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Antimicrobial Agents and Chemotherapy, February 2000, p. 278-282, Vol. 44, No. 2
Faculté de Pharmacie, Université
de Montréal,1 and
Département de Pharmacie, Hôpital
Ste-Justine,2 Montréal, Canada
Received 9 April 1999/Returned for modification 21 July
1999/Accepted 1 November 1999
The objectives of this study were to (i) construct a population
pharmacokinetic (PK) model able to describe vancomycin (VAN) concentrations in serum in pediatric patients, (ii) determine VAN PK
parameters in this population, and (iii) validate the predictive ability of this model in a naive pediatric population. Data used in
this study were obtained from 78 pediatric patients (under 18 years
old). PK analyses were performed using compartmental methods. The most
appropriate model was chosen based on the evaluation of pertinent
graphics and calculation of the Akaike information criterion test. The
population PK analysis was performed using an iterative two-stage
method. A two-compartment PK model using age, sex, weight, and serum
creatinine as covariates was determined to be the most appropriate one
to describe serum VAN concentrations. The quality of fit was very good,
and the distribution of weighted residuals was found to be
homoscedastic (Wilcoxon signed rank test). Fitted population PK
parameters (mean ± standard deviation) were as follows: central
clearance (0.1 ± 0.05 liter/h/kg), central volume of
distribution (0.27 ± 0.07 liter/kg), peripheral volume of
distribution (0.16 ± 0.07 liter/kg), and distributional
clearance (0.16 ± 0.07 liter/kg). The predictive ability of the
developed model (including the above-mentioned covariates) was
evaluated in a naive population of 19 pediatric patients. The
predictability was very good. Precision (±95% confidence interval
[CI]) (peak, 4.1 [±1.4], and trough, 2.2 [±0.7]) and bias
(±95% CI) (peak,
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
A Population Pharmacokinetic Model for Vancomycin in Pediatric
Patients and Its Predictive Value in a Naive Population
0.58 [±2.2], and trough, 0.63 [±1.1]
mg/liter) were significantly (P < 0.05)
superior to those obtained using a conventional method (precision [±95% CI]: peak, 8.03 [±2.46], and trough, 2.7 [±0.74]; bias: peak,
7.1 [±2.9], and trough,
1.35
[±1.2] mg/liter). We propose the use of this population PK model to
optimize VAN clinical therapies in our institution and others with
similar patient population characteristics.
*
Corresponding author. Mailing address: Pharmacokinetics
and Pharmacodynamics, Phoenix International Life Sciences, 2350 Cohen St., St-Laurent, Quebec, Canada H4R 2N6. Phone: (514) 333-0042, ext.
4520. Fax: (514) 333-7666. E-mail: ducharmu{at}pils.com.
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