Pharmacokinetic evaluation of meropenem and vaborbactam for the treatment of urinary tract infection
Pharmacokinetic evaluation of meropenem and vaborbactam for the treatment of urinary tract infection
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DOI：
10.1080/17425255.2018.1511702
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发表时间：
2018-01-01
影响因子：
4.3
通讯作者：
Danziger, Larry H.
中科院分区：
文献类型：
--
作者：
Burgos, Rodrigo M.;Biagi, Mark J.;Danziger, Larry H.
简介：美罗培南/伐硼巴坦（M/V）是首个获批用于治疗复杂性尿路感染（cUTI）（包括肾盂肾炎）的碳青霉烯类和β-内酰胺酶抑制剂复方制剂。Vaborbactam是一种新型的硼酸类β-内酰胺酶抑制剂，对包括肺炎克雷伯菌碳青霉烯酶（KPC）在内的丝氨酸-内酰胺酶具有高亲和力.该复方制剂Vabomere于2017年8月获得美国食品药品监督管理局批准，用于治疗18岁或以上患者的cUTI，包括由以下易感微生物引起的肾盂肾炎：大肠埃希菌、克雷伯氏菌。涉及的领域：有关微生物学，药代动力学，药效学和临床试验评价疗效，安全性和耐受性的相关文献将被讨论。专家意见：目前的治疗选择KPC生产感染，如氨基糖苷类，多粘菌素，磷霉素，替加环素与疗效，毒性，最佳剂量和/或耐药性的发展有关。此外，还出现了对头孢他啶/阿维巴坦新复方制剂的耐药性。目前支持使用M/V治疗产生KPC的感染的临床证据仅限于一项在少数碳青霉烯类耐药肠杆菌科严重感染患者中进行的开放标签、随机化、III期研究。虽然M/V未被批准用于产生KPC的感染，但我们相信M/V将成为产生KPC的肠杆菌科感染的首选药物。
Introduction: Meropenem/vaborbactam (M/V) represents the first carbapenem and -lactamase inhibitor combination approved for treatment of complicated urinary tract infections (cUTIs), including pyelonephritis. Vaborbactam is a novel boronic acid, -lactamase inhibitor with a high affinity for serine -lactamases, including Klebsiella pneumoniae carbapenemase (KPC). This combination, Vabomere, was approved in August 2017 by the United States Food and Drug Administration for the treatment of cUTIs in patients 18years or older, including pyelonephritis, caused by the following susceptible microorganisms: Escherichia coli, K. pneumoniae, and Enterobacter cloacae species complex.Areas covered: Relevant literature regarding microbiology, pharmacokinetics, pharmacodynamics, and clinical trials evaluating efficacy, safety, and tolerability will be discussed.Expert opinion: Current treatment options for KPC-producing infections such as aminoglycosides, polymyxins, fosfomycin, and tigecycline are associated with concerns regarding efficacy, toxicities, optimal dosing, and/or development of resistance. Additionally, resistance to the new combination product of ceftazidime/avibactam has also emerged. Current clinical evidence supporting the use of M/V for KPC-producing infections is limited to an open-label, randomized, phase III study in a small number of patients with serious infections due to carbapenem-resistant Enterobacteriaceae. Although M/V is not approved for KPC-producing infections, we believe that M/V will become a preferred agent for KPC-producing Enterobacteriaceae infections.