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应用蒙特卡罗模拟优化肾清除率增加的感染患者美罗培南的给药方案。

Application of Monte Carlo simulation to optimise the dosage regimen of meropenem in patients with augmented renal clearance for infection.

作者信息

Hou Jia, Zhang Min, Ma Shu-Qing, Cong Ri-Nan, Li Jin-Feng

机构信息

Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, China.

Department of Clinical Laboratory, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, 264200, China.

出版信息

Heliyon. 2024 Jun 7;10(12):e32600. doi: 10.1016/j.heliyon.2024.e32600. eCollection 2024 Jun 30.

Abstract

OBJECTIVE

To optimise the dosing regimen of meropenem for treating (PA) infections in critically ill patients with augmented renal clearance (ARC) using pharmacokinetic/pharmacodynamic (PK/PD) principles and Monte Carlo simulation (MCS).

METHODS

This research involves an MCS based on PK data from patients with ARC and a minimum inhibitory concentration (MIC) distribution of PA. This study simplifies the methods section, focusing on the critical aspects of simulation and target values for effective treatment.

RESULTS

The study highlights key findings and emphasises that tailored dosing based on bacterial MIC values is essential for patients with ARC. It also notes that empirical treatment in patients with ARC should consider the MIC distribution, with 2 g every (q) 6 h administered to achieve the PK/PD target, while 3 g q 6 h is effective in inhibiting resistance.

CONCLUSION

Tailored dosing based on bacterial MIC values is crucial for patients with ARC. Prolonged infusion time alone does not enhance efficacy. Empirical treatment in patients with ARC should consider MIC distribution; a dosage of 2 g q 6 h achieves the PK/PD target, while 3 g q 6 h (≥12 g daily) inhibits resistance.

摘要

目的

运用药代动力学/药效学(PK/PD)原理和蒙特卡洛模拟(MCS),优化美罗培南治疗肾功能增强(ARC)的危重症患者铜绿假单胞菌(PA)感染的给药方案。

方法

本研究基于ARC患者的PK数据和PA的最低抑菌浓度(MIC)分布进行MCS。本研究简化了方法部分,重点关注模拟的关键方面和有效治疗的目标值。

结果

该研究突出了关键发现,并强调基于细菌MIC值的个体化给药对ARC患者至关重要。研究还指出,ARC患者的经验性治疗应考虑MIC分布,每6小时(q)给予2 g以达到PK/PD目标,而每6小时给予3 g可有效抑制耐药性。

结论

基于细菌MIC值的个体化给药对ARC患者至关重要。单纯延长输注时间并不能提高疗效。ARC患者的经验性治疗应考虑MIC分布;每6小时给予2 g的剂量可达到PK/PD目标,而每6小时给予3 g(每日≥12 g)可抑制耐药性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f04/11225735/1063594ee806/gr1.jpg

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