急性腎損傷患者抗生素劑量調(diào)整

1、急性急性腎損傷非透析患者腎損傷非透析患者抗生素劑量的調(diào)整抗生素劑量的調(diào)整朱婷2014年8月19日簡介數(shù)據(jù)歷程榮譽對于非透析的AKIAKI患者l是否需要調(diào)整抗生素劑量？l怎樣調(diào)整劑量？ 根據(jù)抗生素PK/PD參數(shù)進行調(diào)整簡介數(shù)據(jù)歷程榮譽AKIAKI對抗生素劑量的影響l肌酐清除率CLcrl抗生素 PK參數(shù)簡介數(shù)據(jù)歷程榮譽AKIAKI患者肌酐清除率CLCLcrcrlMDRD 方程 eGFR a (ml/min/1.73 m2) = 186 Pcr - 1. 154 年齡 (歲 ) - 0. 203 女性 0. 742 lCockcroftGaultCCr（ml/min)=（男性）（140-年齡）體重(

2、kg)/72血肌酐（mg/dL) （女性）（140-年齡）體重(kg)/85血肌酐（mg/dL)lJelliffe方程Ccr(ml/min)=980.8(年齡20)(0.09女性)/Scr l尿量（僅適用于有尿患者）l新的生物標志物（需要更多證據(jù)支持）胱抑素C（CysC），尿中性粒細胞明膠酶相關(guān)載脂蛋白（NGAL）簡介數(shù)據(jù)歷程榮譽AKIAKI患者肌酐清除率CLCLcrcr簡介數(shù)據(jù)歷程榮譽抗生素PK/PDPK/PD分類時間依賴性時間依賴性且短且短PAEPAE時間依賴性時間依賴性且長且長PAEPAE濃度依賴性濃度依賴性TMICAUC/MICCmax/MIC在有效劑量內(nèi)減少單次服用劑量，增加服用次數(shù)

3、在安全劑量內(nèi)提高單次服用劑量，適當減少服用次數(shù)青霉素類-內(nèi)酰胺類大環(huán)內(nèi)酯類林可霉素類氨曲南達托霉素替加環(huán)素利奈唑胺糖肽類阿奇霉素氨基糖苷類氟喹諾酮類甲硝唑等吳偉東. 從PK/PD角度優(yōu)化抗生素治療A. 浙江省醫(yī)學會重癥醫(yī)學分會.重癥醫(yī)學十年回顧與展望2012年浙江省重癥醫(yī)學學術(shù)年會論文匯編C.浙江省醫(yī)學會重癥醫(yī)學分會:,2012:4.簡介數(shù)據(jù)歷程榮譽S. Blot et al. / Diagnostic Microbiology and Infectious Disease 79 (2014) 7784抗生素PK/PDPK/PD調(diào)整簡介數(shù)據(jù)歷程榮譽氨基糖苷類慶大霉素D. Xuan et al.

4、 International Journal of Antimicrobial Agents 23 (2004) 291295簡介數(shù)據(jù)歷程榮譽慶大霉素：45-80ml/min 7mg/kg q48h 10-30ml/min 4-7mg/kg q36h-q48h氨基糖苷： 10-30ml/min，15-30mg/kg q36h-q48h。氨基糖苷類慶大霉素簡介數(shù)據(jù)歷程榮譽喹諾酮類環(huán)丙沙星Journal of Antimicrobial Chemotherapy(2006) 58, 380386簡介數(shù)據(jù)歷程榮譽喹諾酮類環(huán)丙沙星環(huán)丙沙星，無需調(diào)整劑量。簡介數(shù)據(jù)歷程榮譽青霉素類- -哌拉西林/ /他唑

5、巴坦 Gonalves-Pereira and PvoaCritical Care2011,15:R206Beta-lactams can develop a significantly altered Vd and clearance in septic patients leading to large heterogeneity of possible concentrations 簡介數(shù)據(jù)歷程榮譽青霉素類- -哌拉西林/ /他唑巴坦 簡介數(shù)據(jù)歷程榮譽青霉素類- -哌拉西林/ /他唑巴坦 治療初始24小時內(nèi)，按照標準劑量給藥。然后再根據(jù)腎功能調(diào)整劑量。簡介數(shù)據(jù)歷程榮譽頭孢菌素類頭孢他啶，

6、頭孢吡肟ANTIMICROBIALAGENTS ANDCHEMOTHERAPY, June 2003, p. 18531861簡介數(shù)據(jù)歷程榮譽頭孢菌素類頭孢他啶，頭孢吡肟簡介數(shù)據(jù)歷程榮譽頭孢他啶、頭孢吡肟推薦劑量為：50-80mL/min 2.0 q12h 10-50mL/min 1.0 q12h MIC against susceptible organisms withMIC1 mg/L. 簡介數(shù)據(jù)歷程榮譽碳青霉烯類美羅培南inadequate antimicrobial concentrations were found in 17% of patients with AKI, whic

7、h was again defined as CLcr50 mL/min. 簡介數(shù)據(jù)歷程榮譽碳青霉烯類美羅培南Using standard non-AKIdoses in the first 24 hours of therapy. After that time, dose decreasesto appropriate renally adjusted doses should occur.簡介數(shù)據(jù)歷程榮譽替加環(huán)素Korth -Bradley et al.J Clin Pharmacol 2012;52:1379-1387 簡介數(shù)據(jù)歷程榮譽替加環(huán)素 tigecycline clearanc

8、e was reduced by about 20% resulting in an increase/optimization in AUC0-24of nearly 30%. from a pharmacokinetic point of view, no dosage adjustment based on renal function is warranted. 簡介數(shù)據(jù)歷程榮譽No dose adjustments seem necessary in case of impaired renal function.替加環(huán)素簡介數(shù)據(jù)歷程榮譽萬古霉素International Journal of Antimicrobial Agents 41 (2013) 434 438簡介數(shù)據(jù)歷程榮譽AKI患者，給予標準負荷劑量，