感染与抗生素选择策略ppt课件.ppt

增加持续输注时间 连续输注 给予负荷剂量，使用泵控全天24小时输注 浓度 MIC 连续输注 单次剂量 对?-内酰胺药物提高疗效并限制耐药的策略 ` 对付MDR 绿脓,延长给药时间，提高临床疗效 Antibiotic regimen Bactericidal CFR (%) ? CFR (%) 30-minute infusion prolonged infusion* Cefepime 1g 4h PI q8h 67.1 71.2 + 4.1 Cefepime 2g 4h PI q8h 74.4 79.2 + 4.8 Imipenem 1g 3h PI q8h 69.3 72.0 + 2.7 Meropenem 1g 3h PI q8h 77.1 83.8 +6.7 Meropenem 2g 3h PI q8h 84.1 88.1 + 5.0 Pip/tazo 4.5g 4h PI q8h 56.4 82.7 + 24.3 Pip/tazo 4.5g 4h PI q6h 72.4 85.3 + 9.9 * Simulated 3 hour infusions for imipenem and meropenem, 4 hour infusions for cefepime and piperacillin/tazobactam Bactericidal target = 40% fTMIC for the carbapenems, 50% fTMIC for cefepime and piperacillin/tazobactam 5000 subject Monte Carlo simulation versus 180 Pseudomonas aeruginosa isolated from Hungary Ludwig E, et al. Int J Antimicrob Agents 2006;28:433-438. 时间依赖型抗生素PK/PD指数 达标概率( f%tMlC)最大化方法 增加给药剂量而保持给药间隔不变 减少给药间隔而保持给药剂量不变 延长静脉输液时间 1.5(Cef 1g,Sul 0.5g) q12h 1.5(Cef 1g,Sul 0.5g) q8h 3g(Cef 2g,Sul 1g) q12h 3g(Cef 2g,Sul 1g) q8h 4.5g(Cef 3g,Sul 1.5g) q12h 6g(Cef 4g,Sul 2g) q12h 3g(Cef 2g,Sul 1g) q6h MIC %TMIC MIC %TMIC MIC %TMIC MIC %TMIC MIC %TMIC MIC %TMIC MIC %TMIC 64 9 64 13 64 22 64 32 64 33 64 35 64 43 32 23 32 34 32 35 32 52 32 48 32 48 32 70 16 37 16 56 16 48 16 72 16 63 16 62 16 96 8 51 8 77 8 62 8 92 8 78 8 75 8 123 4 65 4 98 4 75 4 112 4 94 4 88 4 150 2 80 2 119 2 88 2 132 2 109 2 102 2 176 1 94 1 141 1 102 1 152 1 124 1 115 1 203 0.5 108 0.5 162 0.5 115 0.5 172 0.5 139 0.5 128 0.5 230 0.25 122 0.25 183 0.25 128 0.25 192 0.25 154 0.25 142 0.25 256 0.125 136 0.125 204 0.125 142 0.125 212 0.125 169 0.125 155 0.125 283 0.625 150 0.625 226 0.625 155 0.625 232 0.625 185 0.625 168 0.625 310 *基于舒普深药代动力学参数计算。 2. 舒普深1.5g说明书；3. REITBERG DP, MARBLE DA, SCHULTZ RW, et al. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 1988, p. 503-509；5. REITBERG DP, WHALL TJ, CHUNG M, et al. ANTIMICROBIAL AGENTS AND CHEM