期刊
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
卷 50, 期 -, 页码 23-29出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.ijid.2016.06.017
关键词
fosfomycin; Monte Carlo simulation; pharmacokinetics/pharmacodynamics; Pseudomonas aeruginosa
Objective: The purpose of the study was to determine the optimal dosing regimen of intravenous fosfomycin for the treatment of Pseudomonas aeruginosa (PA) based on PK/PD targets. Method: A total of 120 PA isolates were recovered from various clinical specimens at university hospital in Thailand. Minimum Inhibitory Concentrations (MICs) of all the isolates were determined by the E-test method. PK parameters were obtained from a published study. Monte Carlo simulation was performed to calculate the percentage of target attainment (PTA) and cumulative fraction of response (CFR). Results: MIC90 of fosfomycin alone, fosfomycin in combination with carbapenem, carbapenems alone and carbapenems in combination with fosfomycin were > 1,024, 1,024, > 32 and 32 mu g/ml, for multidrug resistant (MDR)-PA and 512, 128, 8 and 3 mu g/ml respectively, for non-MDR PA. Approximately 40% of the non-MDR PA were carbapenem-resistant strains. For non-MDR PA with CRPA, fosfomycin 16 g continuous infusion in combination with carbapenems provided %PTA of approximately 80 and %CFR of > 88. While, %PTA and % CFR > 90 were achieved with fosfomycin 24 g/day prolonged infusion in combination with carbapenem. Conclusions: Prolonged infusion of fosfomycin 16 - 24 g combined with extended carbapenem infusion could be used in non-MDR PA treatment with CRPA. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
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