Population Pharmacokinetic Modeling and Dose Optimization of Vancomycin in Chinese Patients with Augmented Renal Clearance
Abstract
:1. Introduction
2. Results
2.1. Patients and Data Collection
2.2. Population Modeling
2.3. Model Evaluation
2.4. Dosage Recommendation
3. Discussion
4. Materials and Methods
4.1. Patients and Data Collection
4.2. Evaluation of Serum Vancomycin Concentration
4.3. Population Pharmacokinetic Modeling
4.4. Model Validation
4.5. Simulation and Dose Optimization
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Patients (N = 209) |
---|---|
Male, n (%) | 126 (60.3%) |
ICU, n (%) | 82 (39.2%) |
CLcr ≥ 130 mL/min, n (%) | 51 (24.4%) |
Shock, n (%) | 39 (18.7%) |
MOF, n (%) | 7 (3.3%) |
Age, years (mean ± SD) | 66.0 ± 16.4 |
TBW, kg (mean ± SD) | 63.4 ± 12.9 |
Mean CLcr a, mL/min (median (range)) | 86.7 (18.4–390.7) |
Number of samples, n | 424 |
Number of samples per patient, n (%) | |
1 | 103 (49.3%) |
2 | 50 (23.9%) |
3 | 29 (13.9%) |
≥4 | 27 (12.9%) |
Mean daily dosage, mg (median (IQR)) | 1875.0 (1461.9–2352.0) |
Number of samples collected after the start of infusion, n (%) | |
<3 h | 25 (5.9%) |
3–5 h | 16 (3.8%) |
5–12 h | 294 (69.3%) |
12–24 h | 75 (17.7%) |
>24 h | 14 (3.3%) |
Mean concentration after the start of infusion, mg/L | |
<3 h | 29.5 |
3–5 h | 22.9 |
5–12 h | 16.5 |
12–24 h | 15.3 |
>24 h | 10.3 |
Parameter | Base Model Estimate (RSE%) | Final Model Estimate (RSE%) | Bootstrap Median (95% CI) |
---|---|---|---|
CL (L/h) | 2.56(7%) | - | - |
CLmax (L/h) | - | 5.58 (17%) | 5.58 (4.26–8.52) |
CGCLmax50 (L/h) | - | 93.8 (24%) | 94.65 (66.99–178.63) |
s | - | 1.5 (14%) | 1.49 (1.16–1.95) |
Vc (L) | 13.1 (11%) | - | - |
Vc non-ICU (L) | - | 8.02 (12%) | 7.90 (4.90–11.80) |
Vc ICU (L) | - | 35.7 (13%) | 36.66 (26.68–48.37) |
Q (L/h) | 4.9 (26%) | 2.66 (12%) | 2.64 (1.80–3.58) |
Vp (L) | 40.2 (13%) | 36.8 (15%) | 36.26 (25.51–49.36) |
IIV CL | 0.319 (12%) | 0.0771 (16%) | 0.075 (0.05–0.10) |
IIV Vc | 1.65 (39%) | 0.223 (56%) | 0.20 (0.0039–0.53) |
Additive residual error | 0.0479 (18%) | 0.0466 (14%) | 0.045 (0.032–0.060) |
CLcr (mL/min) | Dosage | PTA (%) |
---|---|---|
15–29 | 250 mg Q24 h | 41.44 |
30–44 | 500 mg Q24 h | 53.69 |
45–59 | 750 mg Q24 h | 57.64 |
60–89 | 1250 mg Q24 h | 57.32 |
90–119 | 750 mg Q12 h | 61.58 |
120–149 | 1750 mg Q24 h | 62.33 |
150–179 | 1000 mg Q12 h | 62.56 |
≥180 | 750 mg Q8 h | 61.69 |
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Zhao, S.; He, N.; Zhang, Y.; Wang, C.; Zhai, S.; Zhang, C. Population Pharmacokinetic Modeling and Dose Optimization of Vancomycin in Chinese Patients with Augmented Renal Clearance. Antibiotics 2021, 10, 1238. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10101238
Zhao S, He N, Zhang Y, Wang C, Zhai S, Zhang C. Population Pharmacokinetic Modeling and Dose Optimization of Vancomycin in Chinese Patients with Augmented Renal Clearance. Antibiotics. 2021; 10(10):1238. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10101238
Chicago/Turabian StyleZhao, Sixuan, Na He, Yahui Zhang, Chuhui Wang, Suodi Zhai, and Chao Zhang. 2021. "Population Pharmacokinetic Modeling and Dose Optimization of Vancomycin in Chinese Patients with Augmented Renal Clearance" Antibiotics 10, no. 10: 1238. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10101238