The Most Suitable Dosage Regimen of Antibiotics for MRSA from Economical and Clinical Aspects.

目的。本研究的目的是根据药代动力学参数，从经济学和临床角度评价治疗MRSA感染的3种抗生素万古霉素(VCM)、阿贝卡星(ABK)和替考拉宁(TEIC)的最适剂量和给药间隔。根据从日本获得的VCM的药代动力学平均参数，采用一室模型分析进行计算机模拟研究。对于ABK和TEIC，采用Sawchuk-Zaske方法对MRSA患者的各血药浓度进行药代动力学研究。在氯霉素方面，我们得出的结论是，在开始治疗mrsa感染时，每天给药1,300 mg是最适合日本成年患者的剂量方案，因为该方案能够增加最合适的氯霉素峰值浓度25-40ug/ml和血药浓度低于10ug/ml。相比之下，日本版V…中推荐的剂量更多的CM包装插入(每天4次给予500 mg的VCM，或每天2次给予1000 mg的VCM)不能满足上述浓度。从经济的角度来看，每天一次1300毫克的VCM两周给药比包装插页中描述的给药方法便宜67,550英镑。就ABK而言，对日本成年患者来说，每天服用200毫克ABK被发现是最合适的剂量。此外，在24例成年耐甲氧西林金黄色葡萄球菌患者中检测了TEIC的药代动力学参数。结果表明，热电阻尼器的布料量为0.6436 L/kg，出料量为0.0018 L/kg/h。结果表明，每天给药200 mg不足以达到有效的药物峰值浓度，400 mg/d是最合适的给药剂量，为从临床和经济角度考虑用药提供了最有用的线索。较少

Purpose. The purpose of the study was to evaluate the most suitable dosages and dosing intervals on the basis of pharmacokinetic parameters for three kinds of antibiotics for MRSA infection, vancomycin (VCM), arbekacin (ABK) and teicoplanin (TEIC) from economical and clinical point of view.Methods. On the basis of pharmacokinetic mean-arameters of VCM obtained from Japanese, the computer simulation-study was performed by using one-compartment model analysis. Regarding to ABK and TEIC, the pharmacokinetic study was performed on each plasma concentration obtained from MRSA-patients by using Sawchuk-Zaske method.Results. In the case of VCM, we concluded that 1300 mg of VCM given once daily on commencing treatment of MRSA infection is the most suitable dosage regimen for Japanese adult patients because the regimen enable to increase the most suitable VCM peak concentration of 25-40 ug/mL and traugh level of under 10 ug/mL.In contrast, The dosage recommended in the Japanese version of the V … More CM package insert (500 mg of VCM given four times a day, or 1000 mg of VCM given twice a day) could not satisfy the concentration described above. From the economical point, the two weeks administration of VCM at a dose of 1300 mg once a day is cheaper by \67, 550 than the administration method described in package insert. In the case of ABK, 200 mg of ABK given once a day is found to be the most suitable dasage resimen for Japanese adult patient. Further, the pharmacokinetic parameter of TEIC was examined in 24 of adult MRSA patients. As a result, it was clarified that volume of distribution and clearance for TEIC are 0.6436 L/kg and 0.0018 L/kg/h, respectively. From the result, the administration of TEIC at a dose of 200 mg once a day is not enough to obtain an effective peak concentration of TEIC.The dose of 400 mg a day is found to be the most suitable dosage.The results obtained from the study gave the most useful clue for considering drug administration both from clinical and economical point of views. Less