[ { "key": "8HQ9IP57", "version": 310, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/8HQ9IP57", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/8HQ9IP57", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Kondasinghe et al.", "parsedDate": "2022-12", "numChildren": 1 }, "data": { "key": "8HQ9IP57", "version": 310, "itemType": "journalArticle", "title": "Subcutaneous Levetiracetam and Sodium Valproate Use in Palliative Care Patients", "creators": [ { "creatorType": "author", "firstName": "Jayamangala Sampath", "lastName": "Kondasinghe" }, { "creatorType": "author", "firstName": "Mei Ling", "lastName": "Look" }, { "creatorType": "author", "firstName": "Paula", "lastName": "Moffat" }, { "creatorType": "author", "firstName": "Keiron", "lastName": "Bradley" } ], "abstractNote": "Palliative care patients experience seizures in different stages of their disease and may not tolerate oral medications toward the end of life. Subcutaneous infusions of levetiracetam and sodium valproate are increasingly used off-label. This retrospective analysis (conducted from January 2019 to July 2020 in Australia) reports the effectiveness and adverse effects of levetiracetam and sodium valproate delivered via subcutaneous infusion. The doses ranged from 500 to 3000 mg/d of levetiracetam and 500 to 2500 mg/d of sodium valproate. The concentrations ranged from 20 to 83 mg/mL of levetiracetam and 20 to 50 mg/mL of sodium valproate. Subcutaneous levetiracetam was given for a median duration of 6.5 days, with no seizure recurrences in 75% of patients and no reported adverse effects in any patients. Subcutaneous sodium valproate was given for a median duration of 3.5 days, with no reported seizure recurrences in 83% of patients and one report of a localized skin reaction. This analysis suggests that subcutaneous levetiracetam and sodium valproate can effectively control seizures in palliative care populations, with minimal localized reactions.", "publicationTitle": "Journal of Pain & Palliative Care Pharmacotherapy", "publisher": "", "place": "", "date": "2022-12", "volume": "36", "issue": "4", "section": "", "partNumber": "", "partTitle": "", "pages": "228-232", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Pain Palliat Care Pharmacother", "DOI": "10.1080/15360288.2022.2107145", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1536-0539", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 35930500", "tags": [ { "tag": "Anticonvulsants", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Levetiracetam", "type": 1 }, { "tag": "Palliative Care", "type": 1 }, { "tag": "Piracetam", "type": 1 }, { "tag": "Retrospective Studies", "type": 1 }, { "tag": "Seizures", "type": 1 }, { "tag": "Treatment Outcome", "type": 1 }, { "tag": "Valproic Acid", "type": 1 }, { "tag": "antiepileptic medication", "type": 1 }, { "tag": "levetiracetam", "type": 1 }, { "tag": "palliative care", "type": 1 }, { "tag": "sodium valproate", "type": 1 }, { "tag": "subcutaneous", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T22:20:19Z", "dateModified": "2025-02-19T22:20:19Z" } }, { "key": "T3MFY5PD", "version": 310, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/T3MFY5PD", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/T3MFY5PD", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/8HQ9IP57", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "T3MFY5PD", "version": 310, "parentItem": "8HQ9IP57", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T22:20:19Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/35930500", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:20:19Z", "dateModified": "2025-02-19T22:20:19Z" } }, { "key": "KALDQN4U", "version": 308, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/KALDQN4U", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/KALDQN4U", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/ZRF6KCJX", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "KALDQN4U", "version": 308, "parentItem": "ZRF6KCJX", "itemType": "attachment", "linkMode": "imported_url", "title": "Full Text", "accessDate": "2025-02-19T22:18:00Z", "url": "https://www.jpsmjournal.com/article/S0885392422008247/pdf", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Wernli et al. - 2022 - Subcutaneous Drugs and Off-label Use in Hospice and Palliative Care A Scoping Review.pdf", "md5": "82c120f6df1319803cd9d69ea61d75cd", "mtime": 1740003480389, "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:18:00Z", "dateModified": "2025-02-19T22:18:00Z" } }, { "key": "GD9CGJWK", "version": 307, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/GD9CGJWK", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/GD9CGJWK", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/ZRF6KCJX", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "GD9CGJWK", "version": 307, "parentItem": "ZRF6KCJX", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T22:17:56Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/35870656", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:17:56Z", "dateModified": "2025-02-19T22:17:56Z" } }, { "key": "ZRF6KCJX", "version": 307, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/ZRF6KCJX", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/ZRF6KCJX", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Wernli et al.", "parsedDate": "2022-11", "numChildren": 2 }, "data": { "key": "ZRF6KCJX", "version": 307, "itemType": "journalArticle", "title": "Subcutaneous Drugs and Off-label Use in Hospice and Palliative Care: A Scoping Review", "creators": [ { "creatorType": "author", "firstName": "Ursina", "lastName": "Wernli" }, { "creatorType": "author", "firstName": "Fabienne", "lastName": "Dürr" }, { "creatorType": "author", "firstName": "Sibylle", "lastName": "Jean-Petit-Matile" }, { "creatorType": "author", "firstName": "Andrea", "lastName": "Kobleder" }, { "creatorType": "author", "firstName": "Carla", "lastName": "Meyer-Massetti" } ], "abstractNote": "BACKGROUND: Subcutaneous drug administration is an interesting approach for symptom control in hospice and palliative care. However, most drugs have no marketing authorization for subcutaneous administration and are therefore used off-label. In order to meet the requirements of a safe and effective drug therapy, especially in highly vulnerable patients, it is essential to investigate the scope of evidence of these common practices.\nOBJECTIVES: The purpose of this scoping review was to provide an overview of available data on the tolerability and/or effectiveness of subcutaneously administered and off-label used drugs.\nMETHOD: We performed a scoping review according to the PRISMA extension to identify data available on the tolerability and/or effectiveness of 17 predefined drugs that are commonly administered subcutaneously in Swiss hospices and hospice-like institutions and that have no marketing authorization (off-label use).\nRESULTS: The scoping review identified 57 studies with most data available on their tolerability (68% local, 54% systemic), clinical effects (82%), details on dosage (96%) and routes of application (100%). Information on pharmacokinetic properties was mostly missing and only available for fentanyl, levetiracetam, midazolam, and ondansetron. For seven drugs, less than five articles were identified and no studies on codeine or clonazepam were available.\nCONCLUSION: This work provides an overview of current evidence on subcutaneous and off-label used drugs in hospice and palliative care. Although both are common practices, evidence on tolerability and effectiveness, particularly pharmacokinetic data, is limited and the identified information gaps need to be closed. This work establishes a basis for further research in this area.", "publicationTitle": "Journal of Pain and Symptom Management", "publisher": "", "place": "", "date": "2022-11", "volume": "64", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "e250-e259", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Pain Symptom Manage", "DOI": "10.1016/j.jpainsymman.2022.07.006", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1873-6513", "archive": "", "archiveLocation": "", "shortTitle": "Subcutaneous Drugs and Off-label Use in Hospice and Palliative Care", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 35870656", "tags": [ { "tag": "Clonazepam", "type": 1 }, { "tag": "Codeine", "type": 1 }, { "tag": "Fentanyl", "type": 1 }, { "tag": "Hospice Care", "type": 1 }, { "tag": "Hospices", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Levetiracetam", "type": 1 }, { "tag": "Midazolam", "type": 1 }, { "tag": "Off-Label Use", "type": 1 }, { "tag": "Ondansetron", "type": 1 }, { "tag": "Palliative Care", "type": 1 }, { "tag": "Pharmaceutical Preparations", "type": 1 }, { "tag": "Subcutaneous drug administration", "type": 1 }, { "tag": "hospice care", "type": 1 }, { "tag": "medication safety", "type": 1 }, { "tag": "off-label use", "type": 1 }, { "tag": "palliative care", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T22:17:56Z", "dateModified": "2025-02-19T22:17:56Z" } }, { "key": "II7L76ZK", "version": 305, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/II7L76ZK", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/II7L76ZK", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/93FM2SL5", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "II7L76ZK", "version": 305, "parentItem": "93FM2SL5", "itemType": "attachment", "linkMode": "imported_url", "title": "Full Text PDF", "accessDate": "2025-02-19T22:16:21Z", "url": "http://www.journalofinfection.com/article/S0163445324002330/pdf", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Wolie et al. - 2024 - Outpatient parenteral antimicrobial therapy with carbapenems A systematic review.pdf", "md5": "4b8494846aec7b36698e76eb272e6948", "mtime": 1740003381375, "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:16:21Z", "dateModified": "2025-02-19T22:16:21Z" } }, { "key": "BIC4N9YB", "version": 303, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/BIC4N9YB", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/BIC4N9YB", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/93FM2SL5", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "BIC4N9YB", "version": 303, "parentItem": "93FM2SL5", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T22:16:05Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/39357570", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:16:05Z", "dateModified": "2025-02-19T22:16:05Z" } }, { "key": "93FM2SL5", "version": 303, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/93FM2SL5", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/93FM2SL5", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Wolie et al.", "parsedDate": "2024-11", "numChildren": 2 }, "data": { "key": "93FM2SL5", "version": 303, "itemType": "journalArticle", "title": "Outpatient parenteral antimicrobial therapy with carbapenems: A systematic review", "creators": [ { "creatorType": "author", "firstName": "Z. T.", "lastName": "Wolie" }, { "creatorType": "author", "firstName": "J. A.", "lastName": "Roberts" }, { "creatorType": "author", "firstName": "Y. M.", "lastName": "Wale" }, { "creatorType": "author", "firstName": "S.", "lastName": "Unwin" }, { "creatorType": "author", "firstName": "K.", "lastName": "McCarthy" }, { "creatorType": "author", "firstName": "F. B.", "lastName": "Sime" } ], "abstractNote": "OBJECTIVE: To review the literature on parenteral carbapenems in OPAT and present comprehensive evidence on their safety, efficacy, and stability.\nMETHODS: A systematic review following PRISMA guidelines was conducted through 17 January 2024, using PubMed, Embase, Web of Science, Scopus, and the Cochrane Library to find relevant articles.\nRESULTS: Ertapenem (1 g QD) in OPAT showed high clinical (81-97%) and microbiological (67-90.9%) success rates. Ertapenem (1 g QD) was also comparable to piperacillin/tazobactam (3.375 g every 6 h) for complicated skin infections and superior to cefazolin (2 g every 8 h) and oxacillin (2 g every 4-6 h) for various infections. Ertapenem monotherapy, once daily, achieved an 81% clinical cure rate for urinary tract infections. Additionally, subcutaneous ertapenem in OPAT showed outcomes comparable to parenteral routes. Meropenem continuous infusion (CI) may also be considered safe and effective in selected patient populations; however, its use in OPAT as a CI is limited due to stability concerns.\nCONCLUSION: Parenteral carbapenems are effective, and well-tolerated OPAT treatment options; nonetheless, further studies are warranted to optimize the stability and/or dosing regimens of meropenem and enable its wider use.", "publicationTitle": "The Journal of Infection", "publisher": "", "place": "", "date": "2024-11", "volume": "89", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "106299", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Infect", "DOI": "10.1016/j.jinf.2024.106299", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1532-2742", "archive": "", "archiveLocation": "", "shortTitle": "Outpatient parenteral antimicrobial therapy with carbapenems", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 39357570", "tags": [ { "tag": "Ambulatory Care", "type": 1 }, { "tag": "Anti-Bacterial Agents", "type": 1 }, { "tag": "Bacterial Infections", "type": 1 }, { "tag": "Carbapenems", "type": 1 }, { "tag": "Efficacy", "type": 1 }, { "tag": "Ertapenem", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Infusions, Parenteral", "type": 1 }, { "tag": "Meropenem", "type": 1 }, { "tag": "OPAT", "type": 1 }, { "tag": "Safety", "type": 1 }, { "tag": "Stability", "type": 1 }, { "tag": "Treatment Outcome", "type": 1 }, { "tag": "Urinary Tract Infections", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T22:16:04Z", "dateModified": "2025-02-19T22:16:04Z" } }, { "key": "UFLFQZIH", "version": 301, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/UFLFQZIH", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/UFLFQZIH", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/HMIS42B5", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "UFLFQZIH", "version": 301, "parentItem": "HMIS42B5", "itemType": "attachment", "linkMode": "imported_url", "title": "Full Text", "accessDate": "2025-02-19T22:12:32Z", "url": "https://jintensivecare.biomedcentral.com/track/pdf/10.1186/s40560-020-0429-6", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Sawa et al. - 2020 - Molecular diversity of extended-spectrum β-lactamases and carbapenemases, and antimicrobial resistan.pdf", "md5": "7e79ef7a694e575b319c86767c7ba45d", "mtime": 1740003152681, "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:12:32Z", "dateModified": "2025-02-19T22:12:32Z" } }, { "key": "EUWKH8SE", "version": 300, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/EUWKH8SE", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/EUWKH8SE", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/HMIS42B5", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "EUWKH8SE", "version": 300, "parentItem": "HMIS42B5", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T22:12:29Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/32015881", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:12:29Z", "dateModified": "2025-02-19T22:12:29Z" } }, { "key": "HMIS42B5", "version": 300, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/HMIS42B5", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/HMIS42B5", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Sawa et al.", "parsedDate": "2020", "numChildren": 2 }, "data": { "key": "HMIS42B5", "version": 300, "itemType": "journalArticle", "title": "Molecular diversity of extended-spectrum β-lactamases and carbapenemases, and antimicrobial resistance", "creators": [ { "creatorType": "author", "firstName": "Teiji", "lastName": "Sawa" }, { "creatorType": "author", "firstName": "Kunihiko", "lastName": "Kooguchi" }, { "creatorType": "author", "firstName": "Kiyoshi", "lastName": "Moriyama" } ], "abstractNote": "Along with the recent spread of multidrug-resistant bacteria, outbreaks of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing bacteria present a serious challenge to clinicians. β-lactam antibiotics are the most frequently used antibacterial agents and ESBLs, and carbapenemases confer resistance not only to carbapenem antibiotics but also to penicillin and cephem antibiotics. The mechanism of β-lactam resistance involves an efflux pump, reduced permeability, altered transpeptidases, and inactivation by β-lactamases. Horizontal gene transfer is the most common mechanism associated with the spread of extended-spectrum β-lactam- and carbapenem resistance among pathogenic bacterial species. Along with the increase in antimicrobial resistance, many different types of ESBLs and carbapenemases have emerged with different enzymatic characteristics. For example, carbapenemases are represented across classes A to D of the Ambler classification system. Because bacteria harboring different types of ESBLs and carbapenemases require specific therapeutic strategies, it is essential for clinicians to understand the characteristics of infecting pathogens. In this review, we summarize the current knowledge on carbapenem resistance by ESBLs and carbapenemases, such as class A carbapenemases, class C extended-spectrum AmpC (ESAC), carbapenem-hydrolyzing class D β-lactamases (CHDLs), and class B metallo-β-lactamases, with the aim of aiding critical care clinicians in their therapeutic decision making.", "publicationTitle": "Journal of Intensive Care", "publisher": "", "place": "", "date": "2020", "volume": "8", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "13", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Intensive Care", "DOI": "10.1186/s40560-020-0429-6", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "2052-0492", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 32015881\nPMCID: PMC6988205", "tags": [ { "tag": "Carbapenemase", "type": 1 }, { "tag": "Classification", "type": 1 }, { "tag": "Multidrug resistance", "type": 1 }, { "tag": "β-Lactam", "type": 1 }, { "tag": "β-Lactamase", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T22:12:28Z", "dateModified": "2025-02-19T22:12:28Z" } }, { "key": "YGCISVUX", "version": 298, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/YGCISVUX", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/YGCISVUX", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/FJLTTD69", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "YGCISVUX", "version": 298, "parentItem": "FJLTTD69", "itemType": "attachment", "linkMode": "imported_url", "title": "Full Text", "accessDate": "2025-02-19T22:10:49Z", "url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0237572&type=printable", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Broadhurst et al. - 2020 - Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability) A systemati.pdf", "md5": "7eb887357d8e5532edc40dd63c643f05", "mtime": 1740003049095, "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:10:49Z", "dateModified": "2025-02-19T22:10:49Z" } }, { "key": "4Z8TNJJQ", "version": 297, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/4Z8TNJJQ", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/4Z8TNJJQ", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/FJLTTD69", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "4Z8TNJJQ", "version": 297, "parentItem": "FJLTTD69", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T22:10:47Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/32833979", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:10:47Z", "dateModified": "2025-02-19T22:10:47Z" } }, { "key": "FJLTTD69", "version": 297, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/FJLTTD69", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/FJLTTD69", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Broadhurst et al.", "parsedDate": "2020", "numChildren": 2 }, "data": { "key": "FJLTTD69", "version": 297, "itemType": "journalArticle", "title": "Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews", "creators": [ { "creatorType": "author", "firstName": "Daphne", "lastName": "Broadhurst" }, { "creatorType": "author", "firstName": "Marie", "lastName": "Cooke" }, { "creatorType": "author", "firstName": "Deepa", "lastName": "Sriram" }, { "creatorType": "author", "firstName": "Brenda", "lastName": "Gray" } ], "abstractNote": "OBJECTIVE: To synthesize the current evidence for subcutaneous hydration and medication infusions from systematic reviews and to assess their methodological quality.\nINTRODUCTION: Peripheral intravascular cannula/catheter insertion is a common invasive procedure for administering fluids and medications. Venous depletion is a growing concern for several patient populations. Subcutaneous access for the administration of isotonic solutions and medications is an alternative; however, vascular access assessment and planning guidelines rarely consider this route.\nMETHODS: Systematic review of systematic reviews (PROSPERO CRD42018046504). We searched 6 databases published in English language from 1990 to June 2020, identifying subcutaneous infusions an alternate route for fluids or medication. Methodological quality was evaluated using AMSTAR 2 criteria and data for mechanisms of infusion and outcomes related to effectiveness, safety, efficiency and acceptability extracted. The Johanna Briggs Institute's grades of recommendation informed the strength of recommendation.\nRESULTS: The search yielded 1042 potential systematic reviews; 922 were excluded through abstract and duplicate screen. Of the remaining articles, 94 were excluded, and 26 were included. Overall, evidence is strong for recommending subcutaneous hydration infusions for older adults, weak for pediatric patients and inconclusive for palliative patients. There is strong evidence for 10 medications; weak evidence supporting 28 medications; however, there are eight medications with inconclusive evidence to make a recommendation and four medications not appropriate for subcutaneous delivery.\nCONCLUSION: Subcutaneous access should be considered alongside intravenous therapy for hydration in older adults, and several medications. There are additional benefits in terms of ease of use and cost-effectiveness of this mode. Inclusion of subcutaneous access in clinical guidelines may promote uptake of this route to help preserve vessel health of vulnerable patients. Further high-quality research is needed to inform subcutaneous infusion therapy in a variety of populations (including pediatrics and palliative care) and medications and clarifying the mechanism of delivery.", "publicationTitle": "PloS One", "publisher": "", "place": "", "date": "2020", "volume": "15", "issue": "8", "section": "", "partNumber": "", "partTitle": "", "pages": "e0237572", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "PLoS One", "DOI": "10.1371/journal.pone.0237572", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1932-6203", "archive": "", "archiveLocation": "", "shortTitle": "Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability)", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 32833979\nPMCID: PMC7446806", "tags": [ { "tag": "Dehydration", "type": 1 }, { "tag": "Fluid Therapy", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Hypodermoclysis", "type": 1 }, { "tag": "Infusions, Subcutaneous", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T22:10:46Z", "dateModified": "2025-02-19T22:10:46Z" } }, { "key": "8P4JUQ3C", "version": 296, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/8P4JUQ3C", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/8P4JUQ3C", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/PEEZ2PGL", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "8P4JUQ3C", "version": 296, "parentItem": "PEEZ2PGL", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T22:09:19Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/35294769", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:09:19Z", "dateModified": "2025-02-19T22:09:19Z" } }, { "key": "PEEZ2PGL", "version": 296, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/PEEZ2PGL", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/PEEZ2PGL", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Zhanel et al.", "parsedDate": "2022-04", "numChildren": 1 }, "data": { "key": "PEEZ2PGL", "version": 296, "itemType": "journalArticle", "title": "Sulopenem: An Intravenous and Oral Penem for the Treatment of Urinary Tract Infections Due to Multidrug-Resistant Bacteria", "creators": [ { "creatorType": "author", "firstName": "George G.", "lastName": "Zhanel" }, { "creatorType": "author", "firstName": "Marianna", "lastName": "Pozdirca" }, { "creatorType": "author", "firstName": "Alyssa R.", "lastName": "Golden" }, { "creatorType": "author", "firstName": "Courtney K.", "lastName": "Lawrence" }, { "creatorType": "author", "firstName": "Sheryl", "lastName": "Zelenitsky" }, { "creatorType": "author", "firstName": "Liam", "lastName": "Berry" }, { "creatorType": "author", "firstName": "Frank", "lastName": "Schweizer" }, { "creatorType": "author", "firstName": "Denice", "lastName": "Bay" }, { "creatorType": "author", "firstName": "Heather", "lastName": "Adam" }, { "creatorType": "author", "firstName": "Michael A.", "lastName": "Zhanel" }, { "creatorType": "author", "firstName": "Philippe", "lastName": "Lagacé-Wiens" }, { "creatorType": "author", "firstName": "Andrew", "lastName": "Walkty" }, { "creatorType": "author", "firstName": "Neal", "lastName": "Irfan" }, { "creatorType": "author", "firstName": "Kurt", "lastName": "Naber" }, { "creatorType": "author", "firstName": "Joseph P.", "lastName": "Lynch" }, { "creatorType": "author", "firstName": "James A.", "lastName": "Karlowsky" } ], "abstractNote": "Sulopenem (formerly known as CP-70,429, and CP-65,207 when a component of a racemic mixture with its R isomer) is an intravenous and oral penem that possesses in vitro activity against fluoroquinolone-resistant, extended spectrum β-lactamases (ESBL)-producing, multidrug-resistant (MDR) Enterobacterales. Sulopenem is being developed to treat patients with uncomplicated and complicated urinary tract infections (UTIs) as well as intra-abdominal infections. This review will focus mainly on its use in UTIs. The chemical structure of sulopenem shares properties of penicillins, cephalosporins, and carbapenems. Sulopenem is available as an oral prodrug formulation, sulopenem etzadroxil, which is hydrolyzed by intestinal esterases, resulting in active sulopenem. In early studies, the S isomer of CP-65,207, later developed as sulopenem, demonstrated greater absorption, higher drug concentrations in the urine, and increased stability against the renal enzyme dehydropeptidase-1 compared with the R isomer, which set the stage for its further development as a UTI antimicrobial. Sulopenem is active against both Gram-negative and Gram-positive microorganisms. Sulopenem's β-lactam ring alkylates the serine residues of penicillin-binding protein (PBP), which inhibits peptidoglycan cross-linking. Due to its ionization and low molecular weight, sulopenem passes through outer membrane proteins to reach PBPs of Gram-negative bacteria. While sulopenem activity is unaffected by many β-lactamases, resistance arises from alterations in PBPs (e.g., methicillin-resistant Staphylococcus aureus [MRSA]), expression of carbapenemases (e.g., carbapenemase-producing Enterobacterales and in Stenotrophomonas maltophilia), reduction in the expression of outer membrane proteins (e.g., some Klebsiella spp.), and the presence of efflux pumps (e.g., MexAB-OprM in Pseudomonas aeruginosa), or a combination of these mechanisms. In vitro studies have reported that sulopenem demonstrates greater activity than meropenem and ertapenem against Enterococcus faecalis, Listeria monocytogenes, methicillin-susceptible S. aureus (MSSA), and Staphylococcus epidermidis, as well as similar activity to carbapenems against Streptococcus agalactiae, Streptococcus pneumoniae, and Streptococcus pyogenes. With some exceptions, sulopenem activity against Gram-negative aerobes was less than ertapenem and meropenem but greater than imipenem. Sulopenem activity against Escherichia coli carrying ESBL, CTX-M, or Amp-C enzymes, or demonstrating MDR phenotypes, as well as against ESBL-producing Klebsiella pneumoniae, was nearly identical to ertapenem and meropenem and greater than imipenem. Sulopenem exhibited identical or slightly greater activity than imipenem against many Gram-positive and Gram-negative anaerobes, including Bacteroides fragilis. The pharmacokinetics of intravenous sulopenem appear similar to carbapenems such as imipenem-cilastatin, meropenem, and doripenem. In healthy subjects, reported volumes of distribution (Vd) ranged from 15.8 to 27.6 L, total drug clearances (CLT) of 18.9-24.9 L/h, protein binding of approximately 10%, and elimination half-lives (t½) of 0.88-1.03 h. The estimated renal clearance (CLR) of sulopenem is 8.0-10.6 L/h, with 35.5% ± 6.7% of a 1000 mg dose recovered unchanged in the urine. An ester prodrug, sulopenem etzadroxil, has been developed for oral administration. Initial investigations reported a variable oral bioavailability of 20-34% under fasted conditions, however subsequent work showed that bioavailability is significantly improved by administering sulopenem with food to increase its oral absorption or with probenecid to reduce its renal tubular secretion. Food consumption increases the area under the curve (AUC) of oral sulopenem (500 mg twice daily) by 23.6% when administered alone and 62% when administered with 500 mg of probenecid. Like carbapenems, sulopenem demonstrates bactericidal activity that is associated with the percentage of time that free concentrations exceed the MIC (%f T > MIC). In animal models, bacteriostasis was associated with %f T > MICs ranging from 8.6 to 17%, whereas 2-log10 kill was seen at values ranging from 12 to 28%. No pharmacodynamic targets have been documented for suppression of resistance. Sulopenem concentrations in urine are variable, ranging from 21.8 to 420.0 mg/L (median 84.4 mg/L) in fasted subjects and 28.8 to 609.0 mg/L (median 87.3 mg/L) in those who were fed. Sulopenem has been compared with carbapenems and cephalosporins in guinea pig and murine systemic and lung infection animal models. Studied pathogens included Acinetobacter calcoaceticus, B. fragilis, Citrobacter freundii, Enterobacter cloacae, E. coli, K. pneumoniae, Proteus vulgaris, and Serratia marcescens. These studies reported that overall, sulopenem was non-inferior to carbapenems but appeared to be superior to cephalosporins. A phase III clinical trial (SURE-1) reported that sulopenem was not non-inferior to ciprofloxacin in women infected with fluoroquinolone-susceptible pathogens, due to a higher rate of asymptomatic bacteriuria in sulopenem-treated patients at the test-of-cure visit. However, the researchers reported superiority of sulopenem etzadroxil/probenecid over ciprofloxacin for the treatment of uncomplicated UTIs in women infected with fluoroquinolone/non-susceptible pathogens, and non-inferiority in all patients with a positive urine culture. A phase III clinical trial (SURE-2) compared intravenous sulopenem followed by oral sulopenem etzadroxil/probenecid with ertapenem in the treatment of complicated UTIs. No difference in overall success was noted at the end of therapy. However, intravenous sulopenem followed by oral sulopenem etzadroxil was not non-inferior to ertapenem followed by oral stepdown therapy in overall success at test-of-cure due to a higher rate of asymptomatic bacteriuria in the sulopenem arm. After a meeting with the US FDA, Iterum stated that they are currently evaluating the optimal design for an additional phase III uncomplicated UTI study to be conducted prior to the potential resubmission of the New Drug Application (NDA). It is unclear at this time whether Iterum intends to apply for EMA or Japanese regulatory approval. The safety and tolerability of sulopenem has been reported in various phase I pharmacokinetic studies and phase III clinical trials. Sulopenem (intravenous and oral) appears to be well tolerated in healthy subjects, with and without the coadministration of probenecid, with few serious drug-related treatment-emergent adverse events (TEAEs) reported to date. Reported TEAEs affecting ≥1% of patients were (from most to least common) diarrhea, nausea, headache, vomiting and dizziness. Discontinuation rates were low and were not different than comparator agents. Sulopenem administered orally and/or intravenously represents a potentially well tolerated and effective option for treating uncomplicated and complicated UTIs, especially in patients with documented or highly suspected antimicrobial pathogens to commonly used agents (e.g. fluoroquinolone-resistant E. coli), and in patients with documented microbiological or clinical failure or patients who demonstrate intolerance/adverse effects to first-line agents. This agent will likely be used orally in the outpatient setting, and intravenously followed by oral stepdown in the hospital setting. Sulopenem also allows for oral stepdown therapy in the hospital setting from intravenous non-sulopenem therapy. More clinical data are required to fully assess the clinical efficacy and safety of sulopenem, especially in patients with complicated UTIs caused by resistant pathogens such as ESBL-producing, Amp-C, MDR E. coli. Antimicrobial stewardship programs will need to create guidelines for when this oral and intravenous penem should be used.", "publicationTitle": "Drugs", "publisher": "", "place": "", "date": "2022-04", "volume": "82", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "533-557", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Drugs", "DOI": "10.1007/s40265-022-01688-1", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1179-1950", "archive": "", "archiveLocation": "", "shortTitle": "Sulopenem", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 35294769", "tags": [ { "tag": "Animals", "type": 1 }, { "tag": "Anti-Bacterial Agents", "type": 1 }, { "tag": "Bacteriuria", "type": 1 }, { "tag": "Carbapenems", "type": 1 }, { "tag": "Cephalosporins", "type": 1 }, { "tag": "Ciprofloxacin", "type": 1 }, { "tag": "Ertapenem", "type": 1 }, { "tag": "Escherichia coli", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Fluoroquinolones", "type": 1 }, { "tag": "Gram-Negative Bacteria", "type": 1 }, { "tag": "Guinea Pigs", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Imipenem", "type": 1 }, { "tag": "Lactams", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Membrane Proteins", "type": 1 }, { "tag": "Meropenem", "type": 1 }, { "tag": "Methicillin-Resistant Staphylococcus aureus", "type": 1 }, { "tag": "Mice", "type": 1 }, { "tag": "Probenecid", "type": 1 }, { "tag": "Prodrugs", "type": 1 }, { "tag": "Staphylococcus aureus", "type": 1 }, { "tag": "Urinary Tract Infections", "type": 1 }, { "tag": "beta-Lactamases", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T22:09:19Z", "dateModified": "2025-02-19T22:09:19Z" } }, { "key": "IASGAWYL", "version": 295, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/IASGAWYL", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/IASGAWYL", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/E633SDFF", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "IASGAWYL", "version": 295, "parentItem": "E633SDFF", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T22:00:35Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/34664365", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T22:00:35Z", "dateModified": "2025-02-19T22:00:35Z" } }, { "key": "E633SDFF", "version": 295, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/E633SDFF", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/E633SDFF", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Hiew et al.", "parsedDate": "2021-10", "numChildren": 1 }, "data": { "key": "E633SDFF", "version": 295, "itemType": "journalArticle", "title": "Subcutaneous ertapenem delivered by an Australian outpatient parenteral antimicrobial therapy service: a retrospective comparative efficacy study", "creators": [ { "creatorType": "author", "firstName": "Jonathan", "lastName": "Hiew" }, { "creatorType": "author", "firstName": "Timothy", "lastName": "Whitmore" }, { "creatorType": "author", "firstName": "Mahalia", "lastName": "McEvoy" }, { "creatorType": "author", "firstName": "Deborah", "lastName": "Weatherall" }, { "creatorType": "author", "firstName": "Paul R.", "lastName": "Ingram" }, { "creatorType": "author", "firstName": "Laurens", "lastName": "Manning" } ], "abstractNote": "Subcutaneous (SC) administration of ertapenem in outpatient parenteral antimicrobial therapy (OPAT) services may be a practical alternative to intravenous delivery for complicated infections. The clinical features and outcomes according to route of administration were compared from a large Australian OPAT service. Chronic renal impairment was more common in the SC group, reflecting an opportunity for route of administration as a vein preservation strategy. Adverse events were uncommon and successful outcomes were not different between the groups.", "publicationTitle": "Internal Medicine Journal", "publisher": "", "place": "", "date": "2021-10", "volume": "51", "issue": "10", "section": "", "partNumber": "", "partTitle": "", "pages": "1717-1721", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Intern Med J", "DOI": "10.1111/imj.15511", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1445-5994", "archive": "", "archiveLocation": "", "shortTitle": "Subcutaneous ertapenem delivered by an Australian outpatient parenteral antimicrobial therapy service", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 34664365", "tags": [ { "tag": "Ambulatory Care", "type": 1 }, { "tag": "Anti-Bacterial Agents", "type": 1 }, { "tag": "Anti-Infective Agents", "type": 1 }, { "tag": "Australia", "type": 1 }, { "tag": "Ertapenem", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Infusions, Parenteral", "type": 1 }, { "tag": "Outpatients", "type": 1 }, { "tag": "Retrospective Studies", "type": 1 }, { "tag": "ertapenem", "type": 1 }, { "tag": "outpatient parenteral antimicrobial therapy", "type": 1 }, { "tag": "subcutaneous", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T22:00:34Z", "dateModified": "2025-02-19T22:00:34Z" } }, { "key": "IPQXJE4Y", "version": 294, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/IPQXJE4Y", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/IPQXJE4Y", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/8RZFXUTX", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "IPQXJE4Y", "version": 294, "parentItem": "8RZFXUTX", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T21:56:59Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/31300245", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T21:56:59Z", "dateModified": "2025-02-19T21:56:59Z" } }, { "key": "8RZFXUTX", "version": 294, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/8RZFXUTX", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/8RZFXUTX", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Colin et al.", "parsedDate": "2020-05", "numChildren": 1 }, "data": { "key": "8RZFXUTX", "version": 294, "itemType": "journalArticle", "title": "Subcutaneously administered antibiotics", "creators": [ { "creatorType": "author", "firstName": "E.", "lastName": "Colin" }, { "creatorType": "author", "firstName": "A.", "lastName": "Baldolli" }, { "creatorType": "author", "firstName": "R.", "lastName": "Verdon" }, { "creatorType": "author", "firstName": "G.", "lastName": "Saint-Lorant" } ], "abstractNote": "The subcutaneous route is a widely used route of administration in routine clinical practice, particularly in elderly patients, when the intravenous route cannot be used. This review of the literature highlights the lack of randomized studies and the lack of pharmacokinetic data on the use of this route of administration. Three antibiotics administered subcutaneously can be used for severe infections, with acceptable pharmacokinetic and pharmacodynamic data, when the intravenous administration is not possible: ceftriaxone, ertapenem, and teicoplanin.", "publicationTitle": "Medecine Et Maladies Infectieuses", "publisher": "", "place": "", "date": "2020-05", "volume": "50", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "231-242", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Med Mal Infect", "DOI": "10.1016/j.medmal.2019.06.007", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1769-6690", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 31300245", "tags": [ { "tag": "Administration sous-cutanée", "type": 1 }, { "tag": "Age Factors", "type": 1 }, { "tag": "Anti-Bacterial Agents", "type": 1 }, { "tag": "Antibiotics", "type": 1 }, { "tag": "Antibiotiques", "type": 1 }, { "tag": "Bacterial Infections", "type": 1 }, { "tag": "Ceftriaxone", "type": 1 }, { "tag": "Clinical Trials as Topic", "type": 1 }, { "tag": "Cohort Studies", "type": 1 }, { "tag": "Ertapenem", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Infusions, Intravenous", "type": 1 }, { "tag": "Injections, Intravenous", "type": 1 }, { "tag": "Injections, Subcutaneous", "type": 1 }, { "tag": "Microbial Sensitivity Tests", "type": 1 }, { "tag": "Pharmacocinétique", "type": 1 }, { "tag": "Pharmacokinetics", "type": 1 }, { "tag": "Subcutaneous administration", "type": 1 }, { "tag": "Teicoplanin", "type": 1 }, { "tag": "Tolerability", "type": 1 }, { "tag": "Tolérance", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T21:56:58Z", "dateModified": "2025-02-19T21:56:58Z" } }, { "key": "H96896XF", "version": 293, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/H96896XF", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/H96896XF", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/RI5UWFK6", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "H96896XF", "version": 293, "parentItem": "RI5UWFK6", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T21:54:45Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/31730164", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T21:54:45Z", "dateModified": "2025-02-19T21:54:45Z" } }, { "key": "RI5UWFK6", "version": 293, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/RI5UWFK6", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/RI5UWFK6", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Roubaud Baudron et al.", "parsedDate": "2019-12-01", "numChildren": 1 }, "data": { "key": "RI5UWFK6", "version": 293, "itemType": "journalArticle", "title": "Is the subcutaneous route an alternative for administering ertapenem to older patients? PHACINERTA study", "creators": [ { "creatorType": "author", "firstName": "Claire", "lastName": "Roubaud Baudron" }, { "creatorType": "author", "firstName": "Rachel", "lastName": "Legeron" }, { "creatorType": "author", "firstName": "Julien", "lastName": "Ollivier" }, { "creatorType": "author", "firstName": "Fabrice", "lastName": "Bonnet" }, { "creatorType": "author", "firstName": "Carine", "lastName": "Greib" }, { "creatorType": "author", "firstName": "Florent", "lastName": "Guerville" }, { "creatorType": "author", "firstName": "Charles", "lastName": "Cazanave" }, { "creatorType": "author", "firstName": "David", "lastName": "Kobeh" }, { "creatorType": "author", "firstName": "Véronique", "lastName": "Cressot" }, { "creatorType": "author", "firstName": "Nicolas", "lastName": "Moneger" }, { "creatorType": "author", "firstName": "Marie-Neige", "lastName": "Videau" }, { "creatorType": "author", "firstName": "Elise", "lastName": "Thiel" }, { "creatorType": "author", "firstName": "Carine", "lastName": "Foucaud" }, { "creatorType": "author", "firstName": "Aurélie", "lastName": "Lafargue" }, { "creatorType": "author", "firstName": "Albane", "lastName": "de Thezy" }, { "creatorType": "author", "firstName": "Jessica", "lastName": "Durrieu" }, { "creatorType": "author", "firstName": "Isabelle", "lastName": "Bourdel Marchasson" }, { "creatorType": "author", "firstName": "Geneviève", "lastName": "Pinganaud" }, { "creatorType": "author", "firstName": "Dominique", "lastName": "Breilh" } ], "abstractNote": "BACKGROUND: Antibiotic administration by subcutaneous (SC) injection is common practice in French geriatric wards as an alternative to the intravenous (IV) route, but few pharmacokinetic/pharmacodynamic data are available. Ertapenem is useful for the treatment of infections with ESBL-producing enterobacteria.\nOBJECTIVES: To report and compare ertapenem pharmacokinetic data between IV and SC routes in older persons.\nMETHODS: Patients >65 years of age receiving ertapenem (1 g once daily) for at least 48 h (IV or SC, steady-state) were prospectively enrolled. Total ertapenem concentrations [residual (C0), IV peak (C0.5) and SC peak (C2.5)] were determined by UV HPLC. Individual-predicted AUC0-24 values were calculated and population pharmacokinetic analyses were performed. Using the final model, a Monte Carlo simulation involving 10 000 patients evaluated the influence of SC or IV administration on the PTA. Tolerance to ertapenem and recovery were also monitored. ClinicalTrials.gov identifier: NCT02505386.\nRESULTS: Ten (mean ± SD age=87±7 years) and 16 (age=88±5 years) patients were included in the IV and SC groups, respectively. The mean C0 and C2.5 values were not significantly different between the IV and SC groups (C0=12±5.9 versus 12±7.4 mg/L, P=0.97; C2.5=97±42 versus 67±41 mg/L, P=0.99). The mean C0.5 was higher in the IV group compared with the SC group (C0.5=184±90 versus 51±66 mg/L, P=0.001). The mean individual AUCs (1126.92±334.99 mg·h/L for IV versus 1005.3±266.0 mg·h/L for SC, P=0.38) and PTAs were not significantly different between groups. No severe antibiotic-related adverse effects were noted.\nCONCLUSIONS: SC administration of ertapenem is an alternative to IV administration in older patients.", "publicationTitle": "The Journal of Antimicrobial Chemotherapy", "publisher": "", "place": "", "date": "2019-12-01", "volume": "74", "issue": "12", "section": "", "partNumber": "", "partTitle": "", "pages": "3546-3554", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Antimicrob Chemother", "DOI": "10.1093/jac/dkz385", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1460-2091", "archive": "", "archiveLocation": "", "shortTitle": "Is the subcutaneous route an alternative for administering ertapenem to older patients?", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 31730164", "tags": [ { "tag": "Administration, Intravenous", "type": 1 }, { "tag": "Age Factors", "type": 1 }, { "tag": "Aged", "type": 1 }, { "tag": "Aged, 80 and over", "type": 1 }, { "tag": "Anti-Bacterial Agents", "type": 1 }, { "tag": "Enterobacteriaceae Infections", "type": 1 }, { "tag": "Ertapenem", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "France", "type": 1 }, { "tag": "Geriatrics", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Injections, Subcutaneous", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Monte Carlo Method", "type": 1 }, { "tag": "Prospective Studies", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T21:54:44Z", "dateModified": "2025-02-19T21:54:44Z" } }, { "key": "29L2ISNI", "version": 292, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/29L2ISNI", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/29L2ISNI", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/DWFCPP4W", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "29L2ISNI", "version": 292, "parentItem": "DWFCPP4W", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T21:53:10Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/36374566", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T21:53:10Z", "dateModified": "2025-02-19T21:53:10Z" } }, { "key": "DWFCPP4W", "version": 292, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/DWFCPP4W", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/DWFCPP4W", "type": "text/html" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } }, "creatorSummary": "Jumpertz et al.", "parsedDate": "2022-12-23", "numChildren": 1 }, "data": { "key": "DWFCPP4W", "version": 292, "itemType": "journalArticle", "title": "Subcutaneously administered antibiotics: a review", "creators": [ { "creatorType": "author", "firstName": "Marie", "lastName": "Jumpertz" }, { "creatorType": "author", "firstName": "Romain", "lastName": "Guilhaumou" }, { "creatorType": "author", "firstName": "Matthieu", "lastName": "Million" }, { "creatorType": "author", "firstName": "Philippe", "lastName": "Parola" }, { "creatorType": "author", "firstName": "Jean-Christophe", "lastName": "Lagier" }, { "creatorType": "author", "firstName": "Philippe", "lastName": "Brouqui" }, { "creatorType": "author", "firstName": "Nadim", "lastName": "Cassir" } ], "abstractNote": "BACKGROUND: Subcutaneous (SC) administration of antibiotics represents an attractive alternative to the intravenous (IV) route.\nMETHODS: We performed a systematic electronic search of PubMed and the Cochrane Library for all articles published prior to April 2022, using the key terms and MeSH terms 'subcutaneous', 'antibiotic' and the international non-proprietary name of antibiotics.\nRESULTS: A total of 30 studies were selected including data on the efficacy and tolerability of antibiotics, and seven studies that were conducted in healthy subjects, for relevant information regarding the safety and tolerability of antibiotics. Comparative studies have shown that efficacy is similar for the SC and IV routes for ceftriaxone, teicoplanin and ertapenem. The SC use of other antibiotics such as ampicillin, ceftazidime, cefepime, piperacillin/tazobactam, metronidazole and fosfomycin has also been described. These results have largely been corroborated by pharmacokinetic/pharmacodynamic analyses, especially for time-dependent antibiotics. Complications of SC treatment are rarely severe, with no reports of bacteraemia or other invasive infection related to this route of administration. Therapeutic drug monitoring has been proposed to adapt the dose and avoid toxicity.\nDISCUSSION: The rationale for using SC administration of ceftriaxone, ertapenem and teicoplanin is strong in patients with non-severe infections. It is already commonly practised in some countries, particularly in France. Other antibiotics could be administered subcutaneously, but further studies are needed to validate their use in clinical practice. Further research is needed to safely generalize and optimize this route of administration whenever possible. This would reduce the risk of catheter-related infections and their complications, together with the length of hospital stay.", "publicationTitle": "The Journal of Antimicrobial Chemotherapy", "publisher": "", "place": "", "date": "2022-12-23", "volume": "78", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "1-7", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Antimicrob Chemother", "DOI": "10.1093/jac/dkac383", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1460-2091", "archive": "", "archiveLocation": "", "shortTitle": "Subcutaneously administered antibiotics", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "PMID: 36374566", "tags": [ { "tag": "Anti-Bacterial Agents", "type": 1 }, { "tag": "Cefepime", "type": 1 }, { "tag": "Ceftriaxone", "type": 1 }, { "tag": "Ertapenem", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Teicoplanin", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2025-02-19T21:53:09Z", "dateModified": "2025-02-19T21:53:09Z" } }, { "key": "DAR5VD48", "version": 291, "library": { "type": "group", "id": 643494, "name": "Grupo 5 Métodos", "links": { "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/643494/items/DAR5VD48", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/grupo_5_mtodos/items/DAR5VD48", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/643494/items/4Q8BMYEJ", "type": "application/json" } }, "meta": { "createdByUser": { "id": 3273002, "username": "Dani Saade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/dani_saade", "type": "text/html" } } } }, "data": { "key": "DAR5VD48", "version": 291, "parentItem": "4Q8BMYEJ", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2025-02-19T21:52:02Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/36964691", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2025-02-19T21:52:02Z", "dateModified": "2025-02-19T21:52:02Z" } } ]