阿米卡星的外部验证群体药代动力学及基于新生儿血清浓度实现情况的给药方案评估。

Externally validated population pharmacokinetics of amikacin and evaluation of dosage regimen based on achieved serum concentrations in neonates.

作者信息

Lim Chuan Poh, Candra Samuel Rocky, Tseng Sheng Hsuan, Edison Ebenezer Priyantha, Tan Mary Grace Sy, Yong Mei Hui Amanda, Chen Yufei, Yeo Cheo Lian

机构信息

Division of Pharmacy, Singapore General Hospital, Singapore, Singapore.

Duke-NUS School of Medicine, Singapore, Singapore.

出版信息

Antimicrob Agents Chemother. 2025 Aug 6;69(8):e0081825. doi: 10.1128/aac.00818-25. Epub 2025 Jul 17.

Abstract

Combination antibiotics consisting of beta-lactam and aminoglycoside are commonly utilized in the treatment of neonatal septicaemia. The aims of this study were to (i) develop an externally validated population pharmacokinetic (PK) model, (ii) evaluate the attainment of target peak and trough serum concentrations by the current hospital amikacin dosing protocol and side effects, and (iii) compare intravenous (IV) versus intramuscular (IM) route of amikacin administration, in terms of attaining peak and trough serum concentration targets. Retrospective chart review was carried out over a 5-year period. All neonates who received amikacin with therapeutic drug monitoring performed were included in this study. A one-compartment population PK model was built, and external validation was performed. A total of 181 neonates (534 serum concentrations) were included in the population PK modeling and external validation. There was no apparent systematic bias in the predictions of the model. The external validation performed in the current study found the model to be generally unbiased. Sixty-one percent of the peak and 99% of the trough levels were within the targeted therapeutic ranges of 15-25 and <5 mg/L, respectively. There was no statistical difference in the proportion of trough concentrations that were within therapeutic range for IV as compared to IM, while IM resulted in a higher proportion of trough concentrations within therapeutic range, as well as higher peak concentrations. The current population PK model and external validation study have proven that the PK model built in the current study can be used to conduct reliable population simulations. IM injection can be an alternative route of administration for amikacin in neonates.

摘要

由β-内酰胺类和氨基糖苷类组成的联合抗生素常用于治疗新生儿败血症。本研究的目的是:(i)建立一个经过外部验证的群体药代动力学(PK)模型;(ii)评估当前医院阿米卡星给药方案对目标血清峰浓度和谷浓度的达标情况及副作用;(iii)比较静脉注射(IV)与肌肉注射(IM)阿米卡星的给药途径在达到血清峰浓度和谷浓度目标方面的差异。对5年期间的病历进行了回顾性分析。所有接受阿米卡星治疗并进行治疗药物监测的新生儿均纳入本研究。建立了一个单室群体PK模型,并进行了外部验证。共有181名新生儿(534个血清浓度)纳入群体PK建模和外部验证。模型预测中没有明显的系统偏差。本研究进行的外部验证发现该模型总体上无偏差。分别有61%的峰浓度和99%的谷浓度在15 - 25 mg/L和<5 mg/L的目标治疗范围内。与肌肉注射相比静脉注射谷浓度在治疗范围内的比例无统计学差异,而肌肉注射导致谷浓度在治疗范围内的比例更高,峰浓度也更高。当前的群体PK模型和外部验证研究证明,本研究建立的PK模型可用于进行可靠的群体模拟。肌肉注射可作为新生儿阿米卡星的一种替代给药途径。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0cfa/12326967/f809ca1579aa/aac.00818-25.f001.jpg

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