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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
Pongchaidecha Manat (Department of Pharmacy Faculty of Pharmacy Silpakorn University Nakhon Pathom Thailand.) Changpradub Dhitiwat (Division of Infectious Diseases Department of Medicine Phramongkutklao Hospital Bangkok Thailand.) Bannalung Kanjana (Department of Pharmacy Faculty of Pharmacy Silpakorn University Nakhon Pathom Thailand.) Seejuntra Kajeewan (Department of Pharmacy Ramathibodi Chakri Naruebodindra Hospital Samutprakarn Thailand.) Thongmee Sutthanuch (Department of Pharmacy Chiraprawat Hospital Nakornsawan Thailand.) Unnual Aminta (Department of Pharmacy Faculty of Pharmacy Silpakorn University Nakhon Pathom Thailand.) Santimaleeworagun Wichai (Silpakorn University)
저널정보
대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제52권 제4호
발행연도
2020.1
수록면
573 - 582 (10page)

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Background: Currently, the achievement of the target area under the curve (AUC)/ minimum inhibitory concentration ratio during the first 24 - 48 h of treatment is associated with reduced 30-day mortality and greater microbiological eradication in patients with methicillin-resistant Staphylococcus aureus bacteremia. This study aimed to determine the AUC and pharmacokinetic parameters on the first day of vancomycin administration based on the Bayesian theorem to optimize the dosing regimen in critically ill patients. Materials and Methods: This retrospective study included participants meeting the following criteria: 1) ≥18 years old; 2) receipt of at least one dose of vancomycin; 3) measurement of 2 vancomycin serum concentrations during the first 24 h of treatment; and 4) an intensive care unit admission, mechanical ventilator use, or an Acute Physiology and Chronic Health Evaluation II score >15 points. The AUC on day 1 of treatment and the estimated vancomycin pharmacokinetic parameters were measured using PrecisePK software based on the Bayesian theorem. Results: We obtained 132 vancomycin concentrations from 66 patients. The vancomycin pharmacokinetic parameters were as follows: AUC0-24, 571.09 (± standard deviation [SD] 188.62) mg/L·h; clearance (CL), 2.97 (± SD 1.81) L/h; volume of distribution (Vd), 50.60 (± SD 13.91) L; elimination rate constant, 0.062 (± SD 0.039) h?1; and half-life, 18.19 (± SD 15.96) h. Focusing on the vancomycin loading dose, AUC0-24 400 - 600 was achieved in 41.7, 46.1, 44.4, and 26.3% of patients with loading doses of <20, 20 ? 24.9, 25 ? 30, and >30 mg/kg, respectively. Whereas AUC0-24 ≥521 was achieved in 50, 50, 77.8, and 84.2% of patients with loading doses of <20, 20 ? 24.9, 25 ? 30, and >30 mg/kg, respectively. The CL of vancomycin was correlated with creatinine CL, whereas the Vd of vancomycin was significantly correlated with age and body weight. Conclusion: This study revealed that the higher Vd and CL values on the first day of vancomycin therapy were found in critically ill patients. Additionally, a higher vancomycin loading dose (25 ? 30 mg/kg) might be required to achieve target of AUC0-24 during early phase of administration for critically ill patients.
#AUC #Clearance #Pharmacokinetic #Trough level #Volume of distribution

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참고문헌 (20)

참고문헌 신청
Turner NA / 2019 / Methicillin-resistant Staphylococcus aureus : an overview of basic and clinical research / Nat Rev Microbiol 17:203~218 google schola Hassoun A / 2017 / Incidence, prevalence, and management of MRSA bacteremia across patient populations-a review of recent developments in MRSA management and treatment / Crit Care 21:211 google schola Vestergaard M / 2019 / Antibiotic resistance and the MRSA problem / Microbiol Spectr 7 Crossref Drennan PG / 2019 / The dosing and monitoring of vancomycin : what is the best way forward / Int J Antimicrob Agents 53:401~407 google schola Avent ML / 2019 / Optimising antimicrobial therapy through the use of Bayesian dosing programs / Int J Clin Pharm 41:1121~1130 google schola

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