A Prospective, Controlled Study of Acyclovir

Pharmacokinetics in Obese Patient

Clinical Appraisal

1. Skenario
2. Pertanyaan

Outline

3. PICO
4. Review Jurnal
5. Clinical Appraisal

Skenario

Pertanyaa
n

PICO

Review
Jurnal:
Backgroun
d

The current recommendations for

intravenous (IV) acyclovir dosing in obese
patients suggest using ideal body weight
(IBW) rather than total body weight (TBW). To
our knowledge, no pharmacokinetic analysis
has validated this recommendation.

Review
Jurnal:
Methods

This single-dose pharmacokinetic study

(NCT01714180) was conducted in an
inpatient oncology population. Enrollment
was conducted by 1:1 matching of obese
patients (>190% of IBW) to normal weight
patients (80-120% of IBW). All patients
received a single dose of IV acyclovir 5 mg/kg
infused over 60 minutes. Consistent with
current recommendations, IBW was used for
obese patients and TBW for normal weight
patients. Serial plasma concentrations were
obtained and compared.

Review
Jurnal :
Results

Seven obese and seven normal weight

patients were enrolled with mean body mass
index of 45.0 and 22.5 kg/m2, respectively.
Systemic clearance was substantially higher
in the obese compared to normal weight
patients (mean 19.4 5.3 vs. 14.3 5.4
L/hr, P = 0.047). Area under the
concentration-time curve was lower in the
obese patients (15.2 2.9 vs. 24.0 9.4
mghr/L, P = 0.011), as was maximum
concentration (5.8 0.9 vs. 8.2 1.3 mg/L,
P = 0.031).

Review
Jurnal :
Conclusio
n

Utilization of IBW for dose calculation of

IV acyclovir in obese patients leads to lower
systemic exposure as compared to dosing by
TBW in normal weight patients. While not
directly evaluated in this study, utilization of
an adjusted body weight for dose
determination appears to more closely
approximate the exposure seen in normal
weight patients.

Validitas
Tidak ada randomisasi

Validitas
Follow up?
Pre 24 jam dan setiap
30, 60, 75, 90, 120, 180,
300, 420, 540, dan 720
menit setelah dimulainya
infus

Validitas
ANALISIS
PASIEN Ada
BLINDING
tidak ada (pasien
dan peneliti
sama-sama tahu)

Validitas
Persamaan kedua kelompok di awal ada
Persamaan kelompok diluar perlakuan eksperimen tidak ada

Importance

Menentukan Efek Terapi

konsentrasi asiklovir lebih
tinggi pada pasien
normoweight
Menentukan Presisi Estimasi
Efek Terapi hasil statistik
tidak signifikan

Importance

Applicability
Kemungkinan Penerapan pada
pasien dan setting dapat
diterapkan, butuh penelitian
lebih lanjut dengan
memperhatikan faktor-faktor
limitasi pada jurnal ini.

Potensi keuntungan dan

kerugian tidak dijelaskan
secara rinci

Applicability

Kesimpulan
Jurnal ini layak digunakan sebagai referensi penelitian
selanjutnya.

TERIMA
KASIH