优化针对成年囊性纤维化患者铜绿假单胞菌的β-内酰胺类药物动力学
Optimizing beta-lactam pharmacodynamics against Pseudomonas aeruginosa in adult cystic fibrosis patients.
作者信息
Thompson R Zachary, Martin Craig A, Burgess Donna R, Rutter W Cliff, Burgess David S
机构信息
University of Kentucky HealthCare, Lexington, KY 40508, United States; University of Kentucky College of Pharmacy, Lexington, KY 40536,United States.
University of Kentucky College of Pharmacy, Lexington, KY 40536,United States.
出版信息
J Cyst Fibros. 2016 Sep;15(5):660-3. doi: 10.1016/j.jcf.2016.04.002. Epub 2016 May 4.
BACKGROUND
Patients with cystic fibrosis (CF) exhibit increased clearance of beta-lactams. The purpose of this study was to predict the probability of beta-lactam target attainment (PTA) against Pseudomonas aeruginosa in adult CF patients based on local microbiological data.
METHODS
CF-specific pharmacokinetic parameters were obtained from published data for aztreonam, cefepime, ceftazidime, meropenem and piperacillin-tazobactam. Pharmacodynamic modeling was used to determine the PTA for bolus, prolonged infusion, and continuous infusion regimens.
RESULTS
Prolonged infusion of meropenem 2g every 8h performed the best among all regimens tested, with a PTA of 83%. The PTA was increased with both prolonged and continuous infusion; however, no regimen reached the target PTA of >90% against P. aeruginosa in CF patients at our institution.
CONCLUSIONS
Prolonged and continuous infusion provided higher PTA than bolus for all regimens. Further investigation of novel regimens in CF patients is needed.
背景
囊性纤维化（CF）患者体内β-内酰胺类药物清除率增加。本研究旨在基于当地微生物学数据预测成年CF患者针对铜绿假单胞菌的β-内酰胺类药物达标概率（PTA）。
方法
从已发表的数据中获取氨曲南、头孢吡肟、头孢他啶、美罗培南和哌拉西林-他唑巴坦的CF特异性药代动力学参数。采用药效学模型确定静脉推注、延长输注和持续输注方案的PTA。
结果
在所有测试方案中，每8小时静脉输注2g美罗培南的延长输注方案效果最佳，PTA为83%。延长输注和持续输注均可提高PTA；然而，在我们机构，没有一种方案在CF患者中针对铜绿假单胞菌达到>90%的目标PTA。
结论
对于所有方案，延长输注和持续输注比静脉推注提供更高的PTA。需要对CF患者的新方案进行进一步研究。
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