青霉烯类及碳青霉烯类抗生素的结构特点与分级管理建议  

Structural characteristics of penem and carbapenem antibiotics and suggestions for hierarchy management

作　　者：武明芬 赵志刚[1] WU Mingfen;ZHAO Zhigang(Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院药学部,北京100070

出　　处：《药学服务与研究》2021年第3期193-199,共7页Pharmaceutical Care and Research

基　　金：北京市卫生健康委员会抗菌药物专项项目(2020-30227);中国毒理学会临床毒理专项项目(CST2019CT302)。

摘　　要：目的:为抗菌药物的临床分级管理提供建议,促进青霉烯类和碳青霉烯类抗生素的合理使用。方法:检索国内外文献,对已经上市的青霉烯类和碳青霉烯类抗生素的结构、药理学和药动学特性、抗菌谱及临床应用等进行阐述,分析和比较不同品种的特点,提出分级管理建议。结果和结论:厄他培南具有半衰期长、对产超广谱β-内酰胺酶(ESBLs)肠杆菌科细菌杀菌作用强且不过度覆盖非发酵菌、不易产生耐药性、日均费用低等优点,正确使用在一定程度上可遏制院内细菌耐药发展,有效改善医院耐药环境。法罗培南具有口服吸收好、无肾毒性、对静止期细菌有杀灭作用、抗菌谱更广、对G+菌作用强、细菌对其不易产生耐药性和日均费用低等优势,适用于治疗社区获得性感染。建议根据青霉烯类、碳青霉烯类抗生素的结构特点和抗菌谱进行分级分类管理。将厄他培南、法罗培南作为限制使用级抗菌药物管理,以提高这两种药物临床应用的可及性,减少其他碳青霉烯类品种的使用,并降低碳青霉烯类耐药菌的产生。Objective:To provide suggestions for hierarchy management of antibiotics and promote rational use of penem and carbapenem antibiotics clinically.Methods:The structural characteristics,pharmacological properties,pharmacokinetic characteristics,antibacterial spectrum and clinical application of penem and carbapenem antibiotics on the market were described through the retrieval of both domestic and foreign literature.Then,characteristics of different varieties of antibiotics were analyzed and compared,and suggestions were proposed regarding hierarchy management.Results and Conclusion:Ertapenem has the advantages of long half-life,strong antibacterial effect on extended spectrumβ-lactamases(ESBLs)-producing Enterobacteriaceae,no overcovering non-ermentative bacteria,less susceptibility to drug resistance and lower daily cost.Proper use of ertapenem could prevent development of bacterial resistance in hospital to a certain degree and effectively improve hospital drug resistance environment.Besides,faropenem has the advantages of good oral absorption,no nephrotoxicity,fine disinfection of quiescent bacteria,broarder antibacterial spectrum,strong antibacterial effect on Gram-positive bacteria,lower susceptibility to bacteria resistance and lower average daily cost.Therefore,it is more suitable for the treatment of community-acquired infections.It is recommended that hierarchy management based on the structural characteristics and antibacterial spectrum of penem and carbapenem antibiotics be performed.Ertapenem and faropenem should be managed as restricted antibiotics,so as to improve accessibility of these two drugs in clinical treatment,reduce the use of other varieties of carbapenem antibactics and the development of carbapenem-resistant bacteria.

关 键 词：青霉烯类 碳青霉烯类 厄他培南 法罗培南 抗菌药物分级管理 

分 类 号：R978.11[医药卫生—药品] R95[医药卫生—药学]