Bayesian Estimation of Vancomycin Pharmacokinetics in Obese Children: Matched Case-Control Study
| Autor: | Edmund V. Capparelli, Yi Shuan S. Wu, Jennifer Le, Tri M. Tran, Gale L. Romanowski, Uzra Wahid, Austin Nguyen, John S. Bradley |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Percentile Adolescent Ideal Body Weight Overweight Models Biological Gastroenterology Article Body Mass Index Young Adult chemistry.chemical_compound Pharmacokinetics Vancomycin Interquartile range Internal medicine medicine Humans Pharmacology (medical) Obesity Child Retrospective Studies Pharmacology Creatinine business.industry Case-control study Infant Bayes Theorem medicine.disease Anti-Bacterial Agents Surgery chemistry Case-Control Studies Child Preschool Regression Analysis Female medicine.symptom business Body mass index |
| Zdroj: | Clinical Therapeutics. 37:1340-1351 |
| ISSN: | 0149-2918 |
| Popis: | Purpose The study objective was to compare different body size descriptors that best estimate vancomycin V d and clearance (CL). Methods Patients between 3 months and 21 years old who received vancomycin for ≥48 hours from 2003 to 2011 were evaluated in this matched case-control study. Cases had body mass index in the ≥85th percentile; controls were nonobese individuals who were matched by age and baseline serum creatinine (SCr). Using a 1-compartment model with first-order kinetics, Bayesian post hoc individual V d and CL were estimated. Findings Analysis included 87 matched pairs with 389 vancomycin serum concentrations. Median ages were 10.0 (interquartile range [IQR], 4.8–15.2) years for cases (overweight and obese children) and 10.2 (IQR, 4.5–14.8) years for controls (normal-weight children). Median weights were 44.0 (IQR, 23.4–78.1) kg for cases and 31.3 (IQR, 16.8-47.1) kg for controls. Mean (SD) for the baseline SCr values were also similar between the groups: 0.51 (0.22) (IQR, 0.34–0.67) mg/dL and 0.48 (0.20) (IQR, 0.30–0.60) mg/dL for the cases and controls, respectively. Actual weight and allometric weight (ie, weight 0.75 ) were used in the final model to estimate V d and CL, respectively. The mean V d and CL, based on weight, for cases were lower than controls by 0.012 L/kg and 0.014 L/kg/h, respectively. Implications In obese children, actual weight and allometric weight are reasonable, convenient estimations of body fat to use for estimating vancomycin V d and CL, respectively. However, these pharmacokinetic differences between obese children and those with normal weights are small and may not likely to be clinically relevant in dose variation. |
| Databáze: | OpenAIRE |
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