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评价两个常用碳青霉烯类药物亚胺培南-西司他丁、美罗培南的耐受性。两个药物中,特别是亚胺培南有潜在的神经毒性,如果相对于肾功能或体重的药物剂量过大,能引起毒性发作。亚胺培南-西司他丁的治疗是有限定的,不能达到细菌性脑膜炎的治疗所需要的剂量。另一方面,美罗培南很少引起神经毒性发作,在成人和儿童脑膜炎的3个较大的对照研究中,美罗培南耐受性和疗效是良好的,显示与头孢他啶或头孢曲松相同。相对于亚胺培南-西司他丁,美罗培南的另一个优点是可高速静脉给药,而不增加恶心和呕吐的风险。对有生命危险的感染的治疗,使用碳青霉烯类药物代替头孢菌素类药物的一个明显的原因是亚胺培南-西司他丁和美罗培南有广谱活性。
Evaluate the tolerability of two common carbapenems, imipenem-cilastatin, and meropenem. Two drugs, especially imipenem, have potential neurotoxicity and can cause toxic seizures if the drug is administered in excess of renal function or body weight. The imipenem-cilastatin treatment is limited and does not achieve the dose required for the treatment of bacterial meningitis. Meropenem, on the other hand, rarely causes neurotoxic seizures and meropenem resistance and efficacy are good in 3 larger controlled studies of meningitis in adults and children, showing the same as ceftazidime or ceftriaxone. Another advantage of meropenem relative to imipenem-cilastatin is that it can be administered intravenously at high rates without increasing the risk of nausea and vomiting. One obvious reason for the use of carbapenems in place of cephalosporins for the treatment of life-threatening infections is the broad spectrum of activity of imipenem-cilastatin and meropenem.