ABSTRACT
OBJECTIVE： To provide reference for the formulation of primary medication regimen for antibacterial drug treatment of ICU patients with Escherichia coli infection. METHODS： Based on the surveillance report on E. coli resistance in hospitals issued by CHINET China bacterial drug resistance surveillance network in 2016， 19 third class A hospitals in China were collected as E. coli clinically isolated from ICU wards. Antibiotics with resistance rate of less than 40％ to E. coli and with high utilization rate in clinical practice were selected as the research objects， and a simulated drug delivery scheme was formulated. Monte Carlo simulation method was used to simulate the clinical effect of different dosage regimens on 10 000 cases among “patients with E. coli infection” in ICU wards. The target thresholds were ％fT＞MIC＞50％ （piperacillin/tazobactam， cefoperazone/sulbactam），％fT＞MIC＞40％ （meropenem）， fcmax/MIC＞10 （amikacin）. The cumulative response percentage （CFR） to the target threshold requires that CFR be greater than 90％ for the optimal regimen. The results were compared with those of 275 clinical ICU pationts. RESULTS： Four antibiotics were identified， namely cefoperazone/sulbactam， piperacillin/tazobactam， meropenem and amikacin； sixteen medication regimen were simulated， including 1 kind of cefoperazone/sulbactam “3.0 g， q8 h”； 3 kinds of piperacillin/tazobactam “2.25 g， q6 h” “3.375 g， q8 h” and “3.375 g， q6 h”； 2 kinds of meropenem “0.5 g， q8 h” “1.0 g， q8 h”； 3 kinds of amikacin “0.4 g， q24 h” “0.6 g， q24 h” and “0.8 g， q24 h”. Their CFR values were higher than 90％， all of them could be regarded as primary medication regimen. The clinical results were basically consistent with the simulation results. CONCLUSIONS： Above medication regimen of piperacillin/tazobactam， cefoperazone/sulbactam， meropenem and amikacin can be used as initial empirical drug selection for patients with E. coli infection in ICU.
ABSTRACT
Objective To optimize the antibacterial drug regimen in ICU common staphylococcal infection.Methods The pharmacokinetic and pharmacodynamic parameters of antibacterial drugs were collected in combination with the hospital ICU anti-microbial drug resistance monitoring reports from the national antimicrobial resistance investigation net (Mohnarin)of the Ministry of Health and the performance standards for antimicrobial susceptibility testing (2013)issued by the clinical and laboratory stand-ards institute (CLSI),the minimum inhibitory concentration (MIC)of staphylococci was set by using the discrete uniform distribu-tion method and 16 kinds of administration regimens with 6 antimicrobial agents were worked out.The best initially antimicrobial regimen was optimized by using the pharmacokinetic and pharmacodynamic models and Monte Carlo simulations of cumulative frac-tion of response (CFR)from 5 000 patients.Results The alternative initially drug regimens to the infectious bacteria were:linezolid 0.40 g twice daily and vancomycin 0.75 g twice daily for staphylococcus aureus;amikacin 0.60 g once daily and linezolid 0.40 g twice daily,and vancomycin 0.75 g twice daily for hemolytic staphylococci and staphylococcus epidermidis;linezolid 0.40 g twice daily and vancomycin 0.75 g twice daily for methicillin-resistant Staphylococcus aureus;ampicillin/sulbactam 1.50 g 4 times daily, cefuroxime 0.75 g 4 times daily,amikacin 0.60 g once daily,moxifloxacin 0.40 g once daily for methicillin-sensitive staphylococcus aureus.Conclusion In the Staphylococcus aureus infection occurred in ICU,if which being methicillin-sensitive could be deter-mined,ampicillin/sulbactam,cefuroxime,amikacin and moxifloxacin could be selected for treatment,and linezolid or vancomycin could be selected for treating possible methicillin-resistant Staphylococcus aureus infection or undetermined whether being methicil-lin-resistant Staphylococcus aureus infection.
ABSTRACT
Objective To investigate the analgesic and anti-inflammatory effects of Shui ethnic medicine Maguangwa .Methods Acetic acid-provoked writhing and hot plate provocation of pain were adopted to observe the analgesic effect of Shui ethnic medicine Maguangwa ,and xylene-induced ear swelling was used to observe the anti-inflammatory effect of Shui ethnic medicine Maguangwa There were five experimental groups ,i .e .,the blank control group ,the aspirin group(positive control) ,the 0 .84 g/kg Shui ethnic medicine Maguangwa group(group Ⅰ) ,the 0 .42 g/kg Shui ethnic medicine Maguangwa group(group Ⅱ ) ,and the 0 .21 g/kg Shui ethnic medicine Maguangwa group(group Ⅲ) .Results The writhing latency increased significantly and the writhing frequency de-creased significantly in the positive control group ,group Ⅰ and group Ⅱ ,when compared with the blank control group(P0 .05) .Before medica-tion the pain threshold of mice in each group differed insignificantly (P>0 .05) .At 30 min ,60 min ,90 min and 120 min after medi-cation ,the pain threshold increased significantly in the positive control group ,group Ⅰ ,and group Ⅱ ,when compared to the blank control group(P0 .05) ,or between group Ⅲ and the blank control group(P>0 .05) .When compared with the blank control group ,the right ear mass and degree of swelling decreased significantly in the positive control group ,group I and group Ⅱ (P0 .05) ,or between group Ⅲ and the blank control group(P>0 .05) .Conclusion Shui ethnic medicine Maguangwa exhibits potent analgesic and anti-inflammatory effects in a dose-dependent manner .