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Sakurai N, Kawaguchi H, Kuwabara G, Imoto W, Shibata W, Yamada K, Nakamura Y, Kakeya H. Body Mass Index of Elderly Patients with Normal Renal Function as a Determining Factor for Initial Vancomycin Regimen Designing. Chemotherapy 2022; 67:193-200. [PMID: 35134801 DOI: 10.1159/000522455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Currently, the use of actual body weight is recommended for dosing in vancomycin regimen designs and it is important to perform therapeutic drug monitoring for efficacy and safety. However, the method to determine the appropriate vancomycin regimen for underweight or obese patients remains controversial. The aim of this study was to evaluate the impact of body mass index (BMI) on the relationship among vancomycin doses, trough concentration, and area under the curve (AUC). In addition, we identified the group of patients who were potentially more affected by BMI and evaluated the optimal dosing regimen to achieve the target AUC. METHODS We retrospectively collected data from 462 patients who received vancomycin at the Osaka City University Hospital between January 2013 and September 2019. Patients were classified by their BMI group (underweight < 18.5, normal weight 18.5-25.0, and obese ≥ 25.0 kg/m2). We assessed the association between vancomycin dose versus trough concentration or AUC as well as dose-adjusted trough concentration and AUC in each BMI subgroup to determine the doses for achieving the target AUC. RESULTS The dose-adjusted trough concentration and AUC in elderly patients with normal renal function appeared to increase significantly with an increase in BMI (P < 0.05). Vancomycin doses that enabled the achievement of AUC400 in elderly patients with normal renal function decreased with increasing BMI: 17.7, 15.8, and 12.9 mg/kg per time in the underweight, normal weight, and obesity groups, respectively (P < 0.05). CONCLUSION Elderly patients with normal renal function were the most affected by BMI on vancomycin trough concentration and AUC. The vancomycin regimen design in these patients should be adjusted carefully, not only based on the patient's renal function but also based on BMI.
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Affiliation(s)
- Norihiro Sakurai
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Osaka, Japan,
- Department of Infection Control, Osaka City University Hospital, Osaka, Japan,
| | - Hiroshi Kawaguchi
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Quality and Safety Management, Osaka City University Hospital, Osaka, Japan
| | - Gaku Kuwabara
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Waki Imoto
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Infection Control, Osaka City University Hospital, Osaka, Japan
| | - Wataru Shibata
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Infection Control, Osaka City University Hospital, Osaka, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Infection Control, Osaka City University Hospital, Osaka, Japan
| | - Yasutaka Nakamura
- Department of Pharmacy, Osaka City University Hospital, Osaka, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Infection Control, Osaka City University Hospital, Osaka, Japan
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Huang Y, Yang J, Xie J, Liu L, Liu S, Guo F, Qiu H, Yang Y. Association Between Pathophysiology and Volume of Distribution Among Patients With Sepsis or Septic Shock Treated With Imipenem: A Prospective Cohort Study. J Infect Dis 2021; 221:S272-S278. [PMID: 32176787 DOI: 10.1093/infdis/jiz651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study was performed to explore the apparent volume of distribution (Vd) of imipenem in patients with sepsis or septic shock. METHODS A prospective, observational, single-center study was conducted in patients with sepsis or septic shock. The patients were treated with 1 g of imipenem mixed with 200 mL of normal saline infused intravenously over a 3-hour period at 8-hour intervals. The concentration of imipenem was 5 mg/mL, and the rate of infusion was 5.5 mg/min. Blood samples for measuring imipenem serum concentrations with high-performance liquid chromatography were obtained before and at 0, 1, 2, 3, and 5 hours after drug infusion on study days 1 and 3. Pharmacokinetic parameters were calculated according to a noncompartment model. RESULTS A total of 25 adult patients were enrolled in this study, of whom 15 were diagnosed with sepsis and 10 with septic shock. The initial Vd (Vc) of imipenem was significantly lower in the sepsis than that in the septic shock group (mean [standard deviation], 26.5 [7.1] vs 40.7 [11.0] L; P = .001). The Vc of imipenem was significantly related to serum albumin levels (r = -0.517; P = .008) as well as Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (r = 0.606; P = .001). Multivariate linear regression identified serum albumin levels and APACHE II scores on day 1 as independent factors influencing the Vc of imipenem (P < .05). The difference in Vd between the imipenem steady state and the initial state was significantly higher in nonsurvivors than in survivors (mean [standard deviation], 1.7 [21.5] vs -13.1 [11.4] L; P = .046). CONCLUSIONS APACHE II scores and serum albumin levels were found in this study to be independent factors that may affect the Vc of imipenem in patients with sepsis or septic shock. CLINICAL TRIALS REGISTRATION clinicaltrials.gov, NCT03308214.
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Affiliation(s)
- Yingzi Huang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jie Yang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jianfeng Xie
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ling Liu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Songqiao Liu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Fengmei Guo
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yi Yang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Pan Y, He X, Yao X, Yang X, Wang F, Ding X, Wang W. The effect of body mass index and creatinine clearance on serum trough concentration of vancomycin in adult patients. BMC Infect Dis 2020; 20:341. [PMID: 32404057 PMCID: PMC7218520 DOI: 10.1186/s12879-020-05067-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to evaluate the influence of patient body mass index (BMI) and estimated creatinine clearance (CrCl) on serum vancomycin concentrations to define a possible optimal dosage regimen in overweight patients based on data obtained during therapeutic drug monitoring. Methods This retrospective study used data collected from January 2017 to January 2019. Adult patients (n = 204) received vancomycin treatment at a dose of 1000 mg every 12 h and underwent serum monitoring. Data collected included patient disease category, sex, age, height, weight, vancomycin concentrations, and serum creatinine. The CrCl values were estimated using the Cockcroft-Gault formula. In this study, statistical comparisons were performed on the results of patients according to serum vancomycin concentration. Results Serum vancomycin concentration was significantly related to BMI (P < 0.001) and CrCl (P < 0.05) in adult patients. Furthermore, the trough serum vancomycin concentration showed a logarithmic correlation with BMI (R = − 0.5108, 95% CI: − 0.6082 to − 0.3982, P < 0.001) and CrCl (R = − 0.5739, 95% CI: − 0.6616 to − 0.4707, P < 0.001). The multivariate analysis showed that BMI and CrCl are independent contributors to the trough vancomycin concentration. Moreover, some of the patients with higher BMI (≥ 24 kg/m2) met the goal trough concentration after an adjustment from 1000 mg every 12 h to 1000 mg every 8 h. Conclusions Serum vancomycin concentration decreases progressively with increasing BMI and the augmentation in CrCl in adult patients. The trough concentration of vancomycin should be continuously monitored for patients with a BMI ≥ 24 kg/m2, and the dosage regimen should be adjusted to reach the target trough concentration in these patients to reduce the impact of BMI.
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Affiliation(s)
- Yuyan Pan
- Department of Pharmacy, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China
| | - Xiaomei He
- Department of Pharmacy, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China
| | - Xinyu Yao
- Department of Gastroenterology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213000, China
| | - Xiaofeng Yang
- Department of neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Fengjiao Wang
- Department of Pharmacy, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Xinyuan Ding
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, 215000, China.
| | - Wenjuan Wang
- Department of Pharmacy, Children's Hospital of Soochow University, Suzhou, 215000, China.
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Population Pharmacokinetic Analyses for Arbekacin after Administration of ME1100 Inhalation Solution. Antimicrob Agents Chemother 2019; 63:AAC.00267-19. [PMID: 31182524 DOI: 10.1128/aac.00267-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/01/2019] [Indexed: 11/20/2022] Open
Abstract
ME1100, an inhalation solution of arbekacin, an aminoglycoside, is being developed for the treatment of hospital-acquired and ventilator-associated bacterial pneumonia. The objective of these analyses was to develop a population pharmacokinetic model to describe the arbekacin concentration-time profile in plasma and epithelial lining fluid (ELF) following ME1100 administration. Data were obtained from a postmarketing study for an intravenous (i.v.) formulation of arbekacin, a phase 1 study of ME1100 in healthy volunteers, and a phase 1b study of ME1100 in mechanically ventilated subjects with bacterial pneumonia. Data from the postmarketing study were utilized to develop a population pharmacokinetic model following i.v. administration, and this model was subsequently utilized as the foundation for development of the model characterizing arbekacin disposition following inhalation of ME1100. The final model utilized two compartments for both plasma and ELF disposition, with movement of arbekacin between the ELF and plasma parameterized using linear first-order rate constants. A bioavailability term was included for the inhalational route of administration, which was estimated to be 19.5% for a typical subject. The model included normalized creatinine clearance (CLcrn) and weight as covariates on arbekacin clearance: CL = (weight/52.2)0.855·[(CLcrn-77)·0.0289 + 2.32]. The model simultaneously described arbekacin concentrations following both i.v. and inhaled administration and provided acceptable fits to the plasma and ELF data (r 2 of 0.922 and 0.557 for observed versus fitted concentrations, respectively). The developed model will be useful for conducting future analyses to support ME1100 dose selection.
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Abstract
BACKGROUND Arbekacin (ABK) is used to treat infections caused by methicillin-resistant Staphylococcus aureus and is used widely for the treatment of febrile neutropenia (FN). As ABK has a narrow therapeutic concentration window, the dosage must be adjusted via therapeutic drug monitoring. However, the influence of the physiology of patients with FN on the pharmacokinetic (PK) parameters of ABK remains unclear. Therefore, we examined this influence on ABK PK parameters. METHOD We performed a retrospective cohort study using data from patients with a hematologic malignancy who were ≥18 years and had been administered ABK. We excluded patients who did not receive therapeutic drug monitoring and had an estimated glomerular filtration rate (eGFR) of <30 mL/min, because clinically sufficient data would not be available. RESULT Of the 99 enrolled patients, 25 did not have FN and 74 had FN. Arbekacin clearance (CLabk) was shown to correlate with eGFR in patients with FN (r = 0.32, P = 0.0062) and without FN (r = 0.50, P = 0.01). CLabk was higher in patients with FN than in those without FN. In addition, in the eGFR of <100 mL/min group (normal renal function), CLabk and CLabk/eGFR were also higher in patients with FN than in those without FN. CONCLUSIONS CLabk was increased in patients with FN and normal renal function; therefore, we propose an increased ABK dose for patients with FN and normal renal function.
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Okada A, Kariya M, Irie K, Okada Y, Hiramoto N, Hashimoto H, Kajioka R, Maruyama C, Kasai H, Hamori M, Nishimura A, Shibata N, Fukushima K, Sugioka N. Population Pharmacokinetics of Vancomycin in Patients Undergoing Allogeneic Hematopoietic Stem-Cell Transplantation. J Clin Pharmacol 2018; 58:1140-1149. [DOI: 10.1002/jcph.1106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/25/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Akira Okada
- Department of Clinical Pharmacokinetics; Faculty of Pharmaceutical Sciences; Kobe Gakuin University; Chuo-ku Kobe Japan
| | - Misato Kariya
- Department of Hospital Pharmacy; Kobe Minimally Invasive Cancer Center; Chuo-ku; Kobe Japan
- Department of Hospital Pharmacy; Institute of Biomedical Research and Innovation Hospital; Chuo-ku; Kobe Japan
| | - Kei Irie
- Department of Hospital Pharmacy; Institute of Biomedical Research and Innovation Hospital; Chuo-ku; Kobe Japan
| | - Yutaka Okada
- Department of Hospital Pharmacy; Institute of Biomedical Research and Innovation Hospital; Chuo-ku; Kobe Japan
| | - Nobuhiro Hiramoto
- Department of Cell Therapy; Institute of Biomedical Research and Innovation Hospital; Chuo-ku; Kobe Japan
| | - Hisako Hashimoto
- Department of Cell Therapy; Institute of Biomedical Research and Innovation Hospital; Chuo-ku; Kobe Japan
| | - Ryosuke Kajioka
- Department of Clinical Pharmacokinetics; Faculty of Pharmaceutical Sciences; Kobe Gakuin University; Chuo-ku Kobe Japan
| | - Chika Maruyama
- Department of Clinical Pharmacokinetics; Faculty of Pharmaceutical Sciences; Kobe Gakuin University; Chuo-ku Kobe Japan
| | | | - Mami Hamori
- Depertment of Biopharmaceutics; Faculty of Pharmaceutical Science; Doshisha Women's College of Liberal Arts; Kyo-tanabe Kyoto Japan
| | - Asako Nishimura
- Depertment of Biopharmaceutics; Faculty of Pharmaceutical Science; Doshisha Women's College of Liberal Arts; Kyo-tanabe Kyoto Japan
| | - Nobuhito Shibata
- Depertment of Biopharmaceutics; Faculty of Pharmaceutical Science; Doshisha Women's College of Liberal Arts; Kyo-tanabe Kyoto Japan
| | - Keizo Fukushima
- Department of Clinical Pharmacokinetics; Faculty of Pharmaceutical Sciences; Kobe Gakuin University; Chuo-ku Kobe Japan
| | - Nobuyuki Sugioka
- Department of Clinical Pharmacokinetics; Faculty of Pharmaceutical Sciences; Kobe Gakuin University; Chuo-ku Kobe Japan
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Hagihara M, Kato H, Hamada Y, Hirai J, Sakanashi D, Suematsu H, Nishiyama N, Koizumi Y, Yamagishi Y, Matsuura K, Mikamo H. Population pharmacokinetics of arbekacin in different infectious disease settings and evaluation of dosing regimens. J Infect Chemother 2016; 22:436-43. [PMID: 27260679 DOI: 10.1016/j.jiac.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/05/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022]
Abstract
The efficacy of arbekacin in patients with MRSA infections is influenced by the peak concentration (Cpeak)/MIC ratio (≧8). A daily arbekacin dose of 4-6 mg/kg is primarily used for the treatment of MRSA infection. However, clinical pharmacokinetic studies of arbekacin that evaluate changes in patients with different infectious diseases have been limited. This study was to evaluate the pharmacokinetics of arbekacin in different infectious diseases and to evaluate its dosing regimens. This work describes a single-centre, retrospective study. The pharmacokinetic parameters of arbekacin were calculated from individual serum-concentration data using WinNonlin ver. 6.3. A total of 331 serum samples were obtained from 170 patients. Our drug concentration-time data were well described by a two-compartment open model. The final model showed that drug clearance was related to creatinine clearance and that the total distribution volume (Vd) was related to actual body weight and the presence of bacteremia. The individual Vd in bacteremia patients was significantly higher than those of other patients (bacteremia: 29.7 ± 0.5 L, pneumonia: 20.8 ± 0.4 L, other infections: 21.4 ± 0.4 L; p < 0.05). Additionally, Monte Carlo simulation showed that target (Cpeak/MIC ≧ 8) attainment was only 10.1%, even at a dose of 6 mg/kg, especially for MRSA bacteremia patients with an arbekacin MIC = 2 μg/mL. In conclusion, our study revealed that the Vd may be higher in bacteremia patients than in patients with other infectious diseases. Therefore, an increase in the daily dose of arbekacin should be considered for bacteremia patients.
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Affiliation(s)
- Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Yukihiro Hamada
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Naoya Nishiyama
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Katsuhiko Matsuura
- Department of Pharmacy, Aichi Medical University School of Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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Couffignal C, Pajot O, Laouénan C, Burdet C, Foucrier A, Wolff M, Armand-Lefevre L, Mentré F, Massias L. Population pharmacokinetics of imipenem in critically ill patients with suspected ventilator-associated pneumonia and evaluation of dosage regimens. Br J Clin Pharmacol 2015; 78:1022-34. [PMID: 24903189 DOI: 10.1111/bcp.12435] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/30/2014] [Indexed: 11/29/2022] Open
Abstract
AIMS Significant alterations in the pharmacokinetics (PK) of antimicrobials have been reported in critically ill patients. We describe PK parameters of imipenem in intensive care unit (ICU) patients with suspected ventilator-associated pneumonia and evaluate several dosage regimens. METHODS This French multicentre, prospective, open-label study was conducted in ICU patients with a presumptive diagnosis of ventilator-associated pneumonia caused by Gram-negative bacilli, who empirically received imipenem intravenously every 8 h. Plasma imipenem concentrations were measured during the fourth imipenem infusion using six samples (trough, 0.5, 1, 2, 5 and 8 h). Data were analysed with a population approach using the stochastic approximation expectation maximization algorithm in Monolix 4.2. A Monte Carlo simulation was performed to evaluate the following six dosage regimens: 500, 750 or 1000 mg with administration every 6 or 8 h. The pharmacodynamic target was defined as the probability of achieving a fractional time above the minimal inhibitory concentration (MIC) of >40%. RESULTS Fifty-one patients were included in the PK analysis. Imipenem concentration data were best described by a two-compartment model with three covariates (creatinine clearance, total bodyweight and serum albumin). Estimated clearance (between-subject variability) was 13.2 l h(-1) (38%) and estimated central volume 20.4 l (31%). At an MIC of 4 μg ml(-1) , the probability of achieving 40% fractional time > MIC was 91.8% for 0.5 h infusions of 750 mg every 6 h, 86.0% for 1000 mg every 8 h and 96.9% for 1000 mg every 6 h. CONCLUSIONS This population PK model accurately estimated imipenem concentrations in ICU patients. The simulation showed that for these patients, the best dosage regimen of imipenem is 750 mg every 6 h and not 1000 mg every 8 h.
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Affiliation(s)
- Camille Couffignal
- AP-HP, Hop Bichat, Biostatistics Department, Paris, France; IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France; IAME, UMR 1137, INSERM, F-75018, Paris, France
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Pharmacokinetics of arbekacin in bronchial epithelial lining fluid of healthy volunteers. J Infect Chemother 2014; 20:607-11. [PMID: 24973909 DOI: 10.1016/j.jiac.2014.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Arbekacin is a unique aminoglycoside antibiotic with anti-methicillin-resistant Staphylococcus aureus activity. The efficacy of aminoglycosides is related to their serum maximum concentration. Local concentration of antibiotics in pulmonary epithelial lining fluid, rather than its serum concentration, can help determine its clinical efficacy more precisely for treatment of respiratory infectious disease. The objective of this study was to sequentially measure arbekacin concentration in epithelial lining fluid after infusion of a single clinically available dose. METHOD After the initial blood sampling, arbekacin was intravenously infused into 6 healthy volunteers over 1 h. Epithelial lining fluid and serum samples were collected by bronchoscopic microsampling 1, 1.5, 2, 2.5, 3, 4, 5, and 6 h after the start of 200 mg arbekacin infusion. RESULTS Each probe sampled 10.1 ± 5.2 μl bronchial epithelial lining fluid. The sample dilution factor was 266.7 ± 157.1. Drug concentration was successfully measured in all but 2 of the epithelial lining fluid samples. The maximum concentration of arbekacin in epithelial lining fluid and serum was 10.4 ± 1.9 μg/ml and 26.0 ± 12.2 μg/ml, respectively. The ratio of the maximum drug concentration in the epithelial lining fluid to that in the serum was 0.47 ± 0.19. CONCLUSIONS The maximum concentration of epithelial lining fluid reached levels that would effectively treat most clinical strains of methicillin-resistant S. aureus.
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Okada K, Kimura T, Mikamo H, Kasahara K, Seki M, Takakura S, Tokimatsu I, Ohmagari N, Takahashi Y, Matsumoto K, Igarashi M, Kobayashi M, Hamada Y, Mochizuki T, Kimura M, Nishi Y, Tanigawara Y, Takesue Y. Clinical practice guidelines for therapeutic drug monitoring of arbekacin: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Infect Chemother 2013; 20:1-5. [PMID: 24486168 DOI: 10.1016/j.jiac.2013.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/02/2013] [Accepted: 08/07/2013] [Indexed: 11/27/2022]
Abstract
Arbekacin (ABK) was approved and widely used in Japan for treatment of patients infected with MRSA, and TDM was introduced in clinical practice. The Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring decided to develop a clinical practice guidelines for TDM of ABK for the following reasons. First, although the daily dose of 150-200 mg was approved in Japan, recent PK-PD studies revealed that higher serum concentration is required to achieve better clinical efficacy and several findings concerning the usefulness of higher dosage regimen have obtained recently. Second, although maximal concentrations that obtained immediately after the end of administration (Cmax) was generally adopted, the serum concentration at 1 h after initiation of administration [peak serum concentration (Cpeak)] proved to be more suitable as an efficacy indicator of aminoglycosides. Lastly, as ABK is approved only in Japan, no international practice guideline for TDM has not been available in ABK to date. This guideline evaluated the scientific data associated with serum ABK monitoring and provided recommendations based on the available evidence. Potential limitations of this guideline, however, include the findings that few prospective clinical trials of TDM of ABK are available in the treatment of MRSA infections and that most of the published literature describes observational studies.
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Affiliation(s)
- Kenji Okada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Hiroshige Mikamo
- Department of Infection Control and Prevention, Aichi Medical University, Graduate School of Medicine, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Masafumi Seki
- Division of Infection Control and Prevention, Osaka University Medical Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Shunji Takakura
- Department of Infection Control and Prevention, Kyoto University Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Issei Tokimatsu
- Internal Medicine II, Oita University Faculty of Medicine, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo Medical College Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Kazuaki Matsumoto
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan
| | - Masahiro Igarashi
- Department of Pharmacy, Toranomon Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Masahiro Kobayashi
- Department of Pharmacy, Kitasato University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yukihiro Hamada
- Department of Infection Control and Prevention, Aichi Medical University, Graduate School of Medicine, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Takahiro Mochizuki
- Department of Pharmacy, Shizuoka Cancer Center, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Masao Kimura
- Department of Pharmacy, Aichi Medical University Hospital, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yoshifumi Nishi
- Department of Pharmacy, Kyorin University School of Medicine, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yusuke Tanigawara
- Keio University, School of Medicine, Department of Clinical Pharmacokinetics and Pharmacodynamics, Japan; Sectional Committee of Practice Guidelines for TDM; Antimicrobial Agents, The Japanese Society of Therapeutic Drug Monitoring, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo Medical College Hospital, Japan; Committee of Practice Guidelines for TDM of Antimicrobial Agents, Japanese Society of Chemotherapy, Japan.
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Breaud AR, Henemyre-Harris CL, Schools S, Emezienna N, Clarke W. Rapid quantification of the aminoglycoside arbekacin in serum using high performance liquid chromatography–tandem mass spectrometry. Clin Chim Acta 2013; 418:102-6. [DOI: 10.1016/j.cca.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
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12
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Yamamoto Y, Izumikawa K, Hashiguchi K, Fukuda Y, Kobayashi T, Kondo A, Inoue Y, Morinaga Y, Nakamura S, Imamura Y, Miyazaki T, Kakeya H, Yanagihara K, Kohno S. The efficacy and safety of high-dose arbekacin sulfate therapy (once-daily treatment) in patients with MRSA infection. J Infect Chemother 2012; 18:241-6. [PMID: 22398881 DOI: 10.1007/s10156-012-0397-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
The efficacy and safety of once-daily high-dose arbekacin sulfate therapy for methicillin-resistant Staphylococcus aureus (MRSA) infection were evaluated, with analysis of their relationship to blood drug levels. The study was conducted in patients with pneumonia or sepsis, the cause of which was suspected to be MRSA, who were admitted to the Nagasaki University Hospital or its affiliated hospitals between January 2009 and December 2010. The initial drug dose was set at a level expected to yield the goal peak of 20 μg/ml and a trough level of less than 2 μg/ml, using the Habekacin Therapeutic Drug Monitoring analysis software. Thirteen patients were enrolled: 10 patients had pneumonia and 3 patients had sepsis. Patient mean age was 72.0 years; mean initial drug dose was 269.2 mg. Clinical efficacy at completion of treatment and bacterial eradication-reduction were achieved in 66.7% (6/9) and 62.5% (5/8) of patients, respectively. Incidence of adverse reactions was 38.5% (5/13). In analysis of efficacy in relationship to serum drug levels, the peak drug level was 22.7 ± 5.50 μg/ml, on average, and 15 μg/ml or higher in all 6 responders. Also, in patients with renal dysfunction, it seemed to be essential to ensure a certain peak drug level and to control the trough level appropriately. Although the number of patients was limited, once-daily high-dose arbekacin sulfate therapy may be highly effective, without posing any major safety problems. Further larger-scale studies are needed.
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Affiliation(s)
- Yoshihiro Yamamoto
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Hagihara M, Umemura T, Mori T, Mikamo H. Daptomycin approved in Japan for the treatment of methicillin-resistant Staphylococcus aureus. Ther Clin Risk Manag 2012; 8:79-86. [PMID: 22368449 PMCID: PMC3284219 DOI: 10.2147/tcrm.s23875] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Daptomycin is a lipoglycopeptide antibacterial drug that is rapidly bactericidal for methicillin-resistant Staphylococcus aureus (MRSA) infection and has antibiotic activity against a wide range of Gram-positive organisms. It has been approved by the Ministry of Health, Labor and Welfare in Japan for the treatment for bacteremia, right-sided endocarditis, and skin and skin-structure infections, such as necrotizing fasciitis, due to MRSA on the basis of a Phase III trial conducted in Japan since July, 2011. In Japanese Phase I and III trials, daptomycin therapy given at 4 mg/kg and 6 mg/kg once per day was well tolerated and effective as standard therapy for the treatment of acute bacterial skin and skin-structure infections and bacteremia caused by MRSA, but side effects remain to be evaluated in large-scale trials.
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Affiliation(s)
- Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
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Morita K. [Optimization of antimicrobial therapy based on therapeutic drug monitoring]. YAKUGAKU ZASSHI 2011; 131:1407-13. [PMID: 21963966 DOI: 10.1248/yakushi.131.1407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, the pharmacokinetic (PK)-pharmacodynamic (PD) theory draws attention in the therapy of the infectious disease. Although the theory was only introduced into the field of antimicrobial therapy several years ago, the foundation was in the individualization of administering design by therapeutic drug monitoring (TDM) begun 30 years ago. Although, the main purpose of TDM that had been performed so far was assumption of the evasion of the side effects caused with antimicrobials, it is difficult to say that it has been used as a tool to improve the efficacies. Furthermore, although the information described in the package inserts of antimicrobials must be important grounds to use the agents properly, it was recently recognized that there were pitfalls in PK-PD region. In this review, the following three items are described; 1) problem of dosage regimen described in package insert of antimicrobials, such as aminoglycosides and vancomycin in our country, and findings accumulated through their TDM; 2) strategy for proper use of antimicrobials based on PK-PD theory; 3) finally, the role of the pharmacist expected in the area of the infectious disease treatment.
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Affiliation(s)
- Kunihiko Morita
- Department of Clinical Pharmaceutics, Doshisha Women's College of Liberal Arts, Kyotanabe, Kyoto, Japan.
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Aoyama T, Hirata K, Hirata R, Yamazaki H, Yamamoto Y, Hayashi H, Matsumoto Y. Population pharmacokinetics of fluconazole after administration of fosfluconazole and fluconazole in critically ill patients. J Clin Pharm Ther 2011; 37:356-63. [PMID: 21883330 DOI: 10.1111/j.1365-2710.2011.01297.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Fluconazole is an antifungal agent that is commonly used to treat patients with serious systemic fungal infections in intensive care units. Fosfluconazole is a phosphate prodrug of fluconazole, which was developed to reduce the volume of fluid required to administer fluconazole by intravenous injection. The objective of this study was to characterize the pharmacokinetics of the antifungal fluconazole after the intravenous administration of the prodrug fosfluconazole or fluconazole in critically ill patients with serious systemic fungal infections, by population pharmacokinetic analysis using the nonmem software package. METHODS Clinical biochemical data including serum fluconazole levels were obtained from 57 patients treated in the intensive care unit along with two naïve pooled patients gleaned from previous reports. The pharmacokinetic model of fluconazole was estimated using a one-compartment model. The probability that the area under the concentration-time curve is higher than 800 μg h/mL was determined by simulation. RESULTS It was assumed that all the administered fosfluconazole was converted to fluconazole with an estimated fosfluconazole-fluconazole conversion rate constant of 2·05/h. The significant covariates for clearance for fluconazole (CL) and volume of distribution for fluconazole (Vd) were resulted in creatinine clearance (CLcr) and body weight (BW), respectively, in the final pharmacokinetic model equations: CL (L/h) = 0·799 × [CLcr (mL/min)/92·7](0·685) and Vd (L) = 48·1 × [BW (kg)/65](1·40) , where the interpatient variabilities in CL and Vd and the intrapatient variability were 44·8%, 79·7% and 19·8%, respectively. On the basis of the results of the Monte Carlo simulation, the probabilities of target attainment were 60%, 26% and 11% for 400 mg/day administration as fluconazole equivalent at CLcr values of 40, 70 and 100 mL/min, respectively. WHAT IS NEW AND CONCLUSION The present population pharmacokinetic analysis strongly indicates that fosfluconazole (and fluconazole) dosage should be optimized in terms of CLcr in critically ill patients.
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Affiliation(s)
- T Aoyama
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Nihon University, Chiba, Japan
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16
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Optimal dose finding of garenoxacin based on population pharmacokinetics/pharmacodynamics and Monte Carlo simulation. Eur J Clin Pharmacol 2011; 68:39-53. [PMID: 21796376 PMCID: PMC3249185 DOI: 10.1007/s00228-011-1095-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 06/28/2011] [Indexed: 12/04/2022]
Abstract
Purpose Garenoxacin, a novel des-F(6)-quinolone, possesses potent antibacterial activity against infectious pathogens in the respiratory tract. Population pharmacokinetic/pharmacodynamic (PK/PD) modeling and Monte Carlo simulations were used to optimize garenoxacin dosage regimens. Methods At the end of phase II stage, the clinical dose of garenoxacin was predicted to be 400 mg once daily by the interim PK/PD analysis using phase I and phase II clinical data. The criteria used to determine an optimal dose were (1) the target attainment of the area under the unbound concentration–time curve divided by the minimum inhibitory concentration (fAUC0−24/MIC ratio) and (2) the maintenance of a trough concentration above the mutant prevention concentration. In a confirmatory phase III study, garenoxacin was administered 400 mg once daily to 136 patients infected with mild or moderate chronic respiratory diseases. Results Logistic regression analysis showed that fAUC0−24/MIC ratio was a significant variable that predicted clinical response (p = 0.0164). Of all subjects, 92.4% reached the target value of fAUC0−24/MIC ratio > 30 h, and the clinical efficacy rate of this population was 91.8%. On the other hand, there was no significant relationship between exposure values (AUC0−24 and maximum concentration) and the incidence of adverse events by the Mann–Whitney test. Conclusions The antimicrobial efficacy of the actual phase III study was consistent with the expectation from the Monte Carlo PD simulation. We were able to show that the optimal garenoxacin dosage regimens were successfully determined using prospective population PK/PD analysis and clinical trial simulations. Electronic supplementary material The online version of this article (doi:10.1007/s00228-011-1095-3) contains supplementary material, which is available to authorized users.
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Suzuki S, Murayama Y, Sugiyama E, Sekiyama M, Sato H. [Dose estimation for renal-excretion drugs in neonates and infants based on physiological development of renal function]. YAKUGAKU ZASSHI 2009; 129:829-42. [PMID: 19571518 DOI: 10.1248/yakushi.129.829] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We established dose estimation formulae for renal-excretion drugs using the glomerular filtration rate (GFR), tubular secretion clearance (Sc), and unbound fraction of drug in plasma (fp) as a renal function index of physiological development in neonates and infants not more than 2 years of age. A dose ratio of (DC/DA)=clearance ratio of (CLC/CLA) congruent with(fpC.GFRC)/(fpA.GFRA) for neonates and infants/adults was applied to drugs with fp.GFR>Sc, while DC/DA=CLC/CLA congruent with(beta.BSAC+fpC.GFRC)/(beta.BSAA+fpA.GFRA) was applied to drugs with Sc>fp.GFR using the coefficient of each drug (beta) and body surface area (BSA). Validity of the estimation formulae was investigated in drugs with fp.GFR>Sc such as vancomycin (VCM), arbekacin (ABK), fosfomycin (FOM) and norfloxacin (NFLX), and in drugs with Sc>fp.GFR such as digoxin (DGX) and amoxicillin (AMPC). First, we compared the clearance ratio (CLC/ CLA) of VCM, ABK, and DGX estimated by our method with those calculated using the Japanese population clearance values and those estimated allometrically (BSAC/BSAA). Next, we compared the established doses of all drugs investigated with the doses for neonates and infants calculated from the conventional dose estimation methods for children and our estimation formulae, and evaluated our method. As a result, favorable consistency was observed in the CL ratio for all drugs, and the doses of VCM, FOM, NFLX and AMPC calculated from our estimation formulae approximated the established doses. In conclusion, the validity of the dose estimation method using pharmacokinetic factors related to physiological development (i.e., GFR, fp, Sc) for renal-excretion drugs in neonates and infants was demonstrated.
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Affiliation(s)
- Shinya Suzuki
- Faculty of Pharmaceutical Sciences, Showa University, Tokyo, Japan.
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Yamamoto M, Kuzuya T, Baba H, Yamada K, Nabeshima T. Population pharmacokinetic analysis of vancomycin in patients with gram-positive infections and the influence of infectious disease type. J Clin Pharm Ther 2009; 34:473-83. [DOI: 10.1111/j.1365-2710.2008.01016.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ikeda K, Ikeda C, Katoh K, Tomiyama N, Matzno S, Matsuyama K, Okamura N. Factors Influencing Peak Concentrations of Arbekacin in Patients. ACTA ACUST UNITED AC 2009. [DOI: 10.5649/jjphcs.35.701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fukuoka N, Aibiki M. Recommended dose of arbekacin, an aminoglycoside against methicillin-resistantStaphylococcus aureus, does not achieve desired serum concentration in critically ill patients with lowered creatinine clearance. J Clin Pharm Ther 2008; 33:521-7. [DOI: 10.1111/j.1365-2710.2008.00947.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Otsuka T, Tanaka A, Suemaru K, Inoue T, Nishimiya T, Murase M, Araki H. Evaluation of the clinical application of cystatin C, a new marker of the glomerular filtration rate, for the initial dose-setting of arbekacin. J Clin Pharm Ther 2008; 33:227-35. [DOI: 10.1111/j.1365-2710.2008.00905.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim JH, Lah HO, Yim DS. Population pharmacokinetics of arbekacin in burn patients. Eur J Clin Pharmacol 2008; 64:599-603. [DOI: 10.1007/s00228-008-0470-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 02/02/2008] [Indexed: 11/28/2022]
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Sato N, Kijima K, Koresawa T, Mitomi N, Morita J, Suzuki H, Hayashi H, Shibasaki S, Kurosawa T, Totsuka K. Population Pharmacokinetics of Tebipenem Pivoxil (ME1211), a Novel Oral Carbapenem Antibiotic, in Pediatric Patients with Otolaryngological Infection or Pneumonia. Drug Metab Pharmacokinet 2008; 23:434-46. [DOI: 10.2133/dmpk.23.434] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Staphylococci are among the leading causes of nosocomial infections. Increasing insusceptibility to beta-lactams and the glycopeptides complicates treatment of these infections. This review examines the current status and future perspectives for the therapy of infections caused by Staphylococcus aureus and coagulase-negative staphylococci.
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Affiliation(s)
- A L Casey
- Department of Clinical Microbiology and Infection Control, University Hospital Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
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Sato R, Tanigawara Y, Kaku M, Aikawa N, Shimizu K. Pharmacokinetic-pharmacodynamic relationship of arbekacin for treatment of patients infected with methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2006; 50:3763-9. [PMID: 17065622 PMCID: PMC1635230 DOI: 10.1128/aac.00480-05] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 07/24/2005] [Accepted: 07/11/2006] [Indexed: 11/20/2022] Open
Abstract
Arbekacin is widely used in Japan for the treatment of patients infected with methicillin-resistant Staphylococcus aureus (MRSA). In this study, we have determined the optimal concentration targets of arbekacin for both efficacy and safety. A pharmacokinetic-pharmacodynamic analysis was performed to relate exposure to the drug and clinical cure/improvement or nephrotoxicity. Since we have reported the population pharmacokinetic parameters for arbekacin in the preceding paper (Y. Tanigawara, R. Sato, K. Morita, M. Kaku, N. Aikawa, and K. Shimizu, Antimicrob. Agents Chemother. 50:3754-3762, 2006), individual exposure parameters, such as area under the concentration-time curve (AUC), peak concentration (C(max)), AUC/MIC, C(max)/MIC, and trough concentration (C(min)) were estimated by the Bayesian method. Logistic regression was used to describe the relationship between exposure to the drug and the probability of clinical cure/improvement or nephrotoxicity. For the clinical efficacy analysis, 174 patients confirmed to have an MRSA infection were evaluated. The C(max), C(min), and AUC of arbekacin were associated with the probability of clinical cure/improvement during monotherapy. It was shown that the probability of cure/improvement rose when the C(max) of arbekacin was increased, with an odds ratio of 6.7 for a change in C(max) from 7.9 to 12.5 microg/ml (P = 0.037). For the nephrotoxic risk analysis, 333 patients were included, regardless of whether a pathogen was identified. Logistic regression analysis revealed C(min) and AUC as risk factors of nephrotoxicity (P < 0.005). The estimated probabilities of arbekacin-induced nephrotoxicity were 2.5, 5.2, and 13.1% when the C(min) values were 1, 2, and 5 microg/ml, respectively. The present findings are useful for optimizing the individual dose of arbekacin for the treatment of MRSA-infected patients.
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Affiliation(s)
- Reiko Sato
- Department of Hospital Pharmacy, School of Medicine, Keio University, Tokyo 160-8582, Japan
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