目的:基于药动学(pharmacokinetics,PK)/药效学(pharmacodynamics,PD)模型和蒙特卡洛模拟(Mote Carlo simulation,MCS),分析大肠埃希菌所致脓毒症休克患者抗感染治疗方案的优化过程,为临床感染患者构建合理有效的治疗方案提供参考。方法...目的:基于药动学(pharmacokinetics,PK)/药效学(pharmacodynamics,PD)模型和蒙特卡洛模拟(Mote Carlo simulation,MCS),分析大肠埃希菌所致脓毒症休克患者抗感染治疗方案的优化过程,为临床感染患者构建合理有效的治疗方案提供参考。方法:一患者因不明原因发热入院,初步诊断为尿路感染和脓毒症休克。入院后第一时间完善了相关实验室检查,随后采用PK/PD模型和MCS依据微生物培养结果及其药敏试验确定最优的抗感染治疗方案。结果:入院第3天,微生物培养检出大肠埃希菌,随后的药敏试验提示其对美罗培南、亚胺培南敏感,而对头孢哌酮-舒巴坦钠中介;采用PK/PD模型和MCS对拟定的几个抗感染治疗方案进行分析,结果发现美罗培南(1 g,q8h)和亚胺培南(0.5 g,q6h)的达标概率(probability of target attainment,PTA)均为100.00%,而头孢哌酮-舒巴坦钠(3 g,q12h)的PTA为1.14%,头孢哌酮-舒巴坦钠(3 g,q8h)的PTA为7.65%;最终,临床选择了美罗培南(1 g,q8h)治疗,1周后患者的感染指征基本消失。结论:PK/PD模型和MCS两个工具可以较好地帮助临床药师预测抗感染治疗方案的可能效果,从而更好地协助医生制定和优化治疗方案,进而最大程度保证患者的治疗效果。展开更多
目的:应用PK/PD模型结合蒙特卡洛模拟评价3种抗菌药物对铜绿假单胞菌感染的延长输注给药方案。方法:收集广州市中西医结合医院2020年铜绿假单胞菌对头孢他啶、哌拉西林钠他唑巴坦(8∶1)、美罗培南的药敏报告,制订3种抗菌药物的3 h延长...目的:应用PK/PD模型结合蒙特卡洛模拟评价3种抗菌药物对铜绿假单胞菌感染的延长输注给药方案。方法:收集广州市中西医结合医院2020年铜绿假单胞菌对头孢他啶、哌拉西林钠他唑巴坦(8∶1)、美罗培南的药敏报告,制订3种抗菌药物的3 h延长输注及两步法延长输注共12种给药方案,根据各抗菌药物的药动学/药效学(PK/PD)模型参数,应用蒙特卡洛模拟(Monte Carlo simulation, MCS)计算3种抗菌药物不同给药方案对10 000例感染患者的达标概率(probability of target attainment, PTA)及累积反应分数(cumulative fraction of response, CFR),对各延长输注给药方案进行评价及临床验证。结果:临床标本共分离出296株铜绿假单胞菌,经MCS模拟3种抗菌药物所有延长输注给药方案的CFR均小于90%,CFR最高的为哌拉西林钠他唑巴坦2.25 g/0.5 h+2.25 g/3 h q6h给药方案(88.10%);哌拉西林钠他唑巴坦、美罗培南比头孢他啶对MIC中介的铜绿假单胞菌有更高的PTA及CFR,其中美罗培南1 g/0.5 h+1 g/3 h q8h给药方案对MIC=8μg·mL;的耐药铜绿假单胞菌仍有一定的PTA(60.21%);临床病例验证与MCS结果相仿。结论:该院铜绿假单胞菌中介/耐药率较高,针对MIC中介以上的铜绿假单胞菌感染,可选择哌拉西林钠他唑巴坦或美罗培南,通过增加给药剂量、频次并使用两步法延长输注给药方式优化抗感染方案。展开更多
In this study,we aimed to develop and evaluate a whole-body physiologically based pharmacokinetic(WB-PBPK)/pharmacodynamic(PD)model for saxagliptin,simulate its pharmacokinetic and pharmacodynamic properties in health...In this study,we aimed to develop and evaluate a whole-body physiologically based pharmacokinetic(WB-PBPK)/pharmacodynamic(PD)model for saxagliptin,simulate its pharmacokinetic and pharmacodynamic properties in healthy adults and patients with hepatic function impairment,and provide a new method for the research to the clinical pharmacy of special patients.Based on the drug-specific properties,such as log D,plasma protein binding collected by the published literature,the WB-PBPK model and the PD model were established.After comparing the simulated concentration-time profiles and the pharmacokinetic parameters with data in healthy adults from oral and intravenous clinical investigation,the WB-PBPK model could be optimized.After comparing the simulated DPP-4 inhibition profile with the observed pharmacodynamic in healthy subjects,the PD model could be optimized.The PK/PD model was utilized to predict the mean and variability of the pharmacokinetic and pharmacodynamic profiles in subjects with different hepatic impairment.All of the predicted pharmacokinetic curves were comparable to the observed curves both in healthy subjects and hepatic impairment subjects(Cmax and AUC were less than 1.3-fold).The predicted pharmacodynamic curves were comparable to the observed ones in different oral dosage after optimization,and pharmacodynamics of saxagliptin in hepatic impairment subjects were predicted successfully.The WB-PBPK/PD model can accurately simulate the pharmacokinetics and pharmacodynamics of saxagliptin in normal adults and different hepatic impaired patients.展开更多
文摘目的:应用PK/PD模型结合蒙特卡洛模拟评价3种抗菌药物对铜绿假单胞菌感染的延长输注给药方案。方法:收集广州市中西医结合医院2020年铜绿假单胞菌对头孢他啶、哌拉西林钠他唑巴坦(8∶1)、美罗培南的药敏报告,制订3种抗菌药物的3 h延长输注及两步法延长输注共12种给药方案,根据各抗菌药物的药动学/药效学(PK/PD)模型参数,应用蒙特卡洛模拟(Monte Carlo simulation, MCS)计算3种抗菌药物不同给药方案对10 000例感染患者的达标概率(probability of target attainment, PTA)及累积反应分数(cumulative fraction of response, CFR),对各延长输注给药方案进行评价及临床验证。结果:临床标本共分离出296株铜绿假单胞菌,经MCS模拟3种抗菌药物所有延长输注给药方案的CFR均小于90%,CFR最高的为哌拉西林钠他唑巴坦2.25 g/0.5 h+2.25 g/3 h q6h给药方案(88.10%);哌拉西林钠他唑巴坦、美罗培南比头孢他啶对MIC中介的铜绿假单胞菌有更高的PTA及CFR,其中美罗培南1 g/0.5 h+1 g/3 h q8h给药方案对MIC=8μg·mL;的耐药铜绿假单胞菌仍有一定的PTA(60.21%);临床病例验证与MCS结果相仿。结论:该院铜绿假单胞菌中介/耐药率较高,针对MIC中介以上的铜绿假单胞菌感染,可选择哌拉西林钠他唑巴坦或美罗培南,通过增加给药剂量、频次并使用两步法延长输注给药方式优化抗感染方案。
文摘In this study,we aimed to develop and evaluate a whole-body physiologically based pharmacokinetic(WB-PBPK)/pharmacodynamic(PD)model for saxagliptin,simulate its pharmacokinetic and pharmacodynamic properties in healthy adults and patients with hepatic function impairment,and provide a new method for the research to the clinical pharmacy of special patients.Based on the drug-specific properties,such as log D,plasma protein binding collected by the published literature,the WB-PBPK model and the PD model were established.After comparing the simulated concentration-time profiles and the pharmacokinetic parameters with data in healthy adults from oral and intravenous clinical investigation,the WB-PBPK model could be optimized.After comparing the simulated DPP-4 inhibition profile with the observed pharmacodynamic in healthy subjects,the PD model could be optimized.The PK/PD model was utilized to predict the mean and variability of the pharmacokinetic and pharmacodynamic profiles in subjects with different hepatic impairment.All of the predicted pharmacokinetic curves were comparable to the observed curves both in healthy subjects and hepatic impairment subjects(Cmax and AUC were less than 1.3-fold).The predicted pharmacodynamic curves were comparable to the observed ones in different oral dosage after optimization,and pharmacodynamics of saxagliptin in hepatic impairment subjects were predicted successfully.The WB-PBPK/PD model can accurately simulate the pharmacokinetics and pharmacodynamics of saxagliptin in normal adults and different hepatic impaired patients.
