抗菌剤感受性試験結果の解釈と投与方法の問題点

概要

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In the treatment of infectious diseases, the antimicrobial susceptibility test is an important laboratory test in the selection of appropriate antimicrobial agents. In most hospitals, the antimicrobial susceptibility test is carried out by the method stipulated by NCCLS (National Committee for Clinical Laboratory Standards), a U.S. organization, and thus the standard (break point) used for interpreting the result is based on dosage regimens in that country. In the present study, we calculated time above MIC (T>MIC) for the dosage regimen indicated by Japanese drug packages inserts for ceftazidime (CAZ) and piperacillin (PIPC). T>MIC is a PK/PD parameter related to the effect of beta-lactams and is calculated using Japanese serum concentration measurement data for them. We determined that this parameter covered the full range judged by the susceptibility test to be sensitive (S) and concluded that, based on T>MIC, sufficient efficacy might not be achieved under the Japanese dosage regimen even though the result had been S in the susceptibility test. This is because there are many differences in dosage regimens between Japan and the U.S. Despite the fact that Japan has its own dosage regimens, the break point used is the one in NCCLS, which is based on dosage regimens in the U.S., and thus the results of susceptibility tests in Japan may cause susceptibility to be overestimated.
2005-11-10