在老年患者中,提科普拉宁与万科米辛的对比安全性:一项倾向匹配的多中心研究
Jionghe Wu1, Tingting Liu1, Peng Na2
1Department of Pulmonary and Critical Care Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China.
概括
对老年患者来说,茶叶素更安全.
科学领域:
- 临床药理学 临床药理学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 传染性疾病 传染性疾病
背景情况:
- 范科米辛是一种常见的抗生素,但可能导致脏损伤.
- 老年患者特别容易受到万科米辛诱导的毒性.
- 泰科普拉宁是一种替代性糖类抗生素,具有潜在的更好的安全性.
研究的目的:
- 在老年患者中比较teicoplanin与vancomycin的毒性.
- 调查teicoplanin最低度和脏损伤之间的关系.
- 确定与提科普拉宁相关的毒性风险因素.
主要方法:
- 倾向性得分匹配 (PSM) 用于在老年患者中比较teicoplanin和vancomycin.
- 进行了平均稳定状态最低度 (Cmin,ss) 的动态监测.
- 多变量分析确定了与teicoplanin相关的神经毒性的独立风险因素.
主要成果:
- 泰科普拉宁在PSM后显示出明显较低的毒性率 (16.13%) 与范科米辛 (32.26%) 相比.
- 暴露持续时间和基线肌素是teicoplanin nefrotoxicity的独立风险因素.
- 泰科普拉宁Cmin,ss <40 mg/L与可管理的毒性风险有关.
结论:
- 在老年人中,泰科普拉宁提供了优越的脏安全性,而不是万科米辛.
- 保持提科普拉宁Cmin,ss低于40 mg/L对于最小化毒性至关重要.
- 在临床决策中,应考虑对提科普拉宁治疗的暴露时间和基线肌素.
相关概念视频
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
238
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
238
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
197
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
197
01:22Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
229
As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
229
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
232
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
232
01:15Drug Dosing: Geriatric Patients
228
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
228
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
271
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
271