腹膜透析并金黄色葡萄球菌感染哌拉西林他唑巴坦用药方案分析及优化

Study on Application of PK/PD Theory and CCr in Determining PIP/TAZ's Dose Regimen in Peritoneal Dialysis Patients with S.Aureus Infection

目的促进临床合理用药。方法选择2012年7月至2014年6月经病原菌确诊为金黄色葡萄球菌且对哌拉西林他唑巴坦(PIP/TAZ)敏感的住院腹膜透析患者51例,统计其给药方案,利用抗菌药物药效学/药动学(PK/PD)理论的主要评价参数以及内生肌酐清除率(CCr)分析PIP/TAZ的给药方案,并以此为依据优化其用药方案。结果 51例患者中有23例PIP/TAZ的给药方案为每8 h 1次,28例为12 h 1次4.5 g,给药剂量或给药频次明显超过PK/PD理论以及CCr原则对抗菌药物用药的分析结果;通过PK/PD理论和CCr原则分析,对该类患者可推荐采用每24 h 1次1.5 g的给药方案。结论 PK/PD理论及CCr原则是腹膜透析并感染患者抗菌药物有效应用和优化给药方案的依据,经验用药应以药学理论为指导,为患者提供安全、有效和合理的个体化用药方案。

Objective To investigate and analyze the rationality of the piperacillin/tazobactam （ PIP/TAZ ） dose regimen used in the peri-toneal dialysis patients with S. aureus infection by applying the pharmacokinetics/pharmacodynatics （ PK/PD ） theory and creatinine clear-ance rate （ CCr ） , meanwhile, to recommend a optimized dose regimen so as to ptovide reference for the rational use of PIP/TAZ in these patients. Methods 51 peritoneal dialysis inpatients with S. aureus infection sensitive to PIP/TAZ were selected and their dose regimens were performed the statistics. The dose regimens of PIP/TAZ were analyzed by using the main evaluation parameters of PKPD theory and CCr, Furthermore, on this basis the dose regimen of PIP/TAZ was optimized. Results Among 51 cases, the dose regimen of PIP/TAZ in 23 cases was giving 4. 5 g of PIP/TAZ once per 8 h and which in 28 cases was giving 4. 5 g of PIP/TAZ once per 12 h, their dosage or dosing frequency significantly exceeded the analytical results to antibiotics with the PK/PD theory and CCr principle;the dose regimen of PIP/TAZ 1. 5 g, once per 24 h could be recommended by applying the PK/PD theory and CCr principle. Conclusion The PK/PD theory and CCr principle are the basis the effective application of antibacterial drugs and optimization of dose regimen. The empirical medication should take the pharmacy theory as the guidance to provide safe, effective and rational individualized medication for patients.