在结核病患者中监测里法辛药物:增加剂量的新证据?
M Schiuma1, M Colaneri2, D Cattaneo3
1Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy.
概括
对于结核病,标准的利芬素剂量可能不足. 治疗药物监测 (TDM) 显示,许多患者的药物暴露率低于最佳水平,这表明需要更高的剂量才能有效治疗结核病.
科学领域:
- 药理学 药理学是指药理学的学科.
- 传染性疾病 传染性疾病
- 临床药房 临床药房
背景情况:
- 对于结核病 (TB) 治疗,标准的10mg/kg里法素 (RIF) 剂量可能不足于最佳水平.
- 更高的RIF剂量可以提高微生物疗效,而不会增加不良影响.
- 治疗药物监测 (TDM) 通过测量药物度和曲线下的面积 (AUC) 来帮助优化RIF剂量.
研究的目的:
- 评估使用TDM的结核病患者标准RIF剂量的充分性.
- 通过测量C2,C4,C6,Cmax和AUC来评估RIF暴露.
- 确定是否需要调整剂量以达到目标RIF度和AUC.
主要方法:
- 对接受RIF 10 mg/kg治疗的181名结核病患者的回顾性分析.
- TDM评估了RIF C2,Cmax,AUC,以及Cmax的时间.
- 对于未达到目标Cmax (>8 mg/L) 和AUC (>67.5 mg*h/L) 的患者,调整了剂量.
主要成果:
- 中位数AUC为57.9mg*h/L,只有40.9%的患者达到目标AUC.
- 69.6%的人达到目标Cmax (>8 mg/L),但24.8%的人出现Cmax延迟.
- 在49.2%没有不良事件的患者中,RIF剂量增加到14.1mg/kg的中位数.
结论:
- 基于AUC的TDM表明,在标准剂量的显著比例的结核病患者中,RIF暴露低于最佳水平.
- 为了实现治疗目标和改善结核病治疗结果,可能需要更高的RIF剂量.
- 在结核病管理中,TDM是优化RIF剂量的宝贵工具.
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