Comparison of Vancomycin Clearance Between Augmented Renal Clearance and Normal Renal Function in Critically Ill Infants: A Population Pharmacokinetics Study.

IF 2.3 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Journal of clinical pharmacology Pub Date : 2022-07-01 Epub Date: 2022-02-14 DOI:10.1002/jcph.2029
Guang-Ming Huang, Yue Qiu, Tao-Tao Liu, Jie-Jiu Lu
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引用次数: 2

Abstract

Augmented renal clearance presents as super-renal function with enhanced renal perfusion and glomerular hyperfiltration in many critically ill infants. This study was to compare vancomycin clearance (CL) between critically ill infants with augmented renal clearance and with normal renal function and to optimize the vancomycin dosage. Data were retrospectively obtained from infants treated in intensive care units. Population pharmacokinetics analysis was conducted using nonlinear mixed-effects model software. A total of 66 critically ill infants were included: 47 infants with augmented renal clearance and 19 infants with normal renal function. The median doses of vancomycin for infants with augmented renal clearance and with normal renal function were 48 and 47 mg/kg/day (P > .05), respectively. The median CL in infants with augmented renal clearance was increased 1.96-fold compared with infants who had normal renal function (0.98 versus 0.5 L/h, P < .001). Simulations indicated that the recommended dosage of 60, 70, 80, 90, and 100 mg/kg/day would be appropriate in critically ill infants with an estimated glomerular filtration rate (eGFR) of 130-149, 150-169, 170-189, 190-209, and >210 mL/min/1.73 m2 , respectively. Doses of 70 and 75 mg/kg/day were recommended for infants with augmented renal clearance and gestational ages of 27-32.9 and 33-39 weeks, respectively. Doses of 70, 75, 80, and 90 mg/kg/day were recommended for infants with augmented renal clearance and weights of 2.0-2.9, 3.0-3.9, 4.0-4.9, and 5.0-6.0 kg, respectively. In conclusion, the typical vancomycin dosage is insufficient for critically ill infants with augmented renal clearance. Premature infants and infants of low weight with augmented renal clearance need individualized dosing regimens to obtain an adequate area under the serum concentration time curve over 24 h/minimum inhibitory concentration ratio.

危重婴儿万古霉素清除率在增强肾清除率和正常肾功能之间的比较:人群药代动力学研究。
在许多危重婴儿中,肾脏清除率增强表现为肾灌注增强和肾小球高滤过的超肾功能。本研究旨在比较肾脏清除率增强和肾功能正常的危重婴儿万古霉素清除率(CL),并优化万古霉素的剂量。数据回顾性地从重症监护病房治疗的婴儿中获得。采用非线性混合效应模型软件进行群体药代动力学分析。共纳入66例危重患儿:47例患儿肾清除率增强,19例患儿肾功能正常。肾清除率增强和肾功能正常的婴儿万古霉素的中位剂量分别为48 mg/kg/d和47 mg/kg/d (P > 0.05)。与肾功能正常的婴儿相比,肾清除率增强的婴儿的中位CL增加了1.96倍(分别为0.98 vs 0.5 L/h, P 210 mL/min/1.73 m2)。推荐剂量分别为70和75 mg/kg/天,用于肾清除率增强、胎龄为27-32.9周和33-39周的婴儿。推荐剂量分别为70、75、80和90 mg/kg/天,适用于肾清除率增强、体重在2.0-2.9、3.0-3.9、4.0-4.9和5.0-6.0 kg的婴儿。总之,典型的万古霉素剂量不足以治疗肾清除率增强的危重婴儿。早产儿和低体重且肾清除率增强的婴儿需要个体化给药方案,以便在24小时以上的血清浓度时间曲线下获得足够的面积/最小抑制浓度比。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.10
自引率
3.40%
发文量
176
审稿时长
2 months
期刊介绍: The Journal of Clinical Pharmacology (JCP) is a Human Pharmacology journal designed to provide physicians, pharmacists, research scientists, regulatory scientists, drug developers and academic colleagues a forum to present research in all aspects of Clinical Pharmacology. This includes original research in pharmacokinetics, pharmacogenetics/pharmacogenomics, pharmacometrics, physiologic based pharmacokinetic modeling, drug interactions, therapeutic drug monitoring, regulatory sciences (including unique methods of data analysis), special population studies, drug development, pharmacovigilance, womens’ health, pediatric pharmacology, and pharmacodynamics. Additionally, JCP publishes review articles, commentaries and educational manuscripts. The Journal also serves as an instrument to disseminate Public Policy statements from the American College of Clinical Pharmacology.
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