中国真菌学杂志2025，Vol.20Issue(6)：576-580,5.DOI:10.3969/j.issn.1673-3827.2025.06.003
蒙特卡罗模拟优化肾功能不全患者侵袭性念珠菌病的氟康唑给药方案
Monte Carlo simulation optimization of fluconazole administration regimen for invasive candidiasis in patients with renal insufficiency
摘要
Abstract
Objective To optimize the fluconazole dosing regimen for patients with renal insufficiency suffering from invasive candidiasis and provide a reference for individualized medication in special populations.Methods Patients with renal insufficiency were grouped according to the glomerular filtration rate(GFR).Based on the pharmacokinetics/pharmacodynamics(PK/PD)model of fluconazole,the distribution of common clinical dosing regimens,pharmacokinetic(PK)parameters,and the minimum inhibitory concentration(MIC)of Candida was simulated by Monte Carlo simulation(MCS)using Crystal Ball software.The probability of target attainment(PTA)≥90%or the cumulative fraction of response(CFR)≥90%was used as the evaluation index.Results In the case where the MIC of the target Candida could be accurately obtained,when MIC≤1 mg/L,a dose of 100 mg/d(when MIC=1 mg/L,the dose for patients with mild renal insufficiency needed to be increased to 200 mg/d)could meet the requirement of PTA≥90%;when MIC=2 mg/L,for patients with mild or moderate renal insufficiency,the maintenance dose recommended in the package insert(for patients with severe renal insufficiency,a dose of 100 mg/d was required)could meet the requirement of PTA≥90%;when MIC=4 mg/L,only a dose of 200 mg/d for patients with severe renal insufficiency could meet the requirement of PTA≥90%;and when MIC>4 mg/L,the dose recommended in the package insert could not meet the requirement of PTA≥90%.In the case where only the strain could be identified but the accurate drug susceptibility results could not be obtained,a dose of 200 mg/d for patients with mild renal insufficiency could meet the requirement of CFR≥90%for the target Candida;while patients with moderate or severe renal insufficiency required a dose of 100 mg/d to meet the requirement of CFR≥90%.Conclusion For patients with renal insufficiency using fluconazole,factors such as the Candida strain,MIC value,and the degree of renal function impairment should be comprehensively considered to achieve individualized dosing.关键词
氟康唑/侵袭性念珠菌病/蒙特卡罗模拟/药代动力学/药效学/肾功能不全Key words
fluconazole/invasive candidiasis/Monte Carlo simulation/pharmacokinetics/pharmacodynamics/renal insufficiency引用本文复制引用
刘维,张宇平,羊鸣,余媛媛,廖玮..蒙特卡罗模拟优化肾功能不全患者侵袭性念珠菌病的氟康唑给药方案[J].中国真菌学杂志,2025,20(6):576-580,5.基金项目
桂林市自筹经费科技计划项目(20220114z) （20220114z）
