Population pharmacokinetic analysis for dose regimen optimization of vancomycin in Southern Chinese children.

Publisher: Wiley Country of Publication: United States NLM ID: 101580011 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2163-8306 (Electronic) Linking ISSN: 21638306 NLM ISO Abbreviation: CPT Pharmacometrics Syst Pharmacol Subsets: MEDLINE

Publication: 2015- : Hoboken, NJ : Wiley
Original Publication: New York, NY : Nature Pub. Group

Anti-Bacterial Agents*/pharmacokinetics ; Anti-Bacterial Agents*/administration & dosage ; Area Under Curve* ; Models, Biological* ; Monte Carlo Method* ; Vancomycin*/pharmacokinetics ; Vancomycin*/administration & dosage; Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; China ; Dose-Response Relationship, Drug ; Drug Monitoring/methods ; East Asian People ; Microbial Sensitivity Tests ; Retrospective Studies

Changes in physiological factors may result in large pharmacokinetic variability of vancomycin in pediatric patients, thereby leading to either supratherapeutic or subtherapeutic exposure and potentially affecting clinical outcomes. This study set out to characterize the disposition of vancomycin, quantify the exposure target and establish an optimal dosage regimen among the Southern Chinese pediatric population. Routine therapeutic drug monitoring data of 453 patients were available. We performed a retrospective population pharmacokinetic analysis of hospitalized children prescribed intravenous vancomycin using NONMEM® software. A one-compartment PPK model of vancomycin with body weight and renal functions as covariates based on a cutoff of 2 years old children was proposed in this study. Both internal and external validation showing acceptable and robust predictive performance of the model to estimate PK parameters. The value of area under the curve over 24 h to minimum inhibitory concentration ratio (AUC 0-24 /MIC) ≥ 260 was a significant predictor for therapeutic efficacy. Monte Carlo simulations served as a model-informed precision dosing approach and suggested that different optimal dose regimens in various scenarios should be considered rather than flat dosing. The evaluation of vancomycin exposure-efficacy relationship indicated that lower target level of AUC 0-24 /MIC may be needed to achieve clinical effectiveness in children, which was used to derive the recommended dosing regimen. Further prospective studies will be needed to corroborate and elucidate these results.
(© 2024 The Authors. CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

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0 (Anti-Bacterial Agents)
6Q205EH1VU (Vancomycin)

Date Created: 20240430 Date Completed: 20240715 Latest Revision: 20240717

20240717

PMC11247118

10.1002/psp4.13151

38686551