Steroid resistant minimal change disease

The coagulase-negative staphylococci most frequently associated with clinical infections share similar antimicrobial susceptibility profiles with the exception of  S. saprophyticus  and  S. haemolyticus .  S. saprophyticus  is typically susceptible to most antimicrobials, including the aminopenicillins.  S. haemolyticus  is not only often multi-drug resistant, but may also be resistant to teicoplanin and vancomycin ( 171 , 191 ). Recently, several new antimicrobials with good activity against coagulase-negative staphylococci have been introduced into clinical practice: linezolid,  tigecycline  and daptomycin.  Linezolid displays good activity against the coagulase-negative staphylococci, including glycopeptide resistant strains ( 4 , 18 , 40 , 75 , 150 ). Resistance to linezolid in coagulase-negative staphylococci has recently been described ( 46 ), in particular in a patient with acute myeloid leukemia who failed linezolid for therapy of a bacteremia due to  S. epidermidis . A mutation in the V region of the 23S rRNA gene was present in multiple linezolid-resistant blood isolates (hong 2007). Very little resistance to daptomycin and  tigecycline  has been reported to date ( 142 ,  122 ) The  in vitro  activity of antimicrobials that have been used to treat staphylococcal infections has been recently reviewed by John and Harvin and is presented in the Table. Most of these agents have an MIC90 <  µg/ml.

Although peak plasma prednisolone levels are somewhat lower after administration of Deltacortril Gastro-resistant Tablets and absorption is delayed, total absorption and bioavailability are the same as after plain prednisolone. Prednisolone shows dose dependent pharmacokinetics, with an increase in dose leading to an increase in volume of distribution and plasma clearance. The degree of plasma protein binding determines the distribution and clearance of free, pharmacologically active drug. Reduced doses are necessary in patients with hypoalbuminaemia.

During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.

Steroid resistant minimal change disease

steroid resistant minimal change disease


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