CRRT抗生素剂量调整最终版.ppt

CRRT抗生素剂量调整 ICU临床药师 孙浩 context Continuous renal replacement therapy (CRRT) is now commonly used as a means of support for critically ill patients with renal failure. acute renal failure or chronic renal failure. No recent comprehensive guidelines exist that provide antibiotic dosing recommendations for adult patients receiving CRRT. Doses used in intermittent hemodialysis cannot be directly applied to these patients antibiotic pharmacokinetics are different than those in patients with normal renal function. 目前现状 CRRT广泛用于重症病人肾脏衰竭治疗 缺乏此类人群抗生素剂量调整的指导 （传统的剂量调整方案不适用于CRRT患者） 剂量调整难度大 危重患者/ARF：Vd、PB CRRT:肾脏排泄率》25%有意义 不同抗生素具有不同药代、药动学 患者—抗生素---CRRT三者关系 Data Sources 1995~2004 Data Sources: MEDLINE search from February 1986 to 2008. Data Sources 1995~2004 推荐依据 1.有相关报道 2.没有相关报道：a化学性质 b其它临床数据（分子量、蛋白结合率PB、间断透析的清除率） 几点说明 1.In most cases,the recommended “target” drug concentration corresponds to the upper limit of the MIC range for susceptibility. 2.The goal of our dosing recommendations is to keep the concentration above the target MIC for an optimal proportion of the dosing interval, reflecting known pharmacodynamic properties (timedependent vs. concentration-dependent killing), 3.while minimizing toxicity due to unnecessarily high concentrations. ANTIBIOTICS FOR DRUG-RESISTANT GRAM-POSITIVE BACTERIA Vancomycin The half-life of vancomycin increases significantly in patients with renal insufficiency. CVVH, CVVHD, and CVVHDF all effectively remove vancomycin. a vancomycin loading dose of 15–20 mg/kg is warranted. Vancomycin maintenance dosing for patients receiving CVVH varies from 500 mg q24h to 1500 mg q48h receiving CVVHD or CVVHDF, we recommend a vancomycin maintenance dosage of 1–1.5 g q24h. Monitoring of plasma vancomycin concentrations and subsequent dose adjustments are recommended to achieve desired trough concentrations. A trough concentration of 5–10 mg