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比阿培南药动学/药效学和治疗药物监测的研究进展
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| 篇名： | 比阿培南药动学/药效学和治疗药物监测的研究进展 |
| TITLE： | Research progress in pharmacokinetics/pharmacodynamics and therapeutic drug monitoring of biapenem |
| 摘要： | 比阿培南是一种碳青霉烯类抗菌药物，用于治疗败血症、肺炎、肺脓肿、慢性呼吸道病变继发感染、复杂尿路感染、肾盂肾炎等疾病。本文对比阿培南药动学、药效学和治疗药物监测（TDM）方面的研究进行了综述，发现该药的药动学参数在健康受试者中无明显差异，多次给药无蓄积，但在重症患者以及肾功能异常患者中的药动学参数与健康受试者相比存在较大差异，导致常规治疗方案不能达到预期效果。在药效学方面，可通过增加给药频次、延长滴注时间来提高该药靶目标值的达标率；对于终末期肾病无尿患者的给药，可以延长间隔时间以避免药物蓄积；但对于重症感染患者，每日1.2g的剂量仍不能很好地控制鲍曼不动杆菌、铜绿假单胞菌引起的感染，这限制了其在重症患者中的应用。建议在重症或肾功能异常患者中对该药实施TDM并结合药动学模型探索最佳的给药方案，以保证该药游离血药浓度保持在最低抑菌浓度以上的时间占给药间隔时间的百分比（%fT＞MIC）在有效范围内，使该药在重症或肾功能异常患者中发挥更大疗效；对于无法进行TDM的医疗机构，可通过增加给药频次和延长滴注时间来使该药疗效最大化；针对耐药率较高的铜绿假单胞菌、鲍曼不动杆菌及黏质沙雷菌引起的感染，可联合或者更换其他抗菌药物进行治疗。 |
| ABSTRACT： | Biapenem is a carbapenem antibiotic， and can be used for the treatment of sepsis， pneumonia， lung abscess， chronic respiratory lesions secondary infection， complex urinary tract infection and pyelonephritis， etc. This article reviewed the studies on the pharmacokinetics， pharmacodynamics and therapeutic drug monitoring （TDM） of biapenem. The pharmacokinetic parameters of biapenem are not significantly different in healthy subjects， and there is no accumulation after multiple doses of biapenem. However， there are large differences in pharmacokinetic parameters in patients with severe disease and patients with abnormal renal function compared with healthy subjects， which leads to conventional treatment regimens not achieving the desired outcome. In terms of pharmacodynamics， biapenem can improve the rate of reaching the target value by increasing the frequency of administration and prolonging the infusion time. For patients with anuria in end-stage renal disease， dosing intervals can be extended to avoid drug accumulation. However, for patients with severe infection, a daily dose of 1.2 g still can not control infections caused by Acinetobacter baumannii or Pseudomonas aeruginosa, which limits its use in patients with severe disease. It is recommended to implement TDM in severe patients and patients with abnormal renal function， and explore the best dosing regimen for biapenem in combination with pharmacokinetic models to ensure that the time that the free blood concentration of biapenem remains above minimum inhibitory concentration as a percentage of the time between doses （%fT＞MIC） is within the effective range，so that biapenem can exert a greater efficacy in severe patients and patients with abnormal renal function. For medical institutions that cannot carry out TDM， the efficacy of biapenem can be maximized by increasing the frequency of administration and prolonging the infusion time. For infections caused by P. aeruginosa， A. baumannii and Serratia marcescens with high drug resistance rates， it is recommended to combine or replace other antibiotics. |
| 期刊： | 2023年第34卷第15期 |
| 作者： | 陶兴隆；张宇；武玺坤；马晓松；张甜甜；吴瑕；董维冲；宋宁；张志清 |
| AUTHORS： | TAO Xinglong，ZHANG Yu， WU Xikun，MA Xiaosong，ZHANG Tiantian，WU Xia，DONG Weichong，SONG Ning，ZHANG Zhiqing |
| 关键字： | 比阿培南；药动学；药效学；治疗药物监测 |
| KEYWORDS： | biapenem；pharmacokinetics； pharmacodyna- |
| 阅读数： | 113 次 |
| 本月下载数： | 9 次 |
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