ICU抗菌藥物用藥劑量不足風(fēng)險(xiǎn)研討新

1、ICU抗菌藥物用藥劑量不足風(fēng)險(xiǎn)研討新 VPA 1.2g/d，3d后，VPA 39.91 更改至1.6g/d，7d后，VPA 19.32 （ VAP 達(dá)標(biāo) 濃度 50-100） VAN 1.0g，q12h，2d后，VAN 2.37 （VAN 達(dá)標(biāo)濃度10，甚至更高）臨床常用的給藥劑量 哌拉西林他唑巴坦哌拉西林他唑巴坦 （4.5g/支）支）臨床常用的給藥劑量 美羅培南（美羅培南（0.5g/支）支） However, when a subject is exposed to a standard dose of an antibacterial in daily practice, the pK/p

2、D ratio achieved may be lower than expected as a consequence of the patients clinical condition and the characteristics of the involved pathogen This may be considered as underdosing, the result of which will be a therapeutic failure. In critically ill patients, there are a number of reasons for an

3、inadequate pK/pD ratio of antimicrobials at the site of infection and that should be considered in case of poor clinical outcome or therapeutic failure (table III).1. 給藥劑量不足按照實(shí)際體重計(jì)算用藥劑量 （actual bodyweight）氨基糖苷類、糖肽類、兩性霉素氨基糖苷類、糖肽類、兩性霉素B、達(dá)托霉素、達(dá)托霉素按照標(biāo)準(zhǔn)體重估算給藥劑量 （standardized bodyweight）內(nèi)酰胺類、替加環(huán)素、棘白菌素、大環(huán)內(nèi)

4、脂、喹諾酮類內(nèi)酰胺類、替加環(huán)素、棘白菌素、大環(huán)內(nèi)脂、喹諾酮類宜進(jìn)行劑量調(diào)整人群包括宜進(jìn)行劑量調(diào)整人群包括1.Overweight2.親脂性藥物 actual bodyweight3.親水性藥物 ideal bodyweight2.感染局部濃度不足感染局部濃度不足原因分析原因分析1.血供減少2.細(xì)胞膜通過/進(jìn)入障礙3.分布容積增加/膠體滲透壓減低4.蛋白結(jié)合率高的藥物分布障礙5.屏障作用（CNS）3.清除率增加清除率增加美羅培南比阿培南美羅培南比阿培南With dialysis, without previous liver transplantation/resection,with dial

5、ysis, with previous liver transplantation/resectionwithout dialysis,without previous liver transplantation/resectionwithout dialysis, with previous liver transplantation/resectionConclusion Dialysis increased the CI of linezolid by 3.5 L/h, corresponding to a mean increase of 23%. In patients after

6、liver transplantation/resection, linezolid CI was reduced by 60% relative to patients without prior liver transplantation/resection.No correlation could be established between anidulafungin exposureand disease severity or plasma protein concentrations inthis group of critically ill patients. In this

7、 population, we observed a lower anidulafungin exposure than in the general patient population.In patients infected with a susceptible Candida albicans orglabrata strain with a MIC well below the breakpoint, no problemsare to be expected in the case of a lower exposure. However, in patients with less-susceptible Candida albicans or glabrata strains,a lower exposure can be a problem. If theMICis high