特殊人群中头孢他啶-阿维巴坦的PK/PD特性及剂量调整研究进展
Research advance in pharmacokinetic/pharmacodynamic characteristics and dose adjustment of ceftazidime-avibactam in special populations
李光灿 1张萍 2郑姣妮 2黄兴艳 1单雪峰2
作者信息
- 1. 重庆市开州区人民医院药学部,重庆 405400
- 2. 重庆医科大学附属璧山医院药学部,重庆 402760
- 折叠
摘要
头孢他啶-阿维巴坦(CAZ/AVI)是一种新型β-内酰胺类抗菌药物,具有广谱抗菌活性和良好的耐受性.特殊人群[包括肾功能亢进(ARC)患者、接受连续性肾脏替代治疗(CRRT)患者、新生儿及儿童、肥胖患者、行体外膜肺氧合(ECMO)患者、老年患者、肝功能受损患者]的生理病理差异,可能影响CAZ/AVI的药代动力学(PK)特性,导致治疗失败.目前关于CAZ/AVI在特殊人群中的剂量调整缺乏相应的指南或共识.本文综述了CAZ/AVI在特殊人群中的PK/药效动力学(PD)特性及剂量调整的相关研究,推荐CAZ/AVI的给药剂量为:ARC患者使用常规推荐剂量2.5 g,q8 h;接受CRRT患者感染敏感的菌株(即最低抑菌浓度＜4 mg/L)且感染部位为血流或尿路等亲水性抗菌药物分布较好的部位时,采用1.25 g,q8 h的给药方案;接受CRRT患者感染不太敏感的菌株或药物分布稍差的部位时,可采用2.5 g,q8 h或持续输注的给药方案;肾功能正常或轻度损伤的6个月～＜18岁儿童按62.5 mg/kg,q8 h,输注2 h(单次最大剂量不超过2.5 g)给药;肾功能正常或轻度损伤的3～6个月儿童按50 mg/kg,q8 h,输注2 h给药;肥胖患者可使用常规推荐剂量2.5 g,q8 h,建议行治疗药物监测;行ECMO患者、老年患者及肝功能损伤患者,也可使用常规推荐剂量2.5 g,q8 h.
Abstract
Ceftazidime-avibactam(CAZ/AVI)is a novel β-lactam antibiotic with broad-spectrum antibacterial activity and good tolerability.However,the physiological and pathological differences in special populations[e.g.augmented renal clearance(ARC)patients,undergoing continuous renal replacement therapy(CRRT)patients,neonates and children,obese patients,undergoing extracorporeal membrane oxygenation(ECMO)patients,elderly patients and liver dysfunction patients]may affect the pharmacokinetic(PK)properties of CAZ/AVI,leading to treatment failure.At present,there is currently a lack of corresponding guidelines or consensus on dose adjustment of CAZ/AVI in special populations.This article summarizes the research on PK/pharmacodynamic(PD)characteristics and dose adjustment of CAZ/AVI in special populations and recommends the following dosing regimens:for ARC patients,the recommended dose is 2.5 g,q8 h;for undergoing CRRT patients with infections caused by sensitive strains(i.e.MIC＜4 mg/L)and infections at sites where hydrophilic antibiotics distribute well,a dose of 1.25 g,q8 h may be used;for undergoing CRRT patients with less sensitive strains or sites with poorer drug distribution,a dose of 2.5 g,q8 h or continuous infusion may be considered;for children aged 6 months to＜18 years with normal or mildly impaired renal function,a dose of 62.5 mg/kg,q8 h is infused for 2 h(maximum dose not exceeding 2.5 g per dose);for infants aged 3～6 months with normal or mildly impaired renal function,a dose of 50 mg/kg,q8 h is infused for 2 h;for obese patients,the recommended dose is 2.5 g,q8 h,with therapeutic drug monitoring recommended;undergoing ECMO patients,elderly patients,and those with impaired liver function may also use the recommended dose of 2.5 g,q8 h.
关键词
头孢他啶-阿维巴坦/药代动力学/药效动力学/特殊人群/肾功能异常Key words
ceftazidime-avibactam/pharmacokinetic/phar-macodynamic/special populations/renal dysfunction引用本文复制引用
基金项目
重庆市科卫联合医学科研项目(No.2021MSXM070)
重庆市璧山区社会民生领域科技计划项目(No.BSKJ2023019)
出版年
2024
国家科技期刊平台
NSTL
万方数据