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Pharmacokinetics of polymyxin B in different populations: a systematic review.
- Source :
- European Journal of Clinical Pharmacology; Jun2024, Vol. 80 Issue 6, p813-826, 14p
- Publication Year :
- 2024
-
Abstract
- Background and objectives: Despite being clinically utilized for the treatment of infections, the limited therapeutic range of polymyxin B (PMB), along with considerable interpatient variability in its pharmacokinetics and frequent occurrence of acute kidney injury, has significantly hindered its widespread utilization. Recent research on the population pharmacokinetics of PMB has provided valuable insights. This study aims to review relevant literature to establish a theoretical foundation for individualized clinical management. Methods: Follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, Pop-PK studies of PMB were searched in PubMed and EMBASE database systems from the inception of the database until March 2023. Result: To date, a total of 22 population-based studies have been conducted, encompassing 756 subjects across six different countries. The recruited population in these studies consisted of critically infected individuals with multidrug-resistant bacteria, patients with varying renal functions, those with cystic fibrosis, kidney or lung transplant recipients, patients undergoing extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT), as well as individuals with obesity or pediatric populations. Among these studies, seven employed a one-compartmental model, with the range of typical clearance (CL) and volume (Vc) being 1.18–2.5L /h and 12.09–47.2 L, respectively. Fifteen studies employed a two-compartmental model, with the ranges of the clearance (CL) and volume of the central compartment (Vc), the volume of the peripheral compartment (Vp), and the intercompartment clearance (Q) were 1.27–8.65 L/h, 5.47–38.6 L, 4.52–174.69 L, and 1.34–24.3 L/h, respectively. Primary covariates identified in these studies included creatinine clearance and body weight, while other covariates considered were CRRT, albumin, age, and SOFA scores. Internal evaluation was conducted in 19 studies, with only one study being externally validated using an independent external dataset. Conclusion: We conclude that small sample sizes, lack of multicentre collaboration, and patient homogeneity are the primary reasons for the discrepancies in the results of the current studies. In addition, most of the studies limited in the internal evaluation, which confined the implementation of model-informed precision dosing strategies. [ABSTRACT FROM AUTHOR]
- Subjects :
- MEDICAL information storage & retrieval systems
KIDNEY transplantation
PATIENTS
TRANSPLANTATION of organs, tissues, etc.
EXTRACORPOREAL membrane oxygenation
LUNG transplantation
RESEARCH funding
DRUG resistance in microorganisms
CATASTROPHIC illness
HEMODIALYSIS
DESCRIPTIVE statistics
ACUTE kidney failure
SYSTEMATIC reviews
MEDLINE
GRAM-negative bacterial diseases
ONLINE information services
POLYMYXIN B
CYSTIC fibrosis
OBESITY
DISEASE risk factors
Subjects
Details
- Language :
- English
- ISSN :
- 00316970
- Volume :
- 80
- Issue :
- 6
- Database :
- Complementary Index
- Journal :
- European Journal of Clinical Pharmacology
- Publication Type :
- Academic Journal
- Accession number :
- 177283962
- Full Text :
- https://doi.org/10.1007/s00228-024-03666-w