Dagan O Lonsdale

Dagan O Lonsdale
St George's, University of London | SGUL · Biomedical Sciences Research Centre

About

29
Publications
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669
Citations

Publications

Publications (29)
Article
Full-text available
Background Appropriate vancomycin dosing and therapeutic monitoring is important to optimize treatment for serious Gram-positive infections. In St George's Hospital ICUs, the treatment protocol is a loading dose (<65 kg, 1000 mg; ≥65 kg, 1500 mg), followed by a continuous infusion based on creatinine clearance (CLCR). Vancomycin serum concentration...
Article
Introduction The age of patients admitted into critical care in the UK is increasing. Clinical decisions for very-old patients, usually defined as over 80, can be challenging. Clinicians are frequently asked to predict outcomes as part of discussions around the pros and cons of an intensive care unit (ICU) admission. Measures of overall health in o...
Article
Full-text available
Purpose of Review Sepsis is a leading cause of death worldwide. Groundbreaking international collaborative efforts have culminated in the widely accepted surviving sepsis guidelines, with iterative improvements in management strategies and definitions providing important advances in care for patients. Key to the diagnosis of sepsis is identificatio...
Conference Paper
Full-text available
Background Appropriate vancomycin dosing and therapeutic monitoring is important to optimise treatment. In St George’s Hospital ICUs, non-renal replacement patients receive a loading dose (<65 kg, 1000 mg; ≥65 kg, 1500 mg), alongside a maintenance continuous infusion based on creatinine clearance (CrCl) and daily serum levels (target therapeutic r...
Article
Full-text available
SARS‐CoV‐2 viral loads change rapidly following symptom onset so to assess antivirals it is important to understand the natural history and patient factors influencing this. We undertook an individual patient‐level meta‐analysis of SARS‐CoV‐2 viral dynamics in humans to describe viral dynamics and estimate the effects of antivirals used to‐date. Th...
Article
Full-text available
Introduction: Sepsis from bacterial infection remains a significant cause of morbidity and mortality. Antibiotic use continues to increase in the community and secondary care. This is driven by the potential benefits to the individual patient of a course of antibiotics. Far less attention is given to the potential adverse effects of antibiotic use...
Article
Full-text available
Sepsis secondary to bacterial infection remains a significant cause of morbidity and mortality globally. Recent decades have seen the evolution of international collaborations to improve care for these patients and identify areas for research. In this article we discuss the pathophysiology underlying the condition, review the current recommended ma...
Article
Background The pharmacokinetics of β-lactam antibiotics in critical illness remain poorly characterized, particularly in neonates, children and the elderly. We undertook a pharmacokinetic study of commonly used β-lactam antibiotics in critically ill patients of all ages. The aims were to produce a whole-life β-lactam pharmacokinetic model and desc...
Preprint
Full-text available
Background: SARS-CoV-2 viral loads change rapidly following symptom onset so to assess antivirals it is important to understand the natural history and patient factors influencing this. We undertook an individual patient-level meta-analysis of SARS-CoV-2 viral dynamics in humans to describe viral dynamics and estimate the effects of antivirals used...
Article
Full-text available
Variation in response to biologic therapy for inflammatory diseases, such as psoriasis, is partly driven by variation in drug exposure. Real‐world psoriasis data were used to develop a pharmacokinetic/pharmacodynamic (PK/PD) model for the first‐line therapeutic antibody ustekinumab. The impact of differing dosing strategies on response was explored...
Article
Full-text available
Variation in response to biologic therapy for inflammatory diseases, such as psoriasis, is partly driven by variation in drug exposure. Real‐world psoriasis data were used to develop a pharmacokinetic/pharmacodynamic (PK/PD) model for the first‐line therapeutic antibody ustekinumab. The impact of differing dosing strategies on response was explored...
Article
Dosing of amoxicillin-clavulanic acid in critical illness is difficult as β-lactam pharmacokinetics are altered by physiological changes and therapies initiated in the intensive care unit such as renal replacement therapy (RRT). Successful treatment relies on sustaining a free antibiotic concentration above the minimum inhibitory concentration of t...
Article
Aims: Beta-lactam dose optimisation in critical care is a current priority. We aimed to review the PK of three commonly used beta-lactams (amoxicillin+/-clavulanate, piperacillin-tazobactam and meropenem) to compare PK parameters reported in critically and non-critically ill neonates, children and adults, and to investigate whether allometric and...
Article
Aims: Prescribing is a complex skill required of doctors and, increasingly, other healthcare professionals. Use of a personal formulary can help to develop this skill. In 2006-9, we developed a core list of the 100 most commonly prescribed drugs. Our aim in the present study was to update this 'starter formulary' to ensure its continued relevance...
Poster
Full-text available
Background: Clinical pharmacology is a medical specialty focusing on the safe, effective use of medicines and is essential for UK healthcare 1. However confusion around the role of clinical pharmacologists in the NHS is perceived to affect recruitment to the specialty 2 and limit its clinical contribution. Clinical pharmacologists have particular e...
Article
Introduction Respiratory infection is a common cause of severe sepsis.¹ Current therapeutic guidelines emphasise the importance of early initiation of antibiotic therapy, but make no recommendations on dose. Recent studies have suggested that some critically ill patients fail to achieve sufficient plasma antibiotic concentrations to treat infection...
Article
Full-text available
BACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and inhospital mortality. We hypothesised that urgent surger...
Article
Full-text available
BACKGROUND: Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE: Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surg...
Book
Full-text available
Prescribing Scenarios at a Glance is an innovative resource which allows medical students and junior doctors to practise prescribing skills safely for themselves. Supporting those who wish to develop their prescribing knowledge and clinical reasoning, this book features 50 acute and on call scenarios in a hospital setting. Users will be able to pra...
Book
Full-text available
Prescribing for the first time is a nerve-wracking experience. Of all the tasks performed by new doctors, it is probably the one with greatest direct impact on the wellbeing of patients. Safe and effective practice rests on a good understanding of both clinical pharmacology and practical prescribing. Acquiring this is not easy, particularly when fa...
Article
Ageing alters drug handling by the body (pharmacokinetics) and response to medications (pharmacodynamics). Multiple comorbidities increase the risk of adverse drug reactions and medication burden, with increased potential for drug interactions. Elderly people are seldom included in clinical trials, so underestimation of benefits and overestimation...
Article
This report illustrates the difficulty in managing CNS infection in neurosurgical patients, the altered drug pharmacokinetics associated with critical illness, and the role that therapeutic drug monitoring (TDM) of CSF can play in assisting clinical decision making. The authors present a case of external ventricular drain–related ventriculitis in a...
Article
Full-text available
Background Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfi rmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after no...
Article
Full-text available
A 66-year-old woman presented with progressive exertional dyspnoea, productive cough and dysphonia, particularly when singing; she also experienced a dry obstructed nose, sore mouth and mild dysphagia. She had previously been diagnosed with autoimmune disease affecting her eyes, nasal passages, oropharynx and …

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