在门诊抗菌药物治疗中,针对连续输入万科米辛的个性化患者建模的可行性,是一项回顾性研究
J Nolan1,2, K McCarthy3,4, A Farkas5,6
1The Royal Brisbane and Women's Hospital, Herston, Australia. j.nolan@uq.edu.au.
International journal of clinical pharmacy
|August 2, 2023
概括
科米辛连续输注的贝叶斯模型表明,在门诊亲肠道抗菌药物治疗 (OPAT) 计划中优化剂量的潜力. 这种方法可能会导致更早地达到目标度,并且与标准剂量相比,潜在的不良影响更少.
科学领域:
- 药理动力学和药理动力学
- 传染性疾病 传染性疾病
- 治疗药物监测 治疗药物监测
背景情况:
- 曲线下的面积 (AUC) 与最小抑制度 (MIC) 的比率是针对抗甲素抗性黄金葡萄球菌 (MRSA) 感染的万科米辛连续输液剂量的建议参数.
- 对AUC24的个性化药理动力学-药理动力学 (PK/PD) 计算可能会比目前的治疗药物监测 (TDM) 实践提供更好的治疗剂量,旨在达到15-25 mg/L的稳定状态度 (Css).
研究的目的:
- 为了比较现实世界TDM实践与个性化,PK/PD目标参数,使用贝叶斯预测稳定状态度 (Css) 在接受连续万科米辛输液的门诊患者中.
主要方法:
- 一项回顾性,单一中心研究,涉及门诊亲肠道抗微生物疗法 (OPAT) 计划中接受万科米辛治疗MRSA感染的成年患者.
- 追溯贝叶斯剂量被建模为目标PK/PD参数,并与实际临床数据进行比较.
主要成果:
- 在15名患者中,53%的患者在住院期间实现了目标Css,而83%的患者在门诊期间实现了目标Css.
- 贝叶斯中位数AUC/MIC为613 mg·h/L,Css为25 mg/L. 急性损伤 (33%) 与较高的AUC0-24/MIC值有关.
- 贝叶斯模型表明,所需剂量减少的中位数为250 mg/24h (R2 = 0.81),达到444.8 mg·h/L的中位数AUC24/MIC和18.8 mg/L的Css.
结论:
- 贝叶斯模型可以帮助在OPAT程序中更快地和更低剂量实现目标万科米辛参数,从而有可能减少不良事件.
- 个性化的预测建模可以优化万科米辛的处方,从而比实证剂量更早地达到目标度.
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