MIC-based dose adjustment: facts and fables
MIC-based dose adjustment: facts and fables
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DOI：
10.1093/jac/dkx427
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发表时间：
2018-03-01
影响因子：
5.2
通讯作者：
Turnidge, John
中科院分区：
文献类型：
--
作者：
Mouton, Johan W.;Muller, Anouk E.;Turnidge, John
在过去几十年里，有若干出版物描述了基于抗菌药物最低抑菌浓度（MIC）值，针对个体患者优化抗生素治疗的流程。大多数方法包括治疗药物监测，采用单次MIC测定结果，结合相关的药代动力学/药效学来调整剂量，以优化抗菌药物的暴露量和抗菌效果。然而，使用单次MIC测定获得的结果并不恰当。首先，由于MIC检测本身存在检测差异，常规临床实验室无法以足够的精确度测定MIC来指导用药剂量。其次，无论采用何种方法，任何MIC测定结果都存在差异，这一点必须加以考虑。如果基于治疗药物监测进行剂量调整且涉及MIC测定，就必须考虑MIC的差异，以防止患者可能出现用药剂量不足的情况。我们在此阐述相关问题以及一些可用于临床实践的方法。
Over recent decades, several publications have described optimization procedures for antibiotic therapy in the individual patient based on antimicrobial MIC values. Most methods include therapeutic drug monitoring and use a single MIC determination plus the relevant pharmacokinetics/pharmacodynamics to adjust the dose to optimize antimicrobial drug exposure and antibacterial effects. However, the use of an MIC obtained by a single MIC determination is inappropriate. First, routine clinical laboratories cannot determine MICs with sufficient accuracy to guide dosage owing to the inherent assay variation in the MIC test. Second, the variation in any MIC determination, whatever method is used, must be accounted for. If dose adjustments are made based on therapeutic drug monitoring and include MIC determinations, MIC variation must be considered to prevent potential underdosing of patients. We present the problems and some approaches that could be used in clinical practice.