목적: 이 연구의 목적은 한국인 성인 환자를 대상으로 아미카신 1일 1회 요법을 시행하였을 때의 약동학적 파라미터를 평가하고, 신기능에 따른 아미카신의 약동학적 파라미터를 비교함으로써 최적의 개인화 약물요법을 설계할 수 있도록 하는 것이다. 방법: 그람 음성균 감염에 대해 1일 1회 요법으로 아미카신을 투여 받았던 353명의 한국 성인 환자를 대상으로 항정상태에서 아미카신의 농도를 2회(약물 투여 전 1시간 이내, 약물투여 종료 후 0.5~1시간 이내) 측정하였다. 각 환자의 약동학적 파라미터(분포용적, 청소율, 반감기) 및 혈중 최고 농도, 최저 농도는 환자의 나이, 체중, 신장, 성별, 혈중 크레아티닌 농도, 투여된 약물용량, 측정된 약물의 혈중농도, 감염의 종류 등을 감안하여 산출하였다. 크레아티닌 청소율에 따라 환자를 4군으로 분류하여 아미카신의 약동학적 파라미터를 비교분석하였다. 결과: 본 연구에서 아미카신 혈중 최저, 최고 농도의 평균 ${\pm}$표준편차는 각각 $1.14{\pm}1.95mg/L$, $26.35{\pm}9.28mg/L$이며, 청소율, 분포용적 및 반감기의 평균 ${\pm}$ 표준편차는 각각 $55.40{\pm}23.72mL/hr/kg$, $0.35{\pm}0.12L/kg$, 그리고 $5.22{\pm}3.34hrs$로 산출되었다. 크레아티닌 청소율에 따른 아미카신의 청소율, 분포용적 및 반감기의 유의한 차이가 관찰되었다. 종합적으로 아미카신의 혈중 최저 농도는 크레아티닌 청소율이 40 mL/min 미만인 경우 40 mL/min 이상인 경우에 비해 유의하게 증가하였다. 결론: 아미카신의 약동학적 파라미터들은 신기능에 따라 유의한 차이가 있으므로 최적의 치료효과를 위해서는 환자의 크레아티닌 청소율에 따른 개인화 약물요법이 필요하다.
목적: 이 연구의 목적은 한국인 성인 환자를 대상으로 아미카신 1일 1회 요법을 시행하였을 때의 약동학적 파라미터를 평가하고, 신기능에 따른 아미카신의 약동학적 파라미터를 비교함으로써 최적의 개인화 약물요법을 설계할 수 있도록 하는 것이다. 방법: 그람 음성균 감염에 대해 1일 1회 요법으로 아미카신을 투여 받았던 353명의 한국 성인 환자를 대상으로 항정상태에서 아미카신의 농도를 2회(약물 투여 전 1시간 이내, 약물투여 종료 후 0.5~1시간 이내) 측정하였다. 각 환자의 약동학적 파라미터(분포용적, 청소율, 반감기) 및 혈중 최고 농도, 최저 농도는 환자의 나이, 체중, 신장, 성별, 혈중 크레아티닌 농도, 투여된 약물용량, 측정된 약물의 혈중농도, 감염의 종류 등을 감안하여 산출하였다. 크레아티닌 청소율에 따라 환자를 4군으로 분류하여 아미카신의 약동학적 파라미터를 비교분석하였다. 결과: 본 연구에서 아미카신 혈중 최저, 최고 농도의 평균 ${\pm}$ 표준편차는 각각 $1.14{\pm}1.95mg/L$, $26.35{\pm}9.28mg/L$이며, 청소율, 분포용적 및 반감기의 평균 ${\pm}$ 표준편차는 각각 $55.40{\pm}23.72mL/hr/kg$, $0.35{\pm}0.12L/kg$, 그리고 $5.22{\pm}3.34hrs$로 산출되었다. 크레아티닌 청소율에 따른 아미카신의 청소율, 분포용적 및 반감기의 유의한 차이가 관찰되었다. 종합적으로 아미카신의 혈중 최저 농도는 크레아티닌 청소율이 40 mL/min 미만인 경우 40 mL/min 이상인 경우에 비해 유의하게 증가하였다. 결론: 아미카신의 약동학적 파라미터들은 신기능에 따라 유의한 차이가 있으므로 최적의 치료효과를 위해서는 환자의 크레아티닌 청소율에 따른 개인화 약물요법이 필요하다.
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문제 정의
Thus, pharmacokinetic and pharmacodynamic studies of amikacin therapy need to be performed among various Korean subpopulations. This study aims to evaluate the pharmacokinetic parameters of a once-daily amikacin regimen in adult Korean patients and compare them according to renal function so as to help design the optimal regimen for individualized once-daily amikacin administration.
1,2,3,15,16,18,19,21,22) However, only limited data is available on the pharmacokinetic or pharmacodynamic variations of once-daily amikacin therapy in Korean adult patients with various underlying diseases and states. This study evaluated the pharmacokinetic parameters of once-daily amikacin doses in adult Korean patients. It is worth noting that most of the patients in the study received an 8.
제안 방법
A pharmacokinetic analysis was performed for each patient using the CAPCIL® program.
Individual patient data including serum concentrations, age, weight, height, gender, Scr, dosage history, and indication for therapy were entered into the CAPCIL® program.
Patient characteristics such as gender, age, weight, height, type of infection, underlying disease, baseline biochemical markers, number of treatment days, and dosing information were collected. Biochemical markers [e.
To evaluate the difference between the pharmacokinetic parameters (CL, T1/2, and Vd) of amikacin according to the renal function, the patients were classified into four subgroups based on their CLcr as follows: CLcr <40 mL/min; 40 mL/min CLcr 60 mL/min; 60 mL/min < CLcr 90 mL/min; CLcr > 90 mL/min.
대상 데이터
This retrospective study was undertaken for patients receiving amikacin once daily against gram-negative infection from March 2001 to March 2004 at a tertiary care university hospital in Seoul, Korea. Patients were included for analysis if they were over 18 years of age, have received two or more once-daily doses of amikacin, and have had steady state pre-and post-dose serum concentrations measured.
이론/모형
program. The pharmacokinetic parameters of amikacin including clearance (CL), half-life (T1/2), and volume of distribution (Vd) were calculated using the multiple-point linear method. Individual patient data including serum concentrations, age, weight, height, gender, Scr, dosage history, and indication for therapy were entered into the CAPCIL® program.
성능/효과
1. There were significant differences in the mean values of the CL, T1/2, and Vd among 4 groups stratified by CLcr (p<0.001 for all).
Post hoc analysis showed (1) clearance of amikacin with CLcr lower than 40 mL/min decreased significantly compared to CLcr higher than 60 mL/min, (2) volume of distribution with CLcr lower than 60 mL/min decreased significantly compared to CLcr higher than 90mL/min, and (3) half life with CLcr lower than 40 mL/min increased significantly compared to CLcr higher than 40mL/min. The estimated Ctrough compared by CLcr had differences as shown in Figure 2. No difference was observed in the mean Cpeak values of the patients with different states of renal function (p=0.4471).
This study also showed that more ICU patients than general ward patients had Ctrough levels above 1 mg/L, which might have been due to the impaired renal functions of the ICU patients. The amikacin dosage in patients with high Ctrough levels were adjusted to keep their Ctrough levels below 1 mg/L.
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