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Báo cáo y học: "Clinical review: Balancing the therapeutic, safety, and economic issues underlying effective antipseudomonal carbapenem use"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Balancing the therapeutic, safety, and economic issues underlying effective antipseudomonal carbapenem use. | Available online http ccforum.eom content 12 5 233 Review Clinical review Balancing the therapeutic safety and economic issues underlying effective antipseudomonal carbapenem use Thomas G Slama Department of Infectious Diseases Indiana University School of Medicine Indianapolis Indiana 46260 USA Corresponding author Thomas G Slama slamaidi@aol.com Published 29 October 2008 This article is online at http ccforum.com content 12 5 233 2008 BioMed Central Ltd Critical Care 2008 12 233 doi 10.1186 cc6994 Abstract Antipseudomonal carbapenems have played a useful role in our antimicrobial armamentarium for 20 years. However a review of their use during that period creates concern that their clinical effectiveness is critically dependent on attainment of an appropriate dosing range. Unfortunately adequate carbapenem dosing is missed for many reasons including benefit risk misconceptions a narrow therapeutic window for imipenem and meropenem due to an increased rate of seizures at higher doses increasingly resistant pathogens requiring higher doses than are typically given and cost containment issues that may limit their use. To improve the use of carbapenems several initiatives should be considered increase awareness about appropriate treatment with carbapenems across hospital departments determine optimal dosing regimens for settings where multidrug resistant organisms are more likely encountered use of or combination with an alternative antimicrobial agent having more favorable pharmacokinetic pharmacodynamic or adverse event profile and administer a newer carbapenem with lower propensity for resistance development for example reduced expression of efflux pumps or greater stability against carbapenemases . Introduction Antipseudomonal carbapenems have proven to be valuable in the treatment of serious Gram-negative and polymicrobial mixed aerobic and anaerobic infections. In their two-decade history imipenem and meropenem have primarily been used to treat intractable .