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Population Pharmacokinetics and Dosing Optimization of Amoxicillin in Neonates and Young Infants

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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 [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 [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
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关键词: amoxicillin dosing optimization neonates pharmacokinetics

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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.

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出版当年[2018]版:
大类 | 2 区 医学
小类 | 2 区 微生物学 2 区 药学
最新[2023]版:
大类 | 2 区 医学
小类 | 1 区 药学 2 区 微生物学
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出版当年[2017]版:
Q1 PHARMACOLOGY & PHARMACY Q1 MICROBIOLOGY
最新[2023]版:
Q1 PHARMACOLOGY & PHARMACY Q2 MICROBIOLOGY

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第一作者机构: [1]Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China
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通讯机构: [1]Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, Jinan, China
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