Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patients
Objectives: Since the global broadcast of multidrug-resistant gram-negative bacteria is accelerating, the use of Polymyxin B is sharply increasing, especially in critically ill patients. Unsatisfactory therapeutic effects were obtained because of the abnormal physiological function in critically ill...
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| Format: | Article |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1122310/full |
| _version_ | 1797857884375089152 |
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| author | Danhong Liang Danhong Liang Zhi Liang Guoliang Deng Guoliang Deng Anfen Cen Anfen Cen Dandan Luo Chen Zhang Chen Zhang Suiqin Ni Suiqin Ni |
| author_facet | Danhong Liang Danhong Liang Zhi Liang Guoliang Deng Guoliang Deng Anfen Cen Anfen Cen Dandan Luo Chen Zhang Chen Zhang Suiqin Ni Suiqin Ni |
| author_sort | Danhong Liang |
| collection | DOAJ |
| description | Objectives: Since the global broadcast of multidrug-resistant gram-negative bacteria is accelerating, the use of Polymyxin B is sharply increasing, especially in critically ill patients. Unsatisfactory therapeutic effects were obtained because of the abnormal physiological function in critically ill patients. Therefore, the determination of optimal polymyxin B dosage becomes highly urgent. This study aimed to illustrate the polymyxin B pharmacokinetic characteristics by defining the influencing factors and optimizing the dosing regimens to achieve clinical effectiveness.Methods: Steady-state concentrations of polymyxin B from twenty-two critically ill patients were detected by a verified liquid chromatography-tandem mass spectrometry approach. The information on age, weight, serum creatinine, albumin levels, and Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score was also collected. The population PK parameters were calculated by the non-parametric adaptive grid method in Pmetrics software, and the pharmacokinetic/pharmacodynamics target attainment rate was determined by the Monte Carlo simulation method.Results: The central clearance and apparent volume of distribution for polymyxin B were lower in critically ill patients (1.24 ± 0.38 L h-1 and 16.64 ± 12.74 L, respectively). Moreover, albumin (ALB) levels can be used to explain the variability in clearance, and age can be used to describe the variability in the apparent volume of distribution. For maintaining clinical effectiveness and lowering toxicity, 75 mg q12 h is the recommended dosing regimen for most patients suffering from severe infections.Conclusion: This study has clearly defined that in critically ill patients, age and ALB levels are potentially important factors for the PK parameters of polymyxin B. Since older critically ill patients tend to have lower ALB levels, so higher dosages of polymyxin B are necessary for efficacy. |
| first_indexed | 2024-04-09T21:04:03Z |
| format | Article |
| id | doaj.art-683dbd2706a04f9fa3068683e93973ba |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-09T21:04:03Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-683dbd2706a04f9fa3068683e93973ba2023-03-29T04:56:52ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-03-011410.3389/fphar.2023.11223101122310Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patientsDanhong Liang0Danhong Liang1Zhi Liang2Guoliang Deng3Guoliang Deng4Anfen Cen5Anfen Cen6Dandan Luo7Chen Zhang8Chen Zhang9Suiqin Ni10Suiqin Ni11School of Biology and Biological Engineering, South China University of Technology, Guangzhou, Guangdong, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, ChinaSchool of Biology and Biological Engineering, South China University of Technology, Guangzhou, Guangdong, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, ChinaSchool of Biology and Biological Engineering, South China University of Technology, Guangzhou, Guangdong, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, ChinaSchool of Biology and Biological Engineering, South China University of Technology, Guangzhou, Guangdong, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, ChinaSchool of Biology and Biological Engineering, South China University of Technology, Guangzhou, Guangdong, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, ChinaObjectives: Since the global broadcast of multidrug-resistant gram-negative bacteria is accelerating, the use of Polymyxin B is sharply increasing, especially in critically ill patients. Unsatisfactory therapeutic effects were obtained because of the abnormal physiological function in critically ill patients. Therefore, the determination of optimal polymyxin B dosage becomes highly urgent. This study aimed to illustrate the polymyxin B pharmacokinetic characteristics by defining the influencing factors and optimizing the dosing regimens to achieve clinical effectiveness.Methods: Steady-state concentrations of polymyxin B from twenty-two critically ill patients were detected by a verified liquid chromatography-tandem mass spectrometry approach. The information on age, weight, serum creatinine, albumin levels, and Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score was also collected. The population PK parameters were calculated by the non-parametric adaptive grid method in Pmetrics software, and the pharmacokinetic/pharmacodynamics target attainment rate was determined by the Monte Carlo simulation method.Results: The central clearance and apparent volume of distribution for polymyxin B were lower in critically ill patients (1.24 ± 0.38 L h-1 and 16.64 ± 12.74 L, respectively). Moreover, albumin (ALB) levels can be used to explain the variability in clearance, and age can be used to describe the variability in the apparent volume of distribution. For maintaining clinical effectiveness and lowering toxicity, 75 mg q12 h is the recommended dosing regimen for most patients suffering from severe infections.Conclusion: This study has clearly defined that in critically ill patients, age and ALB levels are potentially important factors for the PK parameters of polymyxin B. Since older critically ill patients tend to have lower ALB levels, so higher dosages of polymyxin B are necessary for efficacy.https://www.frontiersin.org/articles/10.3389/fphar.2023.1122310/fullpolymyxin Bcritically ill patientspopulation pharmacokineticsalbumin levelsdosing optimization |
| spellingShingle | Danhong Liang Danhong Liang Zhi Liang Guoliang Deng Guoliang Deng Anfen Cen Anfen Cen Dandan Luo Chen Zhang Chen Zhang Suiqin Ni Suiqin Ni Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patients Frontiers in Pharmacology polymyxin B critically ill patients population pharmacokinetics albumin levels dosing optimization |
| title | Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patients |
| title_full | Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patients |
| title_fullStr | Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patients |
| title_full_unstemmed | Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patients |
| title_short | Population pharmacokinetic analysis and dosing optimization of polymyxin B in critically ill patients |
| title_sort | population pharmacokinetic analysis and dosing optimization of polymyxin b in critically ill patients |
| topic | polymyxin B critically ill patients population pharmacokinetics albumin levels dosing optimization |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1122310/full |
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