The efficacy and safety of high-dose arbekacin sulfate therapy (once-daily treatment) in patients with MRSA infection
Tóm tắt
The efficacy and safety of once-daily high-dose arbekacin sulfate therapy for methicillin-resistant Staphylococcus aureus (MRSA) infection were evaluated, with analysis of their relationship to blood drug levels. The study was conducted in patients with pneumonia or sepsis, the cause of which was suspected to be MRSA, who were admitted to the Nagasaki University Hospital or its affiliated hospitals between January 2009 and December 2010. The initial drug dose was set at a level expected to yield the goal peak of 20 μg/ml and a trough level of less than 2 μg/ml, using the Habekacin Therapeutic Drug Monitoring analysis software. Thirteen patients were enrolled: 10 patients had pneumonia and 3 patients had sepsis. Patient mean age was 72.0 years; mean initial drug dose was 269.2 mg. Clinical efficacy at completion of treatment and bacterial eradication–reduction were achieved in 66.7% (6/9) and 62.5% (5/8) of patients, respectively. Incidence of adverse reactions was 38.5% (5/13). In analysis of efficacy in relationship to serum drug levels, the peak drug level was 22.7 ± 5.50 μg/ml, on average, and 15 μg/ml or higher in all 6 responders. Also, in patients with renal dysfunction, it seemed to be essential to ensure a certain peak drug level and to control the trough level appropriately. Although the number of patients was limited, once-daily high-dose arbekacin sulfate therapy may be highly effective, without posing any major safety problems. Further larger-scale studies are needed.
Tài liệu tham khảo
Saito A, Miki F, Oizumi K, Rikitomi N, Watanabe A, Koga H, et al. Report: Clinical evaluation methods for new antimicrobial agents for the treatment of respiratory tract infections. Jpn J Chemother 1997;45:762–78 (in Japanese).
Steinkraus G, White R, Friedrich L. Vancomycin MIC creep in non-vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-susceptible clinical methicillin-resistant S. aureus (MRSA) blood isolates from 2001–05. J Antimicrob Chemother. 2007;60:788–94.
Japan Nosocomial Infection Surveillance (Internet) Japan; (cited 01 Nov 2011). Available from: http://www.nih-janis.jp/report/open_report/2010/3/2/zen_Open_Report_201000.pdf.
Kurazono M, Yamada K., Hirai Y, Ida T, Inoue M. Epidemiological survey of drug resistance of methicillin-resistant Staphylococcus aureus isolated in Japan in 2000. Jpn J Chemother 2002;50:494–9 (in Japanese).
Watanabe T, Ohashi K, Matsui K, Kubota T. Comparative studies of the bactericidal, morphological and post-antibiotic effects of arbekacin and vancomycin against methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 1997;39:471–6.
LaPlante KL, Rybak MJ. Clinical glycopeptide-intermediate staphylococci tested against arbekacin, daptomycin, and tigecycline. Diagn Microbiol Infect Dis. 2004;50:125–30.
Yokoyama K, Doi Y, Yamane K, Kurokawa H, Shibata N, Shibayama K, et al. Acquisition of 16S rRNA methylase gene in Pseudomonas aeruginosa. Lancet. 2003;362:1888–93.
Fujimura S, Gomi K, Takane H, Nakano Y, Fuse K, Kikuchi T, et al. Susceptibility to arbekacin of clinical strains of Pseudomonas aeruginosa isolated in the Tohoku area between 2003 and 2007. Jpn J Chemother 2009;57:91–6 (in Japanese).
Zapor MJ, Barber M, Summers A, Miller GH, Feeney LA, Eberly LE, et al. In vitro activity of the aminoglycoside antibiotic arbekacin against Acinetobacter baumannii-calcoaceticus isolated from war-wounded patients at Walter Reed Army Medical Center. Antimicrob Agents Chemother. 2010;54:3015–7.
Aikawa N, Kohno S, Kaku M, Watanabe A, Yamaguchi K, Tanigawara Y. An open clinical study of arbekacin 200 mg q.d. in patients infected with methicillin-resistant Staphylococcus aureus (MRSA): a clinical pharmacology study. Jpn J Chemother 2008;56:299–312 (in Japanese).
Kawano H, Tanigawara Y. Postmarketing surveillance review of arbekacin sulfate in patients with therapeutic drug monitoring. Jpn J Ther Drug Monit 2010;27:55–71 (in Japanese).
Tanikaze N, Komatsu M, Shimakawa K, Yamamoto I. Study of clinical significance of PK/PD (pharmacokinetic/pharmacodynamic) parameters after administering arbekacin to patients with pulmonary methicillin-resistant Staphylococcus aureus infection. Jpn J Chemother 2004;52:469–73 (in Japanese).
Sato R, Tanigawara Y, Kaku M, Aikawa N, Shimizu K. Pharmacokinetic–pharmacodynamic relationship of arbekacin for treatment of patients infected with methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2006;50:3763–9.
Tanigawara Y, Sato R, Morita K, Kaku M, Aikawa N, Shimizu K. Population pharmacokinetics of arbekacin in patients infected with methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2006;50:3754–62.