Карбапенемы через 20 лет после открытия: современные микробиологические и клинические аспекты

Клиническая Микробиология и Антимикробная Химиотерапия. 2007; 9(2):133-152

​ Галкин Д.В.
имипенем меропенем эртапенем резистентность нозокомиальные инфекции
Раздел
Антимикробные препараты
Тип
Журнальная статья
Публикация
Клиническая Микробиология и Антимикробная Химиотерапия. 2007; 9(2):133-152

Аннотация

Карбапенемы — это один из важнейших классов антибиотиков, сочетающий исключительно широкий спектр in vitro активности, низкую токсичность и благоприятные фармако­кинетические параметры. Спектр активности имипенема, меропенема и относительно нового дорипенема включает большинство грам(+), грам(-) аэробов и анаэробов, за исключением метициллинорезистентных штаммов Staphylococcus aureus, Stenotrophomonas maltophilia и большинства штаммов Enterococcus faecium. По сравнению с этими карбапенемами, эртапенем не действует на неферментирующие грамотрицательные бактерии и энтерококки. Тем не менее, эртапенем имеет период полувыведения около 4 часов, что позволяет назначать его один раз в сутки. Эффективность имипенема и меропенема изучена в большом количестве рандомизированных клинических исследований при лечении тяжёлых инфекций различной локализации, включая сепсис и нейтропеническую лихорадку, поэтому эти препараты во всём мире применяют для терапии тяжёлых и среднетяжёлых нозокомиальных инфекций и инфекций, вызванных полимикробной флорой. Спектр антибактериальной активности и фармакокинетические параметры эртапенема обуславливают его использование для лечения тяжёлых внебольничных инфекций и, в ряде случаев, проведения амбулаторной внутривенной антимикробной терапии. Несмотря на завершение III фазы клинических исследований дорипенема, необходимо дальнейшее изучение клинической эффективности и безопасности при различных инфекциях. На рынках некоторых азиатских стран (Япония, Китай, Корея) зарегистрированы такие карбапенемы как панипенем, биапенем и пероральный пенем фаропенем; тебипенем проходит II фазу клинических исследований в Японии.

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