中国医院用药评价与分析2025，Vol.25Issue(2)：153-156,160,5.DOI:10.14009/j.issn.1672-2124.2025.02.006
多黏菌素B治疗危重症患者多药耐药革兰阴性菌感染的给药方案优化
Dose Optimization of Polymyxin B in the Treatment of Multidrug-Resistant Gram-Negative Bacteria in Critically Ill Patients
摘要
Abstract
OBJECTIVE:To optimize the administration of polymyxin B in critically ill patients,so as to provide evidence for rational use of polymyxin B.METHODS:Based on the population pharmacokinetic model and pharmacokinetic/pharmacodynamic target,Monte Carlo simulation was used to predict the probability of target achievement(PTA)for different dosing regimens and the cumulative response of fraction(CFR)of three bacteria in critically ill patients with different weights.The minimum dosage with PTA or CFR≥90％and the incidence of nephrotoxicity<50％was considered as the optimal regimen.RESULTS:(1)A loading dose could improve the PTA in critically ill patients in the first day.(2)When the minimum inhibitory concentration(MIC)was≤0.5 mg/L,the loading dose of 1.5 mg/kg and maintenance dose of 0.5 mg/kg every 12 hours were recommended for patients weighing≥50 kg,and the maintenance dose should be increased to 0.75 mg/kg every 12 hours for patients weighing 40 to<50 kg.When MIC was 1 mg/L,for patients weighing 40 to<50 kg,the loading dose of 2 mg/kg and maintenance dose of 1.25 mg/kg every 12 hours were recommended;for patients weighing 50 to<70 kg,the maintenance dose should be reduced to 1 mg/kg every 12 hours;for patients weighing 70 to 100 kg,the loading dose of 1.5 mg/kg and maintenance dose of 0.5 to 0.75 mg/kg every 12 hours were recommended.When MIC was 2 mg/L,although there were regimens that attained the target,the incidence of nephrotoxicity was higher,and no regimen was recommended.(3)For Klebsiella pneumoniae or Acinetobacter baumannii infection,the loading dose of 1.5 mg/kg and maintenance dose of 0.5 mg/kg every 12 hours were recommended for patients with body weight≥50 kg.For Pseudomonas aeruginosa infection,the above dosage was only suitable for patients weighing 90 to 100 kg,and patients weighing 50 to<70 kg need a loading dose of 2 mg/kg and maintenance dose of 1 to 1.25 mg/kg every 12 hours.The loading dose of 1.5 mg/kg and maintenance dose of 0.75 mg/kg every 12 hours were recommended for patients weighing 70 to<90 kg.CONCLUSIONS:Optimal regimens of polymyxin B should be formulated and optimized based on the characteristics of the patients and the type and sensitivity of the pathogenic bacteria in critically ill patients,the subsequent dosing regimen can be adjusted by therapeutic drug monitoring if necessary.关键词
多黏菌素B/危重症患者/多药耐药革兰阴性菌感染/药动学/药效学/给药方案优化Key words
Polymyxin B/Critically ill patients/Multidrug-resistant Gram-negative bacterial infection/Pharmacokinetics/pharmacodynamics/Dose optimization分类
药学引用本文复制引用
张祎景,陈姣姣,王楚慧,丘愈澜,滕蒙蒙,白楚琪,董亚琳..多黏菌素B治疗危重症患者多药耐药革兰阴性菌感染的给药方案优化[J].中国医院用药评价与分析,2025,25(2):153-156,160,5.基金项目
陕西省创新能力支撑计划项目(No.2023-CX-PT-43) （No.2023-CX-PT-43）
