Abe Noriuyuki, Fukuda Saori, Nakamura Akihiro, Taguchi Yosio, Matsuo Shuji
Department of Clinical Pathology, Tenri Hospital.
Jpn J Antibiot. 2010 Aug;63(4):319-25.
We calculated achievement rates of target attainment of AUC/MIC using Monte Carlo simulation (MCS). Two doses of pazufloxacin mesilate (PZFX) between q.d. and b.i.d. were compared for each species of bacterium. Concentrations for AUC of PZFX of 8 patients were measured at this hospital, and those from a phase I clinical study (phase I, 6 healthy volunteers) were used. MICs of PZFX were determined for each species of bacterium of respiratory organ origin (Pseudomonas aeruginosa, Haemophilus influenzae, Streptococcus pneumoniae, and Klebsiella pneumoniae). AUC per day of 500 mg b.i.d. used twice AUC (PZFX 500 mg x 2/day by patient, PZFX 500 mg x 2/day by phase I). Target attainment of AUC/MIC was AUC/MIC > or = 30 in S. pneumoniae and AUC/MIC > or = 125 in the other species of bacteria (P. aeruginosa, H. influenzae, and K. pneumoniae). As a result, patients showed an about 3 times higher AUC than the phase I subjects (67.9/21.9 microg/mL). In addition, the target attainment of AUC/MIC showed the highest rate in PZFX 500 mg x 2/day in patients with each type of bacteria: H. influenzae (98%), K. pneumoniae (89%), S. pneumoniae (66%), and P aeruginosa (41%). Target attainment of AUC/MIC was H. influenzae (91%), K. pneumoniae (81%), P. aeruginosa (5%), and S. pneumoniae (0%) in phase I. Therefore, the effectiveness of PZFX was estimated to be low using the MCS method with the phase I data.
我们使用蒙特卡洛模拟(MCS)计算了AUC/MIC达到目标值的达成率。针对每种细菌,比较了每日一次至每日两次给药的两种甲磺酸帕珠沙星(PZFX)剂量。在本院测量了8例患者的PZFX的AUC浓度,并使用了来自一项I期临床研究(I期,6名健康志愿者)的数据。测定了呼吸道来源的每种细菌(铜绿假单胞菌、流感嗜血杆菌、肺炎链球菌和肺炎克雷伯菌)的PZFX的MIC。每日500mg,每日两次的AUC使用了两倍的AUC(患者每日500mg×2次,I期每日500mg×2次)。AUC/MIC的目标达成情况为:肺炎链球菌中AUC/MIC≥30,其他细菌种类(铜绿假单胞菌、流感嗜血杆菌和肺炎克雷伯菌)中AUC/MIC≥125。结果显示,患者的AUC比I期受试者高约3倍(67.9/21.9μg/mL)。此外,对于每种细菌类型的患者,AUC/MIC的目标达成率在每日500mg×2次的PZFX中最高:流感嗜血杆菌(98%)、肺炎克雷伯菌(89%)、肺炎链球菌(66%)和铜绿假单胞菌(41%)。I期患者中AUC/MIC的目标达成率为:流感嗜血杆菌(91%)、肺炎克雷伯菌(81%)、铜绿假单胞菌(5%)和肺炎链球菌(0%)。因此,使用I期数据通过MCS方法估计PZFX的有效性较低。