Dosing adjustment of antibiotics in continuous renal replacement therapy

doi:10.3877/cma.j.issn.2096-1537.2017.01.013

Abstract

Abstract:

Acute kidney injury (AKI) is one of the common clinical manifestations in severe sepsis patients, among which 6% patients may need continuous renal replacement therapy (CRRT). CRRT as well as AKI will affect the pharmacokinetics of antibiotics and eventually affect their clinical effect. The key of antibiotics utilization among those AKI patients is the choice of antibiotics typeand dose in the concern of the special pharmacokinetics.

Key words: Continuous renal replacement therapy, Antibiotics, Pharmacokinetics

Chunyao Wang, Li Weng. Dosing adjustment of antibiotics in continuous renal replacement therapy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(01): 60-64.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2017.01.013

https://icu.cma-cmc.com.cn/EN/Y2017/V03/I01/60

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References 42

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不同模式CRRT	计算公式
血液滤过（前稀释）	Q_f×S_c
血液滤过（后稀释）	Q_f×S_c×［Q_b/（Q_b＋Q_rep）］
血液透析	Q_d×S_d
血液滤过透析	（Q_f＋Q_d）×S_d

不同模式CRRT	计算公式
血液滤过（前稀释）	Q_f×S_c
血液滤过（后稀释）	Q_f×S_c×［Q_b/（Q_b＋Q_rep）］
血液透析	Q_d×S_d
血液滤过透析	（Q_f＋Q_d）×S_d

抗菌药物药代动力学类型	相关计算	给药方式
时间依赖性	清除速率=目标浓度×CL_总	根据清除速率持续泵入
浓度依赖性	清除半衰期=ln2×Vd/CL_总	清除半衰期决定给药间隔，重复给予负荷剂量
时间依赖的浓度依赖性	Cp=目标AUC₂₄/24给药间隔=负荷量/（Cp×CL_总）	根据给药间隔，给予负荷剂量

抗菌药物药代动力学类型	相关计算	给药方式
时间依赖性	清除速率=目标浓度×CL_总	根据清除速率持续泵入
浓度依赖性	清除半衰期=ln2×Vd/CL_总	清除半衰期决定给药间隔，重复给予负荷剂量
时间依赖的浓度依赖性	Cp=目标AUC₂₄/24给药间隔=负荷量/（Cp×CL_总）	根据给药间隔，给予负荷剂量

药代动力学分类	抗菌药物分类	代表药物	主要代谢途径	蛋白结合率（%）	药代动力学目标	筛选系数/饱和系数	CRRT的调整剂量	CVVHD的调整剂量
时间依赖性	青霉素类	哌拉西林-他唑巴坦	肾脏	16 （哌拉西林）	平均血药谷浓度>16 mg/L	0.2~0.4	2.250 g/6 h	（2.250~3.375）/6 h
	头孢霉素类	头孢他啶	肾脏	21	平均血药谷浓度>8 mg/L	0.5~0.9	2 g/12 h~2 g/8 h	2 g/12 h
	碳青霉烯类	亚胺培南	肾脏	2	平均血药谷浓度>2 mg/L	1.1~1.3	250 mg/6 h或500 mg/8 h	250 mg/6 h或500 mg/8 h或500 mg/6 h
	碳青霉烯类	美罗培南	肾脏	20	平均血药谷浓度>2 mg/L	1.1~1.3	1 g/12 h	1 g/12 h
浓度依赖性	氨基糖苷类	阿米卡星	肾脏	11	血药峰浓度>64 mg/L	0.8	15 mg/（kg?d）	首剂量为25 mg/kg，之后为15 mg/（kg?d）
浓度依赖性	糖肽类	万古霉素	肾脏	55	AUC/MIC≥400	0.6~0.8	1 g/d	1 g/2 d
时间依赖的浓度依赖性	多黏菌素	黏菌素	肾脏	55	NA	NA	3 MU/8 h	3 MU/8 h
	脂肽类	达托霉素	肾脏	92	AUC/MIC为100~400	0.1~0.2	4~6 mg/（kg·?2 d）	4~6 mg/（kg?2 d）
	唑烷酮类	利奈唑胺	肝脏	31	AUC/MIC>50	0.6~0.9	600 mg/12 h	600 mg/12 h

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