氟喹诺酮类药物治疗天津地区常见致病菌感染的疗效评价

Effect evaluation of fluoroquinolones treating infection of common pathogenic bacteria in Tianjin region

目的根据药动学/药效学(PK/PD)理论评价氟喹诺酮类药物(FQNs)抗感染治疗的给药方案。方法应用蒙特卡洛模拟(monte carlo simulation,MCS)方法对FQNs治疗天津地区常见致病菌引起的感染进行模拟,依据达标概率(probability of target attainment,PTA)评价疗效并推荐给药方案。结果 FQNs 7种给药方案治疗由大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、粪肠球菌及屎肠球菌引起的感染的PTA均为0(MIC90)。参考细菌MIC50值推荐给药方案:对于革兰阴性菌,仅肺炎克雷伯菌感染推荐左氧氟沙星200mg qd;对于革兰阳性菌,金黄色葡萄球菌感染推荐左氧氟沙星200mg qd和莫西沙星400mg qd,左氧氟沙星750mg qd和莫西沙星400mg qd为粪肠球菌感染时的推荐给药方案,屎肠球菌感染则不推荐给予FQNs。结论运用PK/PD模型的蒙特卡洛模拟可协助临床综合考虑药物的体外活性与感染人群的药代动力学特性,FQNs常用给药方案治疗天津地区常见致病菌感染的疗效不佳,经验性治疗上述菌种引起的感染时不推荐首选FQNs,治疗感染性疾病尚需根据适应症来选择抗菌给药方案。

Objective To evaluate the anti-infective dosage regimen of fluoroquinolones （FQNs） based on PK/ PD. Methods Probability of target attainment （PTA） obtained by Monte carlo simulation （MCS） would be used to evaluate the effect of fluoroquinolone drugs treating infection of common pathogenic bacteria in Tianjin region. Results PTAs in MIC90 of FQNs 7 dosage regimens for Escherichia coli, Klebsiella pneumonius, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium were 0. According to the MIC50; For gram-negative bacteria, only Klebsiella pneumonius infection could be recommended levofloxacin 200mg qd. For gram-positive bacteria, Staphylococcus aureus infections were recommended using levofloxacin 200mg qd and moxifloxacin 400mg qd. Levofloxacin 750mg qd and moxifloxacin 400mg qd were recommended for Enterococcus faecalis infections. No recommendation of FQNs dosage regimen for Enterococcus faecium. Conclusion PK/PD model conducted by Monte carlo simulation combines in vitro drug activity and pharmacokinetic characteristics of infected people to help clinic make decision. The common dosage regimens of FQNs were not effective in treating common pathogenic bacteria in Tianjin region. Regimens of FQNs were not recommended as empirical treatment of above-mentioned species.