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Bauters T, Buyle F, Schelstraete P, Dhooge C. Administration of ciprofloxacin through a nasogastric tube in pediatric oncology and stem cell transplantation patients. J Oncol Pharm Pract 2023; 29:413-415. [PMID: 36572994 DOI: 10.1177/10781552221147891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pediatric oncology and hematopoietic stem cell transplantation patients are facing many gastrointestinal side effects of chemotherapy, including nausea, vomiting, mucositis, and diarrhea. International guidelines advise early enteral tube feeding as the first option of nutritional support in children undergoing myeloablative hematopoietic stem cell transplantation. When using enteral feeding tubes for nutritional purposes as well as drug administration, some pharmaceutical, nursing, and technical issues have to be taken into account. Ciprofloxacin is a fluoroquinolone, widely used because of its broad spectrum antimicrobial activity and favorable pharmacokinetic properties. However, its co-administration with polyvalent cations (as present in enteral feeding) makes the absorption of ciprofloxacin more difficult and may alter the pharmacokinetic parameters. Literature data are conflicting on how long the enteral feeding should be discontinued for patients receiving ciprofloxacin via an enteral feeding tube, ranging from 2 h before to 6 h after the administration of ciprofloxacin. Our research question was guided by challenges and concerns of nurses about the delay time between ciprofloxacin administration and restart of the enteral feeding without compromising the nutritional intake of the children. Our guideline was adapted, nurses were instructed accordingly, and patient leaflets with correct information were created.
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Affiliation(s)
- Tiene Bauters
- Pediatric Hematology, Oncology and Stem Cell Transplantation, 60200Ghent University Hospital, Ghent, Belgium.,Pharmacy Department, 60200Ghent University Hospital, Ghent, Belgium
| | - Franky Buyle
- Pharmacy Department, 60200Ghent University Hospital, Ghent, Belgium
| | - Petra Schelstraete
- Department of Pediatric Pulmonology and Infectious Diseases, 60200Ghent University Hospital, Ghent, Belgium
| | - Catharina Dhooge
- Pediatric Hematology, Oncology and Stem Cell Transplantation, 60200Ghent University Hospital, Ghent, Belgium
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2
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Zyryanov SK, Ushkalova EA, Kondratyeva EI, Butranova OI, Kondakova YA. Gene Polymorphism of Biotransformation Enzymes and Ciprofloxacin Pharmacokinetics in Pediatric Patients with Cystic Fibrosis. Biomedicines 2022; 10:biomedicines10051050. [PMID: 35625789 PMCID: PMC9139162 DOI: 10.3390/biomedicines10051050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Ciprofloxacin (CPF) is widely used for the treatment of cystic fibrosis, including pediatric patients, but its pharmacokinetics is poorly studied in this population. Optimal CPF dosing in pediatric patients may be affected by gene polymorphism of the enzymes involved in its biotransformation. (2) Materials and Methods: a two-center prospective non-randomized study of CPF pharmacokinetics with sequential enrollment of patients (n-33, mean age 9.03 years, male-33.36%), over a period from 2016 to 2021. All patients received tablets of the original CPF drug Cyprobay® at a dose of 16.5 mg/kg to 28.80 mg/kg. Blood sampling schedule: 0 (before taking the drug), 1.5 h; 3.0 h; 4.5 h; 6.0 h; 7.5 h after the first dosing. CPF serum concentrations were analyzed by high performance liquid chromatography mass spectrometry. The genotype of biotransformation enzymes was studied using total DNA isolated from whole blood leukocytes by the standard method. (4) Results: a possible relationship between the CA genotype of the CYP2C9 gene (c.1075A > C), the GG genotype of the CYP2D6*4 gene (1846G > A), the AG genotype of the GSTP1 gene (c.313A > G), the GCLC* genotype 7/7 and the CPF concentration in plasma (increased value of the area under the concentration−time curve) was established. Conclusions: Gene polymorphism of biotransformation enzymes may affect ciprofloxacin pharmacokinetics in children.
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Affiliation(s)
- Sergey K. Zyryanov
- Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russian Federation; (S.K.Z.); (E.A.U.)
- Department of Health of the City of Moscow, City Clinical Hospital No. 24, State Budgetary Institution of the City of Moscow, Pistzovaya Str. 10, 127015 Moscow, Russia
| | - Elena A. Ushkalova
- Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russian Federation; (S.K.Z.); (E.A.U.)
| | - Elena I. Kondratyeva
- Research Centre for Medical Genetics, 1 Moskvorechyie Str., 115522 Moscow, Russia;
| | - Olga I. Butranova
- Peoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russian Federation; (S.K.Z.); (E.A.U.)
- Correspondence: ; Tel.: +7-(903)-3767140
| | - Yulia A. Kondakova
- GBUZ NSO City Children’s Clinical Hospital of Emergency Medical Aid, Krasny Prospekt 3, 630007 Novosibirsk, Russia;
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3
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de Cacqueray N, Boujaafar S, Bille E, Moulin F, Gana I, Benaboud S, Hirt D, Béranger A, Toubiana J, Renolleau S, Tréluyer JM, Oualha M. Therapeutic Drug Monitoring of Antibiotics in Critically Ill Children: An Observational Study in a Pediatric Intensive Care Unit. Ther Drug Monit 2022; 44:319-327. [PMID: 35292609 DOI: 10.1097/ftd.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Septic critically ill children are at a high risk of inadequate antibiotic exposure, requiring them to undergo therapeutic drug monitoring (TDM). The aim of this study was to describe the use of TDM for antibiotics in critically ill children. METHODS The authors conducted a single-center observational study between June and December 2019, with all children treated with antibiotics in a pediatric intensive care unit located in a French university hospital. Standard clinical and laboratory data were recorded. Blood samples were collected for routine laboratory tests, and plasma antibiotic levels were assayed using validated analytical methods. RESULTS A total of 209 children received antibiotics. TDM was performed in 58 patients (27.8%) who had a greater mean organ dysfunction (according to the International Pediatric Sepsis Consensus Conference) (3 versus 1 in the non-TDM group; P < 0.05) and were treated with antibiotics for longer. A total of 208 samples were analyzed. The median [interquartile range] assay turnaround time was 3 (1-5) days, and 48 (46.2%) of the 104 initial antibiotic concentration values were below the pharmacokinetic/pharmacodynamic targets. A total of 34 (46%) of the 74 off-target TDM measurements available before the end of the antibiotic treatment prompted dose adjustment. This dose adjustment increased the proportion of on-target TDM measurements (70% versus 20% without adjustment). Subsequent measurements of the minimum inhibitory concentration showed that the use of the European Committee on Antimicrobial Susceptibility Testing's epidemiological cutoff values led to underestimation of pharmacokinetic/pharmacodynamic target attainment in 10 cases (20%). CONCLUSIONS TDM seems to be an effective means of optimizing antibiotic exposure in critically ill children. This requires timely plasma antibiotic assays and minimum inhibitory concentration measurements. It is important to define which patients should undergo TDM and how this monitoring should be managed.
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Affiliation(s)
- Noémie de Cacqueray
- Department of Pediatric Intensive Care Unit, Necker Enfants Malades Hospital, Université de Paris
| | - Sana Boujaafar
- Department of Clinical Pharmacology, Cochin Hospital, Université de Paris
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris
| | - Emmanuelle Bille
- Microbiological Laboratory, Necker Enfants Malades Hospital, Université de Paris; and
| | - Florence Moulin
- Department of Pediatric Intensive Care Unit, Necker Enfants Malades Hospital, Université de Paris
| | - Inès Gana
- Department of Clinical Pharmacology, Cochin Hospital, Université de Paris
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris
| | - Sihem Benaboud
- Department of Clinical Pharmacology, Cochin Hospital, Université de Paris
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris
| | - Déborah Hirt
- Department of Clinical Pharmacology, Cochin Hospital, Université de Paris
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris
| | - Agathe Béranger
- Department of Pediatric Intensive Care Unit, Necker Enfants Malades Hospital, Université de Paris
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris
| | - Julie Toubiana
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker Enfants Malades Hospital, Université de Paris, Paris, France
| | - Sylvain Renolleau
- Department of Pediatric Intensive Care Unit, Necker Enfants Malades Hospital, Université de Paris
| | - Jean M Tréluyer
- Department of Pediatric Intensive Care Unit, Necker Enfants Malades Hospital, Université de Paris
- Department of Clinical Pharmacology, Cochin Hospital, Université de Paris
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris
| | - Mehdi Oualha
- Department of Pediatric Intensive Care Unit, Necker Enfants Malades Hospital, Université de Paris
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Université de Paris
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4
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Zahr N, Urien S, Aubry A, Chauvin C, Comets E, Llopis B, Tissot N, Noe G, Fourniols E, Jaureguiberry S, Bleibtreu A, Funck-Brentano C. Ciprofloxacin population pharmacokinetics during long-term treatment of osteoarticular infections. J Antimicrob Chemother 2021; 76:2906-2913. [PMID: 34363656 DOI: 10.1093/jac/dkab275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ciprofloxacin is an antibiotic used in osteoarticular infections owing to its very good bone penetration. Very few pharmacokinetic data are available in this population. OBJECTIVES To investigate oral ciprofloxacin population pharmacokinetics in adult patients treated for osteoarticular infections and propose guidance for more effective dosing. METHODS A retrospective population-pharmacokinetic analysis was performed on 92 consecutive hospitalized patients in the orthopaedic department. Ciprofloxacin plasma samples were obtained on one or two occasions during treatment. Plasma concentration was measured using ultra-performance liquid chromatography system coupled with tandem mass spectrometry. Data analysis was performed using a non-linear mixed-effect approach via Monolix 2019R2. RESULTS A total of 397 plasma samples were obtained with 11.5% and 41.6% of patients being below the therapeutic target for Gram-negative and staphylococcal infections, respectively. Ciprofloxacin pharmacokinetics were best described by a two-compartment model with a first-order absorption. Ciprofloxacin apparent plasma clearances and volumes of distribution were dependent on patients' fat-free mass according to the allometric rule. Elimination clearance was also positively related to renal function through the modification of diet in renal disease equation (MDRD) and rifampicin co-administration. When patients are co-treated with rifampicin, ciprofloxacin dosage should be increased by 50% to 60%. CONCLUSIONS This study showed that free-fat mass was a better size predictor than total body weight for ciprofloxacin clearance and volumes terms. Moreover, both MDRD and rifampicin status were significant predictors of individual ciprofloxacin clearance. Our study suggests that individual adjustment of ciprofloxacin dose in osteoarticular infections with less-susceptible bacteria might be indicated to reach required efficacy targets.
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Affiliation(s)
- Noël Zahr
- AP-HP, Sorbonne Université, Department of Pharmacology and Clinical Investigation Center (CIC-1901), Pitié-Salpêtrière Hospital; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université Médecine, F-75013 Paris, France.,AP-HP, Sorbonne Université, Pharmacokinetics and Therapeutic Drug Monitoring Unit, Laboratoire de Suivi Thérapeutique Pharmacologique Spécialisé, F-75013 Paris, France
| | - Saik Urien
- 3AP-HP, Université de Paris, Cochin Hospital, Department of Pediatric and Perinatal Pharmacology, Paris, France
| | - Alexandra Aubry
- Sorbonne Université, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, 75013 Paris, France.,Laboratoire de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 75651 Paris cedex 13, France
| | - Charlotte Chauvin
- AP-HP, Sorbonne Université, Department of Pharmacology and Clinical Investigation Center (CIC-1901), Pitié-Salpêtrière Hospital; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université Médecine, F-75013 Paris, France
| | | | - Benoit Llopis
- AP-HP, Sorbonne Université, Department of Pharmacology and Clinical Investigation Center (CIC-1901), Pitié-Salpêtrière Hospital; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université Médecine, F-75013 Paris, France
| | - Nadine Tissot
- AP-HP, Sorbonne Université, Department of Pharmacology and Clinical Investigation Center (CIC-1901), Pitié-Salpêtrière Hospital; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université Médecine, F-75013 Paris, France
| | - Gaëlle Noe
- AP-HP, Sorbonne Université, Department of Pharmacology and Clinical Investigation Center (CIC-1901), Pitié-Salpêtrière Hospital; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université Médecine, F-75013 Paris, France
| | - Eric Fourniols
- AP-HP, Pitié-Salpêtrière Hospital, Department of Orthopedia, Paris, France
| | - Stéphane Jaureguiberry
- AP-HP, Paris Saclay Université, Inserm 1018 Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Bicêtre Hospital, Service de Maladies Infectieuses et Tropicales, Kremlin Bicêtre, France
| | - Alexandre Bleibtreu
- AP-HP, Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Pitié-Salpêtrière Hospital, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - Christian Funck-Brentano
- AP-HP, Sorbonne Université, Department of Pharmacology and Clinical Investigation Center (CIC-1901), Pitié-Salpêtrière Hospital; INSERM, CIC-1901 and UMR-S 1166, Sorbonne Université Médecine, F-75013 Paris, France
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5
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Hirt D, Oualha M, Pasquiers B, Blanot S, Rubinstazjn R, Glorion C, Messaoudi SE, Drummond D, Lopez V, Toubiana J, Béranger A, Boujaafar S, Zheng Y, Capito C, Winter S, Léger PL, Berthaud R, Gana I, Foissac F, Tréluyer JM, Bouazza N, Benaboud S. Population pharmacokinetics of intravenous and oral ciprofloxacin in children to optimize dosing regimens. Eur J Clin Pharmacol 2021; 77:1687-1695. [PMID: 34160669 DOI: 10.1007/s00228-021-03174-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to characterize pharmacokinetics of intravenous and oral ciprofloxacin in children to optimize dosing scheme. METHODS Children treated with ciprofloxacin were included. Pharmacokinetics were described using non-linear mixed-effect modelling and validated with an external dataset. Monte Carlo simulations investigated dosing regimens to achieve a target AUC0-24 h/MIC ratio ≥ 125. RESULTS A total of 189 children (492 concentrations) were included. A two-compartment model with first-order absorption and elimination best described the data. An allometric model was used to describe bodyweight (BW) influence, and effects of estimated glomerular filtration rate (eGFR) and age were significant on ciprofloxacin clearance. CONCLUSION The recommended IV dose of 10 mg/kg q8h, not exceeding 400 mg q8h, would achieve AUC0-24 h to successfully treat bacteria with MICs ≤ 0.25 (e.g. Salmonella, Escherichia coli, Proteus, Haemophilus, Enterobacter, and Klebsiella). A dose increase to 600 mg q8h in children > 40 kg and to 15 mg/kg q8h (max 400 mg q8h, max 600 mg q8h if augmented renal clearance, i.e., eGFR > 200 mL/min/1.73 m2) in children < 40 kg would be needed for the strains with highest MIC (16% of Pseudomonas aeruginosa and 47% of Staphylococcus aureus). The oral recommended dose of 20 mg/kg q12h (not exceeding 750 mg) would cover bacteria with MICs ≤ 0.125 but may be insufficient for bacteria with higher MIC and a dose increase according bodyweight and eGFR would be needed. These doses should be prospectively confirmed, and a therapeutic drug monitoring could be used to refine them individually.
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Affiliation(s)
- D Hirt
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France. .,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France. .,INSERM, U1018, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - M Oualha
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Réanimation et Surveillance Continue Médico-Chirurgicales Pédiatriques, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - B Pasquiers
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France
| | - S Blanot
- Service de Neurochirurgie, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - R Rubinstazjn
- Service de Réanimation Chirurgicale Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - C Glorion
- Service de Chirurgie Orthopédique et Traumatologie Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - S El Messaoudi
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France
| | - D Drummond
- Service de Pneumologie Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - V Lopez
- Service de Réanimation Cardiaque Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - J Toubiana
- Service de Pédiatrie Générale - Équipe Mobile D'infectiologie, Hôpital Necker Enfants Malades, AP-HP, Université de Paris, 149 Rue de Sèvres, 75015, Paris, France
| | - A Béranger
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Réanimation et Surveillance Continue Médico-Chirurgicales Pédiatriques, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Sana Boujaafar
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Yi Zheng
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Carmen Capito
- Service de Chirurgie Viscérale et Urologique Pédiatriques, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - S Winter
- Service d'hématologie, Immunologie et Rhumatologie Pédiatrique Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - P L Léger
- Service de Réanimation Pédiatrique, Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - R Berthaud
- Service de Néphrologie Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - Inès Gana
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - F Foissac
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - J M Tréluyer
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - N Bouazza
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - S Benaboud
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
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6
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Sassen SDT, Mathôt RAA, Pieters R, de Haas V, Kaspers GJL, van den Bos C, Tissing WJE, Te Loo DMWW, Bierings MB, van Westreenen M, van der Sluis IM, Zwaan CM. Population Pharmacokinetics and Pharmacodynamics of Ciprofloxacin Prophylaxis in Pediatric Acute Lymphoblastic Leukemia Patients. Clin Infect Dis 2021; 71:e281-e288. [PMID: 31790556 DOI: 10.1093/cid/ciz1163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ciprofloxacin is used as antimicrobial prophylaxis in pediatric acute lymphoblastic leukemia (ALL) to decrease infections with gram-negative bacteria. However, there are no clear guidelines concerning prophylactic dose. AIMS To determine the pharmacokinetics and pharmacodynamics (PKPD) of ciprofloxacin prophylaxis in a pediatric ALL population. The effect of patient characteristics and antileukemic treatment on ciprofloxacin exposure, the area under the concentration time curve over minimal inhibitory concentration (AUC24/MIC) ratios, and emergence of resistance were studied. METHODS A total of 615 samples from 129 children (0-18 years) with ALL were collected in a multicenter prospective study. A population pharmacokinetic model was developed. Microbiological cultures were collected prior to and during prophylaxis. An AUC24/MIC of ≥125 was defined as target ratio. RESULTS A 1-compartment model with zero-order absorption and allometric scaling best described the data. No significant (P < .01) covariates remained after backward elimination and no effect of asparaginase or azoles were found. Ciprofloxacin AUC24 was 16.9 mg*h/L in the prednisone prophase versus 29.3 mg*h/L with concomitant chemotherapy. Overall, 100%, 81%, and 18% of patients at, respectively, MIC of 0.063, 0.125, and 0.25 mg/L achieved AUC24/MIC ≥ 125. In 13% of the patients, resistant bacteria were found during prophylactic treatment. CONCLUSION Ciprofloxacin exposure shows an almost 2-fold change throughout the treatment of pediatric ALL. Depending on the appropriateness of 125 as target ratio, therapeutic drug monitoring or dose adjustments might be indicated for less susceptible bacteria starting from ≥ 0.125 mg/L to prevent the emergence of resistance and reach required targets for efficacy.
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Affiliation(s)
- S D T Sassen
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R A A Mathôt
- Department of Hospital Pharmacy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - V de Haas
- Dutch Childhood Oncology Group (DCOG), The Hague, The Netherlands
| | - G J L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - C van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D M W W Te Loo
- Department of Pediatric Hemato-Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - M B Bierings
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht/Wilhelmina Children's Hospital, The Netherlands
| | - M van Westreenen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - I M van der Sluis
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C M Zwaan
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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7
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Katragadda S, Neelakantan S, Diao L, Wong N. Population Pharmacokinetic Analysis of Recombinant Factor VIII Fc Fusion Protein in Subjects With Severe Hemophilia A: Expanded to Include Pediatric Subjects. J Clin Pharmacol 2021; 61:889-900. [PMID: 33719084 DOI: 10.1002/jcph.1854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/04/2021] [Indexed: 01/19/2023]
Abstract
Recombinant factor VIII Fc fusion protein (rFVIIIFc) has been indicated for adults and children with hemophilia A. The objective of this article was to build a population pharmacokinetic (PK) model using adult and pediatric data sets and explore relevant dosing scenarios across all ages. The activity-time profiles of rFVIIIFc from 3 clinical studies (all trials registered at https://www.clinicaltrials.gov: NCT01027377, NCT01181128, and NCT01458106) were characterized, and covariates that determine variability of rFVIIIFc PK in children and adults were identified and implemented. Data sets were pooled to estimate population PK parameters. Simulations were conducted to generate activity-time profiles at steady state (SS). The proportion of subjects maintaining SS trough >1 and >3 IU/dL and time >10 IU/dL were estimated. The rFVIIIFc model was a two-compartment model that identified weight and von Willebrand factor as significant covariates. Model-predicted SS peaks and troughs of rFVIIIFc activity-time profiles confirmed the necessity of modifying dosing in pediatric subjects. The model also predicted that the average subject in the adult and adolescent group dosed with 40 IU/kg every 2 days maintained factor VIII activity >10 IU/dL for the entire duration. Children aged <6 years and aged 6 to <12 years receiving this dose maintained factor VIII activity of >10 IU/dL for nearly two-thirds and three-quarters of their time, respectively. In conclusion, these population PK analyses characterize activity-time profiles for rFVIIIFc among pediatric and adult subjects. The model was used for simulation of clinically relevant dosing scenarios, which can provide better protection and better clinical outcomes.
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Affiliation(s)
| | | | - Lei Diao
- EpimAb Biotherapeutics, Shanghai, China
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8
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Orito Y, Kakara M, Okada A, Nagai N. Model-based approach to sampling optimization in studies of antibacterial drugs for infants and young children. Clin Transl Sci 2021; 14:1543-1553. [PMID: 33742784 PMCID: PMC8301546 DOI: 10.1111/cts.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022] Open
Abstract
Clinical trials for pediatric indications and new pediatric drugs face challenges, including the limited blood volume due to the patients’ small bodies. In Japan, the Evaluation Committee on Unapproved or Off‐labeled Drugs with High Medical Needs has discussed the necessity of pediatric indications against the background of a lack of Japanese pediatric data. The limited treatment options regarding antibiotics for pediatric patients are associated with the emergence of antibiotic‐resistant bacteria. Regulatory guidelines promote the use of model‐based drug development to reduce practical and ethical constraints for pediatric patients. Sampling optimization is one of the key study designs for pediatric drug development. In this simulation study, we evaluated the precision of the empirical Bayes estimates of pharmacokinetic (PK) parameters based on the sampling times optimized by published pediatric population PK models. We selected three previous PK studies of cefepime and ciprofloxacin in infants and young children as paradigms. The number of sampling times was reduced from original full sampling times to two to four sampling times based on the Fisher information matrix. We observed that the precision of empirical Bayes estimates of the key PK parameters and the predicted efficacy based on the reduced sampling times were generally comparable to those based on the original full sampling times. The model‐based approach to sampling optimization provided a maximization of PK information with a minimum burden on infants and young children for the future development of pediatric drugs.
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9
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Magréault S, Roy C, Launay M, Sermet-Gaudelus I, Jullien V. Pharmacokinetic and Pharmacodynamic Optimization of Antibiotic Therapy in Cystic Fibrosis Patients: Current Evidences, Gaps in Knowledge and Future Directions. Clin Pharmacokinet 2021; 60:409-45. [PMID: 33486720 DOI: 10.1007/s40262-020-00981-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Antibiotic therapy is one of the main treatments for cystic fibrosis (CF). It aims to eradicate bacteria during early infection, calms down the inflammatory process, and leads to symptom resolution of pulmonary exacerbations. CF can modify both the pharmacokinetic (PK) and pharmacodynamic (PD) profiles of antibiotics, therefore specific PK/PD endpoints should be determined in the context of CF. Currently available data suggest that optimal PK/PD targets cannot be attained in sputum with intravenous aminoglycosides. Continuous infusion appears preferable for β-lactam antibiotics, but optimal concentrations in sputum are unlikely to be reached, with some possible exceptions such as meropenem and ceftolozane. Usual doses are likely suboptimal for fluoroquinolones and linezolid, whereas daily doses of 45-60 mg/kg and 200 mg could be convenient for vancomycin and doxycycline, respectively. Weekly azithromycin doses of 22-30 mg/kg could also be appropriate for its anti-inflammatory effect. The difficulty with achieving optimal concentrations supports the use of combined treatments and the inhaled administration route, as very high local concentrations, concomitantly with low systemic exposure, can be obtained with the inhaled route for aminoglycosides, colistin, and fluoroquinolones, thus minimizing the risk of toxicity.
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10
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Akkerman-Nijland AM, Akkerman OW, Grasmeijer F, Hagedoorn P, Frijlink HW, Rottier BL, Koppelman GH, Touw DJ. The pharmacokinetics of antibiotics in cystic fibrosis. Expert Opin Drug Metab Toxicol 2020; 17:53-68. [PMID: 33213220 DOI: 10.1080/17425255.2021.1836157] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Dosing of antibiotics in people with cystic fibrosis (CF) is challenging, due to altered pharmacokinetics, difficulty of lung tissue penetration, and increasing presence of antimicrobial resistance. AREAS COVERED The purpose of this work is to critically review original data as well as previous reviews and guidelines on pharmacokinetics of systemic and inhaled antibiotics in CF, with the aim to propose strategies for optimization of antibacterial therapy in both children and adults with CF. EXPERT OPINION For systemic antibiotics, absorption is comparable in CF patients and non-CF controls. The volume of distribution (Vd) of most antibiotics is similar between people with CF with normal body composition and healthy individuals. However, there are a few exceptions, like cefotiam and tobramycin. Many antibiotic class-dependent changes in drug metabolism and excretion are reported, with an increased total body clearance for ß-lactam antibiotics, aminoglycosides, fluoroquinolones, and trimethoprim. We, therefore, recommend following class-specific guidelines for CF, mostly resulting in higher dosages per kg bodyweight in CF compared to non-CF controls. Higher local antibiotic concentrations in the airways can be obtained by inhalation therapy, with which eradication of bacteria may be achieved while minimizing systemic exposure and risk of toxicity.
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Affiliation(s)
- Anne M Akkerman-Nijland
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Floris Grasmeijer
- Department of Pharmacy, PureIMS B.V , Roden, The Netherlands.,Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen, The Netherlands
| | - Paul Hagedoorn
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen, The Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen , Groningen, The Netherlands
| | - Bart L Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Daniel J Touw
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
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11
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de Vroom SL, van Hest RM, van Daalen FV, Kuil SD, Mathôt RAA, Geerlings SE, Jager NGL. Pharmacokinetic/pharmacodynamic target attainment of ciprofloxacin in adult patients on general wards with adequate and impaired renal function. Int J Antimicrob Agents 2020; 56:106166. [PMID: 32941947 DOI: 10.1016/j.ijantimicag.2020.106166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/05/2020] [Accepted: 09/10/2020] [Indexed: 01/01/2023]
Abstract
Limited prospective data on pharmacokinetic/pharmacodynamic (PK/PD) target attainment of ciprofloxacin in patients with adequate and impaired renal function (eGFR <30 mL/min/1.73m2) are available in the literature. We aimed to investigate whether the PK/PD target (AUC/MIC ≥125) is attained in patients with adequate and impaired renal function receiving regular and reduced ciprofloxacin doses. This prospective observational cohort study included adult patients on general wards treated with ciprofloxacin. Three blood samples per patient were obtained for ciprofloxacin concentration measurement. Individual AUCs were calculated using a population PK model developed by non-linear mixed-effects modelling. Forty patients were included, of whom eight had impaired renal function and were treated with a guideline-recommended reduced dose. Using the clinical breakpoint MIC of the most isolated bacteria (Escherichia coli, 0.25 mg/L), AUC0-24/MIC ≥125 was attained in 13/32 (41%) patients with adequate renal function receiving regular doses and in 1/8 (13%) patients with impaired renal function receiving reduced doses. Median drug exposure (AUC0-24) for patients with impaired renal function was 19.0 [interquartile range (IQR) 14.2-23.3] mg/L•h, which was statistically significantly lower than that for patients with adequate renal function [29.3 (IQR 25.0-36.0) mg/L•h] (P < 0.01). AUC0-24/MIC ≥125 is not attained in the majority of adult patients on general wards for clinically relevant bacteria with MICs at or just below the clinical breakpoint. The risk of not attaining the target appears to be highest in patients with impaired renal function receiving guideline-recommended reduced doses, as drug exposure is significantly lower in these patients.
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Affiliation(s)
- Suzanne L de Vroom
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Infection and Immunity (AI&II), Meibergdreef 9, Amsterdam, Netherlands.
| | - Reinier M van Hest
- Amsterdam UMC, University of Amsterdam, Department of Hospital Pharmacy, Division of Clinical Pharmacology, Meibergdreef 9, Amsterdam, Netherlands.
| | - Frederike V van Daalen
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Infection and Immunity (AI&II), Meibergdreef 9, Amsterdam, Netherlands
| | - Sacha D Kuil
- Amsterdam UMC, University of Amsterdam, Department of Medical Microbiology, Meibergdreef 9, Amsterdam, Netherlands
| | - Ron A A Mathôt
- Amsterdam UMC, University of Amsterdam, Department of Hospital Pharmacy, Division of Clinical Pharmacology, Meibergdreef 9, Amsterdam, Netherlands
| | - Suzanne E Geerlings
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Infection and Immunity (AI&II), Meibergdreef 9, Amsterdam, Netherlands
| | - Nynke G L Jager
- Amsterdam UMC, University of Amsterdam, Department of Hospital Pharmacy, Division of Clinical Pharmacology, Meibergdreef 9, Amsterdam, Netherlands; Radboud University Medical Center, Department of Hospital Pharmacy, Geert Grooteplein 10, Nijmegen, the Netherlands
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12
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Schlender JF, Teutonico D, Coboeken K, Schnizler K, Eissing T, Willmann S, Jaehde U, Stass H. A Physiologically-Based Pharmacokinetic Model to Describe Ciprofloxacin Pharmacokinetics Over the Entire Span of Life. Clin Pharmacokinet 2019; 57:1613-1634. [PMID: 29737457 PMCID: PMC6267540 DOI: 10.1007/s40262-018-0661-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Physiologically-based pharmacokinetic (PBPK) modeling has received growing interest as a useful tool for the assessment of drug pharmacokinetics by continuous knowledge integration. Objective The objective of this study was to build a ciprofloxacin PBPK model for intravenous and oral dosing based on a comprehensive literature review, and evaluate the predictive performance towards pediatric and geriatric patients. Methods The aim of this report was to establish confidence in simulations of the ciprofloxacin PBPK model along the development process to facilitate reliable predictions outside of the tested adult age range towards the extremes of ages. Therefore, mean data of 69 published clinical trials were identified and integrated into the model building, simulation and verification process. The predictive performance on both ends of the age scale was assessed using individual data of 258 subjects observed in own clinical trials. Results Ciprofloxacin model verification demonstrated no concentration-related bias and accurate simulations for the adult age range, with only 4.8% of the mean observed data points for intravenous administration and 12.1% for oral administration being outside the simulated twofold range. Predictions towards the extremes of ages for the area under the plasma concentration–time curve (AUC) and the maximum plasma concentration (Cmax) over the entire span of life revealed a reliable estimation, with only two pediatric AUC observations outside the 90% prediction interval. Conclusion Overall, this ciprofloxacin PBPK modeling approach demonstrated the predictive power of a thoroughly informed middle-out approach towards age groups of interest to potentially support the decision-making process. Electronic supplementary material The online version of this article (10.1007/s40262-018-0661-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan-Frederik Schlender
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany.
- Systems Pharmacology and Medicine, Bayer AG, 51373, Leverkusen, Germany.
| | - Donato Teutonico
- Systems Pharmacology and Medicine, Bayer AG, 51373, Leverkusen, Germany
- Division of Clinical Pharmacokinetics and Pharmacometrics, Institut de Recherches Internationales Servier, Suresnes, France
| | - Katrin Coboeken
- Systems Pharmacology and Medicine, Bayer AG, 51373, Leverkusen, Germany
| | - Katrin Schnizler
- Systems Pharmacology and Medicine, Bayer AG, 51373, Leverkusen, Germany
| | - Thomas Eissing
- Systems Pharmacology and Medicine, Bayer AG, 51373, Leverkusen, Germany
| | | | - Ulrich Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany
| | - Heino Stass
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany
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13
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Meesters K, Raes AM, Vande Walle JG. What do I need to know about fluoroquinolones for children? Arch Dis Child Educ Pract Ed 2019; 104:254-258. [PMID: 29987158 DOI: 10.1136/archdischild-2017-313513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/11/2018] [Accepted: 06/05/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Kevin Meesters
- Department of Paediatrics and Medical Genetics, Ghent University Hospital, Gent, Belgium.,Department of Paediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ann M Raes
- Department of Paediatrics and Medical Genetics, Ghent University Hospital, Gent, Belgium
| | - Johan G Vande Walle
- Department of Paediatrics and Medical Genetics, Ghent University Hospital, Gent, Belgium
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14
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Bulitta JB, Jiao Y, Landersdorfer CB, Sutaria DS, Tao X, Shin E, Höhl R, Holzgrabe U, Stephan U, Sörgel F. Comparable Bioavailability and Disposition of Pefloxacin in Patients with Cystic Fibrosis and Healthy Volunteers Assessed via Population Pharmacokinetics. Pharmaceutics 2019; 11:pharmaceutics11070323. [PMID: 31295857 PMCID: PMC6681055 DOI: 10.3390/pharmaceutics11070323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 11/16/2022] Open
Abstract
Quinolone antibiotics present an attractive oral treatment option in patients with cystic fibrosis (CF). Prior studies have reported comparable clearances and volumes of distribution in patients with CF and healthy volunteers for primarily renally cleared quinolones. We aimed to provide the first pharmacokinetic comparison for pefloxacin as a predominantly nonrenally cleared quinolone and its two metabolites between both subject groups. Eight patients with CF (fat-free mass [FFM]: 36.3 ± 6.9 kg, average ± SD) and ten healthy volunteers (FFM: 51.7 ± 9.9 kg) received 400 mg pefloxacin as a 30 min intravenous infusion and orally in a randomized, two-way crossover study. All plasma and urine data were simultaneously modelled. Bioavailability was complete in both subject groups. Pefloxacin excretion into urine was approximately 74% higher in patients with CF compared to that in healthy volunteers, whereas the urinary excretion of metabolites was only slightly higher in patients with CF. After accounting for body size and composition via allometric scaling by FFM, pharmacokinetic parameter estimates in patients with CF divided by those in healthy volunteers were 0.912 for total clearance, 0.861 for nonrenal clearance, 1.53 for renal clearance, and 0.916 for volume of distribution. Nonrenal clearance accounted for approximately 90% of total pefloxacin clearance. Overall, bioavailability and disposition were comparable between both subject groups.
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Affiliation(s)
- Jürgen B Bulitta
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA.
| | - Yuanyuan Jiao
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA
| | - Cornelia B Landersdorfer
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville VIC 3052, Australia
| | - Dhruvitkumar S Sutaria
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA
| | - Xun Tao
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA
| | - Eunjeong Shin
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Orlando, FL 32827, USA
| | - Rainer Höhl
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, 90419 Nürnberg, Germany
| | - Ulrike Holzgrabe
- Institute for Pharmacy and Food Chemistry, University of Würzburg, 97074 Würzburg, Germany
| | - Ulrich Stephan
- IBMP-Institute for Biomedical and Pharmaceutical Research, 90562 Nürnberg-Heroldsberg, Germany
- Department of Pharmacology, University of Duisburg, 47057 Essen, Germany
| | - Fritz Sörgel
- IBMP-Institute for Biomedical and Pharmaceutical Research, 90562 Nürnberg-Heroldsberg, Germany.
- Department of Pharmacology, University of Duisburg, 47057 Essen, Germany.
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15
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Balbas-Martinez V, Michelet R, Edginton AN, Meesters K, Trocóniz IF, Vermeulen A. Physiologically-Based Pharmacokinetic model for Ciprofloxacin in children with complicated Urinary Tract Infection. Eur J Pharm Sci 2018; 128:171-179. [PMID: 30503378 DOI: 10.1016/j.ejps.2018.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 01/05/2023]
Abstract
In a recent multicenter population pharmacokinetic study of ciprofloxacin administered to children suffering from complicated urinary tract infection (cUTI), the apparent volume of distribution (V) and total plasma clearance (CL) were decreased by 83.6% and 41.5% respectively, compared to healthy children. To understand these differences, a physiologically-based pharmacokinetic model (PBPK) for ciprofloxacin was developed for cUTI children. First, a PBPK model in adults was developed, modified incorporating age-dependent functions and evaluated with paediatric data generated from a published model in healthy children. Then, the model was then adapted to a cUTI paediatric population according to the degree of renal impairment (KF) affecting renal clearance (CLRenal,) and CYP1A2 clearance (CLCYP1A2). Serum and urine samples obtained from 22 cUTI children were used for model evaluation. Lastly, a parameter sensitivity analysis identified the most influential parameters on V and CL. The PBPK model predicted the ciprofloxacin exposure in adults and children, capturing age-related pharmacokinetic changes. Plasma concentrations and fraction excreted unchanged in urine (fe) predictions improved in paediatric cUTI patients once CLrenal and CLCYP1A2 were corrected by KF. The presented PBPK model for ciprofloxacin demonstrates its adequacy to simulate different dosing scenarios to obtain PK predictions in a healthy population from 3 months old onwards. Model adaptation of CLRenal and CLCYP1A2 according to KF explained partially the differences seen in the plasma drug concentrations and fe vs time profiles between healthy and cUTI children. Nevertheless, it is necessary to further investigate the disease-related changes in cUTI to improve model predictions.
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Affiliation(s)
- Violeta Balbas-Martinez
- Pharmacometrics and Systems Pharmacology, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Ghent University, Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, Ghent, Belgium.
| | - Robin Michelet
- Ghent University, Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, Ghent, Belgium.
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
| | - Kevin Meesters
- Ghent University Hospital, Department of Pediatric Nephrology, Ghent, Belgium; KidZ Health Castlee, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Iñaki F Trocóniz
- Pharmacometrics and Systems Pharmacology, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - An Vermeulen
- Ghent University, Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, Ghent, Belgium.
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16
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Jiao Y, Kim TH, Tao X, Kinzig M, Landersdorfer CB, Drescher SK, Sutaria DS, Moya B, Holzgrabe U, Sörgel F, Bulitta JB. First population pharmacokinetic analysis showing increased quinolone metabolite formation and clearance in patients with cystic fibrosis compared to healthy volunteers. Eur J Pharm Sci 2018; 123:416-428. [DOI: 10.1016/j.ejps.2018.07.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 01/29/2023]
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17
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Facchin A, Bui S, Leroux S, Nacka F, Koehl B, Maksoud E, Fayon M, Jacqz-Aigrain E. Variability of ciprofloxacin pharmacokinetics in children: impact on dose range in sickle cell patients. J Antimicrob Chemother 2018; 73:3423-3429. [DOI: 10.1093/jac/dky328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Facchin
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
- Ecole Doctorale MTCI, Université Paris Descartes, Paris, France
| | - S Bui
- Département de Pédiatrie, CIC1401, CHU de Bordeaux, Bordeaux, France
| | - S Leroux
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
| | - F Nacka
- Département de Pédiatrie, CIC1401, CHU de Bordeaux, Bordeaux, France
| | - B Koehl
- Service d’hématologie, Centre de référence de la drépanocytose, Hôpital Robert Debré, APHP, Paris, France
- Département de Pédiatrie, Hôpital Robert Debré, APHP, Paris, France
| | - E Maksoud
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
| | - M Fayon
- Département de Pédiatrie, CIC1401, CHU de Bordeaux, Bordeaux, France
| | - E Jacqz-Aigrain
- Département de Pharmacologie Pédiatrique et pharmacogénétique, CHU Robert Debré APHP, Paris, France
- Université Paris Diderot, Sorbonne Paris-Cité, Paris, France
- Centre d’investigation clinique, CIC1426, INSERM, Paris, France
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18
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Meesters K, Michelet R, Mauel R, Raes A, Van Bocxlaer J, Vande Walle J, Vermeulen A. Results of a Multicenter Population Pharmacokinetic Study of Ciprofloxacin in Children with Complicated Urinary Tract Infection. Antimicrob Agents Chemother 2018; 62:e00517-18. [PMID: 29987142 DOI: 10.1128/AAC.00517-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/20/2018] [Indexed: 12/15/2022] Open
Abstract
Resistance rates for ciprofloxacin, which is labeled for treating complicated urinary tract infections in children, are rapidly rising. As there is limited knowledge on developmental pharmacology of ciprofloxacin, the primary aim of this study was to develop a population pharmacokinetic model for ciprofloxacin in children treated for complicated urinary tract infections. Children to whom ciprofloxacin was prescribed, intravenous (10 to 15 mg/kg body weight every 12 h) or per os (15 to 20 mg/kg every 12 h), were enrolled. One hundred eight serum and 119 urine samples were obtained during 10 intravenous and 13 oral courses of ciprofloxacin in 22 patients (age range, 0.31 to 15.51 years). A one-compartment model best described our data. Fat-free mass and glomerular filtration rate (estimated by a formula using cystatin C and creatinine), standardized for body surface area, were significant covariates for ciprofloxacin clearance. In our population, ciprofloxacin clearance is 0.16 to 0.43 liter/h/kg of body weight, volume of distribution 0.06 to 2.88 liters/kg, and bioavailability 59.6%. All of our patients had a clinical cure of their infection. Based on target attainment simulations across doses, all children reached the pharmacodynamic target for Enterobacteriaceae, but on average only 53% did for Pseudomonas aeruginosa and 3% for Staphylococcus aureus, at the 15-mg/kg oral dose. For treating urinary tract infections caused by Pseudomonas aeruginosa, oral doses should be at least 20 mg/kg. Furthermore, in our population, fat-free mass and kidney function should be considered, as they prove to be significant covariates for ciprofloxacin clearance and, hence, exposure. (This study has been registered at ClinicalTrials.gov under identifier NCT02598362.).
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McEneny-King A, Foster G, Iorio A, Edginton AN. Data Analysis Protocol for the Development and Evaluation of Population Pharmacokinetic Models for Incorporation Into the Web-Accessible Population Pharmacokinetic Service - Hemophilia (WAPPS-Hemo). JMIR Res Protoc 2016; 5:e232. [PMID: 27927609 PMCID: PMC5177737 DOI: 10.2196/resprot.6559] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hemophilia is an inherited bleeding disorder caused by a deficiency in a specific clotting factor. This results in spontaneous bleeding episodes and eventual arthropathy. The mainstay of hemophilia treatment is prophylactic replacement of the missing factor, but an optimal regimen remains to be determined. Rather, individualized prophylaxis has been suggested to improve both patient safety and resource utilization. However, uptake of this approach has been hampered by the demanding sampling schedules and complex calculations required to obtain individual estimates of pharmacokinetic (PK) parameters. The use of population pharmacokinetics (PopPK) can alleviate this burden by reducing the number of plasma samples required for accurate estimation, but few tools incorporating this approach are readily available to clinicians. OBJECTIVE The Web-accessible Population Pharmacokinetic Service - Hemophilia (WAPPS-Hemo) project aims to bridge this gap by providing a Web-accessible service for the reliable estimation of individual PK parameters from only a few patient samples. This service is predicated on the development of validated brand-specific PopPK models. METHODS We describe the data analysis plan for the development and evaluation of each PopPK model to be incorporated into the WAPPS-Hemo platform. The data sources and structure of the dataset are discussed first, followed by the procedures for handling both data below limit of quantification (BLQ) and absence of such BLQ data. Next, we outline the strategies for building the appropriate structural and covariate models, including the possible need for a process algorithm when PK behavior varies between subjects or significant covariates are not provided. Prior to use in a prospective manner, the models will undergo extensive evaluation using a variety of techniques such as diagnostic plots, bootstrap analysis and cross-validation. Finally, we describe the incorporation of a validated PopPK model into the Bayesian post hoc model to produce individualized estimates of PK parameters. RESULTS Dense PK data has been collected for more than 20 brands of factor concentrate from both industry-sponsored and investigator-driven studies. The model development process is underway for the majority of molecules, with refinement and validation to be completed in 2017. Further, the WAPPS-Hemo co-investigator network has contributed more than 300 PK assessments for use in model development and evaluation. This constitutes the largest repository of this type of PK data globally. CONCLUSIONS The WAPPS-Hemo service aims to eliminate barriers to the uptake of individualized PK-tailored hemophilia treatment. By incorporating this tool into routine practice, clinicians can implement a personalized dosing strategy without performing rigorous sampling or complex calculations. This service is centred on validated models developed according to the robust approach to PopPK modeling described herein. CLINICALTRIAL ClinicalTrials.gov NCT02061072; https://clinicaltrials.gov/ct2/show/NCT02061072 (Archived by WebCite at http://www.webcitation.org/6mRIXJh55).
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Affiliation(s)
| | - Gary Foster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, The Research Institute, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Alfonso Iorio
- Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Hamilton Niagara Hemophilia Program, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Patel K, Goldman JL. Safety Concerns Surrounding Quinolone Use in Children. J Clin Pharmacol 2016; 56:1060-75. [PMID: 26865283 DOI: 10.1002/jcph.715] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 02/02/2023]
Abstract
Fluoroquinolones are highly effective antibiotics with many desirable pharmacokinetic and pharmacodynamic properties including high bioavailability, large volume of distribution, and a broad spectrum of antimicrobial activity. Despite their attractive profile as anti-infective agents, their use in children is limited, primarily due to safety concerns. In this review we highlight the pharmacological properties of fluoroquinolones and describe their current use in pediatrics. In addition, we provide a comprehensive assessment of the safety data associated with fluoroquinolone use in children. Although permanent or destructive arthropathy remains a significant concern, currently available data demonstrate that arthralgia and arthropathy are relatively uncommon in children and resolve following cessation of fluoroquinolone exposure without resulting in long-term sequelae. The concern for safety and risk of adverse events associated with pediatric fluoroquinolone use is likely driving the limited prescribing of this drug class in pediatrics. However, in adults, fluoroquinolones are the most commonly prescribed broad-spectrum antibiotics, resulting in the development of drug-resistant bacteria that can be challenging to treat effectively. The consequence of misuse and overuse of fluoroquinolones leading to drug resistance is a greater, but frequently overlooked, safety concern that applies to both children and adults and one that should be considered at the point of prescribing.
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Affiliation(s)
- Karisma Patel
- Department of Pharmacy, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.,Divisions of Pediatric Infectious Diseases, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.,Divisions of Pediatric Infectious Diseases, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.,Clinical Pharmacology, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
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Jiannong W, Junjie J, Yanming X, Xu W, Jianpeng L, Jingli D, Xin X. Effect of naringenin in Qianggu capsule on population pharmacokinetics in Chinese women with primary osteoporosis. J TRADIT CHIN MED 2015; 35:141-53. [PMID: 25975046 DOI: 10.1016/s0254-6272(15)30021-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize naringenin (NAR) pop- ulation pharmacokinetics (PPK) in Chinese women with primary osteoporosis. METHODS Ninety-eight female patients with primary osteoporosis from the Jingshan, Beixinqiao, Jiaodaokou, Chaoyangmen, and Donghuamen communities in Beijing, China, aged 40 to 80 years, re- ceived oral Qianggu capsules (250 mg). Blood samples were collected before and at 0.5, 1, 2, 3, 4, 6, 8, 10, 12, and 24 h after administration. The concentration of NAR in the blood samples was measured using high performance liquid chromatography-tandem mass spectrometry. PPK analyses were performed with nonlinear mixed-effect modeling software (version 7.1.2, PsN3.2.12). The clearance (C1), central distribution volume (V), absorption rate constant (Ka1), peripheral distribution volume (VII), and inter-compartmental clearance (CLII) were set as parameters and estimated by the base model, covariate model, and final model. Kidney-Yang deficiency [Shenyangxu (SYAX)] and liver-kidney-Yin deficiency (Ganshenyinxu) are patterns of symptoms in Traditional Chinese Medicine that were set as covariates, along with age, height, blood urea nitrogen, serum creatinine, alanine transaminase, aspartate transaminase, and hyperlipidemia. Both stepwise forward and backward procedures were accomplished to build models. The final model was evaluated by internal and external validation, visual predictive check, bootstrap, and leverage analysis. RESULTS A one compartment open model with first order degradation was the best fitted to the concentration-time profiles following oral administration of NAR. The mean of population parameters of the final model, C1, SYAX on C1, V, Ka1, CLII, and VII, were measured to be 37.6 L/h, 0.427 L, 123 L/h, 0.12/h, 0.3056, and 1.446, respectively. Inter-individual variability was estimated and SYAX was identified as a significant covariate. CONCLUSION The population pharmacokinetic model described in this study could effectively characterize the pharmacokinetic profile of NAR following administration of a single dose of oral Qianggu capsules in Chinese women with primary osteoporosis. Among the tested covariates, only SYAX was a significant factor.
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Barker CIS, Germovsek E, Hoare RL, Lestner JM, Lewis J, Standing JF. Pharmacokinetic/pharmacodynamic modelling approaches in paediatric infectious diseases and immunology. Adv Drug Deliv Rev 2014; 73:127-39. [PMID: 24440429 PMCID: PMC4076844 DOI: 10.1016/j.addr.2014.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 12/09/2013] [Accepted: 01/11/2014] [Indexed: 02/02/2023]
Abstract
Pharmacokinetic/pharmacodynamic (PKPD) modelling is used to describe and quantify dose-concentration-effect relationships. Within paediatric studies in infectious diseases and immunology these methods are often applied to developing guidance on appropriate dosing. In this paper, an introduction to the field of PKPD modelling is given, followed by a review of the PKPD studies that have been undertaken in paediatric infectious diseases and immunology. The main focus is on identifying the methodological approaches used to define the PKPD relationship in these studies. The major findings were that most studies of infectious diseases have developed a PK model and then used simulations to define a dose recommendation based on a pre-defined PD target, which may have been defined in adults or in vitro. For immunological studies much of the modelling has focused on either PK or PD, and since multiple drugs are usually used, delineating the relative contributions of each is challenging. The use of dynamical modelling of in vitro antibacterial studies, and paediatric HIV mechanistic PD models linked with the PK of all drugs, are emerging methods that should enhance PKPD-based recommendations in the future.
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Affiliation(s)
- Charlotte I S Barker
- Paediatric Infectious Diseases Research Group, Division of Clinical Sciences, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Infectious Diseases and Microbiology Unit, University College London, Institute of Child Health, London WC1N 1EH, UK
| | - Eva Germovsek
- Infectious Diseases and Microbiology Unit, University College London, Institute of Child Health, London WC1N 1EH, UK
| | - Rollo L Hoare
- Infectious Diseases and Microbiology Unit, University College London, Institute of Child Health, London WC1N 1EH, UK; CoMPLEX, University College London, Physics Building, Gower Street, London WC1E 6BT, UK
| | - Jodi M Lestner
- Paediatric Infectious Diseases Research Group, Division of Clinical Sciences, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Joanna Lewis
- Infectious Diseases and Microbiology Unit, University College London, Institute of Child Health, London WC1N 1EH, UK; CoMPLEX, University College London, Physics Building, Gower Street, London WC1E 6BT, UK
| | - Joseph F Standing
- Infectious Diseases and Microbiology Unit, University College London, Institute of Child Health, London WC1N 1EH, UK; CoMPLEX, University College London, Physics Building, Gower Street, London WC1E 6BT, UK.
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Wang C, Allegaert K, Peeters MYM, Tibboel D, Danhof M, Knibbe CAJ. The allometric exponent for scaling clearance varies with age: a study on seven propofol datasets ranging from preterm neonates to adults. Br J Clin Pharmacol 2014; 77:149-59. [PMID: 23772816 PMCID: PMC3895356 DOI: 10.1111/bcp.12180] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 06/02/2013] [Indexed: 11/29/2022] Open
Abstract
AIM For scaling clearance between adults and children, allometric scaling with a fixed exponent of 0.75 is often applied. In this analysis, we performed a systematic study on the allometric exponent for scaling propofol clearance between two subpopulations selected from neonates, infants, toddlers, children, adolescents and adults. METHODS Seven propofol studies were included in the analysis (neonates, infants, toddlers, children, adolescents, adults1 and adults2). In a systematic manner, two out of the six study populations were selected resulting in 15 combined datasets. In addition, the data of the seven studies were regrouped into five age groups (FDA Guidance 1998), from which four combined datasets were prepared consisting of one paediatric age group and the adult group. In each of these 19 combined datasets, the allometric scaling exponent for clearance was estimated using population pharmacokinetic modelling (nonmem 7.2). RESULTS The allometric exponent for propofol clearance varied between 1.11 and 2.01 in cases where the neonate dataset was included. When two paediatric datasets were analyzed, the exponent varied between 0.2 and 2.01, while it varied between 0.56 and 0.81 when the adult population and a paediatric dataset except for neonates were selected. Scaling from adults to adolescents, children, infants and neonates resulted in exponents of 0.74, 0.70, 0.60 and 1.11 respectively. CONCLUSIONS For scaling clearance, ¾ allometric scaling may be of value for scaling between adults and adolescents or children, while it can neither be used for neonates nor for two paediatric populations. For scaling to neonates an exponent between 1 and 2 was identified.
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Affiliation(s)
- Chenguang Wang
- Division of Pharmacology, LACDR, Leiden University, Leiden, the Netherlands; Intensive Care and Department of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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Hawwa AF, Westwood PM, Collier PS, Millership JS, Yakkundi S, Thurley G, Shields MD, Nunn AJ, Halliday HL, McElnay JC. Prophylactic ranitidine treatment in critically ill children--a population pharmacokinetic study. Br J Clin Pharmacol 2013; 75:1265-76. [PMID: 23016949 DOI: 10.1111/j.1365-2125.2012.04473.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 08/10/2012] [Indexed: 11/28/2022] Open
Abstract
AIMS To characterize the population pharmacokinetics of ranitidine in critically ill children and to determine the influence of various clinical and demographic factors on its disposition. METHODS Data were collected prospectively from 78 paediatric patients (n = 248 plasma samples) who received oral or intravenous ranitidine for prophylaxis against stress ulcers, gastrointestinal bleeding or the treatment of gastro-oesophageal reflux. Plasma samples were analysed using high-performance liquid chromatography, and the data were subjected to population pharmacokinetic analysis using nonlinear mixed-effects modelling. RESULTS A one-compartment model best described the plasma concentration profile, with an exponential structure for interindividual errors and a proportional structure for intra-individual error. After backward stepwise elimination, the final model showed a significant decrease in objective function value (-12.618; P < 0.001) compared with the weight-corrected base model. Final parameter estimates for the population were 32.1 l h(-1) for total clearance and 285 l for volume of distribution, both allometrically modelled for a 70 kg adult. Final estimates for absorption rate constant and bioavailability were 1.31 h(-1) and 27.5%, respectively. No significant relationship was found between age and weight-corrected ranitidine pharmacokinetic parameters in the final model, with the covariate for cardiac failure or surgery being shown to reduce clearance significantly by a factor of 0.46. CONCLUSIONS Currently, ranitidine dose recommendations are based on children's weights. However, our findings suggest that a dosing scheme that takes into consideration both weight and cardiac failure/surgery would be more appropriate in order to avoid administration of higher or more frequent doses than necessary.
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Affiliation(s)
- Ahmed F Hawwa
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
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Abstract
Cross-validation is frequently used for model selection in a variety of applications. However, it is difficult to apply cross-validation to mixed effects models (including nonlinear mixed effects models or NLME models) due to the fact that cross-validation requires "out-of-sample" predictions of the outcome variable, which cannot be easily calculated when random effects are present. We describe two novel variants of cross-validation that can be applied to NLME models. One variant, where out-of-sample predictions are based on post hoc estimates of the random effects, can be used to select the overall structural model. Another variant, where cross-validation seeks to minimize the estimated random effects rather than the estimated residuals, can be used to select covariates to include in the model. We show that these methods produce accurate results in a variety of simulated data sets and apply them to two publicly available population pharmacokinetic data sets.
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Affiliation(s)
- Emily Colby
- Department of Biostatistics, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
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Stockmann C, Sherwin CMT, Zobell JT, Young DC, Waters CD, Spigarelli MG, Ampofo K. Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: III. fluoroquinolones. Pediatr Pulmonol 2013; 48:211-20. [PMID: 22949224 DOI: 10.1002/ppul.22667] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/12/2012] [Indexed: 11/07/2022]
Abstract
This review is the third installment in a comprehensive State of the Art series and aims to evaluate the use of fluoroquinolones in the management of P. aeruginosa infection in both children and adults with cystic fibrosis (CF). Oral and intravenous ciprofloxacin have been shown to be well-tolerated in the treatment of acute pulmonary exacerbations (APE) secondary to P. aeruginosa. Older literature supports an oral dosing regimen of 40 mg/kg/day divided every 12 hr, up to 2 g/day, and intravenous (IV) ciprofloxacin 30 mg/kg/day divided every 8 hr, maximum 1.2 g/day in children, and 750 mg administered orally twice a day or 400 mg IV every 8 hr in adults. However, a recent pharmacodynamic (PD) modeling study shows that the literature, U.S. Food and Drug Administration (FDA)-approved, and Cystic Fibrosis Foundation (CFF) guideline dosing regimens may be suboptimal for the treatment of P. aeruginosa in APE. Further study is warranted to determine if higher doses of ciprofloxacin are needed. Limited pharmacokinetic (PK), PK/PD, and efficacy studies involving levofloxacin exist in adult patients with CF. No pediatric data exists for levofloxacin in CF patients. Further study is needed to determine the tolerability and efficacy of levofloxacin in APE. At this time, the routine use of levofloxacin in the treatment of APE in pediatric and adult patients cannot be recommended.
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Affiliation(s)
- Chris Stockmann
- Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, UT 84108, USA.
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Li Z, Chen Y, Li Q, Cao D, Shi W, Cao Y, Wu D, Zhu Y, Wang Y, Chen C. Population pharmacokinetics of piperacillin/tazobactam in neonates and young infants. Eur J Clin Pharmacol 2013; 69:1223-33. [DOI: 10.1007/s00228-012-1413-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/15/2012] [Indexed: 01/22/2023]
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Labreche MJ, Frei CR. Declining susceptibilities of gram-negative bacteria to the fluoroquinolones: Effects on pharmacokinetics, pharmacodynamics, and clinical outcomes. Am J Health Syst Pharm 2012; 69:1863-70. [DOI: 10.2146/ajhp110464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Matthew J. Labreche
- The Johns Hopkins Hospital, Baltimore, MD; at the time of writing he was Pharmacy Resident, Pharmacotherapy Education & Research Center, University of Texas Health Science Center (UTHSC), San Antonio
| | - Christopher R. Frei
- College of Pharmacy, University of Texas at Austin, and Department of Medicine, UTHSC
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Kleijn HJ, Zollinger DP, van den Heuvel MW, Kerbusch T. Population pharmacokinetic-pharmacodynamic analysis for sugammadex-mediated reversal of rocuronium-induced neuromuscular blockade. Br J Clin Pharmacol 2011; 72:415-33. [PMID: 21535448 PMCID: PMC3175511 DOI: 10.1111/j.1365-2125.2011.04000.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 04/23/2011] [Indexed: 12/17/2022] Open
Abstract
AIMS An integrated population pharmacokinetic-pharmacodynamic model was developed with the following aims: to simultaneously describe pharmacokinetic behaviour of sugammadex and rocuronium; to establish the pharmacokinetic-pharmacodynamic model for rocuronium-induced neuromuscular blockade and reversal by sugammadex; to evaluate covariate effects; and to explore, by simulation, typical covariate effects on reversal time. METHODS Data (n= 446) from eight sugammadex clinical studies covering men, women, non-Asians, Asians, paediatrics, adults and the elderly, with various degrees of renal impairment, were used. Modelling and simulation techniques based on physiological principles were applied to capture rocuronium and sugammadex pharmacokinetics and pharmacodynamics and to identify and quantify covariate effects. RESULTS Sugammadex pharmacokinetics were affected by renal function, bodyweight and race, and rocuronium pharmacokinetics were affected by age, renal function and race. Sevoflurane potentiated rocuronium-induced neuromuscular blockade. Posterior predictive checks and bootstrapping illustrated the accuracy and robustness of the model. External validation showed concordance between observed and predicted reversal times, but interindividual variability in reversal time was pronounced. Simulated reversal times in typical adults were 0.8, 1.5 and 1.4 min upon reversal with sugammadex 16 mg kg(-1) 3 min after rocuronium, sugammadex 4 mg kg(-1) during deep neuromuscular blockade and sugammadex 2 mg kg(-1) during moderate blockade, respectively. Simulations indicated that reversal times were faster in paediatric patients and slightly slower in elderly patients compared with adults. Renal function did not affect reversal time. CONCLUSIONS Simulations of the therapeutic dosing regimens demonstrated limited impact of age, renal function and sevoflurane use, as predicted reversal time in typical subjects was always <2 min.
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Thuo N, Ungphakorn W, Karisa J, Muchohi S, Muturi A, Kokwaro G, Thomson AH, Maitland K. Dosing regimens of oral ciprofloxacin for children with severe malnutrition: a population pharmacokinetic study with Monte Carlo simulation. J Antimicrob Chemother 2011; 66:2336-45. [PMID: 21831986 PMCID: PMC3172043 DOI: 10.1093/jac/dkr314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Severe malnutrition is frequently complicated by sepsis, leading to high case fatality. Oral ciprofloxacin is a potential alternative to the standard parenteral ampicillin/gentamicin combination, but its pharmacokinetics in malnourished children is unknown. Methods Ciprofloxacin (10 mg/kg, 12 hourly) was administered either 2 h before or up to 2 h after feeds to Kenyan children hospitalized with severe malnutrition. Four plasma ciprofloxacin concentrations were measured over 24 h. Population analysis with NONMEM investigated factors affecting the oral clearance (CL) and the oral volume of distribution (V). Monte Carlo simulations investigated dosage regimens to achieve a target AUC0–24/MIC ratio of ≥125. Results Data comprised 202 ciprofloxacin concentration measurements from 52 children aged 8–102 months. Absorption was generally rapid but variable; Cmax ranged from 0.6 to 4.5 mg/L. Data were fitted by a one-compartment model with first-order absorption and lag. The parameters were CL (L/h) = 42.7 (L/h/70 kg) × [weight (kg)/70]0.75 × [1 + 0.0368 (Na+ – 136)] × [1 – 0.283 (high risk)] and V (L) = 372 × (L/70 kg) × [1 + 0.0291 (Na+ – 136)]. Estimates of AUC0–24 ranged from 8 to 61 mg·h/L. The breakpoint for Gram-negative organisms was <0.06 mg/L with doses of 20 mg/kg/day and <0.125 mg/L with doses of 30 or 45 mg/kg/day. The cumulative fraction of response with 30 mg/kg/day was ≥80% for Escherichia coli, Klebsiella pneumoniae and Salmonella species, but <60% for Pseudomonas aeruginosa. Conclusions An oral ciprofloxacin dose of 10 mg/kg three times daily (30 mg/kg/day) may be a suitable alternative antibiotic for the management of sepsis in severely malnourished children. Absorption was unaffected by the simultaneous administration of feeds.
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Affiliation(s)
- Nahashon Thuo
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), PO Box 230, 80108 Kilifi, Kenya
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Suyagh M, Collier PS, Millership JS, Iheagwaram G, Millar M, Halliday HL, McElnay JC. Metronidazole population pharmacokinetics in preterm neonates using dried blood-spot sampling. Pediatrics 2011; 127:e367-74. [PMID: 21220396 DOI: 10.1542/peds.2010-0807] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To characterize the population pharmacokinetics of metronidazole in preterm neonates. PATIENTS AND METHODS Data were collected prospectively from 32 preterm neonates who received intravenous metronidazole for the treatment of or prophylaxis against necrotizing enterocolitis. Dried blood spots (n = 203) on filter paper were analyzed by high-performance liquid chromatography, and the data were subjected to pharmacokinetic analysis performed by using nonlinear mixed-effect modeling. RESULTS A 1-compartment model best described the data. Significant covariates were weight (WT) and postmenstrual age (PMA). The final population models for metronidazole clearance (CL) and volume of distribution (V) were: CL = 0.0247 × (WT/1.00)(0.75) × (1 + 0.107 × [PMA - 30]) and V = 0.726 × WT, where CL is in liters per hour, WT is in kilograms, PMA is in weeks, and V is in liters. This model predicts that the half-life of metronidazole decreases rapidly from ∼40 hours at 25 weeks' PMA to 19 hours at 32 weeks' PMA, after which it starts to plateau. This decrease in half-life is the result of a 5-fold increase in CL compared with only a 2.5-fold increase in V during the same period. CONCLUSIONS Currently, there are no specific dose recommendations for metronidazole in preterm neonates. However, a dosing scheme for preterm neonates that takes into consideration both the weight and PMA has been suggested and should avoid administration of doses that are excessive or more frequent than necessary.
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Affiliation(s)
- Maysa Suyagh
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
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Guillot E, Sermet I, Ferroni A, Chhun S, Pons G, Zahar JR, Jullien V. Suboptimal Ciprofloxacin Dosing as a Potential Cause of DecreasedPseudomonas aeruginosaSusceptibility in Children with Cystic Fibrosis. Pharmacotherapy 2010; 30:1252-8. [DOI: 10.1592/phco.30.12.1252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Xie HG, Cao YJ, Gauda EB, Agthe AG, Hendrix CW, Lee H. Clonidine clearance matures rapidly during the early postnatal period: a population pharmacokinetic analysis in newborns with neonatal abstinence syndrome. J Clin Pharmacol 2010; 51:502-11. [PMID: 20484620 DOI: 10.1177/0091270010370587] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The population pharmacokinetic (PK) profile of oral clonidine was characterized in newborns with neonatal abstinence syndrome, and significant covariates affecting its PK parameters were identified. Plasma clonidine concentration data were obtained from a clinical trial in which 36 newborns, aged 1 to 25 days (postnatal age, PNA) and weighing 2.1 to 3.9 kg, were enrolled to take multiple oral doses of clonidine. The population PK model of clonidine was developed by NONMEM, and significant covariates were identified, followed by nonparametric bootstraps (2000 replicates) and simulation experiments. A 1-compartment open linear PK model was chosen to describe plasma concentrations of clonidine, and body weight and PNA were significant covariates for apparent clearance (CL/F) as follows: CL/F (L/h) = 15.2 × [body weight (kg)/70](0.75) × [PNA (day)(0.441)/(4.06(0.441) + PNA (day)(0.441))]. Furthermore, CL/F of clonidine increased rapidly with PNA during the first month of life after body weight was adjusted. Any optimal dosage regimen for clonidine in term neonates should be based on infant's age and body weight, and 1.5 µg/kg every 4 hours is proposed starting the second week of life based on the simulation results.
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Affiliation(s)
- Hong-Guang Xie
- Center for Drug Development Science, Department of Bio-pharmaceutical Sciences, School of Pharmacy, University of California San Francisco, San Francisco, California, USA
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Takemoto S, Yamaoka K, Nishikawa M, Yano Y, Takakura Y. Bootstrap method-based estimation of the minimum sample number for obtaining pharmacokinetic parameters in preclinical experiments. J Pharm Sci 2010; 99:2176-84. [PMID: 19902519 DOI: 10.1002/jps.21975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Empirically, 3-6 samples at each sampling time point have been used for most preclinical one-point sampling experiments without any theoretical justification. The purpose of the present study is to propose a practical approach to determine the minimum sample number (N(min)) based on Monte Carlo simulation and a bootstrap resampling. A computer program MOMENT(BS), in which a bootstrap resampling algorithm is used to estimate mean and standard deviations of pharmacokinetic parameters, such as area under the curve and mean residence time, was applied to estimate N(min). A new simulation program, MONTE1, was developed to generate simulated data for bootstrap resampling using the model parameters including inter- and/or intra-individual variations. Then, an index, S(2)CV calculated as the sum of the squared coefficient of variation is proposed to determine the N(min). The proposed approach was applied to the actual data in preclinical experiments, and the usefulness of the approach was suggested. An issue that one-point sampling data cannot separately assess inter- and intra-individual variability is discussed.
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Affiliation(s)
- Seiji Takemoto
- Department of Biopharmaceutics and Drug Metabolism, Graduate School of Pharmaceutical Science, Kyoto University, Sakyo-Ku, Kyoto 606-8501, Japan
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Bi XC, Zhang B, Ye YK, He HC, Han ZD, Dai QS, Liang YX, Zeng GH, Wang YS, Chen QB, Zhong WD. Pathogen incidence and antibiotic resistance patterns of catheter-associated urinary tract infection in children. J Chemother 2010; 21:661-5. [PMID: 20071290 DOI: 10.1179/joc.2009.21.6.661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to characterize the pathogens and their antibiotic susceptibilities in children with catheter-associated urinary tract infection (CAUTI) in order to optimize empirical antibiotic therapy and prophylaxis. from 2001 to 2006, 895 children with an indwelling catheter from 3 hospitals in China were included in this study, of whom 335 (37.4%) had CAUTI. Antimicrobial susceptibility testing of 450 bacterial isolates was performed using the ClSi broth and Kirby-bauer agar dilution methods. Escherichia coli was the most frequently isolated pathogen, followed by Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus spp. E. coli had higher susceptibility to ceftazidime (87.4%), cefuroxime (85.1%) and cefatrizine (76.6%) than to sulfamethoxazole (SMZ) (8.0%), amoxicillin (21.7%), ampicillin (17.1%) and cefazolin (37.7%). Isolates of Klebsiella pneumoniae and Proteus species had similar patterns as E. coli. S. aureus had lower susceptibility to SmZ (6.8%), ampicillin (8.2%), and amoxicillin (24.7%); the trend of S. epidermidis was similar. This study demonstrates that the Gram-negative species are the predominating uropathogens of CAUti in children. it is important to know the bacterial spectrum and the susceptibility patterns to various classes of antibiotic agents to improve empiric antibiotic therapy of children with CAUTI in China.
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Xu Z, Seitz K, Fasanmade A, Ford J, Williamson P, Xu W, Davis HM, Zhou H. Population pharmacokinetics of infliximab in patients with ankylosing spondylitis. J Clin Pharmacol 2008; 48:681-95. [PMID: 18401017 DOI: 10.1177/0091270008316886] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The population pharmacokinetics of infliximab were characterized in patients with active ankylosing spondylitis (n = 274). Serum infliximab concentration data, from a 2-year period, were analyzed using NONMEM. A 2-compartment linear pharmacokinetic model was chosen to describe the pharmacokinetic characteristics of infliximab in serum. Population estimates (typical value +/- standard error) were obtained from the final covariate model: clearance (CL: 0.273 +/- 0.007 L/day), volume of distribution in the central compartment (V(1): 3.06 +/- 0.057 L), intercompartment clearance (Q: 1.72 +/- 0.48 L/day), and volume of distribution in the peripheral compartment (V(2): 2.94 +/- 0.17 L). Interindividual variability for CL and V(1) was 34.1% and 17.5%, respectively. White blood cell count at baseline and the antibody-to-infliximab status were significant covariates to CL; body surface area and sex were significant covariates to V(1). The CL for patients with a positive antibody-to-infliximab status was estimated to be 41.9% to 76.7% higher than for the remaining patients. Other covariates (baseline disease activity and the concomitant medication use of prednisolone, omeprazole, nonsteroidal anti-inflammatory drugs, or analgesics) did not affect infliximab pharmacokinetics. The development of antibodies to infliximab was associated with accelerated infliximab clearance and may represent a potential underlying mechanism for an inadequate response, or loss of response, to infliximab treatment.
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Affiliation(s)
- Zhenhua Xu
- Pharmacokinetics, Modeling & Simulation, Clinical Pharmacology Sciences, Centocor Research and Development, Inc., 200 Great Valley Parkway, Malvern, PA 19355, USA
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Sato N, Kijima K, Koresawa T, Mitomi N, Morita J, Suzuki H, Hayashi H, Shibasaki S, Kurosawa T, Totsuka K. Population Pharmacokinetics of Tebipenem Pivoxil (ME1211), a Novel Oral Carbapenem Antibiotic, in Pediatric Patients with Otolaryngological Infection or Pneumonia. Drug Metab Pharmacokinet 2008; 23:434-46. [DOI: 10.2133/dmpk.23.434] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Growth and development can be investigated using readily observable demographic factors such as weight and age. Size is the primary covariate and can be referenced to a 70-kg person with allometry using a coefficient of 0.75 for clearance and 1 for volume. The use of these coefficients is supported by fractal geometric concepts and observations from diverse areas in biology. Fat free mass (FFM) might be expected to do better than total body weight when there are wide variations in fat affecting body composition. Clearance pathways develop in the fetus before birth. The use of postnatal age as a descriptor of maturation is unsatisfactory because birth may occur prematurely; therefore postmenstrual age is a superior predictor of elimination function. A sigmoid E(max) model (Hill equation) describes gradual maturation of clearance in early life leading to a mature adult clearance achieved at a later age.
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Affiliation(s)
- B J Anderson
- Department of Anaesthesiology, University of Auckland School of Medicine, Auckland, New Zealand.
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Brendel K, Dartois C, Comets E, Lemenuel-Diot A, Laveille C, Tranchand B, Girard P, Laffont CM, Mentré F. Are population pharmacokinetic and/or pharmacodynamic models adequately evaluated? A survey of the literature from 2002 to 2004. Clin Pharmacokinet 2007; 46:221-34. [PMID: 17328581 PMCID: PMC2907410 DOI: 10.2165/00003088-200746030-00003] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Model evaluation is an important issue in population analyses. We aimed to perform a systematic review of all population pharmacokinetic and/or pharmacodynamic analyses published between 2002 and 2004 to survey the current methods used to evaluate models and to assess whether those models were adequately evaluated. We selected 324 articles in MEDLINE using defined key words and built a data abstraction form composed of a checklist of items to extract the relevant information from these articles with respect to model evaluation. In the data abstraction form, evaluation methods were divided into three subsections: basic internal methods (goodness-of-fit [GOF] plots, uncertainty in parameter estimates and model sensitivity), advanced internal methods (data splitting, resampling techniques and Monte Carlo simulations) and external model evaluation. Basic internal evaluation was the most frequently described method in the reports: 65% of the models involved GOF evaluation. Standard errors or confidence intervals were reported for 50% of fixed effects but only for 22% of random effects. Advanced internal methods were used in approximately 25% of models: data splitting was more often used than bootstrap and cross-validation; simulations were used in 6% of models to evaluate models by a visual predictive check or by a posterior predictive check. External evaluation was performed in only 7% of models. Using the subjective synthesis of model evaluation for each article, we judged the models to be adequately evaluated in 28% of pharmacokinetic models and 26% of pharmacodynamic models. Basic internal evaluation was preferred to more advanced methods, probably because the former is performed easily with most software. We also noticed that when the aim of modelling was predictive, advanced internal methods or more stringent methods were more often used.
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Abstract
INTRODUCTION Population modelling using mixed effects models provides a means to study variability in paediatric drug responses among individuals representative of those in whom the drug will be used clinically. DISCUSSIONS Explanatory covariates explain the predictable part of the between-individual variability. Growth and development are two major aspects of children not seen in adults. These aspects can be investigated by using size and age as covariates. Problems attributable to co-linearity can be approached by using size as the first covariate. Size standardisation is achieved using allometric scaling, a mechanistic approach that has a strong theoretical and empirical basis. Age is used to describe the maturation of clearance. The quantitative models (linear, exponential, first-order, variable slope sigmoidal) used to describe this maturation process vary depending on the span of the ages under investigation. Measures of response are not always straightforward and can be more difficult to quantify in children. CONCLUSION Covariate investigation in children is improving the understanding of developmental aspects of drug disposition and effects in the paediatric population, ultimately leading to more effective use of medications.
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Affiliation(s)
- Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
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Takemoto S, Yamaoka K, Nishikawa M, Takakura Y. Histogram Analysis of Pharmacokinetic Parameters by Bootstrap Resampling from One-point Sampling Data in Animal Experiments. Drug Metab Pharmacokinet 2006; 21:458-64. [PMID: 17220561 DOI: 10.2133/dmpk.21.458] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A bootstrap method is proposed for assessing statistical histograms of pharmacokinetic parameters (AUC, MRT, CL and V(ss)) from one-point sampling data in animal experiments. A computer program, MOMENT(BS), written in Visual Basic on Microsoft Excel, was developed for the bootstrap calculation and the construction of histograms. MOMENT(BS) was applied to one-point sampling data of the blood concentration of three physiologically active proteins ((111)In labeled Hsp70, Suc(20)-BSA and Suc(40)-BSA) administered in different doses to mice. The histograms of AUC, MRT, CL and V(ss) were close to a normal (Gaussian) distribution with the bootstrap resampling number (200), or more, considering the skewness and kurtosis of the histograms. A good agreement of means and SD was obtained between the bootstrap and Bailer's approaches. The hypothesis test based on the normal distribution clearly demonstrated that the disposition of (111)In-Hsp70 and Suc(20)-BSA was almost independent of dose, whereas that of (111)In-Suc(40)-BSA was definitely dose-dependent. In conclusion, the bootstrap method was found to be an efficient method for assessing the histogram of pharmacokinetic parameters of blood or tissue disposition data by one-point sampling.
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Affiliation(s)
- Seiji Takemoto
- Department of Biopharmaceutics and Drug Metabolism, Graduate School of Pharmaceutical Science, Kyoto University
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Abstract
Developing the skills or expertise to create useful population pharmacokinetic-pharmacodynamic models can be a daunting task-the level of mathematical and statistical complexity is such that newcomers to the field are frequently overwhelmed. A good place to start in learning the field is to read articles in the literature. However, the number of articles dealing with population pharmacokinetic pharmacodynamics is exponentially increasing on a yearly basis, so choosing which articles to read can be difficult. The purpose of this review is to provide a recommended reading list for newcomers to the field. The list was chosen based on perceived impact of the article in the field, the quality of the article, or to highlight some important detail contained within the article. After reading the articles in the list, it is believed that the reader will have a broad overview of the field and have a sound foundation for more-detailed reading of the literature.
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Affiliation(s)
- Peter L Bonate
- Genzyme Corporation, 4545 Horizon Hill Blvd., San Antonio, TX, USA.
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Meibohm B, Läer S, Panetta JC, Barrett JS. Population pharmacokinetic studies in pediatrics: issues in design and analysis. AAPS J 2005; 7:E475-87. [PMID: 16353925 PMCID: PMC2750985 DOI: 10.1208/aapsj070248] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 05/04/2005] [Indexed: 12/23/2022] Open
Abstract
The current review addresses the following 3 frequently encountered challenges in the design and analysis of population pharmacokinetic studies in pediatrics: (1) body size adjustments during the development of pharmacostatistical models, (2) design and validation of limited sampling strategies, and (3) the integration of historical priors in data analysis and trial simulation. Size adjustments with empiric approaches based on body weight or body surface area have frequently proven as a pragmatic tool to overcome large size differences in a pediatric study population. Allometric size adjustments, however, provide a more mechanistic, physiologically based approach that, if used a priori, allows delineation of the effect of size from that of other covariates that show a high degree of collinearity. The frequent lack of dense data sets in pediatric clinical pharmacology because of ethical and logistic constraints in study design can be overcome with the application of D-optimality-based limited sampling schemes in combination with Bayesian and nonlinear mixed-effects modeling approaches. Empirically based dose selection and clinical trial designs for pediatric clinical pharmacology studies can be improved by applying clinical trial simulation techniques, especially if they integrate adult and pediatric in vitro and/or in vivo data as historic priors. Although integration of these concepts and techniques in population pharmacokinetic analyses is not only limited to pediatric research, their application allows researchers to overcome some major hurdles frequently encountered in pharmacokinetic studies in pediatrics and, thus, provides the basis for additional clinical pharmacology research in this previously insufficiently studied fraction of the general population.
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Affiliation(s)
- Bernd Meibohm
- Department of Pharmaceutical Sciences, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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