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Pharmacotherapy:**计算重症患者万古霉素曲线下面积 选哪种工具为宜?

2018-12-27 常路 环球医学

万古霉素浓度时间曲线下面积(AUC)关乎有效性和安全性。2018年12月,发表在《Pharmacotherapy.》的一项研究进行了贝叶斯剂量优化软件和方程计算重症患者万古霉素曲线下面积的审查和验证。

万古霉素浓度时间曲线下面积(AUC)关乎有效性和安全性。2018年12月,发表在《Pharmacotherapy.》的一项研究进行了贝叶斯剂量优化软件和方程计算重症患者万古霉素曲线下面积的审查和验证。

背景:万古霉素AUC与有效性和安全性相关。需要精确计算AUC的方法。

方法:研究人员评估了医生现有的贝叶斯剂量优化软件程序和一阶药代动力学方程,对两种工具评估万古霉素AUC的能力进行评价。既往发表的19名重症患者的丰富的药代动力学数据集,用于验证AUC评估。将贝叶斯软件和方程使用全数据集的子集评估的AUC,与参考AUC进行了对比。研究人员计算了准确性(评估的AUC与参考AUC的比值)和偏倚(评估的AUC减去参考AUC的差值的百分比)。

结果:纳入了5个贝叶斯剂量优化软件程序(成人和儿童动力学(APK)、BestDose、DoseMe、InsightRx、Precise PK)和两个一阶药代动力学方程。在贝叶斯程序中,InsightRx的适应性最强,视觉上更具吸引力,最容易使用,具有最多的公司支持。仅使用谷浓度时,贝叶斯剂量优化软件的准确性(范围,0.79~1.03)和偏倚(5.1%~21.2%)具有差异。Precise PK和BestDose具有最准确的评估值,BestDose的准确值显示出所有程序中的最大变异性,然而,两程序都难以使用。Precise PK的偏倚最低(中位5.1%)。使用单非谷值可产生与多数程序谷值相似的结果。将第二水平添加到谷水平中,可改善DoseMe和InsightRx的准确性和偏倚,但Precise PK和BestDose并非如此。在插入两水平后,APK不能可靠评估AUC。使用两水平,药代动力学方程产生了与贝叶斯软件相似或更好的准确性和偏倚。

结论:使用1个或多个万古霉素水平的贝叶斯剂量优化软件和使用两个万古霉素水平的药代动力学方程,所估计的AUC相似。

原始出处:

Turner RB, Kojiro K, Shephard EA, et al. Review and Validation of Bayesian Dose-Optimizing Software and Equations for Calculation of the Vancomycin Area Under the Curve in Critically Ill Patients. Pharmacotherapy. 2018 Dec;38(12):1174-1183. doi: 10.1002/phar.2191.

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    2019-07-25 yb6560
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    2019-07-16 jj000001
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