基于药代动力学/药效学的美罗培南应用于重症感染儿童患者中提高疗效的治疗策略  

Meropenem for the pharmacological treatment of severe infection in critically ill pediatric patients:dose optimisation and therapeutic drug monitoring

作　　者：何心 刘晓艳[1] HE Xin;LIU Xiaoyan(Department of Pharmacy,Women's Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Jiangsu Province,Nanjing210004,China)

机构地区：[1]南京医科大学附属妇产医院南京市妇幼保健院临床药学科,江苏南京210004

出　　处：《中国当代医药》2022年第34期34-37,共4页China Modern Medicine

基　　金：“南京药学会—常州四药医院药学科研基金”资助项目(2018YX003)。

摘　　要：美罗培南是一种碳青霉烯类抗生素,因其具有广泛的抗菌活性、良好的组织渗透性以及安全性,常用于危重症患儿严重感染的治疗。基于药代动力学(PK)/药效学(PD),美罗培南是一种时间依赖性的抗菌药物,能够预测其抗菌效果的最佳参数是在每个给药间隔期间游离药物浓度保持在最低抑菌浓度(MIC)以上的时间占给药间隔期的百分比(%fT>MIC),因此如何达到合适的%fT>MIC是增加美罗培南的抗菌活性以及改善严重感染患儿治疗结局的关键。本文对重症感染儿童患者美罗培南的PK、药物浓度监测(TDM)以及基于PK/PD如何提高疗效等方面进行介绍。研究表明美罗培南的标准剂量方案在重症感染儿童患者中可能达不到预期的疗效,可通过增加给药剂量、延长输注时间至3或4 h以及持续24 h输注以提高%fT>MIC,从而达到理想的治疗目的。但目前大部分研究是以PK/PD为理论基础进行的PD模拟或案例报道,因此还需要更多的随机对照试验(RCT)来验证。Meropenem is a carbapenem antibiotic,and it is commonly used in critically ill pediatric patients with severe infection because of its broad antimicrobial spectrum,high penetration into tissues and favorable safety profile.Based on pharmacokinetic(PK)and pharmacodynamic(PD)of meropenem,it has a time-dependent antibacterial activity,which means the main parameter associated with therapeutic success is the percentage of time that the levels of antibiotics at the infection site exceed the minimum inhibitory concentration(MIC)(%fT>MIC)of the pathogen.Therefore,how to achieve the appropriate%fT>MIC is the key to increase the antibacterial activity of meropenem and improve the clinical outcome in critically ill pediatric patients with severe infection.The PK profile of meropenem,therapeutic drug monitoring(TDM)and dose optimisation based on PK/PD were reviewed in our paper.Recent studies have shown that the standard dose regimen of meropenem could not achieve the desired efficacy for treating severe infection in critically ill pediatric patients.Increasing the dose,extending the infusion time to 3 or 4 hours,and continuing the infusion for 24 hours could improve%fT>MIC,thus reaching the ideal therapeutic purpose.However,most of the current studies were PD simulation based on PK/PD and case reports.Therefore,these treatment strategies breakthrough the standard dose regimen should need more randomized controlled trials(RCT)to be validated.

关 键 词：美罗培南 药代动力学/药效学 重症感染 儿童患者 

分 类 号：R720.597[医药卫生—急诊医学]