Use of Therapeutic Drug Monitoring to Personalize Antifungals for Blastomycosis in Pediatric Patients on Extracorporeal Membrane Oxygenation: A Case Series
Bibliographic record
Abstract
Amphotericin B and posaconazole are used in the treatment of pulmonary blastomycosis. Previous reports found inadequate treatment to both antifungals due to potential sequestration in extracorporeal membrane oxygenation (ECMO). There is a lack of evidence supporting routine use of therapeutic drug monitoring (TDM) with these agents. We report amphotericin B and posaconazole TDM in two separate cases of patients with pulmonary blastomycosis and on ECMO. Plasma concentrations were collected pre- and post-ECMO membranes and used to calculate pharmacokinetic and pharmacodynamic parameters. Drug sequestration within ECMO was not evident in our cases. As such, we speculate the drugs may have saturated the circuits over time. TDM of amphotericin B and posaconazole may be beneficial in pediatric patients on ECMO, especially near initiation of therapy or after a circuit change. Further studies are warranted to evaluate the relationship between plasma concentrations of these antifungals and efficacy and safety outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".