在老年重症肺炎患者中,基于模型优化teicoplanin的群体药理学和剂量优化
Sung Wook Kang1, Hyeong Geun Jo2, Donghyun Kim3
1Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea.
Journal of critical care
|August 27, 2023
概括
对于老年重症肺炎患者来说,标准的提科普拉宁剂量可能不足. 建议在这个人群中使用更高的提科普拉宁剂量 (12 mg/kg) 以获得最佳的暴露和治疗成功.
科学领域:
- 药理动力学和药理动力学
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
背景情况:
- 患有肺炎的老年重症患者存在独特的药物动力学挑战.
- 优化抗生素剂量对于有效治疗和预防耐药性至关重要.
研究的目的:
- 为了确定teicoplanin的种群药理动力学和药理动力学在老年重症肺炎患者.
- 为了确定这个患者群体最优的提科普拉宁剂量方案.
主要方法:
- 种群药动力学建模 (NONMEM) 用于分析来自15名重症老年患者的血样本.
- 用蒙特卡洛模拟计算了各种剂量策略的目标实现概率 (PTA).
- 根据肌素清除率 (CrCl) 进行了脏剂量调整.
主要成果:
- 种群的药理动力学模型显示,减少CrCl.Cl的患者的清除速度较慢,分布量较大.
- 泰科普拉宁的平均峰值和最低度分别为46.5和8.7毫克/升.
- 只有使用更高剂量方案 (12 mg/kg) 才能达到PTA≥85%,MIC高达0.5 mg/L.
结论:
- 标准的提科普拉宁剂量可能导致老年严重肺炎患者的全身暴露不足.
- 对于经验性治疗或对不太敏感的病原体,应考虑使用更高剂量的泰克托普拉宁 (12 mg/kg) 疗法.
- 基于药理学参数的个性化剂量对于优化这种脆弱人群中的提科普拉宁治疗至关重要.
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