결장수술을 받는 환자에서 예방적 항생제로 투여하는 cefoxitin을 목표농도조절주입방법으로 투여하기 위하여 구축한 약동학 모형의 예측성능평가

Abstract

Aims: We aimed to evaluate the predictive performance of previously constructed cefoxitin pharmacokinetic models and the possibility of administering cefoxitin via the target-controlled infusion (TCI) method in clinical practice. Methods: Cefoxitin (2 g) was dissolved in 50 mL of normal saline to give a concentration of 40 mg mL-1. Before skin incision, cefoxitin was infused with a TCI syringe pump. The target total plasma concentration was set to 80 μg mL-1, which was administered throughout the surgery. Three arterial blood samples were collected to measure the total and free plasma concentrations of cefoxitin at 30, 60, and 120 minutes after the start of cefoxitin administration. The predictive performance of the TCI system was evaluated using four parameters: inaccuracy, divergence, bias, and wobble. Results: The predictive performance of various pharmacokinetic models of cefoxitin was evaluated using 89 total and 89 free plasma concentration measurements from 30 patients. The pooled median (95% confidence interval) biases and inaccuracies were 16.6 (18.4 to 14.8) and 18.5 (16.720.2) for the total concentration model and 20.9 (22.7 to 19.1) and 22.4 (20.624.2) for the free concentration model, respectively. Conclusions: The pooled biases and inaccuracies of the Choi models were clinically acceptable. However, all models consistently produced negatively biased predictions. Administering cefoxitin via the TCI method with a target total concentration of 80 μg mL-1 can maintain a free concentration above 16 μg mL-1 throughout the operation.