Efficacy and safety of intravenous meropenem and tobramycin versus ceftazidime and tobramycin in cystic fibrosis
Efficacy and safety of intravenous meropenem and tobramycin versus ceftazidime and tobramycin in cystic fibrosis
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DOI：
10.1016/j.jcf.2007.07.001
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发表时间：
2008-03-01
影响因子：
5.2
通讯作者：
Griese, Matthias
中科院分区：
文献类型：
--
作者：
Latzin, Philipp;Fehling, Maya;Griese, Matthias
背景：囊性纤维化以慢性细菌性支气管-肺部感染为特征。尽管静脉(IV)抗生素治疗被认为是CF的标准治疗方法，但比较不同抗生素化合物的随机试验很少。方法：我们报道了一项前瞻性的多中心干预试验，静脉注射美罗培南(120 mg/kg/d)或静脉注射头孢他啶(200-400 mg/kg/d)，每种药物与静脉注射妥布霉素(9-12 mg/kg/d)联合使用。观察肺功能、痰微生物负荷和血液炎症标志物的变化。结果：入选118例(59/59)患者，其中首次铜绿假单胞菌感染6例，急性肺加重34例，慢性铜绿假单胞菌定植抑制治疗78例。两种治疗方法均可改善肺功能指标、痰细菌负荷和C反应蛋白水平，但两组间无差异。美罗培南/妥布霉素组患者碱性磷酸酶显著升高(p<；0.0001)。结论：在肺功能、痰微生物负荷和全身炎症状态方面，美罗培南/妥布霉素组与头孢他啶/妥布霉素组疗效相当。在静脉注射治疗期间，应仔细监测肝胆功能，这对既往有肝病的慢性肝病患者可能很重要。C)2007年欧洲囊性纤维化协会。爱思唯尔出版，版权所有。
Background: Cystic fibrosis (CF) is characterized by chronic bacterial broncho-pulmonary infection. Although intravenous (IV) antibiotic therapy is regarded as standard treatment in CF, only few randomised trials comparing different antibiotic compounds exist.Methods: We report on a prospective multicenter interventional trial of IV meropenem (120 mg/kg/day) or IV ceftazidime (200-400 mg/kg/ day), each administered together with IV tobramycin (9-12 mg/kg/day). Outcome measures were changes in lung function, microbiological sputum burden and blood inflammatory marker. Liver and renal function values were measured to assess safety.Results: One hundred eighteen patients (59/59) were included into the study with the following indications: first infection of P aeruginosa (n=6), acute pulmonary exacerbation (n 34) and suppression therapy of chronic R aeruginosa colonization (n=78). Both treatments improved lung function measures, bacterial sputum burden and CRP levels with no differences between treatment groups observed. A significant higher elevation for alkaline phosphatase (p < 0.0001) was observed for patients in the meropenem/tobramycin group.Conclusions: IV antibiotic therapy in CF patients with meropenem/tobramycin is as effective as with ceftazidime/tobramycin regarding lung function, microbiological sputum burden and systemic inflammatory status. Hepato-biliary function should be monitored carefully during IV treatment, possibly important in CF patients with pre-existing liver disease. C) 2007 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.