Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan.
Department of Pharmacy, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan; Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University; 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan.
Pharmacol Ther. 2023 Jun;246:108433. doi: 10.1016/j.pharmthera.2023.108433. Epub 2023 May 4.
As one of the efficient techniques for TDM, the population pharmacokinetic (popPK) model approach for dose individualization has been developed due to the rapidly growing innovative progress in computer technology and has recently been considered as a part of model-informed precision dosing (MIPD). Initial dose individualization and measurement followed by maximum a posteriori (MAP)-Bayesian prediction using a popPK model are the most classical and widely used approach among a class of MIPD strategies. MAP-Bayesian prediction offers the possibility of dose optimization based on measurement even before reaching a pharmacokinetically steady state, such as in an emergency, especially for infectious diseases requiring urgent antimicrobial treatment. As the pharmacokinetic processes in critically ill patients are affected and highly variable due to pathophysiological disturbances, the advantages offered by the popPK model approach make it highly recommended and required for effective and appropriate antimicrobial treatment. In this review, we focus on novel insights and beneficial aspects of the popPK model approach, especially in the treatment of infectious diseases with anti-methicillin-resistant Staphylococcus aureus agents represented by vancomycin, and discuss the recent advancements and prospects in TDM practice.
作为 TDM 的有效技术之一,群体药代动力学(popPK)模型方法由于计算机技术的快速创新进步而得到发展,并已被最近被认为是模型指导下精准给药(MIPD)的一部分。初始剂量个体化和测量后使用 popPK 模型进行最大后验(MAP)-贝叶斯预测是 MIPD 策略中的一类最经典和广泛使用的方法。MAP-贝叶斯预测提供了基于测量进行剂量优化的可能性,甚至在达到药代动力学稳态之前,例如在紧急情况下,特别是对于需要紧急抗菌治疗的传染病。由于危重病患者的药代动力学过程受到病理生理紊乱的影响和高度变化,popPK 模型方法的优势使其非常适合有效和适当的抗菌治疗。在这篇综述中,我们重点介绍了 popPK 模型方法的新见解和有益方面,特别是在治疗以万古霉素为代表的抗耐甲氧西林金黄色葡萄球菌药物的传染病方面,并讨论了 TDM 实践中的最新进展和前景。