Population Pharmacokinetic and Pharmacodynamic Analysis of Linezolid and a Hematologic Side Effect, Thrombocytopenia, in Japanese Patients

被引:119
|
作者
Sasaki, Tomohiro
Takane, Hiroshi [2 ]
Ogawa, Katsuhiro [2 ]
Isagawa, Sayaka
Hirota, Takeshi
Higuchi, Shun
Horii, Toshinobu [3 ]
Otsubo, Kenji [2 ]
Ieiri, Ichiro [1 ]
机构
[1] Kyushu Univ, Grad Sch Pharmaceut Sci, Dept Clin Pharmacokinet, Higashi Ku, Fukuoka 8128582, Japan
[2] Tottori Univ, Fac Med, Dept Hosp Pharm, Yonago, Tottori 683, Japan
[3] Tottori Univ, Fac Med, Infect Control Div, Yonago, Tottori 683, Japan
关键词
RENAL-FUNCTION; INFECTIONS; MODEL; CHEMOTHERAPY; METABOLISM; RIFAMPIN; SAFETY;
D O I
10.1128/AAC.01185-10
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Linezolid is an antimicrobial agent to treat infections by Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). While effective, linezolid treatment frequently is associated with hematological side effects, especially thrombocytopenia. However, little is known about the mechanism of this side effect and the exposure-response relationship. The present population pharmacokinetic/pharmacodynamic (PPK/PD) study was undertaken to elucidate the factors that determine linezolid levels, the relationship between exposure to linezolid and a decrease in platelet counts, and appropriate dosage adjustments based on exposure levels. In total, 50 patients (135 plasma samples) were used for the PPK analysis. The PPK analysis revealed that renal function and severe liver cirrhosis (Child Pugh grade C) significantly affect the pharmacokinetics of linezolid according to the equation clearance (liter/h) = 2.85 x (creatinine clearance/60.9)(0.618) x 0.472(CIR) (CIR indicates cirrhosis status; 0 for noncirrhosis, 1 for cirrhosis patients). Using 603 platelet counts from 45 patients, a PPK/PD analysis with a semimechanistic pharmacodynamic model described the relationship between linezolid exposure and platelet counts quantitatively, and the newly constructed model was validated using external data (776 platelet counts from 60 patients). Simulation indicated considerable risks in patients with insufficient renal function (creatinine clearance, <= 30 ml/min) or severe liver cirrhosis. For these patients, a reduced dosage (600 mg/day) would be recommended for sufficient efficacy (area under the concentration-time curve over 24 h in the steady state divided by the MIC, > 100) and safety.
引用
收藏
页码:1867 / 1873
页数:7
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