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

目的。本研究的目的是从经济和临床的角度，根据药动学参数，评价万古霉素（VCM）、阿贝卡星（ABK）和替柯planin (TEIC) 3种抗生素治疗MRSA感染的最适宜剂量和给药间隔。在日本获得VCM药动学平均参数的基础上，采用单室模型分析进行计算机模拟研究。采用Sawchuk-Zaske法对mrsa患者各血药浓度进行ABK和TEIC的药代动力学研究。在VCM的情况下，我们得出结论，在开始MRSA感染治疗时，每天给予1300mg VCM一次是日本成年患者最合适的给药方案，因为该方案能够将最合适的VCM峰值浓度提高到25-40 ug/mL，谷底水平低于10 ug/mL。相比之下，日本版v…More CM包装说明书中推荐的剂量（500mg VCM每天服用4次，或1000mg VCM每天服用2次）不能满足上述浓度。从经济角度来看，每天一次1300毫克的VCM两周给药比包装说明书中描述的给药方法便宜67,550美元。以ABK为例，发现每天一次200mg的ABK是最适合日本成人患者的损害剂量。进一步，在24例MRSA成人患者中检测了TEIC的药代动力学参数。结果表明，TEIC的分布容积和间隙分别为0.6436 L/kg和0.0018 L/kg/h。从结果来看，每天一次200mg的TEIC剂量不足以获得TEIC的有效峰值浓度。发现每天400毫克的剂量是最合适的剂量。研究结果为从临床和经济角度考虑给药提供了最有用的线索。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