Pharmacokinetics of Vancomycin among Patients with Chemotherapy-Associated Febrile Neutropenia: Which Would Be the Best Dosing to Obtain Appropriate Exposure?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Ethics
2.2. Administration and Determination of Concentrations
2.3. Pharmacokinetic Modeling
2.4. Pharmacodynamics Assessment/Simulations
- Preprocessing layer with normalization of input variables.
- Input layer with 4 to 5 nodes according to the type of index with rectified linear units (ReLUs).
- Hidden layer 1 with 5 (network A) or 10 nodes (networks B, C, and D) with ReLUs.
- Hidden layer 2 with 10 nodes (C and D networks), with ReLUs.
- Hidden layer 3 with 10 nodes (network D only), with ReLUs.
- Output layer with a sigmoid activation function (PTA only defined between 0 and 1). The ANN for prediction of the -based index contain only one node in this layer, while the ANN for secondaryindices was considered as a multi-output model with two nodes in the output layer.
3. Results
3.1. Patient Characteristics
3.2. Pharmacokinetic Analysis
3.3. Pharmacodynamic Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ANC | Absolute neutrophil count |
ANN | Artificial Neural Network |
AKI | Acute Kidney Injury |
Area under the curve | |
Ratio of AUC over MIC | |
Minimal concentration | |
Predicted concentration | |
Clearance | |
Creatinine clearance | |
Daily dose | |
GAM | Generalized additive models |
Estimated glomerular filtration rate | |
Interval between doses | |
IQR | Interquartile range |
MAE | Mean absolute error |
MAPE | Mean absolute error percentage |
MIC | Minimal Inhibitory Concentration |
pcVPC | Prediction-corrected visual predictive check |
Probability of Target Attainment | |
Pharmacokinetic and Pharmacodynamic | |
Serum creatinine | |
Infusion time | |
Typical value of clearance | |
ReLUs | Rectified linear units |
RMSE | Root mean quadratic error |
Volume of distribution | |
Vancomycin |
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Variables | Value |
---|---|
Age (years) [Mean (95% CI)] | 44 (33.6, 54.4) |
Sex (Male/Female) | 8 (57.1%)/6(42.9%) |
Weight (kg) [Median (IQR)] | 60.0 (55.0, 67.0) |
Height (cm) [Mean (95% CI)] | 163.9 (159.3, 168.4) |
Body Surface Area () [Median (IQR)] | 1.64 (1.55, 1.72) |
() [Mean (95% CI)] | 0.582 (0.501, 0.663) |
() [Mean (95% CI)] | 120.3 (109.9, 130.7) |
Protein (g/dL) [Mean (95% CI)] | 5.59 (5.07, 6.12) |
Albumin (g/dL) [Mean (95% CI)] | 3.12 (2.84, 3.41) |
RAL (/) [Median (IQR)] | 960 (650, 1260) |
RAN (/) [Mean (95% CI)] | 264 (187, 341) |
Parameter | Final Model (RSE%) | Median Bootstrap Value [95% CI] | Shrinkage (%) |
---|---|---|---|
Population Parameters | |||
: | 5.2 (5.94) | 5.19 [2.86, 5.85] | |
: | 0.62 (35.3) | 0.58 [0.04, 1.35] | |
4.99 (21.6) | 5.24 [3.50, 27.17] | ||
21.22 (7.28) | 20.62 [8.03, 25.48] | ||
28.28 (13.5) | 28.61 [19.28, 312.98] | ||
Between-subject variability | |||
22.3 (19.4) | 21.2 [9.0, 40.5] | 3.11 | |
76.7 (25.9) | 68.5 [9.0, 129.0] | −1.03 | |
22.3 (24.8) | 26.4 [8.0, 99.6] | 13.4 | |
0.62 (32.2) | 0.61 [−0.24, 0.95] | ||
Residual variability | |||
b | 0.025 (9.5) | 0.03 [0.02, 0.04] | 19.5 |
Model | MAE | RMSE | ||
---|---|---|---|---|
Training | Test | Training | Test | |
Model 1: ANN with one output PTA of | 0.00189 | 0.00199 | 0.00665 | 0.00697 |
Model 2: ANN with two outputs: PTA of between 15–20 and PTA of between 400 and 600 | 0.0327 | 0.0313 | 0.0572 | 0.0542 |
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Parra González, D.; Pérez Mesa, J.A.; Cuervo Maldonado, S.I.; Díaz Rojas, J.A.; Cortés, J.A.; Silva Gómez, E.; Saavedra Trujillo, C.H.; Gómez, J. Pharmacokinetics of Vancomycin among Patients with Chemotherapy-Associated Febrile Neutropenia: Which Would Be the Best Dosing to Obtain Appropriate Exposure? Antibiotics 2022, 11, 1523. https://doi.org/10.3390/antibiotics11111523
Parra González D, Pérez Mesa JA, Cuervo Maldonado SI, Díaz Rojas JA, Cortés JA, Silva Gómez E, Saavedra Trujillo CH, Gómez J. Pharmacokinetics of Vancomycin among Patients with Chemotherapy-Associated Febrile Neutropenia: Which Would Be the Best Dosing to Obtain Appropriate Exposure? Antibiotics. 2022; 11(11):1523. https://doi.org/10.3390/antibiotics11111523
Chicago/Turabian StyleParra González, Daniel, Jefferson Alejandro Pérez Mesa, Sonia Isabel Cuervo Maldonado, Jorge Augusto Díaz Rojas, Jorge Alberto Cortés, Edelberto Silva Gómez, Carlos Humberto Saavedra Trujillo, and Julio Gómez. 2022. "Pharmacokinetics of Vancomycin among Patients with Chemotherapy-Associated Febrile Neutropenia: Which Would Be the Best Dosing to Obtain Appropriate Exposure?" Antibiotics 11, no. 11: 1523. https://doi.org/10.3390/antibiotics11111523