Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal function
Abstract Fosfomycin has been used to treat carbapenem‐resistant Acinetobacter baumannii (CRAB) infections. However, there is insufficient information on dosage adjustment among critically ill patients with renal impairment. This study aims to evaluate the attainment of PK/PD targets for different do...
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| Language: | English |
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Wiley
2024-10-01
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| Series: | Clinical and Translational Science |
| Online Access: | https://doi.org/10.1111/cts.70038 |
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| author | Nattapong Tidwong Anan Chanruang Suthanya Chupradit Suzanne L. Parker Pannee Leelawattanachai Poramed Winichakoon Baralee Punyawudho |
| author_facet | Nattapong Tidwong Anan Chanruang Suthanya Chupradit Suzanne L. Parker Pannee Leelawattanachai Poramed Winichakoon Baralee Punyawudho |
| author_sort | Nattapong Tidwong |
| collection | DOAJ |
| description | Abstract Fosfomycin has been used to treat carbapenem‐resistant Acinetobacter baumannii (CRAB) infections. However, there is insufficient information on dosage adjustment among critically ill patients with renal impairment. This study aims to evaluate the attainment of PK/PD targets for different dosage regimens of CRAB treatment in critically ill patients based on their renal function. Monte Carlo simulations were conducted to assess the probability of achieving time above the minimum inhibitory concentration (T > MIC) of 80% and 100% and to determine the cumulative fraction response (CFR) against institutional MICs. Our results demonstrated that administering fosfomycin 20–24 g/day to individuals with normal renal function (CrCl ≥60 mL/min) achieved the target at a MIC of ≤64 and ≤32 μg/mL during the first 24 h of treatment and at steady state, respectively. Notably, those with renal impairment achieved higher MIC values at a steady state despite dosage reduction. None of the regimens reached the target CFR. Our study suggested that administering fosfomycin at least 20 g/day to those with normal renal function provides sufficient exposure throughout the treatment course when the MIC value is ≤32 μg/mL. Less aggressive dosing regimens are advisable for patients with renal impairment. Additional clinical studies are necessary to verify our suggestions. |
| format | Article |
| id | doaj-art-79ac0281614249c4875c3515056b13fb |
| institution | OA Journals |
| issn | 1752-8054 1752-8062 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Translational Science |
| spelling | doaj-art-79ac0281614249c4875c3515056b13fb2025-08-20T02:11:11ZengWileyClinical and Translational Science1752-80541752-80622024-10-011710n/an/a10.1111/cts.70038Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal functionNattapong Tidwong0Anan Chanruang1Suthanya Chupradit2Suzanne L. Parker3Pannee Leelawattanachai4Poramed Winichakoon5Baralee Punyawudho6Department of Pharmaceutical Care, Faculty of Pharmacy Chiang Mai University Chiang Mai ThailandDepartment of Pharmaceutical Care, Faculty of Pharmacy Chiang Mai University Chiang Mai ThailandDepartment of Pharmaceutical Care, Faculty of Pharmacy Chiang Mai University Chiang Mai ThailandThe University of Queensland Centre for Clinical Research The University of Queensland Brisbane Queensland AustraliaDepartment of Pharmacy, Faculty of Medicine Vajira Hospital Navamindradhiraj University Bangkok ThailandDivision of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine Chiang Mai University Chiang Mai ThailandDepartment of Pharmaceutical Care, Faculty of Pharmacy Chiang Mai University Chiang Mai ThailandAbstract Fosfomycin has been used to treat carbapenem‐resistant Acinetobacter baumannii (CRAB) infections. However, there is insufficient information on dosage adjustment among critically ill patients with renal impairment. This study aims to evaluate the attainment of PK/PD targets for different dosage regimens of CRAB treatment in critically ill patients based on their renal function. Monte Carlo simulations were conducted to assess the probability of achieving time above the minimum inhibitory concentration (T > MIC) of 80% and 100% and to determine the cumulative fraction response (CFR) against institutional MICs. Our results demonstrated that administering fosfomycin 20–24 g/day to individuals with normal renal function (CrCl ≥60 mL/min) achieved the target at a MIC of ≤64 and ≤32 μg/mL during the first 24 h of treatment and at steady state, respectively. Notably, those with renal impairment achieved higher MIC values at a steady state despite dosage reduction. None of the regimens reached the target CFR. Our study suggested that administering fosfomycin at least 20 g/day to those with normal renal function provides sufficient exposure throughout the treatment course when the MIC value is ≤32 μg/mL. Less aggressive dosing regimens are advisable for patients with renal impairment. Additional clinical studies are necessary to verify our suggestions.https://doi.org/10.1111/cts.70038 |
| spellingShingle | Nattapong Tidwong Anan Chanruang Suthanya Chupradit Suzanne L. Parker Pannee Leelawattanachai Poramed Winichakoon Baralee Punyawudho Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal function Clinical and Translational Science |
| title | Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal function |
| title_full | Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal function |
| title_fullStr | Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal function |
| title_full_unstemmed | Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal function |
| title_short | Optimized fosfomycin regimens for treating carbapenem‐resistant Acinetobacter baumannii in critically ill patients with varying degrees of renal function |
| title_sort | optimized fosfomycin regimens for treating carbapenem resistant acinetobacter baumannii in critically ill patients with varying degrees of renal function |
| url | https://doi.org/10.1111/cts.70038 |
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