Aubert G, Carricajo A
Laboratoire de bactériologie, CHU, hôpital de Bellevue, 42055 Saint-Etienne cedex 2, France.
Ann Fr Anesth Reanim. 2004 Jul;23(7):704-13. doi: 10.1016/j.annfar.2004.03.014.
To provide a summary of useful up-to-date knowledge regarding experimental and clinical bacteriology, pharmacokinetics and pharmacodynamics in order to optimise efficacy of antibiotic treatment of hospital patients with serious bacterial infections.
Record of references from national and international journals in Medline.
Extraction of the most relevant theoretical and practical data from studies published over the last 5 years.
Changes in resistance to antibiotics, as well as the limited number of new antibacterial drugs available and the cost of therapeutic failure all militate in favour of a more elaborate approach to therapeutic strategies involving antibiotics, particularly regarding hospitalised patients. The efficacy of antibiotic therapy can be optimised through the utilization of bacteriological, pharmacokinetic and pharmacodynamic data, thereby increasing the likelihood of a successful outcome. While the antibiogram constitutes the fundamental analytical tool for evaluating the activity of antibiotics, the minimum inhibitory concentration (MIC) is of value in selecting appropriate drugs and dosages, particularly for bacterial strains having lower susceptibility. Screening for genes of resistance to antibiotics provides more accurate analysis of bacterial resistance. In recent years, the efficacy of antibiotics has been improved through the use of a number of pharmacodynamic parameters: inhibitory quotient (IQ), area under the serum concentration-time curve to MIC ratio (AUC/MIC) and the time the serum concentration is greater than the MIC (T > MIC). In standard practice, data readily available to the clinician comprise the MIC and serum antibiotic concentrations. There is some discussion concerning optimisation of antibiotic efficacy through the use of these parameters.
Close collaboration between clinicians and microbiologists results in improved quality of antibiotic therapy and better management of antibiotics.
总结有关实验和临床细菌学、药代动力学和药效学的最新实用知识，以优化对患有严重细菌感染的住院患者进行抗生素治疗的疗效。
Medline中来自国内和国际期刊的参考文献记录。
从过去5年发表的研究中提取最相关的理论和实践数据。
抗生素耐药性的变化、可用新抗菌药物数量有限以及治疗失败的成本，都促使人们采取更精细的抗生素治疗策略，特别是对于住院患者。通过利用细菌学、药代动力学和药效学数据，可以优化抗生素治疗的疗效，从而增加成功治疗的可能性。虽然抗菌谱是评估抗生素活性的基本分析工具，但最低抑菌浓度（MIC）在选择合适的药物和剂量时很有价值，特别是对于敏感性较低的细菌菌株。对抗生素耐药基因的筛查能更准确地分析细菌耐药性。近年来，通过使用一些药效学参数提高了抗生素的疗效：抑制商（IQ）、血清浓度-时间曲线下面积与MIC的比值（AUC/MIC）以及血清浓度高于MIC的时间（T＞MIC）。在标准实践中，临床医生容易获得的数据包括MIC和血清抗生素浓度。关于通过使用这些参数优化抗生素疗效存在一些讨论。
临床医生和微生物学家之间的密切合作可提高抗生素治疗质量并更好地管理抗生素。
