Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy.
Infectious Diseases Unit, L. Sacco Hospital, Milan, Italy.
Eur J Drug Metab Pharmacokinet. 2024 Mar;49(2):123-129. doi: 10.1007/s13318-024-00882-8. Epub 2024 Feb 8.
Intravenous drug users (IVDUs) face heightened susceptibility to life-threatening gram-positive bacterial infections, particularly methicillin-resistant Staphylococcus aureus (MRSA). While the standard antibiotic dosing strategies for special patients, such as obese or critically ill individuals, are known to be inadequate, raising concerns about treatment efficacy, a similar sort of understanding has not been assessed for IVDUs yet. With this in mind, this review examines the pharmacokinetic/pharmacodynamic characteristics of antibiotics commonly used against gram-positive bacteria in IVDUs. Focusing on daptomycin, vancomycin, teicoplanin, aminoglycosides, and the novel lipoglycopeptide dalbavancin, the study reveals significant pharmacokinetic variations in IVDUs, suggesting the need for personalized dosing. Concomitant opioid substitution therapy and other factors, such as malnutrition, contribute to altered pharmacokinetics/pharmacodynamics, emphasizing the importance of targeted therapeutic drug monitoring. Overall, our study calls for increased awareness among clinicians regarding the unique pharmacokinetic/pharmacodynamic challenges in IVDUs and advocates for tailored antibiotic dosing strategies to enhance treatment outcomes in this marginalized population.
静脉药物使用者（IVDUs）面临更高的生命威胁革兰氏阳性细菌感染的易感性，特别是耐甲氧西林金黄色葡萄球菌（MRSA）。虽然标准的抗生素剂量策略为特殊患者，如肥胖或危重病人，被认为是不足够的，引起了对治疗效果的关注，但对于 IVDUs 还没有类似的理解。有鉴于此，本综述检查了抗革兰氏阳性细菌抗生素在 IVDUs 中的药代动力学/药效学特征。重点介绍达托霉素、万古霉素、替考拉宁、氨基糖苷类和新型脂糖肽类药物 dalbavancin，研究揭示了 IVDUs 中存在显著的药代动力学变化，表明需要个性化剂量。同时使用阿片类药物替代疗法和其他因素，如营养不良，导致药代动力学/药效学改变，强调了靶向治疗药物监测的重要性。总的来说，我们的研究呼吁临床医生提高对 IVDUs 独特的药代动力学/药效学挑战的认识，并倡导针对该边缘化人群的抗生素剂量策略，以提高治疗效果。
