耐甲氧西林表皮葡萄球菌感染患者万古霉素的给药方案探讨  

Optimization of vancomycin dosing regimen for patients with methicillin-resistant Staphylococcus epidermidis infection

作　　者：赵学群[1] 王屏[2] 姜伟[1] 徐彦贵[2] 

机构地区：[1]天津市第一中心医院感染科,天津300192 [2]天津市第一中心医院药剂科,天津300192

出　　处：《中华医院感染学杂志》2013年第14期3496-3497,3500,共3页Chinese Journal of Nosocomiology

基　　金：天津市卫生局科研基金项目(2012KZ022)

摘　　要：目的应用蒙特卡罗模拟,优化耐甲氧西林表皮葡萄球菌(MRSE)感染患者万古霉素的给药方案,提高其感染治疗效果。方法收集已发表的万古霉素药代动力学参数和医院2011年万古霉素对MRSE的最低抑菌浓度(MIC)分布数据;设置AUC24h/MIC>400,利用蒙特卡罗仿真软件模拟出5000例患者的达标概率(PTA)和累积反应分数(CFR)。结果肾功能正常的患者(A组),当MIC为0.5μg/ml时,万古霉素最低1500mg/d,PTA为99.93%;当MIC为1μg/ml时,万古霉素最低2500mg/d,PTA为95.48%;肌酐清除率在50～80ml/min的患者(B组),当MIC为0.5μg/ml时,最低给予万古霉素1000mg/d,PTA为94.30%;当MIC为1μg/ml时,最低需给予万古霉素2000mg/d,PTA为94.03%;而肌酐清除率在10～50ml/min的患者(C组),只有在MIC为0.5μg/ml时给予750mg/d,PTA为95.36%;各组MIC≥2μg/ml时,即使较高剂量亦难达到满意的抗菌疗效。结论万古霉素治疗窗窄,个体差异大,利用PK/PD理论进行优化给药方案,可使患者用药更加安全、有效。OBJECTIVE To optimize vancomycin dosing regimen for patients with methicillin-resistant Staphylococcus aureus（MRSE）by means of Monte Carlo software so as to improve the therapeutic effect.METHODS The pharmacokinetic parameters of vancomycin already published and MIC distribution data of vancomycin against MRSE were collected from the hospital,AUC24h/MIC400 was set,and PTA and CFR of 5000 patients were simulated by means of Monte Carlo software.RESULTS As for the patients with normal renal function（group A）,when MIC was 0.5μg/ml,the minimal dosage of vancomycin reached 1500mg/d,PTA was 99.93%;when MIC was 1μg/ml,the minimal dosage of vancomycin reached 2500mg/d,PTA was 95.48%.Concerning patients with Ccr 50to 80ml/min（group B）,when MIC was 0.5μg/ml,the minimal dosage of vancomycin reached 1000mg/ d,PTA was 94.30%;when MIC was 1μg/ml,the minimal dosage of vancomycin reached 2000mg/d,PTA was 94.03%.While concerning patients with Ccr 10 to 50ml/min（group C）,vancomycin should be administered 750 mg/d when MIC was 0.5μg/ml,PTA could only reach 95.36%.when MIC of each group was≥2μg/ml,even though a higher dose was hardly satisfactory.CONCLUSIONVancomycin has narrow therapeutic window,with individual differences significant,and the medication may become safer and more effective by the optimization of dosing regimen based upon PK/PD.

关 键 词：PK PD 万古霉素 耐甲氧西林表皮葡萄球菌 

分 类 号：R978.1[医药卫生—药品]