PKPD在合理使用抗生素中的意义剖析.ppt

* 从这张图可以看到，尽管亚胺培南的Cmax比美平要高一些，但在Time above MIC上并无优势，对铜绿假单胞菌的Time above MIC还不如美平。 * 美平0.5g q8h, iv 60min和美平1g, q12h, iv 60min对较耐药细菌，其%TMIC是不够的。 * 4种给药方案对于MIC=4mg/L时的%TMIC，基本都可以达到40%TMIC。 * Again, I’ll talk about Monte Carlo simulation, what kinds of data need for it. One is PK distribution data calculated from Meropenem blood concentration trend and another one is Meropenem MIC distribution data against bacterial species. Monte Carlo simulation uses that data in combination and so generates %TMIC distribution. Then, as the result, Monte Carlo simulation show us the probability of target attainment. The more specific simulation process is the next. * After I set all parameter, I set the number of trials. If I set 10000 trials, I can get 10000 simulated clinical trial data as a result. I’ll show you the calculated %TMIC in the next. * Please look at this chart. It is actually main part of today’s presentation. Dosage regimen is 500mg q12h –against P.aseruginosa. X axis is TMIC. It shows from 10% to 100%.Y axis is Target attainment. In turn, the probability attain the these target TMIC. The chart shows that the probability attain TMIC30 is 70.1%, and the probability attains TMIC50 is 26.5%. In this dosage regimen, we expect that Meropenem has 70% therapeutic effect for mild infection, but we cannot expect high effect against severe infection, or the patients have low immunity. * Let’s move to the next chart. It is comparison of dose 500mg with 1000mg.Obviously higher dose shows higher effect. * Next, it is a little bit complicated, isn’t it. Green line shows 1000mg q12h –twice a day - and red one shows 500mg q8h -3rd times a day. Red one is less amounts of dose but more numbers of dose. These two are not so different at the point (%TA30), but they are more than a little different at the point(%TA50%) The fact is influenced with severe infection case. * Finally, the chart shows all of dosage regimen I mentioned before. Target attainment 30%, which has Bacteria