Clinical application of vancomycin population pharmacokinetics model in patients with neutropenia

Background

To explore the clinical application of a population pharmacokinetics (PPK) model of vancomycin in patients with hematological diseases and neutropenia.

Methods

Patients with hematological diseases and neutropenia were included in the PPK model study. Nonlinear mixed effect modeling approach (NONMEM) was used for model establishment. Monte Carlo simulation was carried out. A total of 74 patients were divided into model group and non-model group for clinical application research. The model group was given the initial dose of 1g q8h, and the non-model group was given 1g q12h as an empiric initial dosage.the follow-up dose adjustments were made according to the concentration results.

Results

This two-compartment model showed good stability and accuracy. The first trough concentration(C0) and the compliance rate of the first C0 were much higher in the model group than that in the non-model group(14.30 ± 4.73 μg/ml and 59.38% vs. 8.02 ± 2.61 μg/ml, 35.71% ). Less patients needed dose adjustments and fewer adjustment times in the model group than those in the non-model group(12.50% and 0.13 ± 0.34times vs 50.00% and 0.61 ± 0.66times). This suggested that for those patients who had a CLCR≥90 ml/min/1.73m2, the initial dose of 1g q8h may help to reach the target C0(10∼20μg/ml) quickly. It also helped to reduce the times and number of patients who need dose adjustments.

Conclusions

Our PPK model of vancomycin in patients with hematologic diseases and neutropenia can be used to shorten the time to reach the target concentration anddn reduce the number of dose adjustments.

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