Abstract
Dalbavancin is a novel semi-synthetic glycopeptide antibiotic. In this study, we aimed to optimize the dosage regimen of dalbavancin in patients with hepatic or renal impairment by Mote Carlo simulation. Pharmacokinetic parameters and microbiological data were collected about dalbavancin. 10,000 patients with renal or hepatic impairment analyzed by Crystal Ball to calculate probability of target attainment (PTA) and cumulative fraction of response (CFR). We found that all bacterial PTA and CFR were more than 90% for dalbavancin in patients with hepatic or renal impairment, except for Enterococcus faecium. There is no need to adjust the dosage regimen of dalbavancin in patients with hepatic or renal impairment.
Highlights
Dalbavancin is a novel semi-synthetic glycopeptide antibiotic currently used clinically to treat infections of skin and soft tissues caused by Gram-positive bacteria [1]
From the Monte Carlo simulation of dalbavancin for patients with renal and hepatic impairment, probability of target attainment (PTA) values with fAUC24 h/minimum inhibitory concentration (MIC) ≥ 300 as target value at different MIC values were shown in Figure 1 and Figure 2
In patients with advanced renal impairment, the clearance rate before and after drug dialysis had increased slightly, PTA > 90% results showed that the highest MIC value was 0.5 μg/mL
Summary
Dalbavancin is a novel semi-synthetic glycopeptide antibiotic currently used clinically to treat infections of skin and soft tissues caused by Gram-positive bacteria [1]. Unlike other glycopeptide antibiotics such as vancomycin and teicoplanin, which are excreted almost exclusively through kidney [2] [3], the excretion of dalbavancin includes renal and non-renal pathways of elimination. It is necessary to optimize the dosage regimen of dalbavancin in patients with hepatic or renal impairment, so as to further improve the efficacy of the drug and reduce adverse reactions. In order to maximize the clinical effect of antibiotics and reduce the possibility of antibiotic resistance, we used the Monte Carlo simulation (MCS) method. In this study, MCS was performed to study the dosage effect of dalbavancin in patients with different hepatic or renal impairment, so as to determine the optimal dosage regimen
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