Real-world performance in therapeutic target attainment of various recommended polymyxin B dose regimens: Secondary data analysis of a prospective multicenter cohort

Abstract

Background

Various population pharmacokinetic studies have suggested controversial optimal dosing regimens for polymyxin B in recent years. The objective of this study was to examine the real-world performance of various dosing regimens in therapeutic target attainment.

Methods

This is a secondary analysis of a large prospective multicenter cohort (ChiCTR2200056667). Patients were retrospectively included from the cohort, and patient demographic characteristics, polymyxin B dosing regimens and corresponding 24-hour areas under the curve (AUCs) were collected. Patients were categorized into various groups according to the dosage regimens, and the corresponding AUC target attainment was analyzed. The target AUC ratio was defined as 50–100 mg/L·h.

Results

A total of 304 AUC data from 247 patients were included in this study. Only 55.3% of the AUCs were in the range of 50–100 mg/L·h. Differences in subgroups stratified by fixed-dosing regimens, weight-based regimens, and renal function-based dosing regimens. Moreover, the differences among the highest target dose strategies (fixed dose of 50 mg/12 h, weight-adjusted dose of 1–1.25 mg/kg/12 h, and CRRT unadjusted dose) were also insignificant.

Conclusion

No polymyxin B dosing strategy is superior in terms of target attainment, which highlights the importance of TDM in the clinical application of polymyxin B.