View : 495 Download: 0

Optimal antipseudomonal ꞵ-lactam drug dosing recommendations in critically-ill Asian patients receiving CRRT

Title
Optimal antipseudomonal ꞵ-lactam drug dosing recommendations in critically-ill Asian patients receiving CRRT
Authors
Jang S.M.Lewis S.J.Rhie S.J.
Ewha Authors
이정연이정
SCOPUS Author ID
이정연scopus; 이정scopus
Issue Date
2022
Journal Title
Journal of Critical Care
ISSN
0883-9441JCR Link
Citation
Journal of Critical Care vol. 72
Keywords
CefepimeCeftazidimeContinuous renal replacement therapyMeropenemMonte Carlo simulationPharmacokinetics/pharmacodynamicsPiperacillin/tazobactam
Publisher
W.B. Saunders
Indexed
SCIE; SCOPUS scopus
Document Type
Article
Abstract
Introduction: The average body weight is smaller in Asian patients compared with Western patients, but influence of body weight in antibiotic dosing is unknown. This study was to predict the optimal ceftazidime, cefepime, meropenem, piperacillin/tazobactam doses in Asian patients undergoing continuous venovenous hemofiltration (CVVH). Methods: Monte Carlo simulations (MCS) were performed using published Asian demographics and pharmacokinetics parameters in 5000 virtual patients at three CVVH effluent rates (Qeff; 20, 30, 40 mL/kg/h). Various dosing regimens were assessed for the probability of target attainments using 60% fT > 1 × MIC or 4xMIC and neurotoxicity risk at 48-h using suggested neurotoxicity thresholds. Results: Ceftazidime 1 g q12h, meropenem 1 g q12h, and piperacillin/tazobactam 3.375 g q6h were optimal for all Qeff settings against fT > 1 × MIC. Cefepime 2 g q24h and 2 g q12h were optimal at 20 and 30–40 mL/kg/h respectively. For the aggressive PD target (4 × MIC), optimal ceftazidime regimens were 1.25 g q8h (20–30 mL/kg/h) and 1.5 g q8h (40 mL/kg/h). Cefepime 2 g q8h and meropenem 1 g q8h were optimal at all Qeff settings. No simulated piperacillin doses attained the aggressive PD target. Increased neurotoxicity risk was predicted with ceftazidime and cefepime doses attaining the efficacy. Conclusion: MCS enabled the prediction of optimal β-lactam dosing regimens for Asian patients receiving CVVH at varying Qeff. Clinical validation is warranted. © 2022 The Authors
DOI
10.1016/j.jcrc.2022.154172
Appears in Collections:
연구기관 > 약학연구소 > Journal papers
Files in This Item:
There are no files associated with this item.
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

BROWSE