In silico evaluation of a beta-lactam dosing guideline among adults with serious infections

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Williams, P
Cotta, MO
Abdul-Aziz, MH
Wilks, K
Farkas, A
Roberts, JA
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2022
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Abstract

Study Objective: The aim of this study was to compare the achievement of therapeutic pharmacokinetic–pharmacodynamic (PK-PD) exposure targets for beta-lactam antibiotics using product information dosing or guideline-based dosing for the treatment of serious infections. Design: In silico study. Data Source: ID-ODSTM (Individually Designed Optimum Dosing Strategies). Patients and Intervention: None. Measurements and Main Results: In silico product information and guideline-based dosing simulations for cefepime, ceftazidime, flucloxacillin, meropenem, and piperacillin/tazobactam were performed using pharmacokinetic models from seriously ill patient populations. The median simulated concentration at 48 and 96 h was used to measure the probability of target attainment (PTA) to achieve predefined therapeutic and toxicity PK-PD targets. A multiple linear regression model was constructed to identify the effect of guideline-based dosing covariates on achieving pre-defined therapeutic targets. In total, 480 dosing simulations were performed. The PTA percentage with guideline-based dosing at 48 and 96 h was 80% and 68%, respectively, yielding significantly higher results when compared to product information dosing (48.45% and 49%, respectively), p < 0.001 at both time points. At 48 h, predefined toxicity thresholds were exceeded in 4.7% and 0% of simulations for guideline-based and product information-based dosing, respectively (p = 0.002). eGFR was significantly associated with the % PTA by guideline-based dosing, with eGFR values of 20 and 50 ml/min both statistically significant in leading to an increase in PTA. Conclusions: Our study demonstrated that achievement of PK-PD exposures associated with an increased likelihood of effectiveness was more likely to occur with guideline-based dosing; especially at 48 h.

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Pharmacotherapy

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© 2022 The Authors. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy published by Wiley Periodicals LLC on behalf of Pharmacotherapy Publications, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Pharmacology and pharmaceutical sciences

beta-lactam

critically ill

guideline

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Williams, P; Cotta, MO; Abdul-Aziz, MH; Wilks, K; Farkas, A; Roberts, JA, In silico evaluation of a beta-lactam dosing guideline among adults with serious infections, Pharmacotherapy, 2022

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