Model-guided dose optimization of cefoperazone-sulbactam and levofloxacin for pneumonia and urinary tract infections in patients with hepatic dysfunction
Abstract
OBJECTIVE
Dose optimization of ceftazidime-sulbactam (CFP-SUL) and levofloxacin (LVFX) for pneumonia and urinary tract infections in patients with hepatic insufficiency.
METHODS
A total of 100 patients were recruited from the First People's Hospital of Chun'an County and Hanchuan People's Hospital between January 2018 and November 2024. It compared two groups, with primary endpoints (successful intention-to-treat, treatment failure, 7-day clinical cure rate, time to cure, symptom improvement), secondary endpoints (reasons for treatment failure, free time (fT) > minimal inhibitory concentration (MIC) target achievement, adverse event incidence), and performed a subgroup analysis.
RESULTS
CFP-SUL's MIC values against bacterial isolates ranged from 16 to 256 mg/L, with 36.70% resistant and 63.60% susceptible. LVFX's MIC ranged from 0.25 to 64 mg/L. Compared with the standard-dose group, the model-guided group showed a significantly higher success rate (98.00% vs. 80.00%), a greater proportion of 7-day clinical cures (68.00% vs. 54.00%), a higher rate of achieving the CFP-SUL pharmacodynamic target (86.00% vs. 70.00%), and a higher rate of achieving targets for both drugs (74.00% vs. 61.00%, P<0.05). The incidence of treatment failures (8.00% vs. 19.00%) and adverse events (5.00% vs. 16.00%) was lower in the model-guided group (P<0.05). Compared with Child-Pugh Class B, Class C patients had a lower incidence of adverse reactions (3.75% vs. 15.00%, P<0.05) and a higher overall…
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