醫學專欄 抗MRSA 靜脈注射藥物治療簡介

1 113 MRSA(Methicillin-resistant Staphylococcus aureus) MRSA(Methicillin-resistant Staphylococcus aureus) / MRSA (Methicillin-resistant Staphylococcus aureus) -lactam penicillins (methicillin, dicloxacillin, nafcillin, oxacillin aminopenicillin) cephalosporins erythromycin fluoroquinolone , MRSA ( ) ( fluoroquinolones) (invasive MRSA infection) 2005 MRSA 94,360 18,650 85% ( ) 14% MRSA MRSA Vancomycin, Teicoplanin, Linezolid, Daptomycin, Tigecycline V ancomycinVancomycin MRSA Vancomycin glycopeptide Vancomycin 1L/kg 25% Vancomycin 114 JOURNAL OF KAOHSIUNG MEDICAL ASSOCIATION 2012.

2 , (MIC) vancomycin MIC 2mcg/ml MRSA vancomycin vancomycin MIC 1mcg/ml vamcomycin MRSA Vancomycin 15-20mg/kg/12hr : vancomycin (trough) Trough MIC MIC Trough 10mcg/ml MRSA trough 15 20mcg/ml (peak) (trough) vancomycin : MRSA Vancomycin : T eicoplaninTeicoplanin vancomycin glycopepetide vancomycin vancomycin vancomycin Teicoplanin vancomycin vancomycin Teicoplanin LinezolidLinezolid oxazolidinone 50s 115 MRSA vancomycin MRSA Linezolid MRSA linezolid vancomycin MRSA linezolid vancomycin linezolid MRSA Linezolid 100% 30 50 vancomycin Linezolid CYP450 (31%) Linezolid (SSRI)

3 (TCA) 600mg q12h Linezolid Linezolid Linezolid DaptomycinDaptomycin lipopeptide Daptomycin MRSA, VRSA, VRE, PNSSP daptomycin MRSA daptomycin MRSA vancomycin daptomycin Daptomycin MRSA daptomycin Daptomycin ( ) MRSA(Methicillin-resistant Staphylococcus aureus) 116 JOURNAL OF KAOHSIUNG MEDICAL ASSOCIATION 2012. , 6% daptomycin Daptomycin 6mg/kg/day 4mg/kg/day CCr 30ml/min Daptomycin CYP450 Statins Daptomycin Creatine phosphokinase ( ) ( ) Statin T igecyclineTigecycline glycylcycline minocycline 30s Tigecycline Tigecycline MIC tigecycline Tigecycline Tigecycline Tigecycline (68%)

4 Tigecycline 30% (Child-Pugh C) 100mg 12 50mg Tigecycline Tigecycline 117 warfarin INR MRSA :1. , , (2010)2. F. Kate Gould1, Richard Brindle, Paul R. Chadwick: Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom. Journal of Antimicrobial Chemotherapy (2009) 63, 849 8613. Kenny MT, Dulworth JK, & Brackman MA: Comparative in vitro activity of teicoplanin and vancomycin against United States teicoplanin clinical trial isolates of gram-positive cocci.

5 Diag Microbiol Infect Dis 1991; 4 Weigelt J, Itani K, Stevens D, et al: Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrob Agents Chemother 2005; 49(6) Wunderink RG, Cammarata SK, Oliphant TH, et al: Continuation of a randomized, double-blind, multicenter study of linezolid versus vancomycin in the treatment of patients with nosocomial pneumonia. Clin Ther 2003; 25(3) Fowler VG, Boucher HW, Corey GR, et al: Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med 2006; 355(7) Sharma M; Riederer K; Chase P; Khatib R : High rate of decreasing daptomycin susceptibility during the treatment of persistent Staphylococcus aureus bacteremia : Eur J Clin Microbiol Infect Dis. 2008 Jun;27(6):433-7. Epub 2008 Jan 23. MRSA(Methicillin-resistant Staphylococcus aureus)