FrancophonIA/ELRC3.0 huggingface dataset:
English: For certain medicinal vancomycin-containing products, the intraperitoneal route and oral route of administration are authorised,
Danish: For visse vancomycinholdige lægemidler er intraperitoneal og oral administration godkendt,
English: In addition, significant differences between the product information of vancomycin-containing medicines across the EU Member States were identified in particular in the indications, posology and method of administration, but also in other sections of the product information.
Danish: Der er desuden konstateret betydelige forskelle mellem produktinformationerne for lægemidler indeholdende vancomycin i EU's medlemsstater, navnlig hvad angår indikationer, dosering og administration, men også i andre afsnit i produktinformationen.
English: Vancomycin containing products are commercially available as:
Danish: Produkter indeholdende vancomycin fås i handelen som:
English: Vancomycin hydrochloride is defined as the hydrochloride salt of a mixture of related glycopeptides for which the characteristics are defined in the European Pharmacopeia 1058 monograph (currently under revision).
Danish: Vancomycinhydrochlorid defineres som hydrochloridsaltet af en blanding af beslægtede glykopeptider, hvis egenskaber er defineret i Ph. Eur monografi 1058 (aktuelt under revision).
English: Vancomycin is a glycopeptide antibiotic authorised around six decades ago.
Danish: Vancomycin er et antibiotikum af glykopeptidtypen, som blev godkendt for omkring 60 år siden.
English: The CHMP noted that the European Society of Clinical Microbiology and Infection (ESCMID) issued a treatment guidance document9,10 for Clostridium difficile infection in 2009 that is currently being updated.
Danish: CHMP bemærkede, at European Society of Clinical Microbiology and Infection (ESCMID)) i 2009 har udsendt en behandlingsvejledning9,10 for infektion med Clostridium difficile, som aktuelt er under ajourføring.
English: A statement in the section 4.2 had been included accordingly by the CHMP.
Danish: CHMP havde indsat en erklæring i punkt 4.2 herom.
English: Therefore, in light of the above the Spanish Medicines Agency (AEMPS) considered in the interest of the Union to refer the matter to the CHMP and request that its gives its opinion under Article 31 of Directive 2001/83/EC on the benefit-risk of vancomycin-containing products and on the need for regulatory measures to be taken.
Danish: På denne baggrund anså den spanske lægemiddelmyndighed (AEMPS) det for at være i Unionens interesse at indbringe sagen for CHMP og anmode udvalget om at afgive en udtalelse i henhold til artikel 31 i direktiv 2001/83/EF om benefit/risk-forholdet for vancomycinholdige produkter og om nødvendigheden af at træffe lovgivningsmæssige foranstaltninger.
English: The Committee, as a consequence, recommends the variation to the terms of the marketing authorisations for vancomycin-containing products.
Danish: Udvalget anbefaler derfor ændring af betingelserne for markedsføringstilladelsen for produkter indeholdende vancomycin.
English: However, to ensure that the established therapeutic dose in terms of IU (potency) is maintained, and as indicated in the Question and Answer on expression/declaration of potency in quantitative and qualitative composition for vancomycin products (EMA/CHMP/QWP/667469/2015), the amount (mg) of active substance in the drug product should be adjusted to achieve the declared product strength in terms of IU.
Danish: Men for at sikre, at den fastlagte terapeutiske dosis i IE (potens) bibeholdes, og i overensstemmelse med spørgsmål og svar om potensangivelse/-deklaration i den kvantitative og kvalitative sammensætning af produkter indeholdende vancomycin (EMA/CHMP/QWP/667469/2015) skal mængden (mg) af aktivt stof i det færdige præparat justeres, så produktets deklarerede styrke i IE opnås.
English: • the CHMP considered that the pharmacokinetic and pharmacodynamic data in the product information need to be updated,
Danish: • CHMP vurderede, at de farmakokinetiske og farmakodynamiske data i produktinformationen bør ajourføres,
English: The SmPC has been amended accordingly, including the dosing regimen in children based on post-menstrual age as a possible way of dosing vancomycin in this population.
Danish: Produktresuméet er ændret i overensstemmelse hermed, herunder doseringsregimet for børn, der er baseret på den postmenstruelle alder som en mulig måde til at fastlægge dosis af vancomycin hos denne population.
English: Trough-only monitoring may be not sufficient to guide vancomycin dosing in all cases, because peak levels (Cmax) are primarily influenced by the volume of distribution.
Danish: Overvågning af dal-koncentrationen alene er ikke nødvendigvis tilstrækkelig til at styre doseringen af vancomycin i alle tilfælde, da peakniveauerne (Cmax) primært bestemmes af fordelingsvolumenet.
English: • Treatment of peritoneal dialysis-associated peritonitis.
Danish: • Behandling af peritonealdialyse-relateret peritonitis.
English: For this specific group, the PDCO recommended one possible dosing regimen based on post-menstrual age (similar to the recommended dosing regimen by the British National Formulary (BNF) for children), but overall CHMP agreed that no universal recommendations on the dosage regimen in neonates could be made and that for establishing the dosing regimen in this population, the advice of a physician experienced in the management of neonates should be sought.
Danish: For denne særlige gruppe anbefalede PDCO ét muligt doseringsregime baseret på den postmenstruelle alder (svarende til det doseringsregime for børn, der anbefales i British National Formulary (BNF)), men overordnet fandt CHMP det ikke muligt at opstille generelle anbefalinger for doseringsregimet hos nyfødte, hvorfor doseringsregimet hos denne population bør fastsættes efter råd fra en læge med erfaring i behandling af nyfødte.
English: Vancomycin is also administered by the oral route for the treatment of Clostridium difficile-infection (CDI).
Danish: Vancomycin administreres også oralt til behandling af infektioner med Clostridium difficile (CDI).
English: Finally, revisions were made to sections 5.1 and 5.2 to reflect current pharmacokinetic and pharmacodynamic data, and to sections 1 and 2 to reflect the amount of active substance in the finished product (based on the potency expressed in IU), and the dose and strength of vancomycin containing products (to be expressed in milligrams).
Danish: Endelig blev der foretaget revisioner i punkt 5.1 og 5.2, som afspejler de nuværende farmakokinetiske og farmakodynamiske data, og i punkt 1 og 2, som afspejler mængden af aktivt stof i det færdige præparat (baseret på potensen i IE), samt dosis og styrke af færdige produkter indeholdende vancomycin (som skal angives i mg).
English: • the CHMP considered that the amount of active substance in the finished product is determined and consistently based on the potency expressed in IU, and that the dose and strength of vancomycin containing products should continue to be expressed in milligrams,
Danish: • CHMP fandt, at mængden af aktivt stof i det færdige produkt bestemmes og konsekvent baseres på styrken angivet i IE, og at dosis og styrke af produkter indeholdende vancomycin fortsat bør angives i mg,
English: Regarding the administration of vancomycin as a continuous infusion in paediatric patients, PDCO confirmed that it is being used in some countries for neonates (and children) with severe infections such as patients with central nervous system infections and/or associated bacteremia.
Danish: Hvad angår kontinuerlig infusion af vancomycin til pædiatriske patienter bekræftede PDCO, at det i nogle lande anvendes til nyfødte (og børn) med svære infektioner såsom CNS-infektioner og/eller tilknyttet bakteriæmi.
English: The CHMP also reviewed the dosage regimen for vancomycin for the various approved indications and patient subpopulations.
Danish: CHMP gennemgik også doseringsregimet for vancomycin til de forskellige godkendte indikationer og underpopulationer af patienter.
English: Overall, the CHMP considered that, out of the discussed methods, the Bayesian interpolation seemed to be an appropriate alternative; it allows predicting many individual pharmacokinetic parameters for extrapolation, minimizes the number of measurements on a single patient and seems to develop optimal strategies for therapeutic intervention.
Danish: Af de diskuterede metoder fandt CHMP samlet set, at Bayesk interpolering var et velegnet alternativ, som giver mulighed for at forudsige mange farmakokinetiske enkeltparametre til ekstrapolering, minimerer antallet af målinger på den enkelte patient og synes at give optimal mulighed for strategier for behandlingsintervention.
English: In addition, in line with the outcome of the MSWG consultation, the CHMP concluded that Bayesian methods could be clinically useful for more accurate dose predictions as a complementary part of routine therapeutic drug monitoring (TDM), especially for the patient groups with altered pharmacokinetic (PK) profile (i.e. children, haemodynamically unstable patients, intensive care), and acknowledged that this is already in clinical use.
Danish: På linje med resultatet af samrådet med MSWG konkluderede CHMP desuden, at Bayeske metoder kunne være klinisk nyttige til mere præcise dosisforudsigelser som en supplerende del af rutinemæssig terapeutisk lægemiddelovervågning, navnlig for patientgrupper med afvigende farmakokinetisk profil (dvs. børn, hæmodynamisk ustabile patienter, intensivt behandlede) og anerkendte, at dette allerede anvendes klinisk.
English: Vancomycin spectrum includes a wide range of pathogens including Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococus pneumoniae, Listeria monocytogenes and Clostridium difficile.
Danish: Vancomycins antibakterielle spektrum omfatter en bred vifte af patogene organismer, herunder Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococus pneumoniae, Listeria monocytogenes og Clostridium difficile.
English: It is also noted that staphylococcal enterocolitis is a rare entity and that its diagnosis is controversial.
Danish: Det bemærkes derudover, at stafylokokenterocolitis er sjælden, og at diagnosen er omdebatteret.
English: The CHMP also reviewed the limits for related substances and impurities in the active substance and in the finished products and it was concluded that the limits for related components and impurities in the drug substance and in the final drug products already authorised are qualified.
Danish: CHMP gennemgik også grænserne for beslægtede stoffer og urenheder i det aktive stof og i de færdige produkter, og det blev konkluderet, at grænserne for beslægtede stoffer og urenheder i det aktive stof og i de allerede godkendte færdige præparater kan anvendes.
English: Furthermore, the role of selective intestinal decontamination is controversial.
Danish: Det er desuden omdebatteret, hvilken rolle selektiv tarmdekontaminering spiller.
English: The CHMP noted that the measurement of trough serum concentrations at steady state is an accepted surrogate to check if effective vancomycin exposure has been achieved.
Danish: CHMP bemærkede, at måling af dal-serumkoncentrationer i steady state er et accepteret surrogat for opnåelse af en effektiv eksponering for vancomycin.
English: In these cases, continuous infusions were used due to a failure of response to treatment or to a persistence of subtherapeutic vancomycin levels despite optimizing dosing and frequency during intermittent vancomycin administration.
Danish: I disse tilfælde er der anvendt kontinuerlig infusion på grund af manglende behandlingsrespons, eller fordi subterapeutiske koncentrationer af vancomycin persisterede, trods optimering af doseringen og doseringshyppigheden ved intermitterende administration af vancomycin.
English: The CHMP noted the guidelines on the management of Peritoneal Dialysis-related peritonitis in adults from the International Society for Peritoneal Dialysis (ISPD) (Li PK et al., 20167), the ISPD recommendations for pediatric patients (Warady BA et al., 20128).
Danish: CHMP noterede sig retningslinjerne for behandling af peritonealdialyse-relateret peritonitis hos voksne fra International Society for Peritoneal Dialysis (ISPD) (Li PK et al., 20167) og ISPD's anbefalinger for pædiatriske patienter (Warady BA et al. 20128).
English: • the existing product information including the indications, dosage recommendations and pharmacokinetic and pharmacodynamic information for vancomycin-containing products in the EU need to be revised in accordance with the latest available information,
Danish: • de eksisterende produktoplysninger, herunder indikationer, doseringsanbefalinger og farmakokinetiske og farmakodynamiske oplysninger for vancomycinholdige produkter i EU bør revideres i overensstemmelse med de seneste tilgængelige oplysninger,
English: • With regards to the “treatment of staphylococcal enterocolitis”, the CHMP concluded that the MAHs did not provide data establishing the efficacy and safety of oral vancomycin in this indication.
Danish: • Hvad angår "Behandling af stafylokok-enterocolitis" konkluderede CHMP, at indehaverne af markedsføringstilladelserne ikke havde fremlagt data, der godtgør virkningen og sikkerheden af oral administration af vancomycin til denne indikation.
English: However, continuous vancomycin infusions have a few disadvantages such as that there may be compatibility issues with other IV medications or solutions that are given concurrently; practical problems associated with reduced line availability when infusions are given over a 24-h period; increased risk of infusing a bolus dose of vancomycin when the intravenous solution is changed or when another medication is infused into the same intravenous tubing which is filled with vancomycin 24 h/day etc.
Danish: Kontinuerlig infusion af vancomycin har imidlertid visse ulemper, såsom eventuelle kompatibilitetsproblemer med andre intravenøse lægemidler eller samtidigt indgivne opløsninger, praktiske problemer relateret til nedsat tilgængelighed af infusionsslangen, når der infunderes gennem 24 timer, og øget risiko for infusion af en bolusdosis af vancomycin, når den intravenøse opløsning skiftes, eller når et andet lægemiddel infunderes i samme infusionsslange, der er fyldt med vancomycin 24 timer i døgnet mv.
English: The CHMP also reviewed the dose recommendation in paediatric population.
Danish: CHMP gennemgik desuden dosisanbefalingen for den pædiatriske population.
English: • Concerning the “decontamination of the GI tract in immune-compromised patients when combined with an aminoglycoside”, the CHMP reviewed the available data submitted throughout this procedure.
Danish: • Hvad angår "dekontaminering af mave-tarm-kanalen hos immunkompromitterede patienter i kombination med et aminoglykosid", gennemgik CHMP de foreliggende data, der var indsendt under proceduren.
English: The CHMP acknowledged that the current therapeutic guidelines stress the importance of therapeutic drug monitoring and the use of the trough vancomycin concentration as a surrogate for the target AUC.
Danish: CHMP anerkendte, at de gældende terapeutiske retningslinjer understreger vigtigheden af terapeutisk lægemiddelovervågning og anvendelse af dal-koncentrationen af vancomycin som surrogat for det tilstræbte AUC.
English: Its effect is mainly bactericidal and it is exerted mainly by the inhibition of the cell wall peptidoglycan synthesis.
Danish: Dets hovedsagelig baktericide virkning udøves i det væsentlige ved hæmning af peptidoglycan-syntesen til cellevæggene.
English: • Treatment of Clostridium difficile infection (CDI), for vancomycin given by oral route of administration.
Danish: • Behandling af infektion med Clostridium difficile (CDI) ved oral administration af vancomycin.
English: • the CHMP considered that the risks of nephrotoxicity, ototoxicity, infusion related adverse reactions and hypersensitivity reactions observed with vancomycin for intravenous use can be minimised by appropriate warnings and recommendations in the product information,
Danish: • CHMP fandt, at de iagttagne risici for nefrotoksicitet, ototoksicitet, infusionsrelaterede bivirkninger og overfølsomhedsreaktioner med vancomycin til intravenøs anvendelse kan minimeres gennem passende advarsler og anbefalinger i produktinformationen,
English: However, having reviewed the data presented by the MAHs, the CHMP also considered the existing limitations of monitoring Ctrough in certain situations.
Danish: Efter at have gennemgået de data, som indehaverne af markedsføringstilladelserne havde fremlagt, tog CHMP dog også hensyn til de begrænsninger, som overvågning af dal-koncentrationen har i visse situationer.
English: The CHMP noted that the current guidelines for the treatment of acute bacterial meningitis from several learned societies (ESCMID4, IDSA5 guideline and UK joint specialist societies guidelines6, European Federation Neurological Societies (EFNS)) recommend vancomycin for both empirical treatment and etiological treatment of MRSA (alone) and penicillin-resistant Streptococcus pneumoniae (PRSP) in combination with other antibacterials in adults and children.
Danish: CHMP bemærkede, at de gældende retningslinjer for behandling af akut bakteriel meningitis fra en række videnskabelige selskaber (ESCMID4, IDSA5, UK joint specialist societies 6 og European Federation Neurological Societies (EFNS)) anbefaler vancomycin til både empirisk og ætiologisk behandling af MRSA (alene) og til penicillinresistente Streptococcus pneumoniae (PRSP) i kombination med andre antibakterielle midler hos voksne og børn.
English: The CHMP reviewed also the optimal way of expressing the strength and dose of vancomycincontaining products.
Danish: CHMP gennemgik også den optimale måde at angive styrke og dosis på for produkter indeholdende vancomycin.
English: The most commonly used dosage regimen (1 g every 12 hours) was considered adequate by the CHMP from a pharmacokinetic and pharmacodynamic perspective for the majority of patients with normal renal function and based on the usual susceptibility of staphylococci (minimum inhibitory concentration (MIC) ≤1 mg/L).
Danish: Det hyppigst anvendte doseringsregime (1 g hver 12. time) blev af CHMP anset for passende i farmakokinetisk og farmakodynamisk henseende for de fleste patienter med normal nyrefunktion og baseret på stafylokokkers sædvanlige følsomhed (mindste hæmmende koncentration (MIC) ≤ 1 mg/l).
English: As a consequence, the CHMP could not recommend any concrete dosing recommendations for continuous infusion in the SmPC of vancomycin for IV use.
Danish: Som følge heraf kunne CHMP ikke give konkrete doseringsanbefalinger for kontinuerlig infusion i produktresuméet for vancomycin til intravenøs anvendelse.
English: • the CHMP considered the available data to be sufficient to support revisions of the indication for both oral use and parenteral use, as well as the posology in adults and paediatrics populations, in line with clinical experience and current therapeutic guidelines,
Danish: • CHMP fandt de foreliggende data tilstrækkelige som grundlag for revision af indikationerne for lægemidler til både oral og parenteral anvendelse og for revision af doseringen til voksne og pædiatriske populationer i henhold til de kliniske erfaringer og gældende behandlingsvejledninger,
English: The CHMP also reviewed the existing data on adverse reactions observed with the use of vancomycin and which confirm that the use of vancomycin for parenteral use is associated with nephrotoxicity and ototoxicity, infusion related adverse reactions like vein and tissue toxicity as well as hypersensitivity reactions.
Danish: CHMP gennemgik også de eksisterende data om observerede bivirkninger ved anvendelse af vancomycin, og som bekræfter, at parenteral anvendelse af vancomycin er forbundet med nefrotoksicitet og ototoksicitet, infusionsrelaterede bivirkninger såsom toksisk virkning på vener og væv samt hypersensitivitetsreaktioner.
English: Therefore, the CHMP discussed different alternative approaches to estimate the vancomycin exposure.
Danish: CHMP diskuterede derfor en række andre metoder til at beregne eksponeringen for vancomycin.
English: The CHMP also acknowledged that some already approved vancomycin containing medicines already include some dosing recommendations for both term and preterm neonates11.
Danish: CHMP anerkendte også, at der for visse allerede godkendte lægemidler indeholdende vancomycin i forvejen er medtaget visse doseringsanbefalinger for både fuldbårne og præmature nyfødte7.
English: Intravenous vancomycin is mainly used for the treatment of serious infections caused by microorganisms with mechanisms of resistance to beta-lactam antibiotics, in particular methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci (CoNS) and enterococci, the latter being often tolerant to β-lactam antibiotics.
Danish: Intravenøst vancomycin anvendes hovedsagelig til behandling af alvorlige infektioner forårsaget af mikroorganismer med resistensmekanismer over for β-lactamantibiotika, især methicillinresistente Staphylococcus aureus (MRSA), koagulase-negative stafylokokker (CoNS) og enterokokker, som ofte er tolerante over for β-lactamantibiotika.
English: The following indications of vancomycin (oral route) for “treatment of staphylococcal enterocolitis” and “Decontamination of the gastrointestinal (GI) tract in immune-compromised patients when combined with an aminoglycoside” were not supported by the CHMP:
Danish: Følgende indikationer for vancomycin (oralt) til "Behandling af stafylokok-enterocolitis" og " dekontaminering af mave-tarm-kanalen hos immunkompromitterede patienter i kombination med et aminoglykosid," støttedes ikke af CHMP:
English: In the case of mild CDI clearly induced by the use of antibiotics, it is acceptable to discontinue the inducing antibiotic and observe the clinical response.
Danish: Ved lettere, klart antibiotikaforårsagede infektioner med Clostridium difficile kan det accepteres at seponere det inducerende antibiotikum og iagttage den kliniske respons.
English: As a consequence, the CHMP is of the view that the benefit-risk for vancomycin containing products in the indication “Decontamination of the gastrointestinal tract in immune-compromised patients when combined with an aminoglycoside” is not established and therefore this indication is not recommended.
Danish: CHMP er følgelig af den opfattelse, at benefit/risk-forholdet for produkter indeholdende vancomycin til indikationen "dekontaminering af mave-tarm-kanalen hos immunkompromitterede patienter i kombination med et aminoglykosid" ikke er fastlagt, hvorfor denne indikation ikke anbefales.
English: In addition, the CHMP reviewed the available evidence submitted within the referral procedure including several references to published literature and a meta-analysis of a total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive and 24 reporting treatment for Gram-negative) and 21 randomized clinical trials (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive and 8 reporting treatment for Gram-negative), confirming the efficacy of vancomycin for the treatment of peritonitis in peritoneal dialysis.
Danish: CHMP gennemgik desuden den evidens, der er forelagt i forbindelse med referralproceduren, og som bekræfter vancomycins virkning ved behandling af peritonitis ved peritonealdialyse, herunder en række litteraturhenvisninger og en metaanalyse af i alt 64 studier (32 vedrørende indledende behandling og negativ dyrkning, 28 vedrørende behandling for grampositive og 24 vedrørende behandling for gramnegative) og 21 randomiserede kliniske studier (14 vedrørende initial behandling og negativ dyrkning, 8 vedrørende behandling for grampositive og 8 vedrørende behandling for gramnegative).