CRRT抗生素剂量调整(最终版).ppt

ANTIFUNGALS 80% of the fluconazole dose is eliminated unchanged via the kidneys. azole-resistant Candida a daily dose of 800 mg for critically ill patients receiving CVVHD or CVVHDF with a combined ultrafiltration and dialysate flow rate of 2 L/h a daily dose of 400 mg for patients receiving CVVH 400 mg (CVVHD and CVVHDF) or to 200 mg (CVVH) if the species is not Candida krusei or Candida glabrata and the fluconazole MIC is _8 mg/L. * PPT课件 Itraconazole and voriconazole The parenteral formulations are solubilized in a cyclodextrin diluent, which is eliminated by the kidneys and will accumulate in patients with renal insufficiency Use of intravenous itraconazole and voriconazole is not recommended for patients with creatinine clearance rates of 30 and 50 mL/min Although oral formulations are not contraindicated（禁忌）, there are few data about triazole dosing for patients receiving CRRT On the basis of pharmacokinetics data, no dose reduction is recommended for patients receiving CRRT. * PPT课件 Amphotericin B. dose adjustments for CRRT are not recommended. * PPT课件 Data Sources: MEDLINE search from February 1986 to 2008. * PPT课件 Pharmacokinetic Factors Influencing Initial Doses of Antibacterials Volume of distribution Although both critical illness and acute renal failure may affect volume of distribution, CRRT itself generally has no effect. Although antibacterial volume of distribution would be expected to increase in the critically il and those with acute renal failure, this is only the case for certain agents. * PPT课件 Pharmacokinetic Factors Influencing Maintenance Doses Maintenance doses are determined by antibacterial clearance. Total clearance=non-CRRT clearance (renal clearance due to residual renal function plus nonrenal clearance) and CRRT clearance * PPT课件 Nonrenal clearance may be affected by critical illness, for example, because of hepatic dysfunction. It may also be increased in the presence of acute renal failure CRRT clearance is affected by PB,