基于蒙特卡罗模拟优化亚胺培南-西司他丁钠的给药方案研究  

Optimization of Therapeutic Regimen of Imipenem-cilastatin Sodium by Monte Carlo Simulation

作　　者：姚卓贤[1] 陈荣[1] 冯凯[1] YAO Zhuo-xian;CHEN Rong;FENG Kai(The First People's Hospital of Changzhou,Changzhou 213000,China)

机构地区：[1]江苏省常州市第一人民医院,江苏常州213000

出　　处：《海峡药学》2024年第8期80-83,共4页Strait Pharmaceutical Journal

基　　金：常州市科技计划指导性项目(2014277)。

摘　　要：目的应用蒙特卡罗模拟亚胺培南-西司他丁钠不同输注方法针对不同致病菌的最佳给药方案。方法回顾性分析某三甲医院2021年常见革兰阴性杆菌分布情况,按照2020年美国临床实验室标准化协会标准,对肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌设定均匀分布的抑菌浓度(MIC)值,确定亚胺培南-西司他丁钠8种给药方案,运用PK/PD模型进行蒙特卡罗模拟10000例患者的目标获得概率(PTA),获得最佳给药方案。结果若MIC≤2μg·mL^(-1)时,除传统输注法0.5 g q8h与1 g q8h的给药方案PTA<90%,其余给药方案PTA均>90%;当MIC≥4μg·mL^(-1)时,采用持续输注的部分给药方式仍获得较好的抗菌效果(PTA>90%),而传统输注达不到理想的抗菌疗效(PTA<90%)。结论对亚胺培南-西司他丁钠敏感的革兰阴性杆菌,采用q6h的给药方案,传统输注与持续输注都能取得理想的治疗效果,而采用q8h的给药方案,持续输注法抗菌疗效效果佳效;对亚胺培南-西司他丁钠产生耐药的革兰阴性杆菌,需采用持续输注法才能获得理想的抗菌疗效。OBJECTIVE Monte Carlo was used to simulate the optimal administration of imipenem-cilastatin sodium with different infusion methods for different pathogens.METHODS The distribution of common gram-negative bacilli in a tertiary hospital in 2021 was retrospectively analyzed.According to the Clinical and Laboratory Standards Institute(CLSI)standard in 2020,the MIC values of uniform distribution for Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii were set,and eight dosing regimens of imipenem-cilastatin sodium were determined.PK/PD model was used to perform Monte Carlo simulation of the target probability of acquisition(PTA)of 10000 patients to obtain the best dosing regimen.RESULTS If MIC≤2μg·mL^(-1),PTA was higher then 90%for all dosing regimens except 0.5 g q8h and 1 g q8h with traditional infusion;When MIC≥4μg·mL^(-1),the partial dosing method of continuous infusion still achieves a better antibacterial effect,with PTA>90%.However,the traditional infusion could not achieve the ideal antibacterial efficacy,with PTA<90%.CONCLUSION For the Gram-negative bacilli sensitive to imipenem-cilastatin sodium,both traditional infusion and continuous infusion can achieve ideal therapeutic effect with q6h dosing scheme,while the antibacterial effect of continuous infusion is better with q8h dosing scheme.Gram-negative bacilli resistant to imipenem-cilastatin sodium need continuous infusion method to obtain ideal antibacterial efficacy.

关 键 词：亚胺培南-西司他丁钠 蒙特卡罗 给药方案 

分 类 号：R969.4[医药卫生—药理学]