机构:[1]Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China[2]Department of Neonatology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China[3]Neonatal Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China临床科室职能科室临床流行病与循证医学中心重症医学科首都医科大学附属北京儿童医院[4]Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China医技科室科研平台职能科室呼吸疾病研究室临床流行病与循证医学中心临床研究中心儿科研究所首都医科大学附属北京儿童医院[5]Department of Neonatology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China[6]Neonatal Intensive Care Unit, CHU de Rennes, Rennes, France[7]Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China[8]Department of Pediatric Pharmacology and Pharmacogenetics, Hopital Robert Debré, APHP, Paris, France
Amoxicillin is widely used to treat bacterial infections in neonates. However, considerable intercenter variability in dosage regimens of antibiotics exists in clinical practice. The pharmacokinetics of amoxicillin has been described in only a few preterm neonates. Thus, we aimed to evaluate the population pharmacokinetics of amoxicillin through a large sample size covering the entire age range of neonates and young infants and to establish evidence-based dosage regimens based on developmental pharmacokinetics-pharmacodynamics. This is a prospective, multicenter, pharmacokinetic study using an opportunistic sampling design. Amoxicillin plasma concentrations were determined using high-performance liquid chromatography. Population pharmacokinetic analysis was performed using NONMEM. A total of 224 pharmacokinetic samples from 187 newborns (postmenstrual age range, 28.4 to 46.3 weeks) were available for analysis. A two-compartment model with first-order elimination was used to describe population pharmacokinetics. Covariate analysis showed that current weight, postnatal age, and gestational age were significant covariates. The final model was further validated for predictive performance in an independent cohort of patients. Monte Carlo simulation demonstrated that for early-onset sepsis, the currently used dosage regimen (25 mg/kg twice daily [BID]) resulted in 99.0% of premature neonates and 87.3% of term neonates achieving the pharmacodynamic target (percent time above MIC), using a MIC breakpoint of 1 mg/liter. For late-onset sepsis, 86.1% of premature neonates treated with 25 mg/kg three times a day (TID) and 79.0% of term neonates receiving 25 mg/kg four times a day (QID) reached the pharmacodynamic target, using a MIC breakpoint of 2 mg/liter. The population pharmacokinetics of amoxicillin was assessed in neonates and young infants. A dosage regimen was established based on developmental pharmacokinetics-pharmacodynamics.
基金:
National Science and Technology Major Projects for Major New Drugs Innovation and Development [2017ZX09304029-002]; Young Taishan Scholars Program of Shandong Province; China Postdoctoral Science FoundationChina Postdoctoral Science Foundation [2015M582102]; Capital's Funds for Health Improvement and Research [2018-4-1142]; Qilu Outstanding Program of Shandong University, Capital Health Research and Development of Special Grant [2016-1-2092]
第一作者机构:[1]Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China
共同第一作者:
通讯作者:
通讯机构:[1]Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China
推荐引用方式(GB/T 7714):
Tang Bo-Hao,Wu Yue-E,Kou Chen,et al.Population Pharmacokinetics and Dosing Optimization of Amoxicillin in Neonates and Young Infants[J].ANTIMICROBIAL AGENTS AND CHEMOTHERAPY.2019,63(2):-.doi:10.1128/AAC.02336-18.
APA:
Tang, Bo-Hao,Wu, Yue-E,Kou, Chen,Qi, Yu-Jie,Qi, Hui...&Zhao, Wei.(2019).Population Pharmacokinetics and Dosing Optimization of Amoxicillin in Neonates and Young Infants.ANTIMICROBIAL AGENTS AND CHEMOTHERAPY,63,(2)
MLA:
Tang, Bo-Hao,et al."Population Pharmacokinetics and Dosing Optimization of Amoxicillin in Neonates and Young Infants".ANTIMICROBIAL AGENTS AND CHEMOTHERAPY 63..2(2019):-