A case of recovery from aphasia following dose reduction of cefepime by bayesian prediction-based therapeutic drug monitoring
A case of recovery from aphasia following dose reduction of cefepime by bayesian prediction-based therapeutic drug monitoring
复制标题
DOI：
10.1016/j.jiac.2019.10.006
复制
发表时间：
2020-05-01
影响因子：
2.2
通讯作者：
Saito, Hideyuki
中科院分区：
文献类型：
--
作者：
Oda, Kazutaka;Miyakawa, Toshikazu;Saito, Hideyuki
已知头孢吡肟对铜绿假单胞菌具有杀菌活性。头孢吡肟引起的神经毒性很可能是由于接触量增加引起的，最近已成为临床实践中的一个主要问题；因此，对于头孢吡肟清除率低（大部分通过肾脏消除）的患者，应适当减少头孢吡肟剂量。在这里，我们报告一个案例，其中有效地使用基于贝叶斯预测的治疗药物监测（Bayes-TDM）来减少肺炎患者的头孢吡肟剂量，以预防神经毒性并发症。一名女性（年龄：59岁，体重：32.5 kg，血清肌酐浓度：1.02 mg/dL）在接受硬皮病和系统性红斑狼疮治疗时出现铜绿假单胞菌引起的肺炎。她开始采用每 8 小时 1.0 g 头孢吡肟（第 X 天）的给药方案进行治疗。第X+5天出现失语，血清头孢吡肟浓度低谷为71.3 mg/L。该浓度比报道的头孢吡肟安全浓度（谷值 22 或 35 mg/L）高出两倍或三倍。因此，我们从第 X+7 天开始使用 Bayes-TDM 将头孢吡肟的剂量减少至每 12 小时 0.5 g。结果，失语症的严重程度在第X+10天下降，并且该剂量成功地持续到第X+13天而无需进一步调整。总之，Bayes-TDM 个体化剂量可能有助于预防与头孢吡肟治疗相关的不良反应。 (c) 2019 年日本化疗学会和日本传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Cefepime is known to exert bactericidal activity against Pseudomonas aeruginosa. Cefepime-induced neurotoxicity, most likely caused by increased exposure, has recently become a major concern in clinical practice; therefore, appropriate dose reduction of cefepime should be applied with respect to patients with low cefepime clearance (mostly eliminated by the kidneys). Here, we report a case in which Bayesian prediction-based therapeutic drug monitoring (Bayes-TDM) was effectively used to reduce the dose of cefepime in a patient with pneumonia to prevent neurotoxic complications. A woman (age: 59 years, body weight: 32.5 kg, serum creatinine concentration: 1.02 mg/dL) developed pneumonia caused by P. aeruginosa while receiving treatment for scleroderma and systemic lupus erythematosus. She started treatment with a dosing regimen of 1.0 g of cefepime every 8 h (day X). On day X+5, aphasia developed, and the serum cefepime concentration was 71.3 mg/L at trough. This concentration was twice or thrice higher than the reported safe concentration of cefepime (22 or 35 mg/L at trough). Therefore, we reduced the dose of cefepime to 0.5 g every 12 h using Bayes-TDM from day X+7. As a result, the severity of aphasia decreased by day X+10, and this dose was successfully continued up to day X+13 without further adjustment. In conclusion, individualizing doses by Bayes-TDM may be useful in preventing adverse effects associated with cefepime treatment. (c) 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.