ABSTRACT
OBJECTIVE: To evaluate the relationship between serum vancomycin level and efficacy in peritoneal dialysis-related peritonitis(PDRP) patients by analyzing our hospital′s data. METHODS: Forty-six PDRP patients admitted in our hospital from August 2015 to April 2018 were collected, then divided into three groups by different regimens(1 g q3d, 1 g q4d, 1 g q5d), the probability of target attainment of the first trough concentration and those after several administrations, the characteristics of distribution of vancomycin serum level and the relation with efficacy were analyzed. RESULTS: The first trough concentrations of 1 g q3d, 1 g q4d and 1 g q5d were (10.51±2.79), (6.78±1.58) and (6.68±1.68) mg·L-1 respectively, with statistical difference between 1 g q3d regimen and 1 g q4d, 1 g q5d (P0.01). The trough concentration after the 3rd administration of 1 g q3d regimen was (16.15±4.79) mg·L-1, the trough concentration after the 2nd administration of 1 g q4d regimen was (10.20±2.0) mg·L-1, and the trough concentration after the 2nd administration of 1 g q5d regimen was (9.49±3.24) mg·L-1. The serum vancomycin level was increasing after repeated administration with obvious statistical difference among the three regimens(P0.01). There was no significant difference in the efficacy between concentration10 mg·L-1 and that ≥10 mg·L-1 or concentration <15 mg·L-1 and that ≥15 mg·L-1(P0.05). CONCLUSION: There is significant inter-individual differences of serum vancomycin level in PDRP patients after IP administration, and vancomycin is accumulated in body after repeated administration. It is suggested to monitor the serum vancomycin concentration and the trough concentration kept above 10 mg·L-1.
ABSTRACT
OBJECTIVE: To provide basis for rational use of biapenem in elderly patients through Monte Carlo simulation. METHODS: A total of 294 strains from five species of Enterobacteriaceae were collected. The MICs of biapenem against the bacteria were measured by double broth dilution method. Six therapeutic regimens (300 mg q24h; 300 mg q12h; 300 mg q8h; 300 mg q6h; 600 mg q24h; 600 mg q12h) were simulated by using Monte Carlo simulation, then the probability of target attainment (PTA) and cumulative fraction of response (CFR) were calculated. RESULTS: In patients at 65-74 years old, only the CFR of 300 mg q24h regimen was 90% for E. coli and E. aerogenes; only the 300 mg q24h regimen had CFRs<90% (89.39% and 88.98%) for K. pneumonia and E. cloacae; for E. aerogenes, all the regimens had CFRs <90%. CONCLUSION: It is suggested that different regimens can be used for target therapy of biapenem on the basis of MICs, while frequency of q12h or higher can be used for experiential therapy of enterobacteriaceae infection in old people in our hospital. Other antimicrobial agents should be chosen for treatment of E. aerogenes.
ABSTRACT
This study established a population pharmacokinetics-pharmacodynamics model of clopidogrel in patients with acute coronary syndrome. Fifty-nine patients were enrolled. The plasma concentration of clopidogrel active metabolite and vasodilator stimulated phosphoprotein platelet reactivity index (VASP-PRI) were selected as the pharmacokinetics index and the pharmacodynamics index, respectively. The covariates including demographic characteristics, laboratory indexes, combined medication, complications and genetic polymorphisms of related enzymes were screened for their influence on the pharmacokinetic and pharmacodynamics parameters. Population pharmacokinetic and pharmacodynamics data analysis was performed using NONMEM software. The general linear model and the indirectly effect model-turnover model for pharmacokinetic and pharmacodynamic analysis were selected as the basic model, respectively. The population typical values of K12, CL/F, V/F, EC50, K(in), and E(max) were 0.259 h(-1), 179 L x h(-1), 632 L, 1.57 ng x mL(-1), 4.29 and 0.664, respectively. CYP2C19 was the covariate in the final pharmacokinetic model, and the model was to design a prior dosage regimen.