한국임상약학회지 (Korean Journal of Clinical Pharmacy)

  • 제21권3호
  • /
  • Pages.208-214
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  • 2011
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  • 1226-6051(pISSN)
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  • 2508-786X(eISSN)
한국임상약학회 (Korean College Of Clinical Pharmacy)
권호 표지

한국인 성인 환자를 대상으로 한 1일 1회 요법 아미카신의 약물동태학

Pharmacokinetics of Once-Daily Amikacin in Korean Adult Patients

  • Kim, Hye-Kyung (Department of Pharmacy, Gangnam Severance Hospital) ;
  • Ji, Eun-Hee (College of Pharmacy, Seoul National University) ;
  • Ahn, Bo-Sook (Department of Pharmacy, Gangnam Severance Hospital) ;
  • Shin, Wan-Gyoon (College of Pharmacy, Seoul National University) ;
  • Oh, Jung-Mi (College of Pharmacy, Seoul National University)
  • 투고 : 2011.05.03
  • 심사 : 2011.07.04
  • 발행 : 2011.09.30
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초록

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.

키워드

참고문헌

  1. Tod M, Lortholary O, Seytre D, et al., Population pharmacokinetic study of amikacin administered once or twice daily to febrile, severely neutropenic adults. Antimicrob Agents Ch 1998; 42: 849-56.
  2. Lugo G, Castañeda-Hernández G. Amikacin bayesian forecasting in critically ill patients with sepsis and cirrhosis. TDM 1997; 19: 271-6.
  3. Bacopoulou F, Markantonis SL, Pavlou E, et al., A study of once-daily amikacin with low peak target concentrations in intensive care unit patients: pharmacokinetics and associated outcomes. J Crit Care 2003; 18: 107-13. https://doi.org/10.1053/jcrc.2003.50003
  4. Raveh D, Kopyt M, Hite Y, et al., Risk factors for nephrotoxicity in elderly patients receiving once-daily aminoglycosides. Q J Med 2002; 95: 291-7. https://doi.org/10.1093/qjmed/95.5.291
  5. Beauchamp D, Labrecque G. Aminoglycoside nephrotoxicity: do time and frequency of administration matter? Current Opinion in Critical Care 2001; 7: 402-8.
  6. Rougier F, Ducher M, Maurin M, et al., Aminoglycoside dosages and nephrotoxicity. Clin Pharmacokinetic 2003; 42: 493-500. https://doi.org/10.2165/00003088-200342050-00007
  7. Giamarellou H, Yiallouros K, Petrikkow G, et al., Comparative kinetics and efficacy of amikacin administered once or twice daily in the treatment of systemic gramnegative infections. J Antimicro Chemoth 1991; 27: 73-9. https://doi.org/10.1093/jac/27.suppl_C.73
  8. Freeman CD, Nicolau DP, Belliveau PP, et al., Once-daily dosing of aminoglycosides: review and recommendations for clinical practice. J Antimicrob Chemoth 1997; 39: 677-86. https://doi.org/10.1093/jac/39.6.677
  9. Rougier F, Claude D, Maurin M, et al., Aminoglycoside Nephrotoxicity: Modeling, simulation, and control. Antimicrob Agents Ch 2003; 47: 1010-6. https://doi.org/10.1128/AAC.47.3.1010-1016.2003
  10. Hatala R, Dinh T, Cook DJ. Once-daily aminoglycoside dosing in immunocompetent adults: a Meta-analysis. Ann Intern Med 1996; 124: 717-25. https://doi.org/10.7326/0003-4819-124-8-199604150-00003
  11. Ferriols-Lisart R, Alós-Almiñana M. Effectiveness and safety of once-daily aminoglycosides: A meta-analysis. Am J Health-Syst Pharm 1996; 53: 1141-50.
  12. Karachalios GN, Houpas P, Tziviskou E, et al., Prospective randomized study of once-daily versus twicedaily amikacin regimens in patients with systemic infections. Int J Clin Pharm Th 1998; 36: 561-4.
  13. Staneva M, Markova B, Atanasova I, et al., Pharmacokinetic and pharmacodynamic approach for comparing two therapeutic regimens using amikacin. Antimicrob Agents Ch 1994; 38: 981-5. https://doi.org/10.1128/AAC.38.5.981
  14. Santre C, Georges H, Jacquier JM, et al., Amikacin levels in bronchial secretions of 10 pneumonia patients with respiratory support treated once daily versus twice daily. Antimicrob Agents Ch 1995; 39: 264-7. https://doi.org/10.1128/AAC.39.1.264
  15. Bressolle F, Gouby A, Martinez JM, et al., Population pharmacokinetics of amikacin in critically ill patients. Antimicrob Agents Ch 1996; 40: 1682-9.
  16. Vanhaeverbeek M. Pharmacokinetics of once-daily amikacin in elderly patients. J Antimicrob Chemoth 1993; 31: 185-7.
  17. Botha FJ, van der Bijil P, Seifart HI, et al., Fluctuation of the volume of distribution of amikacin and its effect on once-daily dosage and clearance seriously ill patients. Inten Care Med 1996; 22: 443-6. https://doi.org/10.1007/BF01712162
  18. Nathalie B, Biatrice AL, Alain L, et al., Diurnal changes in the pharmacokinetic behavior of amikacin. TDM 2000; 22: 307-12.
  19. Romano S, Fdez de Gatta MM, Calvo MV, et al., Population pharmacokinetics of amikacin in patients with haematological malignancies. J Antimicrob Chemoth 1999; 44: 235-42. https://doi.org/10.1093/jac/44.2.235
  20. Gamer JS, Jarvis WR, Emori TG. DCP definitions for nosocomial infections. Am J Infect Control 1998;16:128-40.
  21. Anwera PV. Pharmacokinetic evaluation of single daily dose amikacin. J Antimicro Chemoth 1991; 27 :63-71.
  22. Marik PE, Havlik I, Monteagudo FS, et al., The pharmacokinetics of amikacin in critically ill adult and paediatric patients: comparison of once-versus twice dosing regimens. J Ant. Chemo 1991; 27: 81-9.
  23. Blaser J, Donig C, Ftio R, et al., Multicenter quality control study of amikacin assay for monitoring once-daily dosing regimens. TDM 1995; 17: 133-6.
  24. Raveh D, Kopyt M, Hite Y, et al., Risk factors for nephrotoxicity in elderly patients receiving once-daily aminoglycosides. Q J Med 2002; 95: 291-7. https://doi.org/10.1093/qjmed/95.5.291
  25. Susser Z, Raveh D, Yinnon AM. Safety of once-daily aminoglycosides in the elderly. J Am Geriatr Soc 2000;4 8: 857-9. https://doi.org/10.1111/j.1532-5415.2000.tb04772.x
  26. Bartal C, Danon A, Schlaeffer F, et al., Pharmacokinetic dosing aminoglycosides: A controlled trial. Am J Med 2003; 114: 194-198. https://doi.org/10.1016/S0002-9343(02)01476-6
  27. Zaera S, Hermida J, Tutor C. Effect of analytical inaccuracy on dose adjustment for vancomycin, amikacin, and tobramycin using the abbottbase pharmacokinetic systems. TDM 2002; 24: 696-700.
  28. Desoky E, Meinshausen J, Buhl K., et al., Generation of pharmacokinetic data during routine therapeutic drug monitoring: bayesian approach vs. pharmacokinetic studies. TDM 1993; 15: 281-8.
  29. Ried LD, Mckenna DA, Horn JR. Effect of therapeutic drug monitoring services on the number of serum drug assays ordered for patients: A meta-analysis. TDM 1989; 11: 253-63.
  30. Winston L, Benowitz N. Once-daily dosing of aminoglycosides: How much monitoring is truly required? Am J Med 2003; 114: 239-40. https://doi.org/10.1016/S0002-9343(03)00012-3