慢性肝病时抗菌药物的应用推荐.docxVIP

慢性肝病患者常用抗菌药物应用推荐（文献来源：Periá?ez-Párraga L, Martínez-López I, Ventayol-Bosch P, Puigventós Latorre F, Delgado-Sánchez O. Drug dosage recommendations in patients with chronic liver disease. Rev Esp Enferm Dig 2012; 104: 165-184.）Drug 药物(references) （参考文献）Huet and Kr?henbühl (11,12) category EH 肝提取率Metabolism 代谢Q0 肾外药物部分PB (%)蛋白结合率 Recommendation 建议Gentamicin* (9) 庆大霉素3 0.01 Not undergo hepatic metabolism 不通过肝代谢0-0.3 0-30 No adjustment required 不需要调整Amikacin (9) 阿米卡霉素（阿米卡星）4 Not known未知 – 0.02-0.14.0-11Calculated based on total weight in ascitic patients. Determine and monitor the drug level nephrotoxicity 在腹水患者中的依据患者的总重量计算，确定和监测药物的肾毒性。Tobramycin * (9) 妥布霉素3 0.0002 Not undergo hepatic metabolism 不通过肝代谢0.15-0.4 0-30 No adjustment required 不需要调整Amoxicillin* Prod Info Clamoxyl, 2006 (27) 阿莫西林3 0.034 Partial liver metabolism 部分肝代谢0.4 15-25 Monitor liver function 监测肝功能Amoxicillin/Clavulanic Acid Prod Info Augmentine, 2010 (27) 阿莫西林克拉维酸4 Not known未知 Partial liver metabolism 部分肝代谢0.3-0.5 18-25Monitor liver function (cholestatic jaundice) 监测肝功能（胆汁淤积性黄疸）Ampicillin* Prod Info Ampilevel, 1999 (27) 氨苄西林3 0.037 – 0.2 17-20 Precaution 慎用Ampicillin/sulbactam (9)氨苄西林舒巴坦4 Not known未知 – 0.3 17 Precaution 慎用Cloxacillin* (8)氯唑西林3 0.035 Liver metabolism around 12% 肝脏代谢约为12%0.3-0.6 94-95 Precaution 慎用Piperacillin Sodium/ Tazobactam * Prod Info Tazocel, 2010 (27) 哌拉西林钠/他唑巴坦3 0.02 Partial liver metabolism 部分肝代谢0.2-0.3 30 No dose adjustment is necessary, use with precaution 慎用，不需要调整剂量Azithromycin* Prod Info Zitromax, 1999 (27)阿奇霉素1 1 Liver metabolism around 35%肝脏代谢约35%0.88-0.95 7.0-50 No adjustment required 不需要调整Daptomycin* Prod Info Cubicin, 2006 (27) 达托霉素3 0.002 Studies in vitro found that daptomycin was not metabolized by human liver microsomes 体外研究发现达托霉素不是由人肝微粒体代谢0.2 90-95 Precaution in Child-Pugh C index CPT C级患者慎用Doxycycline (8) 多西环素3 0.3 Liver metabolism around 50% 肝脏代谢约50%0.55-0.45 80-93 Precaution, if hepatotoxicity, assess other antibiotics 慎用,若有肝毒性应评估其他抗生素.Telithromycin* Prod Info