natgillin/translations-raw huggingface dataset:
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. 
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.
Vancomycin administreres også oralt til behandling af infektioner med Clostridium difficile (CDI). 
Vancomycin is also administered by the oral route for the treatment of Clostridium difficile-infection (CDI).
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). 
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).
• 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, 
• 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,
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. 
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.
CHMP gennemgik også doseringsregimet for vancomycin til de forskellige godkendte indikationer og underpopulationer af patienter. 
The CHMP also reviewed the dosage regimen for vancomycin for the various approved indications and patient subpopulations.
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. 
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.
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. 
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.
Vancomycins antibakterielle spektrum omfatter en bred vifte af patogene organismer, herunder Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococus pneumoniae, Listeria monocytogenes og Clostridium difficile. 
Vancomycin spectrum includes a wide range of pathogens including Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococus pneumoniae, Listeria monocytogenes and Clostridium difficile.
Det bemærkes derudover, at stafylokokenterocolitis er sjælden, og at diagnosen er omdebatteret. 
It is also noted that staphylococcal enterocolitis is a rare entity and that its diagnosis is controversial.
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. 
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.
Det er desuden omdebatteret, hvilken rolle selektiv tarmdekontaminering spiller. 
Furthermore, the role of selective intestinal decontamination is controversial.
CHMP bemærkede, at måling af dal-serumkoncentrationer i steady state er et accepteret surrogat for opnåelse af en effektiv eksponering for vancomycin. 
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.
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. 
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.
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). 
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).
• 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, 
• 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,
• 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. 
• 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.
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. 
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.
CHMP gennemgik desuden dosisanbefalingen for den pædiatriske population. 
The CHMP also reviewed the dose recommendation in paediatric population.
• 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. 
• 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.
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. 
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.
Dets hovedsagelig baktericide virkning udøves i det væsentlige ved hæmning af peptidoglycan-syntesen til cellevæggene. 
Its effect is mainly bactericidal and it is exerted mainly by the inhibition of the cell wall peptidoglycan synthesis.
• Behandling af infektion med Clostridium difficile (CDI) ved oral administration af vancomycin. 
• Treatment of Clostridium difficile infection (CDI), for vancomycin given by oral route of administration.
• 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, 
• 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,
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. 
However, having reviewed the data presented by the MAHs, the CHMP also considered the existing limitations of monitoring Ctrough in certain situations.
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. 
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.
CHMP gennemgik også den optimale måde at angive styrke og dosis på for produkter indeholdende vancomycin. 
The CHMP reviewed also the optimal way of expressing the strength and dose of vancomycincontaining products.
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). 
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).
Som følge heraf kunne CHMP ikke give konkrete doseringsanbefalinger for kontinuerlig infusion i produktresuméet for vancomycin til intravenøs anvendelse. 
As a consequence, the CHMP could not recommend any concrete dosing recommendations for continuous infusion in the SmPC of vancomycin for IV use.
• 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, 
• 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,
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. 
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.
CHMP diskuterede derfor en række andre metoder til at beregne eksponeringen for vancomycin. 
Therefore, the CHMP discussed different alternative approaches to estimate the vancomycin exposure.
CHMP anerkendte også, at der for visse allerede godkendte lægemidler indeholdende vancomycin i forvejen er medtaget visse doseringsanbefalinger for både fuldbårne og præmature nyfødte7. 
The CHMP also acknowledged that some already approved vancomycin containing medicines already include some dosing recommendations for both term and preterm neonates11.
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. 
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.
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: 
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:
Ved lettere, klart antibiotikaforårsagede infektioner med Clostridium difficile kan det accepteres at seponere det inducerende antibiotikum og iagttage den kliniske respons. 
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.
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. 
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.
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). 
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.
Alt i alt er CHMP af den opfattelse, at benefit/risk-forholdet for de af denne procedure omfattede produkter indeholdende vancomycin fortsat er positivt under normale anvendelsesbetingelser, forudsat at de vedtagne ændringer, som fremgår af bilag III til denne udtalelse, indarbejdes i produktinformationen. 
In conclusion, the CHMP is of the opinion that the benefit-risk balance of the vancomycin-containing products included in the scope of this procedure remains positive under normal conditions of use, taking into account the agreed changes to the product information as set out in Annex III to the opinion.
CHMP har tilsvarende ændret ordlyden om terapeutisk lægemiddelovervågning i punkt 4.2 af produktresuméet. 
The wording on therapeutic drug monitoring in section 4.2 of the SmPC has been amended accordingly by the CHMP.
CHMP gennemgik i sin vurdering alle foreliggende data, herunder oplysninger indgivet af indehaverne af markedsføringstilladelse i løbet af proceduren, og rådførte sig med det pædiatriske udvalg (PDCO) og de relevante CHMP-arbejdsgrupper: arbejdsgruppen vedrørende smitsomme sygdomme (IDWP), arbejdsgruppen vedrørende farmakokinetik (PKWP), arbejdsgruppen vedrørende kvalitet (QWP), arbejdsgruppen vedrørende modellering og simulering (MSWG) samt eksterne eksperter (European 
In its assessment, the CHMP reviewed all available data, including submissions by the marketing authorisation holders during the procedure and consulted the Paediatric Committee (PDCO), the CHMP relevant working parties/groups: Infectious Disease working party (IDWP), the Pharmacokinetics working party (PKWP), the Quality Working Party (QWP), the Modelling and Simulation Working Group (MSWG)) and external experts (the European Committee on Antimicrobial Susceptibility Testing (EUCAST)).
konkluderede udvalget, at benefit/risk-forholdet for de af proceduren omfattede vancomycinholdige produkter fortsat er positivt ved normale anvendelsesbetingelser, forudsat at de vedtagne ændringer indføres i produktinformationen. 
The Committee, as a consequence, concluded that the benefit-risk balance of the vancomycin containing products included in the scope of this procedure remains positive under normal conditions of use, taking into account the agreed changes to the product information.
Da det i EU er etableret praksis at ordinere dette produkt i mg, var CHMP af den opfattelse, at det er vigtigt at fastholde konventionen om at mærke produkter indeholdende vancomycin efter masse, dvs. mg. 
CHMP was of the opinion that, given the fact that the use of milligram to prescribe this product was established in EU clinical practice, it is essential that the convention of labelling vancomycin products by mass, i.e. milligrams, is retained.
• CHMP foretog en benefit/risk-vurdering af produkter indeholdende vancomycin i henhold til artikel 31 i direktiv 2001/83/EF med gennemgang af alle foreliggende data, herunder de ved proceduren indsendte besvarelser fra indehaverne af markedsføringstilladelserne samt anbefalinger fra det pædiatriske udvalg (PDCO) og de pågældende CHMP-arbejdsgrupper: arbejdsgruppen vedrørende smitsomme sygdomme (IDWP), arbejdsgruppen vedrørende farmakokinetik (PKWP), arbejdsgruppen vedrørende kvalitet (QWP), arbejdsgruppen vedrørende modellering og simulering (MSWG) og eksterne eksperter (European Committee on Antimicrobial Susceptibility Testing (EUCAST)) (det europæiske udvalg om bestemmelse af antimikrobiel følsomhed), 
• the CHMP carried out a benefit-risk evaluation of vancomycin containing products under Article 31 of Directive 2001/83/EC, reviewing all available data, including responses submitted by the marketing authorisation holders during the procedure and recommendations from the Paediatric Committee (PDCO), the CHMP relevant working parties/groups: Infectious Disease working party (IDWP), the Pharmacokinetics working party (PKWP), the Quality Working Party (QWP), the Modelling and Simulation Working Group (MSWG)) and external experts (the European Committee on Antimicrobial Susceptibility Testing (EUCAST),
For spædbørn og børn i alderen fra 1 måned til 18 år fandt CHMP, at dosis af vancomycin ligesom for voksne bør tilpasses individuelt efter vægt, alder, den underliggende infektions art og sværhedsgrad og den kliniske respons. 
For both infants, children aged from one month to 18 years old, the CHMP agreed that, as for adults, the vancomycin dose should be individually adapted according to weight, age and the underlying type and severity of infection and clinical response; the initial vancomycin doses should be calculated based on the body weight.
Dets rolle i behandlingen af MRSA-infektioner underbygges ligeledes af de gældende retningslinjer fra European Society of Clinical Microbiology and Infectious Diseases (ESCMID1,2) og Infectious Diseases Society of America (IDSA3). 
Current guidelines from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID1,2) and Infectious Diseases Society of America (IDSA3) also support its role in the treatment of MRSA infections.
• Behandling af: komplicerede hud- og bløddelsinfektioner, knogle- og ledinfektioner, samfundserhvervet pneumoni, nosokomiel pneumoni (herunder ventilationsrelateret), infektiøs endokarditis, bakteriæmi, der har sammenhæng med eller er mistænkt for at have sammenhæng med nogen af ovennævnte (navnlig dem, der er forårsaget af methicillinresistente Staphylococcus aureus (MRSA)), samt perioperativ antibakteriel profylakse. 
• Treatment of: complicated skin and soft tissue infections, bone and joint infections, community acquired pneumonia, hospital acquired pneumonia including ventilator-associated pneumonia, infective endocarditis, bacteraemia that occurs in association with, or is suspected to be associated with any of the above (particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA)), perioperative antibacterial prophylaxis.