肾功能
分配量
阿米卡星
药代动力学
医学
庆大霉素
肾毒性
泌尿科
肌酐
氨基糖苷
万古霉素
内科学
肾
内分泌学
抗生素
化学
生物
金黄色葡萄球菌
细菌
生物化学
遗传学
作者
Nicholas H. G. Holford,Conor J. O’Hanlon,Karel Allegaert,Brian J. Anderson,Amı́lcar Falcão,Nicolas Simon,Yu-Lung Lo,Alison Thomson,Catherine M.T. Sherwin,Evelyne Jacqz‐Aigrain,Carolina Llanos‐Paez,Stefanie Hennig,Linas Mockus,Carl M. Kirkpatrick
摘要
We propose using glomerular filtration rate (GFR) as the physiological basis for distinguishing components of renal clearance.Gentamicin, amikacin and vancomycin are thought to be predominantly excreted by the kidneys. A mixed effects joint model of the pharmacokinetics of these drugs was developed, with a wide dispersion of weight, age, and serum creatinine. A dataset created from 18 sources resulted in 27,338 drug concentrations from 9,901 patients. Body size and composition, maturation and renal function were used to describe differences in drug clearance and volume of distribution.This study demonstrates that GFR is a predictor of two distinct components of renal elimination clearance: (1) GFR clearance associated with normal GFR and (2) non-GFR clearance not associated with normal GFR. All three drugs had GFR clearance estimated as a drug specific percentage of normal GFR (gentamicin 39%, amikacin 90%, vancomycin 57%). The total clearance (sum of GFR and non-GFR clearance), standardized to 70 kg total body mass, 176 cm, male, renal function 1, was 5.58 L/h (95% CI 5.50-5.69) (gentamicin), 7.77 L/h (95 %CI 7.26-8.19) (amikacin) and 4.70 L/h (95 %CI 4.61-4.80) (vancomycin).GFR provides a physiological basis for renal drug elimination. It has been used to distinguish two elimination components. This physiological approach has been applied to describe clearance and volume of distribution from premature neonates to elderly adults with a wide dispersion of size, body composition and renal function. Dose individualization has been implemented using target concentration intervention.
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