1
|
Kapralos I, Mainas E, Neroutsos E, Apostolidi S, Siopi M, Apostolopoulou O, Dimopoulos G, Sambatakou H, Valsami G, Meletiadis J, Dokoumetzidis A. Population pharmacokinetics of micafungin over repeated doses in critically ill patients: a need for a loading dose? J Pharm Pharmacol 2020; 72:1750-1760. [PMID: 32789881 DOI: 10.1111/jphp.13353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/28/2020] [Revised: 07/04/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the population pharmacokinetics of micafungin in critically ill patients, evaluate and optimize dosage regimens. METHODS An HPLC-fluorescence bioassay for micafungin was developed, fully validated and applied to a pharmacokinetic study conducted in 14 ICU patients. Dense blood sampling was performed from days 1 to 7. A population pharmacokinetic model accounting for interindividual (IIV) and interoccasion variability (IOV) of the PK parameters was developed. Simulations were performed to estimate the probability of target attainment (PTA) for several dosing regimens. KEY FINDINGS A two-compartment pharmacokinetic model best described the data, with population clearance CL = 1.31 L/h and central volume V1 = 14.2 L. The relatively high IOV observed (45% for CL, 27% for V1) sets limits for the dose individualization in this population. The low PTA on the first day of treatment suggests the need of a loading dose. PTA and CFR estimates show that the current micafungin dosage may be insufficient for the treatment of borderline susceptible Candida strains. CONCLUSIONS A loading dose of up to 300 mg of micafungin is needed for the treatment of invasive candidiasis in ICU patients while a maintenance dose of up to 200 mg can be considered in empirical antifungal treatment.
Collapse
Affiliation(s)
- Iasonas Kapralos
- Laboratory of Biopharmaceutics-Pharmacokinetics, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece.,Pharma-Informatics Unit, Athena Research and Innovation Center in Information Communication and Knowledge Technologies, Athens, Greece
| | - Efstratios Mainas
- Intensive Care Unit, Hippokration General Hospital of Athens, Greece
| | - Efthymios Neroutsos
- Laboratory of Biopharmaceutics-Pharmacokinetics, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Stella Apostolidi
- Laboratory of Biopharmaceutics-Pharmacokinetics, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Siopi
- Clinical Microbiology Laboratory, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Apostolopoulou
- Department of Clinical Care Medicine, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Dimopoulos
- Department of Clinical Care Medicine, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | - Georgia Valsami
- Laboratory of Biopharmaceutics-Pharmacokinetics, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristides Dokoumetzidis
- Laboratory of Biopharmaceutics-Pharmacokinetics, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece.,Pharma-Informatics Unit, Athena Research and Innovation Center in Information Communication and Knowledge Technologies, Athens, Greece
| |
Collapse
|