Parker Suzanne L, Dorofaeff Tavey, Lipman Jeffrey, Ballot Daynia E, Bandini Rossella M, Wallis Steven C, Roberts Jason A
a Burns, Trauma and Critical Care Research Centre , The University of Queensland , Brisbane , Australia.
b Paediatric Intensive Care , Lady Cilento Children's Hospital , Brisbane , Australia.
Expert Opin Drug Metab Toxicol. 2016 Jun;12(6):601-14. doi: 10.1080/17425255.2016.1178238. Epub 2016 May 3.
Clinical pharmacokinetic studies of antibiotics can establish evidence-based dosing regimens that improve the likelihood of eradicating the pathogen at the site of infection, reduce the potential for selection of resistant pathogens, and minimize harm to the patient. Innovations in small volume sampling (< 50 μL) or 'microsampling' may result in less-invasive sample collection, self-sampling and dried storage. Microsampling may open up opportunities in patient groups where sampling is challenging.
The challenges for implementation of microsampling to assure suitability of the results, include: acceptable study design, regulatory agency acceptance, and meeting bioanalytical validation requirements. This manuscript covers various microsampling methods, including dried blood/plasma spots, volumetric absorptive microsampling, capillary microsampling, plasma preparation technologies and solid-phase microextraction.
The available analytical technology is being underutilized due to a lack of bridging studies and validated bioanalytical methods. These deficiencies represent major impediments to the application of microsampling to antibiotic pharmacokinetic studies. A conceptual framework for the assessment of the suitability of microsampling in clinical pharmacokinetic studies of antibiotics is provided. This model establishes a 'contingency approach' with consideration of the antibiotic and the type and location of the patient, as well as the more prescriptive bioanalytical validation protocols.
抗生素的临床药代动力学研究可以建立基于证据的给药方案,提高在感染部位根除病原体的可能性,降低选择耐药病原体的可能性,并将对患者的伤害降至最低。小体积采样(<50 μL)或“微量采样”方面的创新可能会减少侵入性样本采集、实现自我采样和干燥保存。微量采样可能会为采样具有挑战性的患者群体带来机会。
实施微量采样以确保结果适用性面临的挑战包括:可接受的研究设计、监管机构的认可以及满足生物分析验证要求。本文涵盖了各种微量采样方法,包括干血/血浆斑、体积吸收性微量采样、毛细管微量采样、血浆制备技术和固相微萃取。
由于缺乏桥接研究和经过验证的生物分析方法,现有的分析技术未得到充分利用。这些不足是微量采样应用于抗生素药代动力学研究的主要障碍。本文提供了一个评估微量采样在抗生素临床药代动力学研究中适用性的概念框架。该模型建立了一种“应急方法”,考虑了抗生素、患者的类型和位置,以及更具规范性的生物分析验证方案。