基于蒙特卡罗模拟评价大肠埃希菌感染患者硫酸依替米星的给药方案  

Evaluation of therapeutic regimens on etimicin sulfate against escherichia coli infection in patients by Monte Carlo simulation

作　　者：李永兵[1] 张风林[1] 戢太阳 夏艺 LI Yong-bing;ZHANG Feng-lin;JI Tai-yang;XIA Yi(Department of pharmacy,People's hospital of Puyang city,Henan Puyang 457000,China;Department of pharmacy,Dongfeng Hospital Affiliated to Hubei University of Medicine,Hubei Shiy an 442000,China;HuangJia lake of Hubei University of Traditional,Chinese Medicine,Hubei Wuhan 430065,China)

机构地区：[1]濮阳市人民医院药剂科,河南濮阳457000 [2]湖北医药学院附属东风医院,湖北十堰442000 [3]湖北中医药大学黄家湖医院,湖北武汉430065

出　　处：《中国医院药学杂志》2019年第22期2283-2286,共4页Chinese Journal of Hospital Pharmacy

摘　　要：目的:结合硫酸依替米星PK/PD模型,应用蒙特卡罗模拟评价硫酸依替米星5种给药方案对大肠埃希菌感染的治疗效果。方法:收集临床分离出的大肠埃希菌菌株并测得硫酸依替米星对其MIC值,每个给药方案对大肠埃希菌进行5 000次蒙特卡罗模拟获得PTA,并计算各方案以AUC0-24 h/MIC≥100为目标的CFR。结果:临床分离得到的60株大肠埃希菌,硫酸依替米星对大肠埃希菌的MIC≥0.5 mg·L^-1的菌株占到了56.67%;随着给药剂量的增加,PTA呈上升趋势,而随着MIC值的上升,所有方案的PTA均下降。当MIC值为0.062 5 mg·L^-1和0.125 mg·L^-1时,所有给药方案的PTA均为100%,当MIC值≥1 mg·L^-1时,硫酸依替米星的所有给药方案PTA为0;给药方案为100,150,200,250 mg·d-1时,CFR均小于90%;硫酸依替米星的给药方案为300 mg·d-1时,CFR为90%;MIC值的敏感相关性为-98.25%^-99.86%,CL的敏感相关性为-7.62%^-17.73%。结论:硫酸依替米星经验性治疗大肠埃希菌感染时,仅有300 mg·d-1给药方案能够达标,临床中使用的其他给药方案并不能达到满意的抗感染治疗效果,将有很大风险面临治疗失败。OBJECTIVE To evaluate the therapeutic efficacy of etimicin sulfate in 5 dosing regimens against Escherichia coli infection using Monte Carlo simulation combined with etimicin sulfate PK/PD model.METHODS The clinical isolates of Escherichia coli were collected and the MIC values of etimicin sulfate to them were measured. The PTA was obtained by performing 5 000 Monte Carlo simulations for E. coli in each dosing regimen, and the CFR targeting AUC0-24 h/MIC≥100 was calculated for each regimen.RESULTS Among 60 clinical isolates of Escherichia coli, etimicin sulfate on Escherichia coli MIC≥0.5 mg·L^-1 strain accounted for 56.67%;With the increase of dose, PTA showed an upward trend, while with the increase of MIC, PTA of all regimens decreased. When MIC were 0.062 5 mg·L^-1 and 0.125 mg·L^-1, the PTA of all therapeutic regimens was 100%, and when the MIC≥1 mg·L^-1, PTA of all therapeutic regimens of etimicin sulfate was 0;When therapeutic regimen was 100 mg·d-1, 150 mg·d-1, 200 mg·d-1, 250 mg·d-1, the CFR was less than 90%. When the therapeutic regimen of etimicin sulfate was 300 mg·d-1, the CFR was 90%. The sensitive correlation of MIC ranged-98.25%^-99.86%, and the CL ranged-7.62%^-17.73%.CONCLUSION In the empirical treatment of Escherichia coli infection with etimicin sulfate, only the 300 mg·d-1 scheme can meet the standard, other therapeutic regimens used in clinical practice can not achieve satisfactory anti-infection treatment effect, there would be a great risk of treatment failure.

关 键 词：硫酸依替米星 蒙特卡罗 PK/PD 大肠埃希菌 

分 类 号：R969.3[医药卫生—药理学]