Abdul-Aziz Mohd H, Lipman Jeffrey, Mouton Johan W, Hope William W, Roberts Jason A
Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
Semin Respir Crit Care Med. 2015 Feb;36(1):136-53. doi: 10.1055/s-0034-1398490. Epub 2015 Feb 2.
The recent surge in multidrug-resistant pathogens combined with the diminishing antibiotic pipeline has created a growing need to optimize the use of our existing antibiotic armamentarium, particularly in the management of intensive care unit (ICU) patients. Optimal and timely pharmacokinetic/pharmacodynamic (PK/PD) target attainment has been associated with an increased likelihood of clinical and microbiological success in critically ill patients. Emerging data, mostly from in vitro and in vivo studies, suggest that optimization of antibiotic therapy should not only aim to maximize clinical outcomes but also to include the suppression of resistance. The development of antibiotic dosing regimens that adheres to the PK/PD principles may prolong the clinical lifespan of our existing antibiotics by minimizing the emergence of resistance. This article summarizes the relevance of PK/PD characteristics of different antibiotic classes on the development of antibiotic resistance. On the basis of the available data, we propose dosing recommendations that can be adopted in the clinical setting, to maximize therapeutic success and limit the emergence of resistance in the ICU.
近期多重耐药病原体的激增，再加上抗生素研发管线的缩减，使得优化现有抗生素武器库的使用变得愈发迫切，尤其是在重症监护病房（ICU）患者的管理中。在重症患者中，最佳且及时地达到药代动力学/药效学（PK/PD）目标与临床和微生物学成功的可能性增加相关。新出现的数据，大多来自体外和体内研究，表明抗生素治疗的优化不仅应旨在最大化临床结果，还应包括抑制耐药性。遵循PK/PD原则制定抗生素给药方案，可能通过减少耐药性的出现来延长现有抗生素的临床使用寿命。本文总结了不同抗生素类别的PK/PD特性与抗生素耐药性发展的相关性。基于现有数据，我们提出了可在临床环境中采用的给药建议，以最大化治疗成功率并限制ICU中耐药性的出现。
