PMID- 30117081
OWN - NLM
STAT- MEDLINE
DCOM- 20190311
LR  - 20190311
IS  - 2210-7711 (Electronic)
VI  - 40
IP  - 5
DP  - 2018 Oct
TI  - Pharmacodynamic model for beta-lactam regimens used in surgical prophylaxis: 
      model-based evaluation of standard dosing regimens.
PG  - 1059-1071
LID - 10.1007/s11096-018-0720-y [doi]
AB  - Background Continual evolution of resistance among bacteria against methods of 
      surgical prophylaxis may make currently used beta-lactam regimens inadequate. 
      Objective To re-evaluate beta-lactam regimens in surgical prophylaxis. Setting A 
      pharmacodynamic Monte Carlo simulation (MCS) model based on a number of patients 
      in China. Methods Pharmacodynamic profiling using Monte Carlo simulation up to 
      4 hours postinfusion was conducted for standard-dose, short-term (0.5 h) and 
      prolonged (2 to 4 h) infusions of ampicillin, cefazolin, cefotaxime, cefoxitin, 
      cefuroxime, ertapenem, and piperacillin/tazobactam in adult patients with normal 
      renal function. Microbiological data were incorporated. Cumulative fraction of 
      response (CFR) was determined for each regimen against populations of S. aureus, 
      coagulase-negative staphylococci and E. coli. The optimal CFR was defined 
      as >/= 90% response. Main Outcome Measure Cumulative fractions of response of 
      pharmacodynamic target attainment. Results During the first 2 hours postinfusion, 
      piperacillin/tazobactam 3.375 g exhibited consistently optimal cumulative 
      fractions against S. aureus, CoNS and E. coli. Ampicillin 2 g (2 h) also 
      displayed optimal CFRs for S. aureus and E. coli but not for coagulase-negative 
      staphylococci. Cefoxitin 2 g didnot achieve any optimal CFRs, even via 2-h 
      prolonged infusion (maximum 72.8% CFR for S. aureus and 64.5% CFR for E. coli). 
      Cefazolin 2 g (4 h) and cefuroxime 1.5 g (4 h) provided desired CFRs across 4 h 
      postinfusion for S. aureus but provided poor CFRs for coagulase-negative 
      staphylococci and E. coli. Only ertapenem 1 g for E. coli and S. aureus and 
      cefotaxime 1 g for E. coli consistently yielded >/= 90% CFRs for 4 hour 
      postinfusion. Conclusions Certain dosing regimens may warrant adjustment for 
      improved prevention efficiency and enhanced empirical antibiotic regimens for 
      surgical prophylaxis.
FAU - Song, XiangQing
AU  - Song X
AD  - Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of 
      Xiangya School of Medicine, Central South University, Tongzipo Road No. 283, 
      Yuelu District, 410013, China. sxqmaster@163.com.
FAU - Long, MingHui
AU  - Long M
AD  - Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of 
      Xiangya School of Medicine, Central South University, Tongzipo Road No. 283, 
      Yuelu District, 410013, China.
LA  - eng
PT  - Journal Article
DEP - 20180816
PL  - Netherlands
TA  - Int J Clin Pharm
JT  - International journal of clinical pharmacy
JID - 101554912
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (beta-Lactams)
SB  - IM
MH  - Administration, Intravenous
MH  - Anti-Bacterial Agents/*administration & dosage
MH  - Antibiotic Prophylaxis/methods/*statistics & numerical data
MH  - Drug Evaluation/methods/statistics & numerical data
MH  - Escherichia coli/drug effects
MH  - Humans
MH  - Microbial Sensitivity Tests/methods
MH  - *Models, Biological
MH  - Monte Carlo Method
MH  - Staphylococcus aureus/drug effects
MH  - Surgical Wound Infection/*prevention & control
MH  - beta-Lactams/*administration & dosage
OTO - NOTNLM
OT  - Antibiotic prophylaxis
OT  - Beta-lactam
OT  - Cumulative fraction of response
OT  - Model-based evaluation
OT  - Monte Carlo simulation
OT  - Pharmacodynamics
OT  - Pharmacokinetics
EDAT- 2018/08/18 06:00
MHDA- 2019/03/12 06:00
CRDT- 2018/08/18 06:00
PHST- 2017/11/03 00:00 [received]
PHST- 2018/08/12 00:00 [accepted]
PHST- 2018/08/18 06:00 [pubmed]
PHST- 2019/03/12 06:00 [medline]
PHST- 2018/08/18 06:00 [entrez]
AID - 10.1007/s11096-018-0720-y [pii]
AID - 10.1007/s11096-018-0720-y [doi]
PST - ppublish
SO  - Int J Clin Pharm. 2018 Oct;40(5):1059-1071. doi: 10.1007/s11096-018-0720-y. Epub 
      2018 Aug 16.