How to optimise antimicrobial prescriptions in the Intensive Care Unit: principles of individualised dosing using pharmacokinetics and pharmacodynamics

Roberts, Jason A.; Joynt, Gavin M.; Choi, Gordon; Gomersall, Charles D.; Lipman, Jeffrey

doi:10.1016/j.ijantimicag.2011.11.002

Cited by 69 publications

(57 citation statements)

References 61 publications

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“…First, we did not include patients who had septic shock or who were on continuous renal replacement therapy. Such factors could alter the PK profiles of doripenem (10,46). Second, our data do not include doripenem concentrations at the target site of infection.…”

Section: Discussionmentioning

confidence: 99%

“…However, the doripenem dosing regimen should be individualized on the basis of each patient's characteristics. For example, when sepsis and, in particular, when septic shock induce a greater volume of distribution (V) and a greater total body clearance (CL), which contribute to lower plasma concentrations of hydrophilic antibiotics, such as doripenem, the probability of target attainment (PTA) may be compromised due to a shorter fT MIC (10)(11)(12). In addition, race is an important individual characteristic that may affect the pharmacokinetics (PK) or pharmacodynamics (PD) of antimicrobials, possibly owing to differences in fat distribution, metabolism, and antibiotic CL (13,14).…”

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confidence: 99%

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Population Pharmacokinetic Analysis of Doripenem after Intravenous Infusion in Korean Patients with Acute Infections

Lee

Kim

Jin

et al. 2017

Antimicrob Agents Chemother

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We investigated the population pharmacokinetics (PK) of doripenem in Korean patients with acute infections and determined an appropriate dosing regimen using a Monte Carlo simulation for predicting pharmacodynamics (PD). Patients (n ϭ 37) with a creatinine clearance (CL CR ) of 20 to 50 ml/min or Ͼ50 ml/min who received a 250-mg or 500-mg dose of doripenem over the course of 1 h every 8 h, respectively, were included in this study. Blood samples were taken predosing and 0 h, 0.5 h, and 4 to 6 h after the fourth infusion. A nonlinear mixed-effect modeling tool was used for the PK analysis and pharmacodynamic simulation; doripenem PK were well described by a one-compartment model. The population mean values of the body weight (WT)-normalized clearance (CL/WT) and the body weight-normalized volume of distribution (V/WT) were 0.109 liter/h/kg of body weight (relative standard error, 9.197%) and 0.280 liter/kg (relative standard error, 9.56%), respectively. Doripenem CL was significantly influenced by CL CR . The proposed equation to estimate doripenem CL in Korean patients was CL/WT ϭ 0.109 ϫ WT ϫ (CL CR /57) 0.688 , where CL/WT is in liters per hour per kilogram. CL in Korean patients was expected to be lower than that in Caucasian patients, regardless of renal function. The Monte Carlo simulation showed that 90% attainment of target PK/PD magnitudes could be achieved with the usual dosing regimens when the MIC was Յ1 mg/liter. However, prolonged infusions (4 h) should be considered, especially when patients have augmented renal function and for patients infected with pathogens with a high MIC. Our results provide an individualized doripenem dosing regimen for patients with various renal functions and for patients infected with bacteria with decreased susceptibility.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Population Pharmacokinetic Analysis of Doripenem after Intravenous Infusion in Korean Patients with Acute Infections

Lee

Kim

Jin

et al. 2017

Antimicrob Agents Chemother

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“…Dena den, proteinekiko lotura handia duten medikamentuetan, hipoalbuminemia Vd-aren handipenarekin eta medikamentuen CL azkarragoarekin erlazionatuta egoten da normalean. Beraz, kasuistika desberdinak gerta daitezke, dosifikazio optimoa aukeratzerakoan aztertu beharko direnak [16].…”

Section: Proteinekiko Lotura Modifikatzeaunclassified

“…Gutxiegitasun hepatikoa gibel-entzimen igoerarekin dago erlazionatuta, baita bilirrubinarenarekin eta amoniakoarenarekin ere. Bestalde, koagulazio-faktoreen eta albuminaren sintesiaren murrizpena ekar dezake [16] eta horrek, aipatu bezala, farmakoen Vd-an eta proteinekiko loturan eragin dezake. b) Giltzurrun-gutxiegitasun akutua (GGA) Oliguria edo anuria eragiten duen gaitz honek giltzurrun-funtzioaren galtze partziala edo osoa dakar.…”

Section: Argitzapenean Aldaketakunclassified

Analisi farmakozinetiko/farmakodinamikoa antimikrobianoen erabilera hobetzeko gaixo larrietan

Soraluce

Rodríguez-Gascón

Isla

2018

EKAIA

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Laburpena: Azken urteotan infekzioen tratamendua mundu mailako osasun publikoko arazo bilakatu da, erresistentzien garapenaren ondorioz, bakterio multirresistenteen agerpena izugarri igo baita. Antibiotiko berrien gabeziak merkatuan daudenen dosifikazioen optimizazioaren premia areagotzen du. Zenbait pazientetan, gaixo larrietan esaterako, aipatutakoa egitea bereziki zaila suerta daiteke. Izan ere, beraien egoera fisiopatologikoa dela eta, medikamentuen farmakozinetika eta farmakodinamia eraldatuta daukate. Analisi farmakozinetiko/farmakodinamikoak, Monte Carlo simulazioekin batera, dosifikazio-erregimenen optimizazioa ahalbidetzen du. Horrela, tratamenduaren arrakasta bermatu eta erresistentzien agerpena ekiditen da.Hitz gakoak: Antibiotikoak, populazio-farmakozinetika, analisi farmakozinetiko/farmakodinamikoa, Monte Carlo simulazioa.Abstract: Nowadays, the treatment of infectious diseases has become a global health issue, due to multi-resistant antibiotic bacteria. The lack of new antibiotics enhances urgent need for current antimicrobials' dosing regimens optimization. This could become an extremely challenging duty when treating some kind of patients, such as the critically ill; as due to their physiophatological situation, both pharmacokinetics and pharmacodynamics might be altered. PK/PD analysis, together with Monte Carlo Simulation, might be a useful tool in order to optimize dosing regimens of antibiotic agents and, therefore, improve clinical outcome and diminish emergence of resistances.

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“…The underlying pathophysiological mechanism of ARC is not yet completely unveiled. However, the biological response to inflammation and infection, combined with the administration of fluid boluses and vasoactive compounds increase cardiac output and renal blood flow, resulting in an increased glomerular filtration rate, are considered to be involved [11]. In critically ill children, ARC was recently described in 50 patients receiving amoxicillin-clavulanic acid [12].…”

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confidence: 99%

Antibiotic PK/PD Research in Critically Ill Neonates and Children: How do we Proceed?

Smits

Cock

2018

Int. J. Pharmacokinet.

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How to optimise antimicrobial prescriptions in the Intensive Care Unit: principles of individualised dosing using pharmacokinetics and pharmacodynamics

Cited by 69 publications

References 61 publications

Population Pharmacokinetic Analysis of Doripenem after Intravenous Infusion in Korean Patients with Acute Infections

Population Pharmacokinetic Analysis of Doripenem after Intravenous Infusion in Korean Patients with Acute Infections

Analisi farmakozinetiko/farmakodinamikoa antimikrobianoen erabilera hobetzeko gaixo larrietan

Antibiotic PK/PD Research in Critically Ill Neonates and Children: How do we Proceed?

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