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
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篇名: 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
TITLE: Research advance in pharmacokinetic/pharmacodynamic characteristics and dose adjustment of ceftazidime-avibactam in special populations
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2.5g,q8h;接受CRRT患者感染敏感的菌株(即最低抑菌浓度<4mg/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1.25g,q8h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2.5g,q8h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62.5mg/kg,q8h,输注2h(单次最大剂量不超过2.5g)给药;肾功能正常或轻度损伤的3~6个月儿童按50mg/kg,q8h,输注2h给药;肥胖患者可使用常规推荐剂量2.5g,q8h,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2.5g,q8h。
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 179368757@qq.com 2.5 g, q8 h.
期刊: 2024年第35卷第16期
作者: 李光灿;张萍;郑姣妮;黄兴艳;单雪峰
AUTHORS: LI Guangcan,ZHANG Ping,ZHENG Jiaoni,HUANG Xingyan,SHAN Xuefeng
关键字: 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
KEYWORDS: ceftazidime-avibactam; pharmacokinetic; phar-
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