한국임상약학회지 (Korean Journal of Clinical Pharmacy)

  • 제27권2호
  • /
  • Pages.83-91
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  • 2017
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  • 1226-6051(pISSN)
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  • 2508-786X(eISSN)
한국임상약학회 (Korean College Of Clinical Pharmacy)
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국내 3차 병원의 비만 암환자에서 각각 다른 체중 측정 공식들을 적용한 piperacillin/tazobactam의 용량 적절성 비교 연구

Comparison of Appropriate Piperacillin/Tazobactam Doses in Korean Obese Patients with Cancer Based on Different Body Size Descriptor Equations in a Tertiary Care Hospital

  • Kim, Ji Hyun (Department of Pharmacy, Chonnam National University) ;
  • Yang, Young-Mo (College of Pharmacy, Chosun University) ;
  • Yoon, Hyonok (College of Pharmacy, Research Institute of Pharmaceutical Science, Gyeongsang National University) ;
  • Choi, Eun Joo (College of Pharmacy, Chosun University)
  • 투고 : 2017.05.22
  • 심사 : 2017.06.20
  • 발행 : 2017.06.30
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초록

Background: Piperacillin/tazobactam (TZP) is an antibiotic against a broad spectrum of gram-positive, gram-negative, and aerobic and anaerobic strains of bacteria. Due to changes in its pharmacokinetic and pharmacodynamic parameters by TZP-treated patients' renal functions and obesity, it is important to administrate and monitor TZP based on their renal functions and Body Mass Index (BMI) levels. The purpose of this study was to determine the appropriateness of administration doses of TZP based on renal functions of obese cancer patients in a tertiary hospital. Methods: This study was retrospectively conducted with obese cancer patients with $BMI{\geq}30kg/m^2$ in a tertiary hospital, Korea from September 2004 to August 2014. Data were collected through Electronic Medical Record (EMR) which contained laboratory data and TZP dosing of each patient. Results: Among 7,058 patients during the study period, 102 prescriptions were selected based on inclusion and exclusion criteria and classified by their renal functions. Although TZP should be used based on patients' renal functions to adjust its dose, its initial dose and dosing interval were consistently used without considering patients' renal functions on a regular basis. Especially, in the comparison with FDA dosing standard of TZP, approximately twice patients with $20mL/min{\leq}CrCl{\leq}40mL/min$ received domestically 4.5 g instead of 2.25 g as the TZP starting dose. Conclusion: The appropriate doses of TZP were administered to almost all of obese cancer patients; however, the recommended TZP dose was different between Korea and other countries by twice the amount. Further related studies are necessary to clearly determine the results, to optimize TZP treatment for obese patients with cancer in clinical practice, and to design and develop new TZP formulations for them in pharmaceutical industry.

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참고문헌

  1. Piperacillin/tazobactam. Micromedex 2.0. Available from http://www.micromedexsolutions.com/micromedex2/librarian. Accessed August 19, 2015.
  2. $Zosyn^{(R)}$ prescribing information, 2009. Available from http://www.fda.gov/ohrms/dockets/dockets/06p0195/06P-0195-EC1-Attach-1.pdf. Accessed August 19, 2015.
  3. Sturm AW, Allen N, Rafferty KD, Fish DN, Toschlog E, Newell M, et al. Pharmacokinetic analysis of piperacillin administered with tazobactam in critically ill, morbidly obese surgical patients. Pharmacotherapy 2014;34:28-35. https://doi.org/10.1002/phar.1324
  4. Shah PJ, Ryzner KL. Evaluating the appropriate use of piperacillin/tazobactam in a community health system: a retrospective chart review. P T. 2013;38:462-83.
  5. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011;52:e56-93. https://doi.org/10.1093/cid/cir073
  6. National Comprehensive Cancer Network. Prevention and treatment of cancer-related infections version 1.2013. Available from http://oralcancerfoundation. org/treatment/pdf/infections.pdf. Accessed August 20, 2015.
  7. Lodise TP Jr, Lomaestro B, Drusano GL. Piperacillin-tazobactam for pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clin Infect Dis 2007;44:357-63. https://doi.org/10.1086/510590
  8. Patel N, Scheetz MH, Drusano GL, Lodise TP. Identification of optimal renal dosage adjustments for traditional and extended-infusion piperacillin-tazobactam dosing regimens in hospitalized patients. Antimicrob Agents Chemother 2010;54:460-5. https://doi.org/10.1128/AAC.00296-09
  9. Tazocin prescribing information (Korean), 2012. Available from http://www.health.kr/images/insert_pdf/IN_A11A4320A0029_01.pdf. Accessed August 20, 2015.
  10. Karino F, Nishimura N, Ishihara N, Moriyama H, Miura K, Hamaguchi S, et al. Nephrotoxicity induced by piperacillin-tazobactam in late elderly Japanese patients with nursing and healthcare associated pneumonia. Biol Pharm Bull 2014;37:1971-6. https://doi.org/10.1248/bpb.b14-00362
  11. Winter MA, Guhr KN, Berg GM. Impact of various body weights and serum creatinine concentrations on the bias and accuracy of the Cockcroft-Gault equation. Pharmacotherapy 2012;32:604-12. https://doi.org/10.1002/j.1875-9114.2012.01098.x
  12. Spruill WJ, Wade WE, Cobb HH 3rd. Estimating glomerular filtration rate with a modification of diet in renal disease equation: implications for pharmacy. Am J Health Syst Pharm 2007;64:652-60. https://doi.org/10.2146/ajhp060239
  13. Dowling TC, Matzke GR, Murphy JE, Burckart GJ. Evaluation of renal drug dosing: prescribing information and clinical pharmacist approaches. Pharmacotherapy 2010;30:776-86. https://doi.org/10.1592/phco.30.8.776
  14. Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Guidance for industry: pharmacokinetics in patients with impaired renal function - study design, data analysis, and impact on dosing and labeling, March 2010. Available from http://www.fda.gov/downloads/Drugs/Guidances/UCM204959.pdf. Accessed August 21, 2015.
  15. Pai MP. Estimating the glomerular filtration rate in obese adult patients for drug dosing. Adv Chronic Kidney Dis. 2010;17:e53-62. https://doi.org/10.1053/j.ackd.2010.05.010
  16. Janmahasatian S, Duffull SB, Chagnac A, Kirkpatrick CM, Green B. Lean body mass normalizes the effect of obesity on renal function. Br J Clin Pharmacol 2008;65:964-5. https://doi.org/10.1111/j.1365-2125.2008.03112.x
  17. Obesity and overweight, World Health Organization. Available from http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed August 21, 2015.
  18. Brown DL, Masselink AJ, Lalla CD. Functional range of creatinine clearance for renal drug dosing: a practical solution to the controversy of which weight to use in the Cockcroft-Gault equation. Ann Pharmacother 2013;47:1039-44. https://doi.org/10.1345/aph.1S176
  19. Demirovic JA, Pai AB, Pai MP. Estimation of creatinine clearance in morbidly obese patients. Am J Health Syst Pharm 2009;66:642-8. https://doi.org/10.2146/ajhp080200
  20. Park EJ, Pai MP, Dong T, Zhang J, Ko CW, Lawrence J, et al. The influence of body size descriptors on the estimation of kidney function in normal weight, overweight, obese, and morbidly obese adults. Ann Pharmacother 2012;46:317-28. https://doi.org/10.1345/aph.1Q374
  21. Wilhelm SM, Kale-Pradhan PB. Estimating creatinine clearance: a meta-analysis. Pharmacotherapy 2011;31:658-64. https://doi.org/10.1592/phco.31.7.658
  22. Green B, Duffull SB. What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol 2004;58:119-33. https://doi.org/10.1111/j.1365-2125.2004.02157.x
  23. Janmahasatian S, Duffull SB, Ash S, Ward LC, Byrne NM, Green B. Quantification of lean bodyweight. Clin Pharmacokinet 2005;44:1051-65. https://doi.org/10.2165/00003088-200544100-00004
  24. Ozmen S, Kaplan MA, Kaya H, Akin D, Danis R, Kizilkan B, et al. Role of lean body mass for estimation of glomerular filtration rate in patients with chronic kidney disease with various body mass indices. Scand J Urol Nephrol 2009;43:171-6. https://doi.org/10.1080/00365590802502228
  25. Bow EJ, Rotstein C, Noskin GA, Laverdiere M, Schwarer AP, Segal BH, et al. A randomized, open-label, multicenter comparative study of the efficacy and safety of piperacillin-tazobactam and cefepime for the empirical treatment of febrile neutropenic episodes in patients with hematologic malignancies. Clin Infect Dis 2006;43:447-59. https://doi.org/10.1086/505393
  26. Hamidah A, Rizal AM, Nordiah AJ, Jamal R. Piperacillin-tazobactam plus amikacin as an initial empirical therapy of febrile neutropenia in paediatric cancer patients. Singapore Med J 2008;49:26-30.
  27. Janson B, Thursky K. Dosing of antibiotics in obesity. Curr Opin Infect Dis 2012;25:634-49. https://doi.org/10.1097/QCO.0b013e328359a4c1
  28. Leykin Y, Miotto L, Pellis T. Pharmacokinetic considerations in the obese. Best Pract Res Clin Anaesthesiol 2011;25:27-36. https://doi.org/10.1016/j.bpa.2010.12.002
  29. Cheatham SC, Fleming MR, Healy DP, Chung CE, Shea KM, Humphrey ML, et al. Steady-state pharmacokinetics and pharmacodynamics of piperacillin and tazobactam administered by prolonged infusion in obese patients. Int J Antimicrob Agents 2013;41:52-6. https://doi.org/10.1016/j.ijantimicag.2012.09.004
  30. Zakrison TL, Hille DA, Namias N. Effect of body mass index on treatment of complicated intra-abdominal infections in hospitalized adults: comparison of ertapenem with piperacillin-tazobactam. Surg Infect (Larchmt) 2012;13:38-42. https://doi.org/10.1089/sur.2010.095
  31. Nichols KR, Knoderer CA, Cox EG, Kays MB. System-wide implementation of the use of an extended-infusion piperacillin/tazobactam dosing strategy: feasibility of utilization from a children's hospital perspective. Clin Ther 2012;34:1459-65. https://doi.org/10.1016/j.clinthera.2012.05.005
  32. Zeenny R, Nasr Z, Adaimy I. Retrospective evaluation of the appropriate use of piperacillin/tazobactam in a tertiary care teaching hospital in lebanon. Acta Medica Mediterranea 2014;30:655-63.
  33. Lee GC, Liou H, Yee R, Quan CF, Neldner K. Outcomes of extendedinfusion piperacillin-tazobactam: a retrospective analysis of critically ill patients. Clin Ther 2012;34:2297-300. https://doi.org/10.1016/j.clinthera.2012.11.005
  34. Kim A, Sutherland CA, Kuti JL, Nicolau DP. Optimal dosing of piperacillin-tazobactam for the treatment of Pseudomonas aeruginosa infections: prolonged or continuous infusion? Pharmacotherpay 2007;27:1490-7. https://doi.org/10.1592/phco.27.11.1490