Therapeutic drug monitoring and use of an adjusted body weight strategy for high-dose voriconazole therapy
| Autor: | David M. Sudekum, Shikha Polega, Patrick G. Richards, Kimberlyn M. Dang, Nina West, Beena Cheriyan, Curtis D. Collins, Anurag N. Malani, Michelle Brinker-Bodley, Lisa Kerr, Carol A. Kauffman, Kay Lyn Stalker |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male 0301 basic medicine Microbiology (medical) Antifungal Agents 030106 microbiology Pharmacology 03 medical and health sciences 0302 clinical medicine Humans Medicine Drug Dosage Calculations Pharmacology (medical) Trough Concentration Obesity 030212 general & internal medicine Dosing Aged Retrospective Studies Aged 80 and over Voriconazole medicine.diagnostic_test business.industry Maintenance dose Body Weight Middle Aged Methylprednisolone acetate Regimen Infectious Diseases Methylprednisolone Therapeutic drug monitoring Anesthesia Female Drug Monitoring business medicine.drug |
| Zdroj: | Journal of Antimicrobial Chemotherapy. :dkw550 |
| ISSN: | 1460-2091 0305-7453 |
| DOI: | 10.1093/jac/dkw550 |
| Popis: | A high-dose 12 mg/kg/day (6 mg/kg twice daily) voriconazole regimen was recommended by the CDC to treat patients injected with contaminated methylprednisolone acetate that caused a multi-state fungal outbreak in 2012-13. Therapeutic drug monitoring results of this unique regimen are unknown, as is the most appropriate dosing weight for obese patients. We evaluated voriconazole trough measurements for this dosing scheme, as well as the use of adjusted body weight dosing for obese patients.Voriconazole trough levels were analysed in obese (BMI ≥35 kg/m 2 ) and non-obese (BMI 35 kg/m 2 ) patients who were given initial therapy with 12 mg/kg/day.Of 138 patients, the first steady-state voriconazole troughs were supratherapeutic (5 mg/L) in 65 (47%) patients, therapeutic (2-5 mg/L) in 57 (41%) patients and subtherapeutic (2 mg/L) in 16 (12%) patients. Twenty-three patients had pre-steady-state dose decreases due to supratherapeutic levels, with subsequent first steady-state troughs in the therapeutic ( n = 17) and subtherapeutic ( n = 6) categories. Voriconazole doses11 and8 mg/kg/day produced mainly first steady-state supratherapeutic troughs in 44 obese and 94 non-obese patients, respectively. An initial 12 mg/kg/day was progressively lowered to a median maintenance dose of 8.5 mg/kg/day in the obese and 8.6 mg/kg/day in the non-obese.A high-dose voriconazole regimen produced initial supratherapeutic troughs that required dose adjustment downward by nearly 30%. Adjusted body weight dosing in obese patients resulted in a similar maintenance dose to total body weight dosing in the non-obese, and appears to be a sensible dosing strategy for these patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|