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Research advance in pharmacokinetic/pharmacodynamic characteristics and dose adjustment of ceftazidime-avibactam in special populations
- ZHONGGUO YAOFANG Vol. 35, Issue 16, Pages: 2055-2060(2024)
- 作者机构：
1.重庆市开州区人民医院药学部，重庆 405400
2.重庆医科大学附属璧山医院药学部，重庆 402760
- 作者简介：
- 基金信息：
DOI：10.6039/j.issn.1001-0408.2024.16.21
CLC： R978.1;R969.3Published：30 August 2024，
Received：21 March 2024，
Revised：02 August 2024，
- 稿件说明：
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李光灿,张萍,郑姣妮等.特殊人群中头孢他啶-阿维巴坦的PK/PD特性及剂量调整研究进展 Δ[J].中国药房,2024,35(16):2055-2060.
LI Guangcan,ZHANG Ping,ZHENG Jiaoni,et al.Research advance in pharmacokinetic/pharmacodynamic characteristics and dose adjustment of ceftazidime-avibactam in special populations[J].ZHONGGUO YAOFANG,2024,35(16):2055-2060.
李光灿,张萍,郑姣妮等.特殊人群中头孢他啶-阿维巴坦的PK/PD特性及剂量调整研究进展 Δ[J].中国药房,2024,35(16):2055-2060. DOI： 10.6039/j.issn.1001-0408.2024.16.21.
LI Guangcan,ZHANG Ping,ZHENG Jiaoni,et al.Research advance in pharmacokinetic/pharmacodynamic characteristics and dose adjustment of ceftazidime-avibactam in special populations[J].ZHONGGUO YAOFANG,2024,35(16):2055-2060. DOI： 10.6039/j.issn.1001-0408.2024.16.21.
摘要
头孢他啶-阿维巴坦（CAZ/AVI）是一种新型
β
-内酰胺类抗菌药物，具有广谱抗菌活性和良好的耐受性。特殊人群[包括肾功能亢进（ARC）患者、接受连续性肾脏替代治疗（CRRT）患者、新生儿及儿童、肥胖患者、行体外膜肺氧合（ECMO）患者、老年患者、肝功能受损患者
]
的生理病理差异，可能影响CAZ/AVI的药代动力学（PK）特性，导致治疗失败。目前关于CAZ/AVI在特殊人群中的剂量调整缺乏相应的指南或共识。本文综述了CAZ/AVI在特殊人群中的PK/药效动力学（PD）特性及剂量调整的相关研究，推荐CAZ/AVI的给药剂量为：ARC患者使用常规推荐剂量2.5 g，q8 h；接受CRRT患者感染敏感的菌株（即最低抑菌浓度＜4 mg/L）且感染部位为血流或尿路等亲水性抗菌药物分布较好的部位时，采用1.25 g，q8 h的给药方案；接受CRRT患者感染不太敏感的菌株或药物分布稍差的部位时，可采用2.5 g，q8 h或持续输注的给药方案；肾功能正常或轻度损伤的6个月～＜18岁儿童按62.5 mg/kg，q8 h，输注2 h（单次最大剂量不超过2.5 g）给药；肾功能正常或轻度损伤的3～6个月儿童按50 mg/kg，q8 h，输注2 h给药；肥胖患者可使用常规推荐剂量2.5 g，q8 h，建议行治疗药物监测；行ECMO患者、老年患者及肝功能损伤患者，也可使用常规推荐剂量2.5 g，q8 h。
Abstract
Ceftazidime-avibactam （CAZ/AVI）is a novel
β
-lactam antibiotic with broad-spectrum antibacterial activity and good tolerability. However， the physiological and pathological differences in special populations [e.g. augmented renal clearance （ARC） patients， undergoing continuous renal replacement therapy （CRRT） patients， neonates and children， obese patients， undergoing extracorporeal membrane oxygenation （ECMO） patients， elderly patients and liver dysfunction patients
]
may affect the pharmacokinetic （PK） properties of CAZ/AVI， leading to treatment failure. At present， there is currently a lack of corresponding guidelines or consensus on dose adjustment of CAZ/AVI in special populations. This article summarizes the research on PK/pharmacodynamic （PD） characteristics and dose adjustment of CAZ/AVI in special populations and recommends the following dosing regimens： for ARC patients， the recommended dose is 2.5 g， q8 h； for undergoing CRRT patients with infections caused by sensitive strains （i.e. MIC＜4 mg/L） and infections at sites where hydrophilic antibiotics distribute well， a dose of 1.25 g， q8 h may be used； for undergoing CRRT patients with less sensitive strains or sites with poorer drug distribution， a dose of 2.5 g， q8 h or continuous infusion may be considered； for children aged 6 months to ＜18 years with normal or mildly impaired renal function， a dose of 62.5 mg/kg， q8 h is infused for 2 h （maximum dose not exceeding 2.5 g per dose）； for infants aged 3～6 months with normal or mildly impaired renal function， a dose of 50 mg/kg， q8 h is infused for 2 h； for obese patients， the recommended dose is 2.5 g， q8 h， with therapeutic drug monitoring recommended； undergoing ECMO patients， elderly patients， and those with impaired liver function may also use the recommended dose of 2.5 g， q8 h.
关键词
头孢他啶-阿维巴坦药代动力学药效动力学特殊人群肾功能异常
Keywords
pharmacokineticphar-macodynamicspecial populationsrenal dysfunction
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