摘要
面临耐药性致病菌的逐年增加,新型抗菌药物亟待开发。众所周知,新药开发是一个艰难和复杂的过程。制定合理给药方案是药物开发的重要课题,而以制定抗菌药物的合理给药方案最富挑战性。近二十年来,便宜快捷的体外动力学实验和动物体内感染模型以及药效学数据处理方法不断完善,其价值在抗菌新药开发上被不断验证和肯定,弥补了临床试验所无法获得的信息。近十年来临床群体药代动力学模型和蒙地卡罗模拟结合临床前实验确定的靶值,致病菌MIC分布,利用电脑模拟比较不同给药方案的中靶率,已成为临床三期试验确定最佳给药方案行之有效的方法和针对耐药菌抗菌药物临床剂量再评价和进一步调整的科学依据。可以预期,在今后的抗菌素新药的开发上,人们将更有把握从临床前的实验数据来预计临床最佳给药方案,并优化临床试验的设计,达到既快速又经济的目的。
There is a pressing need for new antibacterial agents due to the development of drug-resistant pathogens. Unfortunately drug development is a difficult and complicated process. The traditional approach in searching for a right dose is quite empirical, both costly and time-consuming. To enhance the ability to predict the likelihood of success for lead compound selection, in vitro pharmcodynamic and in vivo animal infection models are now extensively used. The value of these pre-clinical experiments, combined with mathematical modeling, helps to identify a pharmcokinetic （PK）-pharmacodynamic （PD） exposure measure which best predicts the therapeutic efficacy, and to quantify the magnitude of this index required for in vivo efficacy. PK-PD target attainment analyses using Monte Carlo simulation to integrate interpatient variability in drug exposure （PK）, drug potency （MIC）, and in vivo exposure targets that are predictive of positive therapeutic outcomes are influencing antibacterial drug development for proof of concept, for dose and dosing interval selection, for determining susceptibility breakpoints, and for evaluating the clinical meaning of antibacterial resistance. In this article, the key concepts of antibacterial PK-PD and model based antibacterial drug development strategy and process are critically reviewed.
出处
《中国临床药理学与治疗学》
CAS
CSCD
2007年第10期1099-1113,共15页
Chinese Journal of Clinical Pharmacology and Therapeutics
关键词
药动学
药效学
抗菌素
体外动力学模型
动物模型
蒙地卡罗模拟
pharmacokinetics
pharmacodynamics
antibacterial
in vitro model
animal models
Monte Carlo simulation
model based drug development
