medicina47巻4号

2010年04月発行

今月の主題 抗菌薬の使い方を究める 各抗菌薬の特徴と使い方

カルバペネム系抗菌薬の使い方

著者： 冲中敬二¹ 大曲貴夫¹

所属機関： ¹静岡県立静岡がんセンター感染症科

ページ範囲：P.630 - P.635

ポイント

★ターゲットとする細菌を念頭に置いて使用する．

★カルバペネム系抗菌薬のスペクトラムは非常に広く，使用する際にはカバーできていない病原体を常に意識する．

★T＞MIC（time above MIC）に依存する薬剤であり，原則的には投与回数を分けたほうが治療効果を期待できる．

★基質特異性拡張型βラクタマーゼ（ESBL）産生菌や多剤耐性菌のように治療に不可欠な細菌も存在する．

★いざという時の効果を担保するためにも，乱用は避けなければならない．

参考文献

1）Mandell GL, Bennett JE, Dolin R：Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th Edition Churchill Livingstone, Philadelphia, 2010

2）Drusano GL, Craig WA：Relevance of pharmacokinetics and pharmacodynamics in the selection of antibiotics for respiratory tract infections. J Chemother 9（Suppl 3）：38-44, 1997

3）Nicolau DP：Pharmacokinetic and pharmacodynamic properties of meropenem. Clin Infect Dis 47 （Suppl 1）：S32-40, 2008

4）Zhanel GG, et al：Comparative review of the carbapenems. Drugs 67：1027-1052, 2007

5）Kotapati S, et al：Clinical and economic benefits of a meropenem dosage strategy based on pharmacodynamic concepts. Am J Health Syst Pharm 61：1264-1270, 2004

6）Li C, et al：Population pharmacokinetic analysis and dosing regimen optimization of meropenem in adult patients. J Clin Pharmacol 46：1171-1178, 2006

7）Lomaestro BM, Drusano GL：Pharmacodynamic evaluation of extending the administration time of meropenem using a Monte Carlo simulation. Antimicrob Agents Chemother 49：461-463, 2005

8）Calandra G, et al：Factors predisposing to seizures in seriously ill infected patients receiving antibiotics：experience with imipenem／cilastatin. Am J Med 84：911-918, 1988

9）Norrby SR, Gildon KM：Safety profile of meropenem：a review of nearly 5,000 patients treated with meropenem. Scand J Infect Dis 31：3-10, 1999

10）Paul M, Yahav D, Fraser A：Empirical antibiotic monotherapy for febrile neutropenia：systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 57：176-189, 2006

11）Harbarth S, et al：Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis 33：1462-1468, 2001

12）Carmeli Y, et al：Emergence of antibiotic-resistant Pseudomonas aeruginosa：comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother 43：1379-1382, 1999

13）Georges B, et al：Risk of emergence of Pseudomonas aeruginosa resistance to beta-lactam antibiotics in intensive care units. Crit Care Med 34：1636-1641, 2006

14）Pena C, et al：Effects of carbapenem exposure on the risk for digestive tract carriage of intensive care unit-endemic carbapenem-resistant Pseudomonas aeruginosa strains in critically ill patients. Antimicrob Agents Chemother 51：1967-1971, 2007

15）Owens RC Jr：An overview of harms associated with beta-lactam antimicrobials：where do the carbapenems fit in? Crit Care 12 （Suppl 4）：S3, 2008

16）Zanetti G, et al：Cefepime versus imipenem-cilastatin for treatment of nosocomial pneumonia in intensive care unit patients：a multicenter, evaluator-blind, prospective, randomized study. Antimicrob Agents Chemother 47：3442-3447, 2003

17）Edwards SJ, et al：Carbapenems versus other beta-lactams in treating severe infections in intensive care：a systematic review of randomised controlled trials. Eur J Clin Microbiol Infect Dis 27：531-543, 2008

18）Garbino J, et al：A randomized prospective study of cefepime plus metronidazole with imipenem-cilastatin in the treatment of intra-abdominal infections. Infection 35：161-166, 2007

19）Jacoby GA：AmpC beta-lactamases. Clin Microbiol Rev 22：161-182, 2009

20）Pai H, Kang CI, Byeon JH：Epidemiology and clinical features of bloodstream infections caused by AmpC-type-beta-lactamase-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 48：3720-3728, 2004

21）Goossens H, Grabein B：Prevalence and antimicrobial susceptibility data for extended-spectrum beta-lactamase-and AmpC-producing Enterobacteriaceae from the MYSTIC Program in Europe and the United States（1997-2004）. Diagn Microbiol Infect Dis 53：257-264, 2005