2002 Fiscal Year Final Research Report Summary
Optimization of Antibiotic Chemotherapy Based on Pharmacokinetics and Phannacodynamics of Antibiotics in Patients with Severe Infections
| Project/Area Number |
13672399
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
応用薬理学・医療系薬学
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| Research Institution | Keio University |
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Principal Investigator |
MORITA Kunihiko School of Medicine, Hospital Pharmacy, Associate Professor, 医学部, 助教授 (80327717)
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| Co-Investigator(Kenkyū-buntansha) |
KOBAYASHI Yoshio School of Medicine, Clinical Laboratory , Assistant Professor, 医学部, 講師 (80118950)
TANIGAWARA Yusuke School of Medicine, Hospital Pharmacy, Professor, 医学部, 教授 (30179832)
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| Project Period (FY) |
2001 – 2002
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| Keywords | carbapenem / aminoglycoside / glycopeptide / therapeutic drug monitoring / peak serum concentration / trough serum concentration / CRP / clinical efficacy |
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| Research Abstract |
To optimization of antibiotic chemotherapy, we investigated the relationship between clinical efficacies and pharmacokinetics of carbapenem, aminoglycosides, and glycopeptides in patients with sivere infections such as P. aeruginosa and/or S. aureus. Firstly, we compared retrospectively the serum levels of meropenem (MEPM), a carbapenem antibiotic, and its efficacy observed under the four-times daily (injection of 500 mg at 6-h interval) regimen with those observed under twice-daily regimen in 22 patients (mean age±SE, 62.4±3.7) with severe infections. The clinical efficacy of MEPM was evaluated by the degrees of decreased CRP level, as a marker of inflammatory, during the treatment periods. The mean trough level of MEPM in the effective patient group (7.5mcg/mL) was higher than that of the non-effective patient group (2.2 mcg/mL). The mean trough level of MEPM in four-times daily regimen group (6.0 mcg/mL) was higher than that in two-times daily regimen group (2.0mcg/mL). No relationship between the mean peak levels in these regimens was found. These results indicated that the injection of 500 mg of MEPM at 6-h interval was more effective than the injection of 500-1000 mg at 12-h or more longer interval. We investigated retrospectively the relationship between clinical efficacies and serum levels of aminoglycosides such as arbekacin (ABK), amikacin (AMK) and tobramycin (TOB) in the patients with sivere infections. As for efficacy, serum peak levels (Cmax) was associated to the clinical cure rate. Monitoring of trough is important to prevent the occurrence of nephrotoxicity, whereas Cmax can be associated with efficacy. These findings will be useful for optimal use of this aminoglycoside for the treatment of MRSA-infected patients
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