Use of a clinically derived exposure-response relationship to evaluate potential tigecycline-Enterobacteriaceae susceptibility breakpoints

Diagn Microbiol Infect Dis. 2009 Jan;63(1):38-42. doi: 10.1016/j.diagmicrobio.2008.09.014.

Abstract

Potential tigecycline-Enterobacteriaceae susceptibility breakpoints were evaluated using 2 approaches, which differed in the nature of the probabilities assessed by MIC value. Using a previously derived tigecycline population pharmacokinetic model and Monte Carlo simulation, a probability density function of steady-state area under the concentration-time curve for 24 h (AUC(SS(0-24))) values for 9999 patients was generated. AUC(SS(0-24)) values were divided by clinically relevant fixed MIC values to derive AUC(SS(0-24))/MIC ratios, which were used to calculate the clinical response expectation by MIC value based upon a logistic regression model for efficacy (1st approach). For the 2nd approach, the probability of pharmacokinetic-pharmacodynamic (PK-PD) target attainment was calculated as the proportion of patients with AUC(SS(0-24))/MIC ratios greater than the threshold value of 6.96, the PK-PD target associated with optimal clinical response. Probabilities of clinical response and PK-PD target attainment were poorly correlated at MIC values >0.25 mg/L. For instance, the median probability of clinical success was 0.76, whereas the probability of PK-PD target attainment was 0.27 at an MIC value of 1 mg/L, suggesting that the probability of PK-PD target attainment metrics underestimates the clinical performance of tigecycline at higher MIC values.

MeSH terms

  • Anti-Bacterial Agents / pharmacokinetics*
  • Anti-Bacterial Agents / therapeutic use
  • Area Under Curve
  • Bayes Theorem
  • Computer Simulation
  • Dose-Response Relationship, Drug
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae Infections / drug therapy
  • Female
  • Humans
  • Logistic Models
  • Male
  • Microbial Sensitivity Tests / methods
  • Minocycline / analogs & derivatives*
  • Minocycline / pharmacokinetics
  • Minocycline / therapeutic use
  • Models, Biological
  • Monte Carlo Method
  • Skin Diseases, Bacterial / drug therapy
  • Tigecycline

Substances

  • Anti-Bacterial Agents
  • Tigecycline
  • Minocycline