ICU抗菌药物用药剂量不足风险探讨(新).ppt

ICU 抗菌药物用药剂量不足风险探讨 ICU 临床药师 孙浩 VPA 1.2g/d，3d后，VPA 39.91 更改至1.6g/d，7d后，VPA 19.32 （ VAP 达标 浓度 50-100） VAN 1.0g，q12h，2d后，VAN 2.37 更改至1.0g，q8h，8d后，VAN 8.8-11.52 （VAN 达标浓度＞10，甚至更高） 临床常用的给药剂量 哌拉西林他唑巴坦 （4.5g/支） 临床常用的给药剂量 美罗培南（0.5g/支） However, when a subject is exposed to a standard dose of an antibacterial in daily practice, the pK/pD ratio achieved may be lower than expected as a consequence of the patient’s 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 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. 给药剂量不足 按照实际体重计算用药剂量 （actual bodyweight） ☆氨基糖苷类、糖肽类、两性霉素B、达托霉素 按照标准体重估算给药剂量 （standardized bodyweight） ☆内酰胺类、替加环素、棘白菌素、大环内脂、喹诺酮类 宜进行剂量调整人群包括 1.Overweight 2.亲脂性药物 actual bodyweight 3.亲水性药物 ideal bodyweight 2.感染局部浓度不足 原因分析 1.血供减少 2.细胞膜通过/进入障碍 3.分布容积增加/胶体渗透压减低 4.蛋白结合率高的药物分布障碍 5.屏障作用（CNS） 3.清除率增加 Conclusion Dialysis increased the CI of linezolid by 3.5 L/h, corresponding to a mean increase of 23%. In patients after liver transplantation/resection, linezolid CI was reduced by 60% relative to patients without prior liver transplantation/resection. No correlation could be established between anidulafungin exposure and disease severity or plasma protein concentrations in this group of critically ill patients. In this population, we observed a lower anidulafungin exposure than in the general patient population. In patients infected with a susceptible Candida albicans or glabrata strain with a MIC well below the breakpoint, no problems are 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