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在新生儿和儿科外体膜氧化和连续脏替代疗法中,美罗的处置

Pavla Pokorná^1,2,3,4, Danica Michaličková¹, Dick Tibboel^2,4

¹Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, 128 00 Prague, Czech Republic.

Antibiotics (Basel, Switzerland)

|May 24, 2024

概括

身体外膜氧化 (ECMO) 不会改变新生儿和儿童的美罗的药理动力学. 连续脏替代疗法 (CRRT) 增加了美罗的分发量,需要个性化剂量以进行最佳的治疗药物监测.

科学领域:

药理学药理学是指药理学的学科.
关键护理医学关键护理医学
儿童传染病儿童传染病

背景情况:

梅罗是新生儿和儿童严重感染的关键抗生素.
身体外膜氧化 (ECMO) 和连续置换疗法 (CRRT) 是用于重症儿科患者的复杂生命支持模式.
在这些疗法中了解药物药理动力学 (PK) 对于有效治疗至关重要.

研究的目的:

评估ECMO对儿科患者梅罗PK的影响.
评估CRRT对美洛PK的影响.
为ECMO和/或CRRT患者提出优化的美罗胺剂量策略.

主要方法:

使用NONMEM V7.3.0对来自45名儿科患者的152个美罗烯血度进行的人口PK分析.
将ECMO和CRRT状态作为PK模型中的共变量纳入.
蒙特卡洛模拟以确定各种剂量方案和最小抑制度 (MIC) 的目标实现概率 (PTA).

主要成果:

体重是美罗胺分布体积 (Vd) 和清除量 (CL) 的一个显著的共同变量.
CRRT与VD的两倍增加有关;ECMO没有显著影响美罗PK.
在MIC ≤ 4 mg/L时,标准剂量实现了可接受的PTA 40% fT > MIC (美罗烯免费时间高于MIC).

结论:

在新生儿和儿童中,ECMO不会改变美洛PK.
由于CRRT显著增加了美罗Vd,因此需要调整剂量.
目前的美罗胺剂量可能不足以达到100%的fT>MIC,特别是CRRT,需要个性化剂量建议.

关键词:

蒙特卡洛模拟的蒙特卡洛模拟.孩子们的孩子们的孩子们的孩子们.持续的置换疗法治疗.身体外膜氧化氧化更多的是openemenem.新生儿们的新生儿

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