采用药动学/药效学模型结合蒙特卡罗模拟评价阿米卡星给药方案  

Evaluation of Amikacin Therapeutic Regimens by PK/PD Model Combined with Monte Carlo Simulation

作　　者：李永兵[1] 郭咸希[2] 宋相安[3] 张风林[1] 郭首兵[1] 角灿武[1] Li Yongbing;Guo Xianxi;Song Xiang’an;Zhang Fenglin;Guo Shoubing;Jiao Canwu(Department of Pharmacy,People’s Hospital of Puyang City,Henan Puyang 457000,China;Department of Pharmacy,Renmin Hospital of Wuhan University;Department of Infectious Diseases,People’s Hospital of Puyang City)

机构地区：[1]濮阳市人民医院药剂科,河南濮阳457000 [2]武汉大学人民医院药学部 [3]濮阳市人民医院感染性疾病科

出　　处：《中国药师》2020年第6期1140-1143,共4页China Pharmacist

摘　　要：目的:基于药动学(PK)/药效学(PD)模型及蒙特卡罗模拟评价阿米卡星常用给药方案抗感染治疗效果,促进临床合理用药。方法:收集EUCAST数据库中阿米卡星对大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的最小抑菌浓度(MIC)数据,以AUC0-24h/MIC≥75为目标进行蒙特卡罗模拟,获得阿米卡星对细菌不同MIC的达标概率(PTA);结合细菌不同MIC分布情况,计算阿米卡星不同给药方案的累积反应分数(CFR)。结果:当细菌MIC≤0.25 mg·L^-1时,阿米卡星所有给药方案PTA=100%,均能达到较好的抗感染效果;当细菌MIC为0.5 mg·L^-1和1 mg·L^-1时,通过增加阿米卡星的给药剂量仍能获得较高的PTA,可能会获得较好疗效;当细菌MIC≥2 mg·L^-1时,所有给药方案的PTA≤12.16%,阿米卡星常规给药均无法达到好的治疗效果。对于4种不同细菌,阿米卡星0.6 g·d^-1给药方案的CFR最高,但是对所有细菌的CFR均低于90%。结论:在临床治疗细菌感染患者时,应当根据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MIC来确定是否应用阿米卡星及其给药剂量,但是不推荐阿米卡星应用常规剂量对可能存在大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌感染的患者进行经验性抗感染治疗。Objective:To evaluate the therapeutic effect of commonly used dosage of amikacin for infected patients by Monte Carlo simulation combined with amikacin PK/PD model.Methods:The MIC data of amikacin on Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii in the EUCAST database were collected,and Monte Carlo simulation was performed with AUC0-24h/MIC≥75 as the target.The PTA of amikacin on different MIC was obtained.Combined with the different MIC distribution of bacteria,the CFR of amikacin therapeutic regimen was calculated.Results:When the MIC≤0.25 mg·L^-1,all therapeutic regimen PTA was 100%.When the MIC was 0.5 mg·L^-1 or 1 mg·L^-1,higher PTA could be obtained by increasing the dose of amikacin.When the MIC≥2 mg·L^-1,the PTA≤12.16%.The conventional dosage couldn’t achieve good treatment results.For 4 different bacteria,the amikacin 0.6 g·d^-1 dosing regimen had the highest CFR,but the CFR of all therapeutic regimens was less than 90%.Conclusion:In the clinical treatment of patients with bacterial infection,amikacin use and its dosage should be determined according to the MIC of amikacin on Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii.It is not recommended to apply the conventional dosage to patients with possible Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii infection for the empirical anti-infection treatment.

关 键 词：阿米卡星 药动学/药效学模型 蒙特卡罗模拟 给药方案 

分 类 号：R978.1[医药卫生—药品]