抗感染药物给药方案的设计精要.ppt

PK/PD原理与抗感染方案的设计 中南大学湘雅二医院 刘艺平 不同的β-内酰胺类其最优化的药物暴露时间不同 疗效最大化所需要的 %T MIC : ~ 60%–70% for 头孢菌素类 ~ 50% for 青霉素类 ~ 40% for 碳青霉烯类 给药方案的设计 延长输注法（prolonged infusion therapy ，PIT） 优化两步滴定法（ optimized two-step infusion therapy，OTIT） 案例 男45岁，体重60kg，血肌酐值为72μmol/L,现发热，体温升高39.5，诊断为败血症，血培养为非耐药的鲍曼不动杆菌，如果选择美罗培南作为抗感染药物，如何选择给药方案。 针对绿脓杆菌，美平的不同给药方案的效果 结果 优化两步输注法 Table 1 Pharmacokinetic-pharmacodynamic parameters of meropenem simulated by an in vitro pharmacodyanmic model 结论与启示 1. 延长输注与优化两步输注法可以改变时间依耐性性药物T〉mic的时间，体外实验证实直接影响细菌的清除效果。 2.临床中可通过辅助设计提高抗感染药物的疗效。 3.体内疗效有待于进一步研究。 参考文献 [1] Li C, Kuti J L, Nightingale C H, et al. Population pharmacokinetic analysis and dosing regimen optimization of meropenem in adult patients[J]. J Clin Pharmacol,2006,46 10 :1171-1178. [2] Zhou Q T, He B, Zhang C, et al. Pharmacokinetics and pharmacodynamics of meropenem in elderly chinese with lower respiratory tract infections: population pharmacokinetics analysis using nonlinear mixed-effects modelling and clinical pharmacodynamics study[J]. Drugs Aging,2011,28 11 :903-912. [3] Du X, Li C, Kuti J L, et al. Population pharmacokinetics and pharmacodynamics of meropenem in pediatric patients[J]. J Clin Pharmacol,2006,46 1 :69-75. 参考文献 [4] Lomaestro BM, Drusano GL. Pharmacodynamic evaluation of extending the administration time of meropenem using a Monte Carlo simulation. Antimicrob Agents Chemother. 2005. 49 1 : 461-3. [5] Eguchi K, Kanazawa K, Shimizudani T, Kanemitsu K, Kaku M. Experimental verification of the efficacy of optimized two-step infusion therapy with meropenem using an in vitro pharmacodynamic model and Monte Carlo simulation. J Infect Chemother. 2010. 16 1 : 1-9. Eguchi K, etal. Experimental verification of the efficacy of optimized two-step infusion therapy with meropenem using an in vitro pharmacodynamic model and Monte Carlo simulation. J Infect Chemother. 2010. 16 1 : 1-9. Eguchi K, etal. Experimental verification of the efficacy of optimized two-step infusion therapy with