natgillin/translations-raw huggingface dataset:
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.
Odbor CHMP priznava, da trenutne terapevtske smernice poudarjajo pomen terapevtskega spremljanja zdravila in uporabo koncentracije vankomicina pred naslednjim odmerkom (Ctrough) kot nadomestka za ciljno vrednost AUC.
The Committee, as a consequence, recommends the variation to the terms of the marketing authorisations for vancomycin-containing products.
Odbor posledično priporoča spremembo pogojev dovoljenja za promet z zdravili, ki vsebujejo vankomicin.
The CHMP reviewed also the optimal way of expressing the strength and dose of vancomycincontaining products.
Odbor CHMP je pregledal tudi optimalen način izražanja jakosti in odmerka zdravil, ki vsebujejo vankomicin.
• Treatment of peritoneal dialysis-associated peritonitis.
• Zdravljenje peritonitisa, povezanega s peritonealno dializo.
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.
Poleg tega je odbor CHMP pregledal razpoložljive dokaze, predložene v postopku napotitve, vključno z več sklici na objavljeno literaturo in metaanalizo skupno 64 študij (32 o začetnem zdravljenju in negativni kulturi, 28 o zdravljenju okužb z grampozitivnimi povzročitelji in 24 o zdravljenju okužb z gramnegativnimi povzročitelji) ter 21 randomiziranih kliničnih preskušanj (14 o začetnem zdravljenju in negativni kulturi, 8 o zdravljenju okužb z grampozitivnimi povzročitelji in 8 o zdravljenju okužb z gramnegativnimi povzročitelji), ki je potrdila učinkovitost vankomicina za zdravljenje peritonitisa pri peritonealni dializi.
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.
Odbor je pregledal tudi mejne vrednosti za sorodne snovi innečistoče v zdravilni učinkovini in končnem zdravilu ter zaključil, da so omejitve za sorodne sestavine in nečistoče v zdravilni učinkovini in končnih zdravilih, ki so že odobrena, ustrezne.
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).
Odbor CHMP je najpogosteje uporabljeno shemo odmerjanja (1 g na vsakih 12 ur) štel za ustrezno z vidika farmakokinetike in farmakodinamike za večino bolnikov z normalno ledvično funkcijo in osnovano na običajni občutljivosti stafilokokov (minimalna inhibitorna koncentracija (MIK) ≤ 1 mg/l).
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.
Tudi trenutne smernice Evropskega združenja za klinično mikrobiologijo in nalezljive bolezni (ESCMID1,2) in Ameriškega združenja za nalezljive bolezni (IDSA3) podpirajo vlogo vankomicina pri zdravljenju okužb z MRSA.
However, having reviewed the data presented by the MAHs, the CHMP also considered the existing limitations of monitoring Ctrough in certain situations.
Vendar je odbor CHMP po pregledu podatkov, ki so jih predstavili imetniki dovoljenja za promet z zdravilom, obravnaval tudi obstoječe omejitve za spremljanje vrednosti Ctrough v določenih okoliščinah.
• 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,
• odbor CHMP je menil, da je tveganje nefrotoksičnosti, ototoksičnosti, z infuzijo povezanih neželenih reakcij in preobčutljivostnih reakcij, ki so bile ugotovljene pri intravenski uporabi zdravil, ki vsebujejo vankomicin, mogoče zmanjšati z ustreznimi opozorili in priporočili v informacijah o zdravilu;
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.
Odbor CHMP je izpostavil, da je merjenje serumske koncentracije pred naslednjim odmerkom v stanju dinamičnega ravnovesja sprejemljiv nadomestek za preverjanje, ali je bila dosežena učinkovita izpostavljenost vankomicinu.
The CHMP also reviewed the dose recommendation in paediatric population.
Pregledal je tudi priporočila za odmerjanje pri pediatrični populaciji.
The CHMP also acknowledged that some already approved vancomycin containing medicines already include some dosing recommendations for both term and preterm neonates11.
Odbor CHMP priznava, da nekatera odobrena zdravila, ki vsebujejo vankomicin, že vključujejo nekatera priporočila za odmerjanje pri donošenih in nedonošenih novorojenčkih11.
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.
Odbor CHMP je ugotovil, da trenutne smernice za zdravljenje akutnega bakterijskega meningitisa številnih strokovnih združenj (ESCMID4, IDSA5, skupne smernice združenj specialistov v Združenem kraljestvu6 in Evropske zveze nevroloških društev (EFNS) priporočajo vankomicin za empirično in etiološko zdravljenje okužb z MRSA (v monoterapiji) in okužb s proti penicilinu odporno bakterijo Streptococcus pneumoniae (PRSP) v kombinaciji z drugimi antibiotiki pri odraslih in otrocih.
However, increases in the rates of heteroresistance and tolerance to vancomycin, combined with its pharmacodynamic (i.e. slow bactericidal activity, variable tissue penetration) and clinical (clinical failures reported in patients with invasive infections produced by Staphylococcus aureus with a MIC above 1 mcg/mL) shortcomings have questioned the current role of vancomycin for the treatment of these infections.
Vendar zvišane stopnje heterorezistence in toleranca na vankomicin v kombinaciji s farmakodinamičnimi (tj. počasna baktericidna aktivnost, različna penetracija tkiv) in kliničnimi (poročila o klinična neodzivnost pri bolnikih z invazivnimi okužbami zaradi Staphylococcus aureus z MIK nad 1 µg/ml) pomanjkljivostmi postavljajo pod vprašaj obstoječo vlogo vankomicina pri zdravljenju teh okužb.
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.
Odbor je posledično zaključil, da razmerje med koristmi in tveganji za zdravila, ki vsebujejo vankomicin in so bila zajeta v tem postopku, ostaja pozitivno pri normalnih pogojih uporabe, ob upoštevanju dogovorjenih sprememb v informacijah o zdravilu.
• 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,
• odbor CHMP je menil, da mora količina zdravilne učinkovine v končnem zdravilu dosledno temeljiti na potenci, izraženi v mednarodnih enotah (i.e.), in da je treba odmerek in jakost zdravil, ki vsebujejo vankomicin, še naprej izražati v miligramih.
Vancomycin is also administered by the oral route for the treatment of Clostridium difficile-infection (CDI).
Vankomicin se daje tudi peroralno za zdravljenje okužbe s Clostridium difficile (Clostridium difficile, CDI).
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.
Posledično odbor CHMP meni, da razmerje med koristmi in tveganji za zdravila, ki vsebujejo vankomicin, pri indikaciji „dekontaminacija prebavil pri bolnikih z oslabljenim imunskim sistemom v kombinaciji z aminoglikozidom“ ni pojasnjeno in zato indikacija ni priporočljiva.
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).
Odbor CHMP je upošteval smernice za obravnavo peritonitisa, povezanega s peritonealno dializo, pri odraslih, ki jih je pripravilo Mednarodno združenje za peritonealno dializo (ISPD) (Li PK et al., 20167) in priporočila ISPD za pediatrične bolnike (Warady BA et al., 20128).
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.
Odbor je pregledal tudi obstoječe podatke o opaženih neželenih učinkih zaradi uporabe vankomicina, ki potrjujejo, da je parenteralna uporaba vankomicina povezana z nefrotoksičnostjo in ototoksičnostjo, neželenimi učinki, povezanimi z infundiranjem, kot so toksični učinki na vene in tkiva ter preobčutljivostne reakcije.
5 IDSA: http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Guidelines/Infections_by_Organ_System/Central_Nervous_System_(CNS)/B acterial_Meningitis/
5 Ameriško združenje za infekcijske bolezni (IDSA): http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Guidelines/Infections_by_Organ_System/Central_Nervous_System_(CNS)/B acterial_Meningitis/.
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.
Vankomicin se intravensko uporablja predvsem za zdravljenje resnih okužb z mikroorganizmi, ki imajo mehanizme odpornosti proti betalaktamskim antibiotikom, zlasti okužb s proti meticilinu odporno bakterijo Staphylococcus aureus (MRSA) in koagulazno negativnim stafilokokom (KNS), ter enterokoki, pri katerih se pogosto pojavlja toleranca na betalaktamske antibiotike.
Grounds for the variation to the terms of the marketing authorisation, as applicable
Podlaga za ustrezno spremembo pogojev dovoljenja za promet z zdravilom
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)).
Odbor CHMP je med postopkom pregledal vse razpoložljive podatke, vključno z vlogami imetnikov dovoljenj za promet z zdravilom, in se posvetoval z Odborom za pediatrijo (PDCO), ustreznimi delovnimi skupinami/skupinami odbora CHMP: delovno skupino za nalezljive bolezni (IDWP), delovno skupino za farmakokinetiko (PKWP), delovno skupino za kakovost (QWP), delovno skupino za modeliranje in simulacije (MSWG) ter zunanjimi strokovnjaki (Evropskim odborom za testiranje protimikrobne občutljivosti (EUCAST)).
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.
Na koncu je Odbor menil, da razmerje med koristmi in tveganji za zdravila, ki vsebujejo vankomicin in so bila zajeta v tem postopku, ostaja pozitivno pri normalnih pogojih uporabe, ob upoštevanju dogovorjenih sprememb informacij o zdravilu, kot je določeno v Prilogi III k mnenju.
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:
Indikacije za vankomicin (peroralno) za „zdravljenje stafilokoknega enterokolitisa“ in „dekontaminacijo prebavil pri bolnikih z oslabljenim imunskim sistemom v kombinaciji z aminoglikozidom" odbor CHMP ni podprl:
8 ISPD recommendations for paediatric patients (Warady BA et al., 2012) - https://ispd.org/media/pdf/Consensus__Change_20_.pdf 9https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/fulltext_treatment_guidance_ Clostridium_difficile_infection.pdf
8 Priporočila ISPD za pediatrične bolnike (Warady BA et al., 2012) - https://ispd.org/media/pdf/Consensus__Change_20_.pdf.
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.
Glede na dejstvo, da se je v klinični praksi EU uveljavila uporaba miligramov za predpisovanje zdravila, je Odbor menil, da je bistveno, da se ohrani dogovorjeno označevanje zdravil, ki vsebujejo vankomicin, z maso, tj. miligrami.
As a consequence, the CHMP could not recommend any concrete dosing recommendations for continuous infusion in the SmPC of vancomycin for IV use.
Posledično odbor CHMP ni mogel pripraviti konkretnih priporočil za odmerjanje v obliki neprekinjenega infundiranja za povzetek glavnih značilnosti za vankomicin pri intravenozni uporabi.
• 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),
• odbor CHMP je izvedel oceno razmerja med koristmi in tveganji zdravil, ki vsebujejo vankomicin, v skladu s členom 31 Direktive 2001/83/ES, in pregledal vse razpoložljive podatke, vključno z odzivi, ki so jih med postopkom predložili imetniki dovoljenj za promet z zdravilom, in priporočili Odbora za pediatrijo (PDCO) ter ustreznih delovnih skupin odbora CHMP: delovne skupine za nalezljive bolezni (IDWP), delovne skupine za farmakokinetiko (PKWP), delovne skupine za kakovost (QWP), delovne skupine za modeliranje in simulacije (MSWG) ter zunanjih strokovnjakov (Evropskega odbora za testiranje protimikrobne občutljivosti (EUCAST);
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.
Ta omogoča napovedovanje številnih posameznih farmakokinetičnih parametrov za ekstrapolacijo, zmanjšuje število meritev pri enem bolniku in, kot kaže, omogoča razvoj optimalnih strategij za terapevtsko intervencijo.
6 Joint guideline: https://www.britishinfection.org/files/5614/5674/2938/McGill_meningitis_guidelines_Final_published_proof.pdf 7 PD-related peritonitis https://ispd.org/ispd-guidelines/ guidelines on the management of PD-related peritonitis in adults from the International Society for Peritoneal Dialysis (ISPD) (Li PK et al., 2016 http://www.pdiconnect.com/content/36/5/481.full
7 Peritonitis, povezan s peritonealno dializo https://ispd.org/ispd-guidelines/ Smernice za obravnavo peritonitisa, povezanega s peritonealno dializo pri odraslih iz Mednarodnega združenja za peritonealno dializo (ISPD) (Li PK et al., 2016 http://www.pdiconnect.com/content/36/5/481.full.
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.
Odbor je za dojenčke in otroke v starosti od enega meseca do 18 let menil, da je treba odmerek vankomicina individualno prilagoditi glede na telesno maso, starost, vrsto in resnost osnovne okužbe ter klinični odziv, kot velja za odrasle bolnike.
1 ESCMID guidelines: https://www.escmid.org/escmid_publications/medical_guidelines/escmid_guidelines/ 2 ESCMID guideline https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/Eu_Rec_Antimicrobal.pdf 3 IDSA guideline http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Guidelines/Antimicrobial_Agent_Use/Vancomycin/Vancomycin/ 4 Bacterial meningitis:ESCMID guideline for bacterial meningitis: http://www.clinicalmicrobiologyandinfection.com/article/S1198743X(16)00020-3/abstract
4 Bakterijski meningitis: Smernice ESCMID za bakterijski meningitis: http://www.clinicalmicrobiologyandinfection.com/article/S1198743X(16)00020-3/abstract.
• the CHMP considered that vancomycin represent a crucial therapeutic option in the context of the treatment of serious infections (complicated skin and soft tissue infections, bone and joint infections, community acquired pneumonia, hospital acquired pneumonia including ventilatorassociated pneumonia, infective endocarditis, acute bacterial meningitis, bacteraemia that occurs in association with, or is suspected to be associated with, any of the above, perioperative antibacterial prophylaxis, peritoneal dialysis-associated peritonitis and treatment of Clostridium difficile infection) caused by Gram-positive pathogens, particularly those caused by MRSA,
• Odbor CHMP je menil, da vankomicin predstavlja ključno terapevtsko možnost pri zdravljenju hudih okužb (zapletenih okužb kože in mehkih tkiv; okužb kosti in sklepov; zunajbolnišnične pljučnice; bolnišnično pridobljene pljučnice, vključno z ventilatorsko pljučnico; infektivnega endokarditisa, akutnega bakterijskega meningitisa; bakteriemije, ki se pojavi v povezavi s katerim koli od zgoraj navedenih stanj ali v primeru suma takšne povezave; pri perioperativni antibakterijski profilaksi, pri zdravljenju peritonitisa, povezanega s peritonealno dializo in zdravljenju okužbe s Clostridium difficile z grampozitivnimi povzročitelji, zlasti MRSA;
• Treatment of Clostridium difficile infection (CDI), for vancomycin given by oral route of administration.
• Zdravljenje okužb s Clostridium difficile z vankomicinom, uporabljenim peroralno.
• 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.
• Zdravljenje: zapletenih okužb kože in mehkih tkiv; okužb kosti in sklepov; zunajbolnišnične pljučnice; bolnišnično pridobljene pljučnice, vključno z ventilatorsko pljučnico; infektivnega endokarditisa; bakteriemije, ki se pojavi v povezavi s katerim koli od zgoraj navedenih stanj (zlasti če je povzročitelj proti meticilinu odporna bakterija Staphylococcus aureus (MRSA)) oziroma obstaja sum takšne povezave; perioperativna antibakterijska profilaksa.
It is currently made clear that TDM frequency needs to be individualised based on the clinical situation and response to treatment; specific recommendations are made for hemodynamically stable and unstable patients, patients with normal renal function and patients on intermittent haemodialysis.
Priporočila so specifična za hemodinamsko stabilne in nestabilne bolnike, bolnike z normalnim delovanjem ledvic in bolnike na intermitentni hemodializi.
The guidance provides treatment recommendations for initial and recurrent CDI.
Smernice vsebujejo priporočila za začetno zdravljenje in zdravljenje ponavljajočih se okužb s Clostridium difficile.
will enter into force, the limits of the impurities in the drug substance and final drug products will need to be revised accordingly, where applicable.
Ko začne v Evropski farmakopeji veljati monografija o vankomicinu, bo treba po potrebi ustrezno popraviti mejne vrednosti nečistoč v zdravilni učinkovini in končnih zdravilih.
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.
Odbor PDCO je potrdil, da se v nekaterih državah pri novorojenčkih (in otrocih) s hudimi okužbami (kot so okužbe centralnega živčnega sistema in/ali povezano bakteriemijo) uporablja dajanje vankomicina v obliki neprekinjenega infundiranja.
However, the CHMP noted that the 2 g/day dose often results in Ctrough values below the target of 10 to 20 mg/l; therefore in order to achieve the optimal target concentration, the CHMP agreed that 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.
Odbor je menil, da je treba za doseganje optimalne ciljne koncentracije odmerek vankomicina individualno prilagoditi glede na telesno maso, starost, vrsto in resnost osnovne okužbe ter klinični odziv.
Food enhances the absorption.
Hrana poveča absorpcijo.
Do not eat, drink or smoke while handling the product.
Ne jejte, pijte ali kadite, ko delate z zdravilom.
Renal clearance is the minor route of elimination.
Renalni očistek je manj pomembni način eliminacije.
If the tablet is not taken up voluntarily by the dog it can also be given with food or directly into the mouth.
Če pes ne vzame tablete prostovoljno, jo lahko daste tudi s hrano ali direktno v gobec.
Individual variation in Cmax and t1/2 was observed.
Opazovali so posamezno variacijo Cmax in t1/2.
Interaction with other medicinal products and other forms of interaction: None known.
Medsebojno delovanje z drugimi zdravili in druge oblike interakcij: Niso znane.
The chewable tablets should not be broken or divided.
Žvečljivih tablet ne smete drobiti ali deliti.
CONTENTS BY WEIGHT, BY VOLUME OR BY NUMBER OF DOSES
VSEBINA PO TEŽI, VOLUMNU ALI ŠTEVILU ODMERKOV
In some cases, soap and water is not sufficient to remove the product spilled on the fingers, therefore gloves must be used.
V nekaterih primerih milo in voda ne zadoščata za odstranitev zdravila, ki se je razlilo na prstih, zato je treba uporabiti rokavice.
Use with caution in dogs with pre-existing epilepsy.
Uporabljajte previdno pri psih z že obstoječo epilepsijo.