阿米卡辛治疗药物监测:在发展中国家环境下评估治疗性能和分析技术
Nadine Arnold Steffens1, Rodrigo Redel Petreceli1, Victor Coden Azevedo2
1Graduate Program in Pharmaceutical Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
Clinical biochemistry
|January 6, 2025
概括
许多患者难以达到治疗性阿米卡辛 (AMK) 水平,增加了感染治疗失败的风险. 治疗药物监测 (TDM) 可以优化AMK剂量并改善患者的治疗结果.
科学领域:
- 药理学 药理学是指药理学的学科.
- 临床化学 临床化学
- 传染性疾病 传染性疾病
背景情况:
- 微生物感染给医疗保健带来了重大挑战.
- 治疗药物监测 (TDM) 对于优化抗微生物药物方案至关重要,特别是对于具有狭窄治疗指数的阿米卡 (AMK) 等药物.
- 在非常规的TDM环境中评估AMK度对于临床实践至关重要.
研究的目的:
- 在常规TDM设置之外的患者中评估阿米卡辛 (AMK) 血度.
- 为了比较常规临床使用的免疫测试和染色学方法的性能.
- 为了确定影响AMK治疗性能的因素.
主要方法:
- 从39名成年患者中收集高峰 (Cmax) 和低谷 (Cmin) 血样本的前景采集.
- 使用超高性能液体染色学与质谱学 (UPLC-MS/MS) 结合使用AMK度的量化.
- 使用Passing-Bablok回归和Bland-Altman分析进行光偏振免疫试验 (FPIA) 和UPLC-MS/MS的比较.
主要成果:
- 观察到AMK度的广泛变化,中位数Cmax为41.40μg/mL,中位数Cmin为1.87μg/mL.
- 治疗目标失败率很高:Cmax为83.1%,Cmin为31.7%.
- 老年患者和功能下降患者表现出不同的Cmax和Cmin目标实现模式.
结论:
- 很大一部分患者没有达到Cmax治疗目标,因此有治疗失败的风险.
- 虽然Cmin目标更频繁地实现,但建议TDM与剂量调整来提高AMK治疗的有效性.
- 需要进一步的研究,以充分优化AMK治疗药物监测.
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