天津医药 ›› 2016, Vol. 44 ›› Issue (8): 1040-1042.doi: 10.11958/20150428

• 药物临床观察 • 上一篇    下一篇

万古霉素和利奈唑胺治疗革兰阳性球菌感染给药方案优化

刘畅1, 2 , 廖莎莎1 , 朱立勤3 , 张蓓3△, 刘薇4△   

  1. 1天津医科大学一中心临床学院 (邮编300192); 2天津医科大学总医院; 3天津市第一中心医院; 4天津市卫生和计划生育委员会
  • 收稿日期:2015-12-25 修回日期:2016-03-25 出版日期:2016-08-15 发布日期:2016-08-22
  • 通讯作者: 张蓓E-mail: ba.ma.lei@163.com; 刘薇E-mail: lance1971@163.com E-mail:ba.ma.lei@163.com
  • 作者简介:刘畅 (1986), 女, 硕士在读, 主要从事临床药学研究

Optimization of vancomycin and linezolid dosage regimen for treatment of Gram-positive cocci infections

LIU Chang1,2 , LIAO Shasha1 , ZHU Liqin3 , ZHANG Bei 3△, LIU Wei 4△   

  1. 1 The First Central Clinical College of Tianjin Medical University, Tianjin 300192, China; 2 Tianjin Medical University General Hospital; 3 Tianjin First Central Hospital; 4 Tianjin Health and Family Planning Commission
  • Received:2015-12-25 Revised:2016-03-25 Published:2016-08-15 Online:2016-08-22
  • Contact: ZHANG Bei E-mail:ba.ma.lei@163.com; LIU Wei E-mail: lance1971@163.com E-mail:ba.ma.lei@163.com

摘要: 摘要: 目的 评价并优化万古霉素和利奈唑胺治疗不同革兰阳性球菌感染的给药方案。方法 根据抗菌药物的药动学/药效学理论, 将万古霉素和利奈唑胺的药代动力学参数, 结合这 2 种药物对表皮葡萄球菌、 金黄色葡萄球菌、 粪肠球菌和屎肠球菌的体外药效学数据进行蒙特卡洛模拟, 通过比较 2 种药物不同给药方案对 4 种革兰阳性球菌的累积反应分数 (CFR) 来评价并优化给药方案。结果 当患者感染表皮葡萄球菌时, 推荐使用万古霉素 3 500 mg/d 的给药方案; 当患者感染金黄色葡萄球菌时, 推荐使用万古霉素 2 500 mg/d 的方案; 当患者感染粪肠球菌时, 推荐使用万古霉素 3 000 mg/d 或利奈唑胺 400 mg/次, 每日 2 次的方案; 当患者感染屎肠球菌时, 推荐使用万古霉素 2 500 mg/d 或利奈唑胺 400 mg/次, 每日 2 次的方案。结论 在应用万古霉素和利奈唑胺治疗革兰阳性球菌感染时,应根据感染菌种类选择不同的给药方案。

关键词: 万古霉素, 革兰氏阳性菌, 利奈唑胺, 蒙特卡洛模拟

Abstract: Abstract: Objective To estimate and optimize the dosage regimen of vancomycin and linezolid for treatment in different Gram-positive cocci infections. Methods The pharmacokinetic data of vancomycin and linezolid were collected, and the pharmacodynamics in vitro of these drugs for staphylococcus epidermidis, staphylococcus aureus, enterococcus faecalis and enterococcus faecium were analysed. The cumulative response fraction (CFR) was evaluated in different dosage regimens of two drugs against four types of bacteria. Results The regimen of 3 500 mg/d vancomycin was recommended for patients with staphylococcus epidermidis infection. The regimen of 2 500 mg/d vancomycin was recommended for patients with staphylococcus aureus infection. The regimens of 3 000 mg/d vancomycin and 400 mg linezolid given 2 times/day were recommended for patients with enterococcus faecalis infection. The regimens of 2 500 mg/d vancomycin and 400 mg linezolid given 2 times/day were recommended for patients with enterococcus faecium infection. Conclusion In application of vancomycin and linezolid for treatment of Gram-positive cocci infections, different dosage regimens should be used in different types of infections.

Key words: Vancomycin, Gram-positive bacteria, Linezolid, Monte Carlo simulation