Limits...
Teicoplanin dosing strategy for treatment of Staphylococcus aureus in Korean patients with neutropenic fever.

Ahn BJ, Yim DS, Lee DG, Kwon JC, Kim SH, Choi SM - Yonsei Med. J. (2011)

Bottom Line: The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC24/MIC>125 [or 345] using logistic analysis.The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever.To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea.

ABSTRACT

Purpose: The present study was conducted to determine and compare the target attainment rate (TAR) between microorganism-nonspecific (C(trough)) and microorganism- specific (AUC24/MIC) targets over two weeks of teicoplanin administration according to several dose regimens for the treatment of Staphylococcus aureus in Korean patients with neutropenic fever.

Materials and methods: One thousand virtual concentrations were obtained for each dose using the population pharmacokinetic parameters of teicoplanin adopted from a published study. Simulation of 1,000 virtual MICs was performed using the MICs of 78 clinical isolates of S. aureus collected from a hospital in Korea. Thereafter, these simulated MICs were randomly allocated to 1,000 virtual patients in whom the TARs for AUC24/MIC>125 [or 345] and C(trough)>10 [or 20] mg/L were determined. The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC24/MIC>125 [or 345] using logistic analysis.

Results: The standard dose regimen of teicoplanin showed TARs of about 70% [or 33%] and 70% [or 20%] at steady-state in cases with AUC24/MIC>125 [or 345] and C(trough)>10 [or 20] mg/L, respectively.

Conclusion: The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever. To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.

Show MeSH

Related in: MedlinePlus

TARs according to several therapeutic targets with several dosing schemes during 2 weeks of teicoplanin administration; TAR for Ctrough >10 mg/L, Ctrough >20 mg/L, AUC24/MIC >125 and AUC24/MIC >345. TAR, target attainment rate; AUC, area under the curve; MIC, minimuminhibitory concentration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3104459&req=5

Figure 3: TARs according to several therapeutic targets with several dosing schemes during 2 weeks of teicoplanin administration; TAR for Ctrough >10 mg/L, Ctrough >20 mg/L, AUC24/MIC >125 and AUC24/MIC >345. TAR, target attainment rate; AUC, area under the curve; MIC, minimuminhibitory concentration.

Mentions: The standard dosing regimen (400 mg every 12 hr for 3 doses, then 400 mg once a day, iv) recommended by the summary in the package insert of teicoplanin for severe infections has a TAR of about 70% under steady-state (SS) conditions when Ctrough >10 mg/L and AUC24/MIC >125 were used as the therapeutic targets of teicoplanin. However, with an AUC24/MIC >345, only 33% of all patients with staphylococcal infection attained the target. When Ctrough >20 mg/L was used as a MIC-nonspecific target, less than 20% of all patients with the adopted PK parameter distributions achieved the target under SS conditions. Even though a 400 mg twice daily dose was given for maintenance, only 65% achieved a SS-TAR. Table 1 and Fig. 3 show the TARs according to several therapeutic targets with several different dosing schemes over two weeks of teicoplanin administration.


Teicoplanin dosing strategy for treatment of Staphylococcus aureus in Korean patients with neutropenic fever.

Ahn BJ, Yim DS, Lee DG, Kwon JC, Kim SH, Choi SM - Yonsei Med. J. (2011)

TARs according to several therapeutic targets with several dosing schemes during 2 weeks of teicoplanin administration; TAR for Ctrough >10 mg/L, Ctrough >20 mg/L, AUC24/MIC >125 and AUC24/MIC >345. TAR, target attainment rate; AUC, area under the curve; MIC, minimuminhibitory concentration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104459&req=5

Figure 3: TARs according to several therapeutic targets with several dosing schemes during 2 weeks of teicoplanin administration; TAR for Ctrough >10 mg/L, Ctrough >20 mg/L, AUC24/MIC >125 and AUC24/MIC >345. TAR, target attainment rate; AUC, area under the curve; MIC, minimuminhibitory concentration.
Mentions: The standard dosing regimen (400 mg every 12 hr for 3 doses, then 400 mg once a day, iv) recommended by the summary in the package insert of teicoplanin for severe infections has a TAR of about 70% under steady-state (SS) conditions when Ctrough >10 mg/L and AUC24/MIC >125 were used as the therapeutic targets of teicoplanin. However, with an AUC24/MIC >345, only 33% of all patients with staphylococcal infection attained the target. When Ctrough >20 mg/L was used as a MIC-nonspecific target, less than 20% of all patients with the adopted PK parameter distributions achieved the target under SS conditions. Even though a 400 mg twice daily dose was given for maintenance, only 65% achieved a SS-TAR. Table 1 and Fig. 3 show the TARs according to several therapeutic targets with several different dosing schemes over two weeks of teicoplanin administration.

Bottom Line: The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC24/MIC>125 [or 345] using logistic analysis.The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever.To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea.

ABSTRACT

Purpose: The present study was conducted to determine and compare the target attainment rate (TAR) between microorganism-nonspecific (C(trough)) and microorganism- specific (AUC24/MIC) targets over two weeks of teicoplanin administration according to several dose regimens for the treatment of Staphylococcus aureus in Korean patients with neutropenic fever.

Materials and methods: One thousand virtual concentrations were obtained for each dose using the population pharmacokinetic parameters of teicoplanin adopted from a published study. Simulation of 1,000 virtual MICs was performed using the MICs of 78 clinical isolates of S. aureus collected from a hospital in Korea. Thereafter, these simulated MICs were randomly allocated to 1,000 virtual patients in whom the TARs for AUC24/MIC>125 [or 345] and C(trough)>10 [or 20] mg/L were determined. The relationship of the maintenance dose with the steady-state TAR was predicted with respect to the AUC24/MIC>125 [or 345] using logistic analysis.

Results: The standard dose regimen of teicoplanin showed TARs of about 70% [or 33%] and 70% [or 20%] at steady-state in cases with AUC24/MIC>125 [or 345] and C(trough)>10 [or 20] mg/L, respectively.

Conclusion: The current standard dose regimen was predicted to be insufficient to adequately treat S. aureus in Korean patients with neutropenic fever. To assure at least an 80% TAR in this population, dose adjustment of teicoplanin should be considered.

Show MeSH
Related in: MedlinePlus