Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands.
J Antimicrob Chemother. 2018 Mar 1;73(3):564-568. doi: 10.1093/jac/dkx427.
Over recent decades, several publications have described optimization procedures for antibiotic therapy in the individual patient based on antimicrobial MIC values. Most methods include therapeutic drug monitoring and use a single MIC determination plus the relevant pharmacokinetics/pharmacodynamics to adjust the dose to optimize antimicrobial drug exposure and antibacterial effects. However, the use of an MIC obtained by a single MIC determination is inappropriate. First, routine clinical laboratories cannot determine MICs with sufficient accuracy to guide dosage owing to the inherent assay variation in the MIC test. Second, the variation in any MIC determination, whatever method is used, must be accounted for. If dose adjustments are made based on therapeutic drug monitoring and include MIC determinations, MIC variation must be considered to prevent potential underdosing of patients. We present the problems and some approaches that could be used in clinical practice.
近几十年来，已有多篇出版物描述了基于抗菌药物 MIC 值的个体患者抗生素治疗的优化程序。大多数方法包括治疗药物监测，并使用单次 MIC 测定以及相关的药代动力学/药效学来调整剂量，以优化抗菌药物暴露和抗菌效果。然而，使用单次 MIC 测定获得的 MIC 值并不合适。首先，由于 MIC 试验固有的检测变异性，常规临床实验室无法获得足够准确的 MIC 值来指导剂量。其次，无论使用何种方法，都必须考虑任何 MIC 测定的变异性。如果基于治疗药物监测进行剂量调整并包括 MIC 测定，则必须考虑 MIC 变化，以防止患者潜在的剂量不足。我们提出了一些可能在临床实践中使用的问题和方法。
