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环丙沙星在儿童囊性纤维化患者中的药代动力学

Pharmacokinetics of ciprofloxacin in pediatric cystic fibrosis patients.

作者信息

Schaefer H G, Stass H, Wedgwood J, Hampel B, Fischer C, Kuhlmann J, Schaad U B

机构信息

Department of Clinical Research, Wuppertal, Germany.

出版信息

Antimicrob Agents Chemother. 1996 Jan;40(1):29-34. doi: 10.1128/AAC.40.1.29.

Abstract

The pharmacokinetic characteristics of ciprofloxacin were studied in 10 children with cystic fibrosis, aged from 6 to 16 years, who had completed the standard regimen of intravenous ceftazidime and amikacin. The aim of the investigation was to derive dosing guidelines for young cystic fibrosis patients to be treated with ciprofloxacin. Each child received ciprofloxacin given as two 30-min infusions (10 mg/kg of body weight each) 12 h apart; this was followed by the administration of oral ciprofloxacin (15 mg/kg every 12 h). Blood samples were taken after both infusions and after the first oral dose. A total of 232 ciprofloxacin concentrations (203 concentrations in plasma and 29 concentrations in urine) were analyzed by use of NONMEM and a two-compartment body model with seven parameters: total body clearance (CL), volume of the central compartment (V2), volume of the peripheral compartment (V3), intercompartmental clearance, renal clearance, absorption rate constant, and bioavailability. The influences of weight (range, 18 to 42 kg) and age (range, 6 to 16 years) were investigated. CL (in liters per hour) was found to be linearly correlated with weight (typical value of CL = 8.8 + 0.396. WT, where WT is weight; (interindividual coefficient of variation, 7.8%). V2 and V3 were directly proportional to weight, with slopes of 0.7 and 1.3 liters/kg, respectively. Interindividual variabilities were calculated to be 22.6 and 14.9% for V2 and V3, respectively. No dependency of the other pharmacokinetic parameters on age or weight was seen. Because of the high correlations between age and weight, only one covariable was necessary. Weight had the strongest effect. Bioavailability (population mean) was estimated to be 61.8%, and renal clearance (population mean) was estimated to be 11.4 liters/h. The residual (intraindividual) variability was 31.9%. The protein binding was about 34%, which is similar to the results obtained for adults. In order to define the appropriate dosage regimen for children suffering from cystic fibrosis, a formula was derived so that steady-state concentrations, similar to those obtained in adults after the administration of dosages of 400 mg three times daily intravenously and 750 mg twice daily orally, could be reached. The calculated total daily dose increased with increasing body weight. Given as milligrams per kilogram of body weight, the calculated dosage regimens suggest that for younger children (weight range, 14 to 28 kg), 28 to 20 mg/kg orally twice daily should be given, and for older children (weight range, 28 to 42 kg), 20 to 15 mg/kg orally twice daily should be given. For intravenous administration, dosages of 15 to 10 mg/kg twice daily are sufficient.

摘要

在10名6至16岁患有囊性纤维化的儿童中研究了环丙沙星的药代动力学特征,这些儿童已完成静脉注射头孢他啶和阿米卡星的标准疗程。该研究的目的是得出用于接受环丙沙星治疗的囊性纤维化患儿的给药指南。每个儿童接受环丙沙星,分两次30分钟输注(每次10mg/kg体重),间隔12小时;随后口服环丙沙星(每12小时15mg/kg)。在两次输注后以及首次口服给药后采集血样。使用NONMEM和具有七个参数的二室模型分析了总共232个环丙沙星浓度(血浆中203个浓度,尿液中29个浓度):总体清除率(CL)、中央室容积(V2)、外周室容积(V3)、室间清除率、肾清除率、吸收速率常数和生物利用度。研究了体重(范围18至42kg)和年龄(范围6至16岁)的影响。发现CL(每小时升)与体重呈线性相关(CL的典型值=8.8 + 0.396×WT,其中WT是体重;个体间变异系数为7.8%)。V2和V3与体重成正比,斜率分别为0.7和1.3升/千克。V2和V3的个体间变异分别计算为22.6%和14.9%。未观察到其他药代动力学参数与年龄或体重的相关性。由于年龄和体重之间的高度相关性,仅需要一个协变量。体重的影响最强。生物利用度(总体均值)估计为61.8%,肾清除率(总体均值)估计为11.4升/小时。残余(个体内)变异为31.9%。蛋白结合率约为34%,与成人获得的结果相似。为了确定囊性纤维化患儿的合适给药方案,推导了一个公式,以便能够达到类似于成人静脉注射每日三次400mg和口服每日两次750mg后获得的稳态浓度。计算出的每日总剂量随体重增加而增加。以每千克体重毫克数表示,计算出的给药方案表明,对于年幼儿童(体重范围14至28kg),应口服每日两次28至20mg/kg,对于年长儿童(体重范围28至42kg),应口服每日两次20至15mg/kg。对于静脉给药,每日两次15至10mg/kg的剂量就足够了。

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