Kobayashi Ryo, Otomo Shinya, Shiba Yusuke, Ebinuma Keiichi, Sudoh Toshiaki
Department of Pharmacy, Jichi Medical University Hospital.
Yakugaku Zasshi. 2016;136(11):1557-1562. doi: 10.1248/yakushi.16-00025.
According to a recent study and meta-analysis, trough levels of >10 μg/mL teicoplanin (TEIC) may be acceptable for the treatment of uncomplicated infection, but no method of TEIC personalized medicine has been established. Vancomycin (VCM) and TEIC are glycopeptide antibiotic agents effective against methicillin-resistance Staphyloccocus aureus. This study aimed to establish TEIC personalized medicine at a steady state calculated by VCM pharmacokinetic parameters. Bayesian forecasting and population mean methods were employed to estimate individual total VCM clearance (CL) using existing population pharmacokinetics (PPK) parameter, and the differences between the CL calculated by these two methods were defined as ΔCL. Serum drug concentration data for patients treated with TEIC were collected at a steady state concentration (>96 h post infusion). There was a significant relationship between the prediction error of TEIC trough level and ΔCL. The relation between ΔCL and TEIC trough concentration at steady state was used to develop the following equation to determine the maintenance dose: TEIC (μg/mL)=1.1119X-6.124ΔCL+3.9164 (X is defined as TEIC trough concentration calculated from the PPK parameter). The results of this study indicated that it is possible to improve the prediction error of TEIC trough concentration at a steady state for patients who have received VCM therapy.
根据最近的一项研究和荟萃分析，替考拉宁（TEIC）谷浓度>10μg/mL对于单纯性感染的治疗可能是可接受的，但尚未建立TEIC个体化给药方法。万古霉素（VCM）和TEIC是对耐甲氧西林金黄色葡萄球菌有效的糖肽类抗生素。本研究旨在根据VCM药代动力学参数计算的稳态下建立TEIC个体化给药方法。采用贝叶斯预测法和总体均值法，利用现有的群体药代动力学（PPK）参数估计个体的总VCM清除率（CL），将这两种方法计算的CL差值定义为ΔCL。在稳态浓度（输注后>96小时）收集接受TEIC治疗患者的血清药物浓度数据。TEIC谷浓度的预测误差与ΔCL之间存在显著关系。利用ΔCL与稳态下TEIC谷浓度之间的关系建立以下方程来确定维持剂量：TEIC（μg/mL）=1.1119X - 6.124ΔCL + 3.9164（X定义为根据PPK参数计算的TEIC谷浓度）。本研究结果表明，对于接受VCM治疗的患者，有可能改善稳态下TEIC谷浓度的预测误差。
