Butranova Olga I, Ushkalova Elena A, Zyryanov Sergey K, Chenkurov Mikhail S
Department of General and Clinical Pharmacology, Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya St. 6, 117198 Moscow, Russia.
State Budgetary Institution of Healthcare of the City of Moscow "City Clinical Hospital No. 24 of the Moscow City Health Department", Pistzovaya Srt. 10, 127015 Moscow, Russia.
Biomedicines. 2023 Mar 17;11(3):940. doi: 10.3390/biomedicines11030940.
Neonatal Infections are among the most common reasons for admission to the intensive care unit. Neonatal sepsis (NS) significantly contributes to mortality rates. Empiric antibiotic therapy of NS recommended by current international guidelines includes benzylpenicillin, ampicillin/amoxicillin, and aminoglycosides (gentamicin). The rise of antibacterial resistance precipitates the growth of the use of antibiotics of the Watch (second, third, and fourth generations of cephalosporines, carbapenems, macrolides, glycopeptides, rifamycins, fluoroquinolones) and Reserve groups (fifth generation of cephalosporines, oxazolidinones, lipoglycopeptides, fosfomycin), which are associated with a less clinical experience and higher risks of toxic reactions. A proper dosing regimen is essential for effective and safe antibiotic therapy, but its choice in neonates is complicated with high variability in the maturation of organ systems affecting drug absorption, distribution, metabolism, and excretion. Changes in antibiotic pharmacokinetic parameters result in altered efficacy and safety. Population pharmacokinetics can help to prognosis outcomes of antibiotic therapy, but it should be considered that the neonatal population is heterogeneous, and this heterogeneity is mainly determined by gestational and postnatal age. Preterm neonates are common in clinical practice, and due to the different physiology compared to the full terms, constitute a specific neonatal subpopulation. The objective of this review is to summarize the evidence about the developmental changes (specific for preterm and full-term infants, separately) of pharmacokinetic parameters of antibiotics used in neonatal intensive care units.
新生儿感染是入住重症监护病房最常见的原因之一。新生儿败血症（NS）显著导致死亡率上升。当前国际指南推荐的NS经验性抗生素治疗包括苄青霉素、氨苄西林/阿莫西林和氨基糖苷类（庆大霉素）。抗菌药物耐药性的增加促使了观察类（第二代、第三代和第四代头孢菌素、碳青霉烯类、大环内酯类、糖肽类、利福霉素类、氟喹诺酮类）和储备类（第五代头孢菌素、恶唑烷酮类、脂糖肽类、磷霉素）抗生素使用的增长，这些抗生素临床经验较少且毒性反应风险较高。合适的给药方案对于有效且安全的抗生素治疗至关重要，但在新生儿中选择给药方案很复杂，因为影响药物吸收、分布、代谢和排泄的器官系统成熟度差异很大。抗生素药代动力学参数的变化会导致疗效和安全性改变。群体药代动力学有助于预测抗生素治疗的结果，但应考虑到新生儿群体是异质性的，这种异质性主要由胎龄和出生后年龄决定。早产儿在临床实践中很常见，由于其生理与足月儿不同，构成了一个特殊的新生儿亚群体。本综述的目的是总结关于新生儿重症监护病房使用的抗生素药代动力学参数发育变化（分别针对早产儿和足月儿）的证据。
