The dose of sulbactam in pediatric patients with Acinetobacter baumannii infection using Monte Carlo simulation
Article Sidebar
Main Article Content
Abstract
Background: Acinetobacter baumannii is a Gram-negative bacterium that has been reported to be increasingly resistant to antibiotics. With recommendations for high dosage sulbactam therapy. However, there are few studies on appropriate dosing in pediatric patients. Therefore, pharmacokinetic principles need to be applied to determine the correct dosages.
Objectives: To investigate the pharmacokinetic variables of sulbactam in pediatric patients aged 1 to 12 years with A. baumannii infection and use these data to determine the appropriate dosage using the Monte Carlo simulation.
Methods: Conducted a systematic literature review on pharmacokinetics and dosing regimens of sulbactam in pediatric patients, determined the dosing regimens with identified variables using the Monte Carlo simulation, and calculating the percentage of time the drug concentration exceeded the minimum inhibitory concentration (MIC) by at least 60% and determining the probability of achieving the target drug level by setting it above 80%.
Results: For MIC values of less than 2 mg/L, the recommended dose was 25-200 mg/kg every 4 hours and 150-200 mg/kg every 6 hours. For MIC values between 4-8 mg/L, the proper dose was 150-200 mg/kg every 4 hours, and for an MIC value of 16 mg/L, the appropriate dose was 200 mg/kg every 4 hours.
Conclusions: The identified dosages provide guidelines for the treatment of Acinetobacter baumannii in pediatric patients, achieving a drug level index greater than 80% at various MIC values. However, it should be used with caution and close clinical monitoring.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของวิทยาลัยพยาบาลบรมราชชนนี จังหวัดนนทบุรี
ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับวิทยาลัยพยาบาลบรมราชชนนี จังหวัดนนทบุรี และคณาจารย์ท่านอื่น ในวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
References
Wu HJ, Xiao ZG, Lv XJ, Huang HT, Liao C, Hui C-Y, et al. Drug-resistant Acinetobacter baumannii: from molecular mechanisms to potential therapeutics (Review). Exp Ther Med. 2023;25(5):209. doi: 10.3892/etm.2023.11908.
Principe L, Di Bella S, Conti J, Perilli M, Piccirilli A, Mussini C, et al. Acinetobacter baumannii resistance to sulbactam/ durlobactam: a systematic review. Antibiotics (Basel). 2022;11(12):1793. doi: 10.3390/antibiotics11121793.
O’Donnell JP, Bhavnani SM. The Pharmacokinetics/Pharmacodynamic relationship of Durlobactam in combination with Sulbactam in Vitro and in Vivo infection Model Systems Versus Acinetobacter baumannii-calcoaceticus Comples. Clin Infect Dis. 2023;76Suppl2:S202-9. doi: 10.1093/cid/ciad096.
Wang X, Xiong L, Yu W, Huang C, Ji J, Ying C, et al. Evaluation of piperacillin/ sulbactam, piperacillin/tazobactam and cefoperazone/sulbactam dosages in gram-negative bacterial bloodstream infections by Monte Carlo simulation. Antibiotics (Basel). 2023;12(2):363. doi: 10.3390/antibiotics120202363.
Schaad UB, Guenin K, Straehl P. Single-dose pharmacokinetics of intravenous sulbactam in pediatric patients. Rev Infect Dis. 1986;8Suppl5:S512-7. doi: 10.1093/chlinids/8.supplement_5.s512.
Nahata MC, Vashi VI, Swanson RN, Messing MA, Chung M. Pharmacokinetics of ampicillin and sulbactam in pediatric patients. Antimicrob Agents Chemother. 1999;43(5):1225-9. doi: 10.1128/AAC.43.5.1225.
Onita T, Ikawa K, Ishihara N, Tamaki H, Yano T, Naora K, et al. Pharmacodynamic evaluation of Ampicillin-sulbactam in pediatric patients using plasma and urine data. Pediatric Infect Dis J. 2022;41(5):411-6. doi: 10.1097/INF.0000000000003496.
Chaijamorn W, Charoensareerat T, Srisawat N, Pattharachayakul S, Boonpeng A. Cefepime dosing regimens in critically ill patients receiving continuous renal replacement therapy: a Monte Carlo simulation study. J Intensive Care. 2018;6:61. doi: 10.1186/s40560-018-0030-8.
Charoensareerat T, Chaijamorn W, Kerdnimith P, Kosumwisaisakul N, Teeranaew P, Rungkitwattanakul D, et al. Optimal meropenem dosing regimens in patients undergoing continuous renal replacement therapy: systematic review and Monte Carlo simulations. Blood Purif. 2023;52(6):503-15. doi: 10.1159/000529694.
Chen H, Liu Q, Chen Z, Li C. Efficacy of sulbactam for the treatment of Acinetobacter baumannii complex infection: A systematic review and meta-analysis. J Infect Chemother. 2017;23(5):278-85. doi: 10.1016/j.jiac.2017.01.005.
Jaruratanasirikul S, Nitchot W, Wongpoowarak W, Samaeng M, Nawakitrangsan M. Population pharmacokinetics and Monte Carlo simulations of sulbactam to optimize dosage regimens in patients with ventilator-associated pneumonia caused by Acinetobacter baumannii. Eur J Pharm Sci. 2019;136:104940. doi: 10.1016/j.ejps. 2019.05.018.
Jaruratanasirikul S, Wongpoowarak W, Wattanavijitkul T, Sukarnjanaset W, Samaeng M, Nawakitrangsan M, et al. Population pharmacokinetics and pharmacodynamics modeling to optimize dosage regimens of sulbactam in critically Ill patients with severe sepsis caused by acinetobacter baumannii. Antimicrob Agents Chemother. 2016;60(12):7236-44. doi: 10.1128/AAC.01669-16.
Liu J, Shu Y, Zhu F, Feng B, Zhang Z, Liu L, et al. Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: a systematic review and network meta-analysis. J Glob Antimicrob Resist. 2021;24:136-47. doi: 10.1016/j.jgar.2020.08.021.
Rungkitwattanakul D, Charoensareerat T, Kerdnimith P, Kosumwisaisakul N, Teeranaew P, Boonpeng A, et al. Imipenem dosing recommendations for patients undergoing continuous renal replacement therapy: systematic review and Monte Carlo simulations. Ren Replace Ther. 2021;7(61):1-11. doi: 10.1186/s41100-021-00380-6.
Setiawan E, Cotta MO, Abdul-Aziz MH, Widjanarko D, Sosilya H, Lukas DL, et al. Population pharmacokinetics and dosing dimulations of Ampicillin and Sulbactam in Hospitalised adult patients. Clin Pharmacokinet. 2023;62(4):573-86. doi: 10.1007/s40262-023-01219-5.
Ye L, Cheng L, Kong L, Zhao X, Xie G, He J, et al. Pharmacokinetic and pharmacodynamic analysis of cefoperazone/ sulbactam for the treatment of pediatric sepsis by Monte Carlo simulation. Anal Methods. 2022;14(11):1148-54. doi: 10.1039/d1ay01385h.
e-Phis System, Thammasat University Hospital. Statistics report on the prescription of Sulbactam as a single drug by physicians in pediatric patients at Thammasat University Hospital from January 2023 to October 2023. Pathum Thani: Thammasat University Hospital; 2023. (in Thai).
Zhu S, Zhang J, Lv Z, Zhu P, Oo C, Yu M, et al. Prediction of tissue exposures of Meropenem, Colistin, and Sulbactam in pediatrics using physiologically based pharmacokinetic modeling. Clin Pharmacokinet. 2022;61(10):1427-41. doi: 10.1007/s40262-022-01161-y.
