Veeraraghavan Balaji, Bakthavatchalam Yamuna Devi, Soman Rajeev, Swaminathan Subramanian, Manesh Abi, Nagvekar Vasanth, Nangia Vivek
Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Med Microbiol. 2021 Jul;39(3):286-288. doi: 10.1016/j.ijmmb.2021.04.002. Epub 2021 Apr 21.
Serious infections caused by MBLs with or without OXA-48-like expressing Enterobacterales remain challenging to treat. Since aztreonam is stable to MBLs, it can be combined with ceftazidime/avibactam to protect against concurrently expressed ESBLs and class C β-lactamases in MBL pathogens. However, in the light of dose-limiting hepatotoxicity of aztreonam, short half life of avibactam, significant protein binding of aztreonam, appropriate dosing and method of administration to optimize PK/PD and toxicodynamics for this combination is being debated. Based on in-vitro PK/PD studies, simultaneous administration of 6/1.5 g of ceftazidime/avibactam and 8 g of aztreonam per day has been recently suggested.
由产MBL酶（无论是否产OXA-48样酶）的肠杆菌科细菌引起的严重感染的治疗仍然具有挑战性。由于氨曲南对MBL酶稳定，它可与头孢他啶/阿维巴坦联合使用，以抵御MBL病原体中同时表达的ESBL酶和C类β-内酰胺酶。然而，鉴于氨曲南存在剂量限制性肝毒性、阿维巴坦半衰期短、氨曲南蛋白结合率高，对于这种联合用药，如何通过适当的给药剂量和给药方法来优化药代动力学/药效学（PK/PD）及毒效动力学仍存在争议。基于体外PK/PD研究，最近有人建议每天同时给予6/1.5克头孢他啶/阿维巴坦和8克氨曲南。
