非结核分枝杆菌感染的治疗药物监测。
Therapeutic Drug Monitoring in Non-Tuberculosis Mycobacteria Infections.
机构信息
School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Pharmacy Building (A15), Sydney, NSW, 2006, Australia.
Westmead Hospital, Westmead, NSW, Australia.
出版信息
Clin Pharmacokinet. 2021 Jun;60(6):711-725. doi: 10.1007/s40262-021-01000-6. Epub 2021 Mar 10.
Nontuberculous mycobacteria can cause minimally symptomatic self-limiting infections to progressive and life-threatening disease of multiple organs. Several factors such as increased testing and prevalence have made this an emerging infectious disease. Multiple guidelines have been published to guide therapy, which remains difficult owing to the complexity of therapy, the potential for acquired resistance, the toxicity of treatment, and a high treatment failure rate. Given the long duration of therapy, complex multi-drug treatment regimens, and the risk of drug toxicity, therapeutic drug monitoring is an excellent method to optimize treatment. However, currently, there is little available guidance on therapeutic drug monitoring for this condition. The aim of this review is to provide information on the pharmacokinetic/pharmacodynamic targets for individual drugs used in the treatment of nontuberculous mycobacteria disease. Lacking data from randomized controlled trials, in vitro, in vivo, and clinical data were aggregated to facilitate recommendations for therapeutic drug monitoring to improve efficacy and reduce toxicity.
非结核分枝杆菌可引起症状轻微的自限性感染,也可导致多器官进行性和危及生命的疾病。由于检测和流行率的增加等多种因素,这种疾病已成为一种新出现的传染病。已经发布了多项指南来指导治疗,但由于治疗的复杂性、获得性耐药的可能性、治疗的毒性以及高治疗失败率,治疗仍然很困难。鉴于治疗时间长、复杂的多药物治疗方案以及药物毒性的风险,治疗药物监测是优化治疗的一种极好方法。然而,目前针对这种情况,治疗药物监测的指导意见很少。本综述的目的是提供有关治疗非结核分枝杆菌病中使用的个别药物的药代动力学/药效学目标的信息。由于缺乏随机对照试验数据,因此汇总了体外、体内和临床数据,以提出治疗药物监测建议,以提高疗效和降低毒性。