老年感染性疾病患者阿米卡星的给药方案评价与分析  

Evaluation and Analysis of Amikacin Therapeutic Regimens in Elderly Patients with Infectious Diseases

作　　者：李永兵[1] 宋相安[2] 张风林[1] 角灿武[1] 张俊忠[1] LI Yong-bing;SONG Xiang-an;ZHANG Feng-lin;JIAO Can-wu;ZHANG Jun-zhong(Department of Pharmacy,PuyangPeople’s Hospital,Puyang Henan 457000,China;Department of Infectious Diseases,Puyang People’s Hospital,Puyang Henan457000,China)

机构地区：[1]濮阳市人民医院药剂科,河南濮阳457000 [2]濮阳市人民医院感染性疾病科,河南濮阳457000

出　　处：《药品评价》2020年第3期58-60,共3页Drug Evaluation

摘　　要：目的:结合阿米卡星PK/PD模型,应用蒙特卡罗模拟评价阿米卡星临床常用剂量对大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动I杆菌感染的老年患者的治疗效果。方法:收集EUCAST数据库中阿米卡星对I大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的MC值数据,将阿米卡星每个给药I方案进.行5000次蒙特卡罗模拟,以AUC0-24h/MC≥75为目标获得达标I概率(PTA)和累积反应分数(CFR)。结果:对于老年感染性疾病患者,当MC≤05mg/IL时,阿米卡星所有给药方案的PTA均为100%;细菌的MC值为1mg/L和2mg/L时,增加阿米卡星给药剂量仍然能够获得较高的PTA;细菌MC≥16mg/L时,所有的给药方案PTA为0;阿米卡星所有给药方案的ICFR均小于90%。结论:在临床治疗老年感染性疾病患者时,当阿米卡星对大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的MC≤2mg/L时,可以应用常规剂量的阿米卡星进行抗感染治疗,不推荐应用阿米卡星常规剂量经验性治疗医院获得性感染。Objective: Combined with amikacin PK/PD model, Monte Carlo simulation was used to evaluate the therapeutic effect of commonly used dosage of amikacin in the elderly patients infected with Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. Methods: The MIC of amikacin on Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii was collected in EUCAST database, and 5, 000 Monte Carlo simulations were carried out for each therapeutic regimen of amikacin, PTA and CFR were obtained by targeting AUC0-24 h/MIC≥75. Results: For elderly patients with infectious diseases, when MIC≤0.5 mg/L, PTA of all herapeutic regimens was 100%, when MIC was 1 mg/Lor 2 mg/L, Higher PTA could be obtained by increasing the dose of amikacin;when MIC≥16 mg/L, PTA of all therapeutic regimens was 0;CFR of all therapeutic regimens was less than 90%. Conclusion: For the elderly patients with infectious diseases, when MIC≤2 mg/L, the conventional dosage of amikacin can be used for anti-infection treatment;It is not recommended to apply amikacin to the empirical treatment of hospital acquired infections with conventional dosage.

关 键 词：老年 感染性疾病 阿米卡星 药动学/药效学 蒙特卡罗 

分 类 号：R969[医药卫生—药理学]