Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage Recommendations
The main goal of our study was to characterize the population pharmacokinetics of vancomycin in critically ill Chinese neonates to develop a pharmacokinetic model and investigate factors that have significant influences on the pharmacokinetics of vancomycin in this population. The study population c...
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Frontiers Media S.A.
2018-06-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphar.2018.00603/full |
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| author | Zhi-ling Li Yi-xi Liu Yi-xi Liu Zheng Jiao Gang Qiu Jian-quan Huang Yu-bo Xiao Yu-bo Xiao Shu-jin Wu Shu-jin Wu Chen-yu Wang Wen-juan Hu Hua-jun Sun |
| author_facet | Zhi-ling Li Yi-xi Liu Yi-xi Liu Zheng Jiao Gang Qiu Jian-quan Huang Yu-bo Xiao Yu-bo Xiao Shu-jin Wu Shu-jin Wu Chen-yu Wang Wen-juan Hu Hua-jun Sun |
| author_sort | Zhi-ling Li |
| collection | DOAJ |
| description | The main goal of our study was to characterize the population pharmacokinetics of vancomycin in critically ill Chinese neonates to develop a pharmacokinetic model and investigate factors that have significant influences on the pharmacokinetics of vancomycin in this population. The study population consisted of 80 neonates in the neonatal intensive care unit (ICU) from which 165 trough and peak concentrations of vancomycin were obtained. Nonlinear mixed effect modeling was used to develop a population pharmacokinetic model for vancomycin. The stability and predictive ability of the final model were evaluated based on diagnostic plots, normalized prediction distribution errors and the bootstrap method. Serum creatinine (Scr) and body weight were significant covariates on the clearance of vancomycin. The average clearance was 0.309 L/h for a neonate with Scr of 23.3 μmol/L and body weight of 2.9 kg. No obvious ethnic differences in the clearance of vancomycin were found relative to the earlier studies of Caucasian neonates. Moreover, the established model indicated that in patients with a greater renal clearance status, especially Scr < 15 μmol/L, current guideline recommendations would likely not achieve therapeutic area under the concentration-time curve over 24 h/minimum inhibitory concentration (AUC24h/MIC) ≥ 400. The exceptions to this are British National Formulary (2016–2017), Blue Book (2016) and Neofax (2017). Recommended dose regimens for neonates with different Scr levels and postmenstrual ages were estimated based on Monte Carlo simulations and the established model. These findings will be valuable for developing individualized dosage regimens in the neonatal ICU setting. |
| first_indexed | 2024-12-11T07:56:03Z |
| format | Article |
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| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-11T07:56:03Z |
| publishDate | 2018-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-dfc61ab9ec134ef3869d5d084cf58b962022-12-22T01:15:13ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122018-06-01910.3389/fphar.2018.00603356441Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage RecommendationsZhi-ling Li0Yi-xi Liu1Yi-xi Liu2Zheng Jiao3Gang Qiu4Jian-quan Huang5Yu-bo Xiao6Yu-bo Xiao7Shu-jin Wu8Shu-jin Wu9Chen-yu Wang10Wen-juan Hu11Hua-jun Sun12Department of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pharmacy, Huashan Hospital, Fudan University, Shanghai, ChinaSchool of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaDepartment of Pharmacy, Huashan Hospital, Fudan University, Shanghai, ChinaDepartment of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pharmacy, Huashan Hospital, Fudan University, Shanghai, ChinaDepartment of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, ChinaDepartment of Pharmacy, Huashan Hospital, Fudan University, Shanghai, ChinaDepartment of Pharmacy, Gansu Provincial Hospital, Lanzhou, ChinaDepartment of Pharmacy, Huashan Hospital, Fudan University, Shanghai, ChinaDepartment of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, ChinaThe main goal of our study was to characterize the population pharmacokinetics of vancomycin in critically ill Chinese neonates to develop a pharmacokinetic model and investigate factors that have significant influences on the pharmacokinetics of vancomycin in this population. The study population consisted of 80 neonates in the neonatal intensive care unit (ICU) from which 165 trough and peak concentrations of vancomycin were obtained. Nonlinear mixed effect modeling was used to develop a population pharmacokinetic model for vancomycin. The stability and predictive ability of the final model were evaluated based on diagnostic plots, normalized prediction distribution errors and the bootstrap method. Serum creatinine (Scr) and body weight were significant covariates on the clearance of vancomycin. The average clearance was 0.309 L/h for a neonate with Scr of 23.3 μmol/L and body weight of 2.9 kg. No obvious ethnic differences in the clearance of vancomycin were found relative to the earlier studies of Caucasian neonates. Moreover, the established model indicated that in patients with a greater renal clearance status, especially Scr < 15 μmol/L, current guideline recommendations would likely not achieve therapeutic area under the concentration-time curve over 24 h/minimum inhibitory concentration (AUC24h/MIC) ≥ 400. The exceptions to this are British National Formulary (2016–2017), Blue Book (2016) and Neofax (2017). Recommended dose regimens for neonates with different Scr levels and postmenstrual ages were estimated based on Monte Carlo simulations and the established model. These findings will be valuable for developing individualized dosage regimens in the neonatal ICU setting.https://www.frontiersin.org/article/10.3389/fphar.2018.00603/fullneonatevancomycinpopulation pharmacokineticMonte Carlo simulationindividualized therapy |
| spellingShingle | Zhi-ling Li Yi-xi Liu Yi-xi Liu Zheng Jiao Gang Qiu Jian-quan Huang Yu-bo Xiao Yu-bo Xiao Shu-jin Wu Shu-jin Wu Chen-yu Wang Wen-juan Hu Hua-jun Sun Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage Recommendations Frontiers in Pharmacology neonate vancomycin population pharmacokinetic Monte Carlo simulation individualized therapy |
| title | Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage Recommendations |
| title_full | Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage Recommendations |
| title_fullStr | Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage Recommendations |
| title_full_unstemmed | Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage Recommendations |
| title_short | Population Pharmacokinetics of Vancomycin in Chinese ICU Neonates: Initial Dosage Recommendations |
| title_sort | population pharmacokinetics of vancomycin in chinese icu neonates initial dosage recommendations |
| topic | neonate vancomycin population pharmacokinetic Monte Carlo simulation individualized therapy |
| url | https://www.frontiersin.org/article/10.3389/fphar.2018.00603/full |
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