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环丙沙星对铜绿假单胞菌和鲍曼不动杆菌有很好的抗菌活性,并且可以经肝、肾等多种途径清除,因此常用于重症监护室(ICU)中多脏器损伤等重症患者的治疗。但随着其应用的增多,细菌耐药性随之出现。本文主要从临床疗效和对之产生耐药性考虑,优化环丙沙星在ICU患者治疗中的给药方案。用102例ICU患者的环丙沙星血清浓度建立群体药动学模型,采用药动学一药效学蒙特卡洛模拟的方法进行环丙沙星不同给药方案的筛选。以fAUC_(24)/MIC≥90 h作为临床效果的靶值,TMsw≤20%[T_(Msw)是0～24 h药物浓度保持在突变选择窗范围(MSW)的时间]作为选择耐药的靶值。结果显示对铜绿假单胞菌和鲍曼不动杆菌,环丙沙星400 mg每日2次或3次的常规给药方案达不到T(MSW)预期的
Ciprofloxacin against Pseudomonas aeruginosa and Acinetobacter baumannii have good antibacterial activity, and can be cleared by the liver, kidney and other means, it is commonly used in intensive care unit (ICU) in multiple organ injury Treatment of critically ill patients. However, with the increase of its application, the emergence of bacterial resistance. This article mainly from the clinical efficacy and resistance to its consideration, optimizing ciprofloxacin in the treatment of patients with ICU dosing regimen. A population pharmacokinetic model was established using serum concentrations of ciprofloxacin in 102 patients with ICU. Pharmacokinetic-pharmacodynamic Monte Carlo simulation was used to screen different dosage regimens of ciprofloxacin. TMsw ≤ 20% [T (Msw) is the time between 0-24 h for the drug concentration to stay within the mutation selection window (MSW)] as the target of clinical effect with fAUC_ (24) / MIC ≥ 90 h as the target of clinical effect. Target value. The results showed that conventional administration of 400 mg ciprofloxacin twice or three times daily to Pseudomonas aeruginosa and Acinetobacter baumanni less than the expected T (MSW)