO q8h.
The patient's maintenance immunosuppressive agent (Tacrolimus .5 mg PO q12h
) was increased to 1 mg PO q12h
prior to discharge.
Patients in the 750-mg/ 1,500-mg q12h
and 1,000-mg/2,000-mg q8h groups met the primary efficacy endpoint of an 80% or greater clinical success (83% and 92%, respectively) within 2-3 days.