β-lactam類抗生素延長輸注方式之簡介

Introduction of β-lactam Antibiotics Extended Infusion

細菌導致疾病，疾病造成死亡。重症醫療與細菌的戰鬥，是一場永無止境的戰爭。抗生素的近代發展腳步緩慢，故應致力於使現有抗生素達到最佳的治療效果。廣效的乙內醯胺（β-lactam）類抗生素常被用為重症病人的經驗療法，文獻指出β-lactam類抗生素屬時間依賴型抗生素，將此類抗生素給藥的輸注時間拉長，可達到較佳的藥品動態學及效用學、進而降低死亡率、增加臨床治癒率；再者，延長輸注給藥方式也可降低給藥頻次，減少護理師勞動或節省藥費成本。在實際操作延長輸注給藥時，須仰賴護理師確認藥品安定性、併用藥品的相容性及輸注管路的殘存藥量等注意事項以避免影響藥效。本文藉由文獻回顧了解既有β-lactam類抗生素改變為延長輸注所帶來的諸多成效，提出實際操作相關注意事項，期使β-lactam類抗生素延長輸注成為重症醫療對抗細菌的重要策略。

Bacterial infection leads to severe sepsis, which may result in death. Therefore, the struggle between intensivists and bacteria is endless. Moreover, the development of new antibacterial agents has slackened consistently in the recent years. Therefore, we must optimize the use of antibiotics. Nowadays, the broad-spectrum β-lactams are being widely used as empirical therapy in critical care. Because of their time-dependent killing characteristic, extending the infusion time of β-lactams may help in achieving better pharmacodynamic results. A related series of studies shows that extended infusion of β-lactams can decrease mortality rate and increase clinical cure rate. Additionally, extended infusion can reduce the dosing frequency, thereby lessening the cost of nursing labor and drugs. In clinical practice, factors such as the stability of β-lactams, compatibility of concurrent drugs, and the residual volume in the pipeline should be considered to prevent treatment failure. This article not only provides the rationale and evidence for extended infusion of β-lactams, but also discusses the factors to be considered when implementing the protocol of extended infusion of β-lactams.