Vancomycin population pharmacokinetics and dosing proposal for the initial treatment in obese adult patients
Status PubMed-not-MEDLINE Jazyk angličtina Země Švýcarsko Médium electronic-ecollection
Typ dokumentu časopisecké články
PubMed
38895623
PubMed Central
PMC11183791
DOI
10.3389/fphar.2024.1364681
PII: 1364681
Knihovny.cz E-zdroje
- Klíčová slova
- Monte Carlo simulation, clinical pharmacy, glomerular filtration rate, lean body mass, non-linear mixed-effects modeling, obesity, therapeutic drug monitoring,
- Publikační typ
- časopisecké články MeSH
AIM: The aim of this study was to develop a vancomycin population pharmacokinetic model in adult obese patients and propose covariate-based dosing individualization in order to maximize the achievement of the newly recommended PK/PD target, according to a revised consensus guideline from 2020. METHODS: Therapeutic drug monitoring data from initial vancomycin therapy (first 3 days of treatment) in adult obese (BMI ≥ 30 kg/m2) patients from 2013 to 2022 were analyzed using a non-linear mixed-effects modeling method, and Monte Carlo simulations were then used to find the optimal dosage maximizing the PK/PD target attainment. RESULTS: A total of 147 vancomycin serum levels obtained from 138 patients were included in the analysis. Based on the covariate model diagnosis among all tested variables, no reliable predictor of vancomycin volume of distribution (Vd) was identified, while clearance (CL) was positively correlated with eGFR and lean body mass. Creatinine-based eGFR predicted vancomycin CL better than cystatin C-based eGFR. The median (interquartile range) value from conditional modes of individual estimates of Vd, CL, and elimination half-life in our population was 74.0 (70.5-75.4) L, 6.65 (4.95-8.42) L/h, and 7.7 (6.0-10.0) h, respectively. CONCLUSION: We proposed dosing individualization based on the covariate found in order to maximize the achievement of the newly recommended PK/PD target of the AUC/MIC ratio of 400-600. Clinical pharmacy/pharmacology interventions may lead to an improvement in vancomycin dosing with a reflection in PK/PD target attainment.
Department of Applied Pharmacy Faculty of Pharmacy Masaryk University Brno Czechia
Department of Clinical Pharmacy Bulovka University Hospital Prague Czechia
Department of Clinical Pharmacy Military University Hospital Prague Prague Czechia
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