美罗培南（Meropenem）：在重症监护患者中使用美罗培南的综述。,Drugs

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美罗培南（Meropenem）：在重症监护患者中使用美罗培南的综述。
Drugs ( IF 13.0 ) Pub Date : 2000-04-25 , DOI: 10.2165/00003495-200059030-00016
M Hurst ₁ , H M Lamb

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UNLABELLED美罗培南是一种碳青霉烯抗菌剂，对革兰氏阴性，革兰氏阳性和厌氧微生物具有抗菌活性。涉及重症监护病房（ICU）患者分离株的体外研究表明，美罗培南对大多数革兰氏阴性病原体的活性要强于其他比较品（包括亚胺培南），尽管与亚胺培南相比，美罗培南对大多数革兰氏阳性生物的活性较低。对美罗培南的抗药性在大多数细菌中并不常见。在成人和小儿ICU患者的一系列严重感染中，以美罗培南作为初始经验性单药治疗有效。就令人满意的临床和细菌学反应而言，美罗培南单药疗法在4项比较试验中与亚胺培南/西司他丁同样有效。就临床和细菌学反应而言，美罗培南单药治疗在院内下呼吸道感染（LRTIs）患者中的两项试验明显优于头孢他啶组合治疗。与基于头孢他啶的治疗相比，美洛培南对革兰氏阳性和革兰氏阴性生物的活性也更高。但是，两项针对一系列严重感染患者的研究发现，美罗培南和头孢菌素类药物治疗在临床或细菌学应答方面无显着差异。在患有严重感染的儿童的对比试验中，美罗培南与基于头孢菌素的治疗同样有效。美洛培南可以大丸剂或输液方式耐受，临床试验显示，不良事件的发生率与头孢菌素类药物相似。中枢神经系统对它的耐受性很好，很少有癫痫发作的报道，因此可以高剂量用于脑膜炎患者。与亚胺培南/西司他丁相反，与药物有关的恶心和呕吐的发生率较低，并且不会随剂量或给药速度的增加而增加。结论美洛培南是一种耐受性良好的广谱抗菌剂，当用作最初的经验性单一疗法时，与亚胺培南/西司他丁在治疗重症监护病房成人和儿童的一系列严重感染（包括医院感染）方面一样有效。与基于头孢菌素的联合治疗相比，美罗培南单药治疗可能更有效地治疗医院LRTI，并且可以用作单药治疗。美罗培南在重症监护病房成人和儿童严重感染的经验治疗中具有重要作用。

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Meropenem: a review of its use in patients in intensive care.

UNLABELLED Meropenem is a carbapenem antibacterial agent that has antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms. In vitro studies involving isolates from patients in intensive care units (ICUs) indicate that meropenem is more active against most gram-negative pathogens than other comparators (including imipenem), although, compared with imipenem, meropenem is less active against most gram-positive organisms. Resistance to meropenem is uncommon in most bacteria. Treatment with meropenem as initial empirical monotherapy was effective in a range of serious infections in adult and paediatric ICU patients. Meropenem monotherapy was as effective as imipenem/cilastatin in 4 comparative trials in terms of satisfactory clinical and bacteriological responses. Meropenem monotherapy was significantly more effective than ceftazidime-based combination treatments in 2 trials in patients with nosocomial lower respiratory tract infections (LRTIs) in terms of both clinical and bacteriological responses. Meropenem was also more active than ceftazidime-based treatments against both gram-positive and gram-negative organisms. However, 2 studies in patients with a range of serious infections found no significant differences between meropenem and cephalosporin-based treatments in terms of clinical or bacteriological response. Meropenem was also as effective as cephalosporin-based treatments in comparative trials in children with serious infections. Meropenem is well tolerated as either a bolus or an infusion, and clinical trials have shown similar incidences of adverse events to those observed with cephalosporin-based treatments. It is well tolerated by the CNS, with seizures reported infrequently, and can therefore be used at high doses and in patients with meningitis. The incidence of drug-related nausea and vomiting is low and, in contrast to imipenem/cilastatin, does not increase with dose or speed of administration. CONCLUSIONS Meropenem is a well tolerated broad spectrum antibacterial agent that, when used as initial empirical monotherapy, is as effective as imipenem/cilastatin in the treatment of a range of serious infections (including nosocomial) in adults and children in ICUs. Compared with cephalosporin-based combination treatments, meropenem monotherapy may be more effective in the treatment of nosocomial LRTIs and can be used as monotherapy. Meropenem has an important role in the empirical treatment of serious infections in adults and children in ICUs.

更新日期：2019-11-01

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