翁心华抗菌药物临床药学实践的体会.docx

抗菌药物临床药学实践的体会 翁心华 复旦大学附属华山医院感染科 2012-05 病原菌的定植与感染 危险因素 念珠菌评分（candida score EPCAN 研究 念珠菌评分（candida score ――应用研究 (2006-2007) ICU高危人群评估（BAMSG研究） ―一改良版 华山医院10年间念珠菌血症(1998-2007) 与血培养分离到同种念珠菌的部位 美国感染协会：念珠菌病治疗指南（2009版） 定植并不一定感染，感染多半伴有定植! tm pin cal Treatment of Suspected Disseminated Candidiasis in Febrile No门netitropenic Pmti启nts才 Candida species colonizatian (preferably at multiple sitesf Multiple other risk factors Absence of any other uncorrected causes of fever The absence of cdomzation tiy species inriicj曲tea a lower nskfor invasive candidias. s- and wairants deta^ing empincal therapy * [The utihty of antihmg^l therapy (or Lhiv Byndramv ha^ not bwn t柜血闵严 Pnpp?B PG ct aj din Dis 2004,38 161-189 启示… 抗菌药物的PD/PK What Are the Reasons for Failure of Antifungal Therapy? HOfltirm ^unosdpp^cssion lying Q艇強q B冷访 HOflt irm ^unosdpp^cssion lying Q艇強q B冷访 OMon dysFbn:1lofl Dlagnois/MatiagtifTint Fin nf diagno?i? ■ ifitHrcurrnfti inftK：ritxis ? Li：k 酣 rifBCW squill oontfu -mocuiun-i -Drug (nteracfjorw COn?rrtF0tiQns AbSorpt-or Wiri恤仙 Ehrnnaticn Pharmacodynamic (PD| ii^d^fjiice dn g scpusj^ A itifjnijrTi nf^isiance -Drug inkvrKliorH (snla^oniBrn尹 Lack cf furiQicklal aciivtty? ■ Vlrvlfnp? (旳tpxirtf) ■Mfl m fsnvuflton PK/PD SERVM LEVELS J ISSUE LEVELS hiMpdi U IjllBMt Inwk MiC MEC Kilhnq hiw wdlownlimiHiift Hisidm i* vnlk PAFE PD PD CORREIATION JT-MIC Alie MIC Cp^ MIC) dose a!ptimizatior) TOXICITY fEFFICACY tRESI?ANCE ? 的关联 PK/PD Mmiir.tt?s_ 亠 Mmiir. tt?s_ 亠J9IIH4旨那卡阳 的重要参数 抗真菌药物的PK/PD Lewis RE, et al. Curr Opin Pharmacol, 2007 抗真菌药物的 Time aUIC[I m^d?pi-ndnrt killing short ar mat PAFE iFlucytosineWC^jMIC ltim?o?p?ndsr)t billing prolongaj PAFE.Trlazoles-yeE -tgnJI-s*n- lls-LLeCLEKLJTAo3 Time aUIC [I m^d?pi-ndnrt killing short ar mat PAFE i Flucytosine WC^jMIC ltim?o?p?ndsr)t billing prolongaj PAFE. Trlazoles -yeE -tgnJI-s*n- lls-LLeCLEKLJTA o 3 Pea^WIC Qr AUC/MilC(conce-n traT i mi-dp 咽 n r A.nnpho(c ri cin EGtilwMndins 山iidMU A R.jf Ch-i jmn. 47 117Q-1 1Ftfi PK/PD 从抗真菌药物的治疗来看血药浓