在接受连续脏替代治疗的重症儿童和年轻成年人中Cefepime的药理动力学
Kathryn Pavia1,2, H Rhodes Hambrick2,3, Kelli Paice1,2
1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
The Journal of antimicrobial chemotherapy
|July 19, 2023
概括
在接受连续脏替代疗法 (CKRT) 的重症儿童中使用Cefepime的剂量需要仔细考虑. 虽然标准剂量达到对某些细菌的目标,但更高的目标往往被错过,这表明需要精确的剂量.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 药理动力学和药理动力学
- 传染病管理 传染病管理
背景情况:
- 塞菲皮姆是治疗重症儿童败血症的关键抗生素.
- 脏排泄是塞费皮姆的主要排泄途径.
- 对于患有功能障碍或接受连续置换疗法 (CKRT) 的儿科患者,需要调整剂量.
研究的目的:
- 在接受CKRT的重症儿科患者中描述cefepime的药理动力学 (PK) 概况.
- 评估Cefepime在这个特定患者群体中的目标实现.
主要方法:
- 一项针对β-乳糖抗生素的药理动力学/药理动力学 (PK/PD) 研究确定了符合条件的患者.
- 包括儿童患者在CKRT至少24小时,他们至少接受了两剂塞费皮姆.
- 使用贝叶斯估计与儿科人口PK模型 (MwPharm++) 来确定PK参数.
- 目标达到被定义为自由塞费皮姆度超过最小抑制度 (MIC) 的时间.
主要成果:
- 分析了7名儿科患者 (2-20岁),CKRT适用于功能衰竭,肝功能衰竭或液体过载.
- 废水流速有所不同,但cefepime清除率和MIC以上的时间 (T>MIC) 与以前发表的儿科数据相比较.
- 所有患者在1xMIC时实现了针对Pseudomonas aeruginosa的100%T>MIC,但只有一个患者在4xMIC时达到100%T>MIC.
结论:
- 大多数接受CKRT的重症儿科患者没有达到100%自由塞费皮姆度超过4倍MIC的严格目标.
- 基于模型的精确剂量策略可能有利于优化这种脆弱人群的塞费皮姆治疗.
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