f******e
发帖数: 19 | 1 大致情况： 她患了脑垂体肿瘤， 5/15的手术，术后状态非常好。5/20出现头痛，呕吐
，烦燥不安。5/21做腰穿抽出脑脊液确定高度感染 ......患者用过万古霉素，斯渥（
利奈），美平，舒普森，米诺环素（口服），头孢，氯霉素都有用过。没有效果。很明
显，患者曾经是用过很多抗生素，对多抗生素有抗药性。医生化验效果如下：
我想有价值的就是两次脑脊液细菌培养发现：鲍曼不动杆菌，并且药敏确定对：多粘菌
素E敏感。
建议用colistin sulfate. 但医生没有用过这个药物，不知道板上的医生们有什么建议
。 老人还在重症观察室，好心的医生们请帮忙。 |
a*****8
发帖数: 2115 | 2 In order to answer your questions, a more detail picture of patient is
required including body weight, height, culture data, sensitivity, MIC to
colistin, renal function, urine output as well as antibiotic history,
allergy etc. The information you provided is not enough to calculate
colistin dosing. Where is the patient? different country is using different
polymixin products. |
f******e
发帖数: 19 | 3
different
【在 a*****8 的大作中提到】
: In order to answer your questions, a more detail picture of patient is
: required including body weight, height, culture data, sensitivity, MIC to
: colistin, renal function, urine output as well as antibiotic history,
: allergy etc. The information you provided is not enough to calculate
: colistin dosing. Where is the patient? different country is using different
: polymixin products.
|
f******e
发帖数: 19 | 4 Thank you so much for your reply. Could you drop me your telephone number
and contact information so I can talk with you. I truly appreciate your help
. I am also getting the data from them to answer your question. |
f******e
发帖数: 19 | 5 肾功：肌酣偏低，25 UMOL/升
体重： 70公斤
身高： 1.55 米
抗生素的使用历史：平时使用抗生素较多，最近两个月用过：美罗培南，万古霉素，斯
渥，氯霉素，头孢，米诺环素。现在正在用的是多粘菌素E.
过敏反应: 无
每天排尿量：2900 （注射量：3400）一直以来较为正常。
多粘菌素E
最近两天不太认识自家的人。但是精神状态不算很差。COLISTIN SULFATE有了第三天，
暂时没有发现是否有起作用。要过两天化验一下才知道是否还有鲍曼。我头一起从网上
买了10支，能用10天。75MG一支，一天用一支，用量是否有点保守？
我本身是护士，从来没有听说这种药。 网上显示可以和其他抗生素合用，你的见解如
何。也看到瑞金医院的医生使用过此药，
其中7例为大剂量（9～12 g/d）单独治疗，13例分别联合米诺环素或左氧氟沙星治疗；
平均疗程（13.3±5.3）d，临床有效率50.0%，细菌清除率35.0%。10例经上述治疗无效
的患者中有5例改为注射硫酸多黏菌素E治疗，平均疗程（16.8±5.0）d，临床有效率80
.0%，细菌清除率60.0%。20例患者总临床有效率70.0%，细菌清除率50.0%，病死率30.0
%。
非常感谢！
help
【在 f******e 的大作中提到】
: Thank you so much for your reply. Could you drop me your telephone number
: and contact information so I can talk with you. I truly appreciate your help
: . I am also getting the data from them to answer your question.
|
f******e
发帖数: 19 | 6 chinese patient
【在 f******e 的大作中提到】
: 肾功：肌酣偏低，25 UMOL/升
: 体重： 70公斤
: 身高： 1.55 米
: 抗生素的使用历史：平时使用抗生素较多，最近两个月用过：美罗培南，万古霉素，斯
: 渥，氯霉素，头孢，米诺环素。现在正在用的是多粘菌素E.
: 过敏反应: 无
: 每天排尿量：2900 （注射量：3400）一直以来较为正常。
: 多粘菌素E
: 最近两天不太认识自家的人。但是精神状态不算很差。COLISTIN SULFATE有了第三天，
: 暂时没有发现是否有起作用。要过两天化验一下才知道是否还有鲍曼。我头一起从网上
|
a*****8
发帖数: 2115 | 7 please let me know the entire sensitivity patter for Acinetobacter, such
whether it is sensitive to tigecycline, what is the MIC to colistin.
Generally speaking: Acinetobacter can be treated with high dose Ampicillin/
sulbactam (it is the sulbactam component), tigecycline ( it is not
bacteremia, however recent evidence showed that tigecycline are not
recommended in critically ill patient), colistin.
So, colistin is not a unreasonable choice.
are there repeat cultures after colistin?
估计这位老人在中国，colistin的产品和产地很有关系，我们一般计量是在150-300 mg
每天，但是有效成分和厂家很有关系，所以我很难给你个准确的对或者错，尤其是我
对中国的产品不是很了解。老人的病情有没有好转？ 我不是医生，我是感染科的药剂
师。就我的经验来看，colistin 是最后一线的药物，给药计量因病人不同。
Population pharmacokinetics of colistin methanesulfonate and formed colistin
in critically ill patients from a multicenter study provide dosing
suggestions for various categories of patients.
great paper, and they have equation of how to calculate colistin dosing. Max
daily load 300 mg and maintaince dose varies from 60-400 mg daily. 需要老人
年纪，Scr, MIC to colistin。 |
f******e
发帖数: 19 | 8 Thank you so much for your quick reply. What is the MIC to colistin?
I am getting the information from the family now about the sensitivity to
tigecycline. I will get back to you soon. Thanks a million/
mg
【在 a*****8 的大作中提到】
: please let me know the entire sensitivity patter for Acinetobacter, such
: whether it is sensitive to tigecycline, what is the MIC to colistin.
: Generally speaking: Acinetobacter can be treated with high dose Ampicillin/
: sulbactam (it is the sulbactam component), tigecycline ( it is not
: bacteremia, however recent evidence showed that tigecycline are not
: recommended in critically ill patient), colistin.
: So, colistin is not a unreasonable choice.
: are there repeat cultures after colistin?
: 估计这位老人在中国，colistin的产品和产地很有关系，我们一般计量是在150-300 mg
: 每天，但是有效成分和厂家很有关系，所以我很难给你个准确的对或者错，尤其是我
|
f******e
发帖数: 19 | 9 Thank you so much for your quick reply. What is the MIC to colistin?
I am getting the information from the family now about the sensitivity to
tigecycline. I will get back to you soon. Thanks a million/
mg
【在 a*****8 的大作中提到】
: please let me know the entire sensitivity patter for Acinetobacter, such
: whether it is sensitive to tigecycline, what is the MIC to colistin.
: Generally speaking: Acinetobacter can be treated with high dose Ampicillin/
: sulbactam (it is the sulbactam component), tigecycline ( it is not
: bacteremia, however recent evidence showed that tigecycline are not
: recommended in critically ill patient), colistin.
: So, colistin is not a unreasonable choice.
: are there repeat cultures after colistin?
: 估计这位老人在中国，colistin的产品和产地很有关系，我们一般计量是在150-300 mg
: 每天，但是有效成分和厂家很有关系，所以我很难给你个准确的对或者错，尤其是我
|
f******e
发帖数: 19 | 10 Hi,
我妈所在的医院对她脑脊液里的鲍曼做了三次药敏，都是对多粘菌素E敏感 。
OLISTIN是德国公司在希腊生产的药物。age is 61.
Thank you so much. I am looking forward to your reply.
【在 f******e 的大作中提到】
: Thank you so much for your quick reply. What is the MIC to colistin?
: I am getting the information from the family now about the sensitivity to
: tigecycline. I will get back to you soon. Thanks a million/
:
: mg
|
s**********t
发帖数: 217 | 11 tigecycline is a bacteriostatic drug. Should be avoid in CNS infection if we
can.
You need to ask micro lab to do colistin MIC specifically. Even in USA.
【在 f******e 的大作中提到】
: Hi,
: 我妈所在的医院对她脑脊液里的鲍曼做了三次药敏，都是对多粘菌素E敏感 。
: OLISTIN是德国公司在希腊生产的药物。age is 61.
: Thank you so much. I am looking forward to your reply.
|
a*****8
发帖数: 2115 | 12 Totally, you will need to know MIC (minimum inhibitory concentration) of
Acinetobactor to colistin. Also colistin is a prodrug, with a very good
renal function, you might not achieve adequate serum concentration
especially in CNS.
Also, what is Serum creatinine?
Colistin dosing is always a controversial topic. Even in US, it is not seen
commonly.
Honestly, at this point, it is difficult to provide a dose.
With current dose, how is patient doing?
Also, in US, colistin product is colistin sodium where you mentioned you are
using colistin sulfate. I am not very familiar with the pharmacokinetics of
colistin sulfate. You may need to find some european data to support the
dosing of colistin sulfate.
we
【在 s**********t 的大作中提到】
: tigecycline is a bacteriostatic drug. Should be avoid in CNS infection if we
: can.
: You need to ask micro lab to do colistin MIC specifically. Even in USA.
|
