从PK-PD看抗菌药物的合理应用 李光辉.pptxVIP

从PK/PD看抗菌药物的合理应用;;;Peak/MIC;抗菌药药效学; 药物敏感试验;药敏试验的临床意义;CHINET 2012年15家医院31277株肠杆菌科细菌耐药率（%）;CHINET 2012年15家医院19613株非发酵菌耐药率（%）;各种酶抑制剂复方制剂的比较;头孢哌酮/舒巴坦与头孢菌素、亚胺培南特性比较;抗菌药药效学—— MIC and MBC参数的不足;抗菌药药效学;Effect of increasing concentrations of tobramycin(a), Ciprofloxacin(b) and Ticarcillin(c) on the bacterial activity against Pseudomonas Aeruginosa;抗菌药药效学;抗菌药药效学;Post-Antibiotic Effect (PAE);药效学/药动学（PK/PD）原则 ——根据杀菌活性对抗菌药物进行分类;PK/PD parameters correlating with  antibacterial efficacy;根据PK/PD原理制订的给药方案可以达到更高的疗效和清除病原菌的作用，并可能防止疗程中细菌产生耐药性 与时间依赖型药物杀菌活力有关的PK/PD参数是T＞MIC，即血药浓度达到或超过MIC持续的时间占2次给药间期的百分比 与浓度依赖型药物杀菌活力有关的主要参数是AUC24/MIC或Cmax/MIC ;Pharmacodynamics Parameters Outcome;Time-dependent agents;;Scand J Infect Dis Suppl 96:11-16,1995;Pharmacodynamic Goals (TMIC as percent of Interval) with Beta-Lactams ;;;Relationship Between TMIC and Efficacy for Cephalosporins (Yellow), Penicillins (Aqua) and Carbapenems (Red);;8. Okamura K, et al. Acta Urol Jpn. 1989;35:727-734. 9. Suzuyama Y, et al. Chemotherapy. 1984;32(S-4):355-367. 10. Aoyama H, et al. Jpn J Antibiot. 1988;41:1279-1284. 11. Tsuyuki K, et al. Chemotherapy. 1984;32(S-4):404-412 12. Cho N, et al. World Gynecol. 1984;36(8):649-675. ;药效学/药动学（PK/PD）原则 ——头孢哌酮-舒巴坦复合制剂中头孢哌酮PK/PD参数比较;普深在肺组织内的平均浓度超过常见致病菌的MIC90值;34;头孢哌酮/舒巴坦(2:1)3种给药方案对非发酵菌不同MIC值时%TMIC（头孢哌酮）;舒普深3g,q8h,疗程14天治疗鲍曼不动杆菌HAP患者PK/PD参数与临床疗效关系的研究（n=12);Kuti et al. Am J Health Syst Pharm 2002;59:2209–2215;替加环素PK/PD特性;替加环素PTA 结果;多粘菌素PK/PD特性;大环内酯类PK/PD研究;糖肽类抗生素 PK/PD研究;;;LINEZOLID治疗大鼠股部肺炎链球菌感染;斯沃AUC24/MIC 100临床疗效卓越;利奈唑胺PTA结果;Concentration-dependent agents;;Levofloxacin PK/PD Parameters Against S. pneumoniae in Neutropenic Mouse Thigh Infection Model;Relationship between 24 Hr AUC/MIC and mortality for fluoroquinolones against S. pneumoniae in immunocompetent animals;Relationship between 24 Hr AUC/MIC and mortality for fluoroquinolones against Gram-negative bacilli in immunocompromised animals;Clinical failure rate 43% 11.5% 1% ;Relationship Between 24