Research advance in pharmacokinetic/pharmacodynamic characteristics and dose adjustment of ceftazidime-avibactam in special populations
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.
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