Teicoplanin dosing strategy for treatment of Staphylococcus aureus in Korean patients with neutropenic fever.
Teicoplanin dosing strategy for treatment of Staphylococcus aureus in Korean patients with neutropenic fever.
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DOI：
10.3349/ymj.2011.52.4.616
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发表时间：
2011-07
影响因子：
2.4
通讯作者：
Choi SM
中科院分区：
文献类型：
--
作者：
Ahn BJ;Yim DS;Lee DG;Kwon JC;Kim SH;Choi SM
本研究旨在根据治疗韩国中性粒细胞减少性发热患者金黄色葡萄球菌的几种剂量方案，确定并比较替考拉宁给药两周内微生物非特异性（Ctrough）和微生物特异性（AUC24/MIC）目标之间的目标达到率（TAR）。使用已发表的研究中采用的替考拉宁群体药代动力学参数，获得了每个剂量的一千个虚拟浓度。使用从韩国一家医院收集的 78 个金黄色葡萄球菌临床分离株的 MIC，对 1,000 个虚拟 MIC 进行了模拟。此后，这些模拟 MIC 被随机分配给 1,000 名虚拟患者，其中确定了 AUC24/MIC >125 [或 345] 和 Ctrough > 10 [或 20] mg/L 的 TAR。使用 Logistic 分析，根据 AUC24/MIC >125 [或 345] 预测维持剂量与稳态 TAR 的关系。替考拉宁的标准剂量方案显示，在 AUC24/MIC > 125 [或 345] 和 Ctrough > 10 [或 20] mg/L 的情况下，稳态时的 TAR 分别约为 70% [或 33%] 和 70% [或 20%]。预计目前的标准剂量方案不足以充分治疗韩国中性粒细胞减少性发热患者的金黄色葡萄球菌。为了确保该人群的 TAR 至少达到 80%，应考虑调整替考拉宁的剂量。
The present study was conducted to determine and compare the target attainment rate (TAR) between microorganism-nonspecific (Ctrough) and microorganism-specific (AUC24/MIC) targets over two weeks of teicoplanin administration according to several dose regimens for the treatment of Staphylococcus aureus in Korean patients with neutropenic fever. One thousand virtual concentrations were obtained for each dose using the population pharmacokinetic parameters of teicoplanin adopted from a published study. Simulation of 1,000 virtual MICs was performed using the MICs of 78 clinical isolates of S. aureus collected from a hospital in Korea. Thereafter, these simulated MICs were randomly allocated to 1,000 virtual patients in whom the TARs for AUC24/MIC >125 [or 345] and Ctrough >10 [or 20] mg/L were determined. The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC24/MIC >125 [or 345] using logistic analysis. The standard dose regimen of teicoplanin showed TARs of about 70% [or 33%] and 70% [or 20%] at steady-state in cases with AUC24/MIC >125 [or 345] and Ctrough >10 [or 20] mg/L, respectively. The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever. To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.
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