Individualization of Piperacillin Dosing for Critically III Patients: Dosing Software To Optimize Antimicrobial Therapy
Identifieur interne : 004105 ( Main/Exploration ); précédent : 004104; suivant : 004106Individualization of Piperacillin Dosing for Critically III Patients: Dosing Software To Optimize Antimicrobial Therapy
Auteurs : T. W. Felton [Royaume-Uni] ; J. A. Roberts [Australie] ; T. P. Lodise [États-Unis] ; M. Van Guilder [États-Unis] ; E. Boselli [France] ; M. N. Neely [États-Unis] ; W. W. Hope [Royaume-Uni]Source :
- Antimicrobial agents and chemotherapy [ 0066-4804 ] ; 2014.
Descripteurs français
- KwdFr :
- Acide pénicillanique (administration et posologie), Acide pénicillanique (analogues et dérivés), Acide pénicillanique (pharmacocinétique), Acide pénicillanique (usage thérapeutique), Adolescent, Adulte, Adulte d'âge moyen, Antibactériens (administration et posologie), Antibactériens (pharmacocinétique), Antibactériens (usage thérapeutique), Calcul des posologies, Clairance métabolique, Créatinine (métabolisme), Créatinine (sang), Femelle, Humains, Infections bactériennes (microbiologie), Infections bactériennes (traitement médicamenteux), Jeune adulte, Maladie grave (), Mâle, Médecine individualisée (), Pharmacothérapie assistée par ordinateur, Pipéracilline (administration et posologie), Pipéracilline (pharmacocinétique), Pipéracilline (usage thérapeutique), Pseudomonas aeruginosa (), Sujet âgé, Sujet âgé de 80 ans ou plus, Tests de sensibilité microbienne, Théorème de Bayes.
- MESH :
- administration et posologie : Acide pénicillanique, Antibactériens, Pipéracilline.
- analogues et dérivés : Acide pénicillanique.
- microbiologie : Infections bactériennes.
- métabolisme : Créatinine.
- pharmacocinétique : Acide pénicillanique, Antibactériens, Pipéracilline.
- sang : Créatinine.
- traitement médicamenteux : Infections bactériennes.
- usage thérapeutique : Acide pénicillanique, Antibactériens, Pipéracilline.
- Pascal (Inist)
- Adolescent, Adulte, Adulte d'âge moyen, Calcul des posologies, Clairance métabolique, Femelle, Humains, Jeune adulte, Maladie grave, Mâle, Médecine individualisée, Pharmacothérapie assistée par ordinateur, Pipéracilline, Posologie, Homme, Malade, Logiciel, Antimicrobien, Pseudomonas aeruginosa, Sujet âgé, Sujet âgé de 80 ans ou plus, Tests de sensibilité microbienne, Théorème de Bayes, Traitement, Antibactérien, Antibiotique.
- Wicri :
- topic : Homme, Logiciel, Antibiotique.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents (administration & dosage), Anti-Bacterial Agents (pharmacokinetics), Anti-Bacterial Agents (therapeutic use), Antibacterial agent, Antibiotic, Antimicrobial agent, Bacterial Infections (drug therapy), Bacterial Infections (microbiology), Bayes Theorem, Creatinine (blood), Creatinine (metabolism), Critical Illness (therapy), Drug Dosage Calculations, Drug Therapy, Computer-Assisted, Female, Human, Humans, Male, Metabolic Clearance Rate, Microbial Sensitivity Tests, Middle Aged, Patient, Penicillanic Acid (administration & dosage), Penicillanic Acid (analogs & derivatives), Penicillanic Acid (pharmacokinetics), Penicillanic Acid (therapeutic use), Piperacillin, Piperacillin (administration & dosage), Piperacillin (pharmacokinetics), Piperacillin (therapeutic use), Posology, Precision Medicine (methods), Pseudomonas aeruginosa (drug effects), Software, Treatment, Young Adult.
- MESH :
- chemical , administration & dosage : Anti-Bacterial Agents, Penicillanic Acid, Piperacillin.
- chemical , analogs & derivatives : Penicillanic Acid.
- chemical , blood : Creatinine.
- chemical , metabolism : Creatinine.
- chemical , pharmacokinetics : Anti-Bacterial Agents, Penicillanic Acid, Piperacillin.
- chemical , therapeutic use : Anti-Bacterial Agents, Penicillanic Acid, Piperacillin.
- drug effects : Pseudomonas aeruginosa.
- drug therapy : Bacterial Infections.
- methods : Precision Medicine.
- microbiology : Bacterial Infections.
- therapy : Critical Illness.
- Adolescent, Adult, Aged, Aged, 80 and over, Bayes Theorem, Drug Dosage Calculations, Drug Therapy, Computer-Assisted, Female, Humans, Male, Metabolic Clearance Rate, Microbial Sensitivity Tests, Middle Aged, Young Adult.
Abstract
Piperacillin-tazobactam is frequently used for empirical and targeted therapy of infections in critically ill patients. Considerable pharmacokinetic (PK) variability is observed in critically ill patients. By estimating an individual's PK, dosage optimization Bayesian estimation techniques can be used to calculate the appropriate piperacillin regimen to achieve desired drug exposure targets. The aim of this study was to establish a population PK model for piperacillin in critically ill patients and then analyze the performance of the model in the dose optimization software program BestDose. Linear, with estimated creatinine clearance and weight as covariates, Michaelis-Menten (MM) and parallel linear/MM structural models were fitted to the data from 146 critically ill patients with nosocomial infection. Piperacillin concentrations measured in the first dosing interval, from each of 8 additional individuals, combined with the population model were embedded into the dose optimization software. The impact of the number of observations was assessed. Precision was assessed by (i) the predicted piperacillin dosage and by (ii) linear regression of the observed-versus-predicted piperacillin concentrations from the second 24 h of treatment. We found that a linear clearance model with creatinine clearance and weight as covariates for drug clearance and volume of distribution, respectively, best described the observed data. When there were at least two observed piperacillin concentrations, the dose optimization software predicted a mean piperacillin dosage of 4.02 g in the 8 patients administered piperacillin doses of 4.00 g. Linear regression of the observed-versus-predicted piperacillin concentrations for 8 individuals after 24 h of piperacillin dosing demonstrated an r2 of >0.89. In conclusion, for most critically ill patients, individualized piperacillin regimens delivering a target serum piperacillin concentration is achievable. Further validation of the dosage optimization software in a clinical trial is required.
Url:
Affiliations:
- Australie, France, Royaume-Uni, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, Californie, Grand Manchester, Rhône-Alpes, État de New York
- Los Angeles, Lyon, Manchester
- Université de Californie du Sud, Université de Manchester
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Le document en format XML
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W." last="Felton">T. W. Felton</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The University of Manchester, Manchester Academic Health Science Centre, NIHR Clinical Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust</s1><s2>Manchester</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region><settlement type="city">Manchester</settlement></placeName><orgName type="university">Université de Manchester</orgName></affiliation></author><author><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J. A." last="Roberts">J. A. Roberts</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane and Royal Brisbane and Women's Hospital Brisbane</s1><s2>Queensland</s2><s3>AUS</s3><sZ>2 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Queensland</wicri:noRegion></affiliation></author><author><name sortKey="Lodise, T P" sort="Lodise, T P" uniqKey="Lodise T" first="T. P." last="Lodise">T. P. Lodise</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Albany College of Pharmacy and Health Sciences</s1><s2>Albany, New York</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Van Guilder, M" sort="Van Guilder, M" uniqKey="Van Guilder M" first="M." last="Van Guilder">M. Van Guilder</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Laboratory of Applied Pharmacokinetics, University of Southern California, School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region><settlement type="city">Los Angeles</settlement></placeName><orgName type="university">Université de Californie du Sud</orgName></affiliation></author><author><name sortKey="Boselli, E" sort="Boselli, E" uniqKey="Boselli E" first="E." last="Boselli">E. Boselli</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Anaesthesiology and Intensive Care, Édouard Herriot Hospital, Hospices Civils de Lyon</s1><s2>Lyon</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Neely, M N" sort="Neely, M N" uniqKey="Neely M" first="M. N." last="Neely">M. N. Neely</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Laboratory of Applied Pharmacokinetics, University of Southern California, School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region><settlement type="city">Los Angeles</settlement></placeName><orgName type="university">Université de Californie du Sud</orgName></affiliation></author><author><name sortKey="Hope, W W" sort="Hope, W W" uniqKey="Hope W" first="W. W." last="Hope">W. W. Hope</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Department of Molecular and Clinical Pharmacology, University of Liverpool</s1><s2>Liverpool</s2><s3>GBR</s3><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Antimicrobial agents and chemotherapy</title><title level="j" type="abbreviated">Antimicrob. agents chemother.</title><idno type="ISSN">0066-4804</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Antimicrobial agents and chemotherapy</title><title level="j" type="abbreviated">Antimicrob. agents chemother.</title><idno type="ISSN">0066-4804</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Anti-Bacterial Agents (administration & dosage)</term><term>Anti-Bacterial Agents (pharmacokinetics)</term><term>Anti-Bacterial Agents (therapeutic use)</term><term>Antibacterial agent</term><term>Antibiotic</term><term>Antimicrobial agent</term><term>Bacterial Infections (drug therapy)</term><term>Bacterial Infections (microbiology)</term><term>Bayes Theorem</term><term>Creatinine (blood)</term><term>Creatinine (metabolism)</term><term>Critical Illness (therapy)</term><term>Drug Dosage Calculations</term><term>Drug Therapy, Computer-Assisted</term><term>Female</term><term>Human</term><term>Humans</term><term>Male</term><term>Metabolic Clearance Rate</term><term>Microbial Sensitivity Tests</term><term>Middle Aged</term><term>Patient</term><term>Penicillanic Acid (administration & dosage)</term><term>Penicillanic Acid (analogs & derivatives)</term><term>Penicillanic Acid (pharmacokinetics)</term><term>Penicillanic Acid (therapeutic use)</term><term>Piperacillin</term><term>Piperacillin (administration & dosage)</term><term>Piperacillin (pharmacokinetics)</term><term>Piperacillin (therapeutic use)</term><term>Posology</term><term>Precision Medicine (methods)</term><term>Pseudomonas aeruginosa (drug effects)</term><term>Software</term><term>Treatment</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Acide pénicillanique (administration et posologie)</term><term>Acide pénicillanique (analogues et dérivés)</term><term>Acide pénicillanique (pharmacocinétique)</term><term>Acide pénicillanique (usage thérapeutique)</term><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Antibactériens (administration et posologie)</term><term>Antibactériens (pharmacocinétique)</term><term>Antibactériens (usage thérapeutique)</term><term>Calcul des posologies</term><term>Clairance métabolique</term><term>Créatinine (métabolisme)</term><term>Créatinine (sang)</term><term>Femelle</term><term>Humains</term><term>Infections bactériennes (microbiologie)</term><term>Infections bactériennes (traitement médicamenteux)</term><term>Jeune adulte</term><term>Maladie grave ()</term><term>Mâle</term><term>Médecine individualisée ()</term><term>Pharmacothérapie assistée par ordinateur</term><term>Pipéracilline (administration et posologie)</term><term>Pipéracilline (pharmacocinétique)</term><term>Pipéracilline (usage thérapeutique)</term><term>Pseudomonas aeruginosa ()</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tests de sensibilité microbienne</term><term>Théorème de Bayes</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Penicillanic Acid</term><term>Piperacillin</term></keywords><keywords scheme="MESH" type="chemical" qualifier="analogs & derivatives" xml:lang="en"><term>Penicillanic Acid</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Creatinine</term></keywords><keywords scheme="MESH" type="chemical" qualifier="metabolism" xml:lang="en"><term>Creatinine</term></keywords><keywords scheme="MESH" type="chemical" qualifier="pharmacokinetics" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Penicillanic Acid</term><term>Piperacillin</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term><term>Penicillanic Acid</term><term>Piperacillin</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Acide pénicillanique</term><term>Antibactériens</term><term>Pipéracilline</term></keywords><keywords scheme="MESH" qualifier="analogues et dérivés" xml:lang="fr"><term>Acide pénicillanique</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Pseudomonas aeruginosa</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Bacterial Infections</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Precision Medicine</term></keywords><keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Infections bactériennes</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Bacterial Infections</term></keywords><keywords scheme="MESH" qualifier="métabolisme" xml:lang="fr"><term>Créatinine</term></keywords><keywords scheme="MESH" qualifier="pharmacocinétique" xml:lang="fr"><term>Acide pénicillanique</term><term>Antibactériens</term><term>Pipéracilline</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Créatinine</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Critical Illness</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections bactériennes</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Acide pénicillanique</term><term>Antibactériens</term><term>Pipéracilline</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Bayes Theorem</term><term>Drug Dosage Calculations</term><term>Drug Therapy, Computer-Assisted</term><term>Female</term><term>Humans</term><term>Male</term><term>Metabolic Clearance Rate</term><term>Microbial Sensitivity Tests</term><term>Middle Aged</term><term>Young Adult</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Calcul des posologies</term><term>Clairance métabolique</term><term>Femelle</term><term>Humains</term><term>Jeune adulte</term><term>Maladie grave</term><term>Mâle</term><term>Médecine individualisée</term><term>Pharmacothérapie assistée par ordinateur</term><term>Pipéracilline</term><term>Posologie</term><term>Homme</term><term>Malade</term><term>Logiciel</term><term>Antimicrobien</term><term>Pseudomonas aeruginosa</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tests de sensibilité microbienne</term><term>Théorème de Bayes</term><term>Traitement</term><term>Antibactérien</term><term>Antibiotique</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term><term>Logiciel</term><term>Antibiotique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Piperacillin-tazobactam is frequently used for empirical and targeted therapy of infections in critically ill patients. Considerable pharmacokinetic (PK) variability is observed in critically ill patients. By estimating an individual's PK, dosage optimization Bayesian estimation techniques can be used to calculate the appropriate piperacillin regimen to achieve desired drug exposure targets. The aim of this study was to establish a population PK model for piperacillin in critically ill patients and then analyze the performance of the model in the dose optimization software program BestDose. Linear, with estimated creatinine clearance and weight as covariates, Michaelis-Menten (MM) and parallel linear/MM structural models were fitted to the data from 146 critically ill patients with nosocomial infection. Piperacillin concentrations measured in the first dosing interval, from each of 8 additional individuals, combined with the population model were embedded into the dose optimization software. The impact of the number of observations was assessed. Precision was assessed by (i) the predicted piperacillin dosage and by (ii) linear regression of the observed-versus-predicted piperacillin concentrations from the second 24 h of treatment. We found that a linear clearance model with creatinine clearance and weight as covariates for drug clearance and volume of distribution, respectively, best described the observed data. When there were at least two observed piperacillin concentrations, the dose optimization software predicted a mean piperacillin dosage of 4.02 g in the 8 patients administered piperacillin doses of 4.00 g. Linear regression of the observed-versus-predicted piperacillin concentrations for 8 individuals after 24 h of piperacillin dosing demonstrated an r<sup>2</sup> of >0.89. In conclusion, for most critically ill patients, individualized piperacillin regimens delivering a target serum piperacillin concentration is achievable. Further validation of the dosage optimization software in a clinical trial is required.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Auvergne-Rhône-Alpes</li><li>Californie</li><li>Grand Manchester</li><li>Rhône-Alpes</li><li>État de New York</li></region><settlement><li>Los Angeles</li><li>Lyon</li><li>Manchester</li></settlement><orgName><li>Université de Californie du Sud</li><li>Université de Manchester</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Felton, T W" sort="Felton, T W" uniqKey="Felton T" first="T. W." last="Felton">T. W. Felton</name></region><name sortKey="Hope, W W" sort="Hope, W W" uniqKey="Hope W" first="W. W." last="Hope">W. W. Hope</name></country><country name="Australie"><noRegion><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J. A." last="Roberts">J. A. Roberts</name></noRegion></country><country name="États-Unis"><region name="État de New York"><name sortKey="Lodise, T P" sort="Lodise, T P" uniqKey="Lodise T" first="T. P." last="Lodise">T. P. Lodise</name></region><name sortKey="Neely, M N" sort="Neely, M N" uniqKey="Neely M" first="M. N." last="Neely">M. N. Neely</name><name sortKey="Van Guilder, M" sort="Van Guilder, M" uniqKey="Van Guilder M" first="M." last="Van Guilder">M. Van Guilder</name></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Boselli, E" sort="Boselli, E" uniqKey="Boselli E" first="E." last="Boselli">E. Boselli</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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