摘要
目的以药动学/药效学(PK/PD)模型为基础,采用蒙特卡洛模拟,针对重症感染患者的个体差异,设计比阿培南个性化用药方案以改善临床效果。方法收集重症患者比阿培南药动学参数,以常见致病菌大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌为目标菌株,引用中国细菌耐药监测研究报告中比阿培南对常见细菌最低抑菌浓度(MIC)值分布,通过调整给药剂量、给药间隔、滴注时间等方法制订不同给药方案,应用蒙特卡洛模拟计算各目标菌株不同给药方案的药效学获得概率(PTA)和累积反应分数(CFR),评估各给药方案治疗重症感染的抗菌效果。结果当MIC<0.125 mg/L时,比阿培南对5种目标菌株所有给药方案PTA值均>90%;当MIC≥4 mg/L时,所有给药方案PTA值均<90%;比阿培南对大肠埃希杆菌所有治疗方案CFR值均>90%,对鲍曼不动杆菌CFR值均<30%。结论比阿培南对大肠埃希菌的治疗可采用传统给药方案;对肺炎克雷伯菌的治疗可选择600 mg q6 h延时滴注3 h为最佳治疗方案,或根据MIC值优化给药方案;对于鲍曼不动杆菌、铜绿假单胞菌及金黄色葡萄球菌,应考虑换用或联用其他抗菌药物以达到疗效。
Objective Based on pharmacokinetic/pharmacodynamic(PK/PD)models,Monte Carlo simulation was used to design a personalized medication regimen of Biapenem to improve the clinical effect in patients with severe infection.Methods The pharmacokinetic parameters of Biapenem were collected from severe patients,and the target strains were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii and Staphylococcus aureus,which were common pathogenic bacteria.The minimal inhibit concentration(MIC)value distribution of Biapenem against common bacteria was quoted in the bacterial drug resistance monitoring report in China.Different administration regimens were formulated by adjusting administration dose,administration interval and infusion time,and the probability of target attainment(PTA)and cumulative fraction of response(CFR)of different administration regimens of each target strain were calculated by Monte Carlo simulation to evaluate the antibacterial effect of each administration regimen in the treatment of severe infections.Results When MIC<0.125 mg/L,PTA values of Biapenem were more than 90%in all administration regimens of 5 target strains.When MIC≥4 mg/L,PTA values of all administration regimenes were<90%.The CFR values of Biapenem for Escherichia coli were more than 90%,and for Acinetobacter baumannii,CFR values were less than 30%.Conclusion Biapenem can be used in the treatment of Escherichia coli by traditional administration.For the treatment of Klebsiella pneumoniae,600 mg q6 h delayed infusion for 3 h is the best treatment plan,or optimize the administration plan according to the MIC value.For Acinetobacter baumannii,pseudomonas aeruginosa and Staphylococcus aureus,replacement or combination of other antibiotics should be considered to achieve efficacy.
作者
宋媛媛
江华东
孙莹莹
SONG Yuanyuan;JIANG Huadong;SUN Yingying(Department of Pharmacy,Lianyungang Hospital of Traditional Chinese Medicine,Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province,Lianyungang222000,China)
出处
《中国当代医药》
CAS
2024年第2期14-18,共5页
China Modern Medicine
基金
江苏省连云港市卫生科技项目(QN202005)
南京医科大学康达学院科研发展基金课题(KD2022KYJJZD 126)。
关键词
比阿培南
蒙特卡洛模拟
药动学
药效学
重症患者
给药方案
Biapenem
Monte Carlo simulation
Pharmacokinetic
Pharmacodynamic
Critical patient
Administration regimen
