在新生儿重症监护病房的多中心队列中,阿西克洛维尔的剂量实践
Henry P Foote1, Haley Thomassy1,2, Leonardo Baquero1,2
1From the Department of Pediatrics, Duke University School of Medicine, Durham, NC.
The Pediatric infectious disease journal
|June 26, 2024
概括
新生儿简单疹病毒感染的阿西克洛维尔剂量随着时间的推移而有所改善,但仍然不一致. 许多婴儿,特别是那些出生满期的婴儿,仍然接受的剂量偏离了人群的药理动力学建议.
科学领域:
- 新生儿药理学 新生儿药理学
- 传染病治疗 传染病治疗
- 药理动力学 药理动力学
背景情况:
- 乙克洛维尔是新生儿简单疹病毒 (HSV) 感染的标准治疗方法,对于降低婴儿发病率和死亡率至关重要.
- 然而,阿西克洛维尔治疗存在毒性风险,需要精确的剂量.
- 种群药动力学 (PopPK) 分析提供了推剂量指南.
研究的目的:
- 评估新生儿重症监护室 (NICU) 发布的阿西克洛维尔剂量建议的遵守情况.
- 将当前的阿西克洛维尔剂量实践与已建立的PopPK指南进行比较.
- 评估2014年PopPK建议之前和之后的剂量实践的变化.
主要方法:
- 一项多中心队列研究分析了从1997年到2020年在NICU中的6862名婴儿的阿西克洛维尔剂量.
- 主要结局是治疗疗程的比例在每日推剂量和频率的80%-120%之间.
- 使用线性概率建模,比较了2014年PopPK建议之前和之后的剂量模式.
主要成果:
- 只有41%的治疗疗程满足了PopPK对婴儿<30周月经后年龄 (PMA) 的建议,71%为30至<36周PMA,<1%为≥36周PMA.
- 与之前相比,2014年PMA后36周以下的婴儿的剂量坚持显著改善.
- 对于婴儿≥36周PMA或当比较最近的时期 (2008-2013与2015-2020) 时,没有观察到明显的改善.
结论:
- 虽然在一些早产婴儿群体中,阿西克洛维尔剂量坚持改善了,但不推的剂量仍然很普遍.
- 最佳的剂量策略需要进一步研究,特别是对于预产婴儿.
- 持续的监测和研究对于确保新生儿安全有效的阿西克洛维尔治疗至关重要.
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