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- Title
Application of pharmacokinetic/pharmacodynamic analysis to evaluate the adequacy of antimicrobial therapy for pediatric acute otitis media in Spain before and after the introduction of the PCV7 vaccine.
- Authors
Ibar-Bariain, Maitane; Rodríguez-Gascón, Alicia; Isla, Arantxa; Ángeles Solinís, María; Canut-Blasco, Andrés
- Abstract
Objectives. To evaluate, by applying pharmacokinetic/pharmacodynamic (PK/PD) analysis, if the change in antibiotic susceptibility after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in Spain had any influence on the usefulness of the antimicrobials more frequently used as empirical treatment of pediatric acute otitis media (AOM). Material and methods. PK parameters and susceptibility of Streptococcus pneumoniae and Haemophilus influenzae were obtained from bibliography. Monte Carlo simulation was used to estimate the cumulative fraction of response (CFR), understood as the expected probability of therapy success. For amoxicillin and amoxicillin/clavulanate, the target was free antibiotic concentration remaining above the minimum inhibitory concentration (MIC) for =50% of the dosing interval (fT>MIC=50%), whereas for cefuroxime axetil and cefotaxime, the target was fT>MIC=60%. CFR values =90% were considered successful. Results. When all serotypes of S. pneumoniae are considered, amoxicillin and cefotaxime turned out to reach a high probability of success, and difference before and after vaccination was scarce. For H. influenzae, CFR values were higher with amoxicillin/clavulanate than with amoxicillin. For both microorganisms, cefuroxime axetil resulted in low probability of success in the two periods of study. Conclusions. We have shown that the introduction of the PCV7 vaccination did not lead to changes in the probability of success of the current empiric treatments of the AOM. Integrated PK/PD analysis has demonstrated to be a useful tool to identify changes in antimicrobial activity after the implantation of a vaccination program, providing complementary information to the simple assessment of MIC values.
- Subjects
PHARMACOKINETICS; ACUTE otitis media; MICROBIAL sensitivity tests; PNEUMOCOCCAL vaccines; STREPTOCOCCUS pneumoniae; AMOXICILLIN
- Publication
Revista Española de Quimioterapia, 2019, Vol 32, Issue 2, p121
- ISSN
0214-3429
- Publication type
Article