Sérové koncentrace meropenemu u pacientů vyžadujících intenzivní péči: retrospektivní analýza

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Autoři: Jana Uricová; Ivana Kacířová; Hana Brozmanová
Působiště autorů: Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Czech Republic
Vyšlo v časopise: Čes. slov. Farm., 2020; 69, 230-236
Kategorie: Původní článek

Souhrn

Úvod: Cílem retrospektivní analýzy bylo posoudit, zda stávající dávkovací režimy meropenemu vedou k adekvátní expozici meropenemu.

Metody: Do práce byly zahrnuty pouze údolní kon-centrace při prvním měření. Ke zhodnocení dosažení farmakokineticko/farmakodynamického (PK/PD) cíle byly použity MIC patogenů definovaných v European Committee on Antimicrobial Susceptibility testing.

Výsledky: Do studie bylo zahrnuto 83 pacientů. Byla pozorována velká variabilita sérových hladin mero-penemu (medián 34,3 mg/l, rozptyl < 1,0–146,1 mg/l). Nejnižší PK/PD cíl pro citlivé patogeny (100 % T > MIC) byl dosažen u 100 % pacientů na dialýze a kontinuální eliminační metodě (CRRT) a u 91 % pacientů bez eliminační metody. Pro patogeny s intermediární citlivostí 100 % T > MIC bylo dosaženo u všech pacientů na CRRT a 96 % pacientů na dialýze, jen 74 % pacientů bez eliminační metody dosáhlo tento PK/PD cíl. Pacienti na RRT měli vyšší pravděpodobnost dosažení nejvyššího PK/PD cíle 100 % T > 5 × MIC, P < 0,05. Vyšší podíl pacientů na RRT by vyžadoval snížení dávky meropenemu, pokud by byl zvolen horní limit 100 % T > 10 × MIC, P < 0,05.

Závěr: Aplikace standardní dávky meropenemu kriticky nemocným pacientům vede k velké variabilitě hladin. Nastavení dávky pro konkrétního pacienta je důležité pro dosažení adekvátní expozice meropenemu.

Klíčová slova:

meropenem – údolní koncentrace – MIC – farmakokineticko/farmakodynamický cíl

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