CRRT抗生素剂量调整(最终版).ppt

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1、CRRT抗生素剂量调整ICU临床药师contextContinuousrenalreplacementtherapy(CRRT)isnowcommonlyusedasameansofsupportforcriticallyillpatientswithrenalfailure.acuterenalfailureorchronicrenalfailure.Norecentcomprehensiveguidelinesexistthatprovideantibioticdosingrecommendationsforadultpat

2、ientsreceivingCRRT.Dosesusedinintermittenthemodialysiscannotbedirectlyappliedtothesepatientsantibioticpharmacokineticsaredifferentthanthoseinpatientswithnormalrenalfunction.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、PBCRRT:肾脏排泄率》25%

3、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DataSources1995~2004DataSources:MEDLINEsearchfromFebruary1986to2008.DataSources1995~2004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.Inmostcases,therecommended“target”drugconcentrationcorrespondstotheupperlimitoftheMI

4、Crangeforsusceptibility.2.ThegoalofourdosingrecommendationsistokeeptheconcentrationabovethetargetMICforanoptimalproportionofthedosinginterval,reflectingknownpharmacodynamicproperties(timedependentvs.concentration-dependentkilling),3.whileminimizingtoxicityduetounnece

5、ssarilyhighconcentrations.ANTIBIOTICSFORDRUG-RESISTANTGRAM-POSITIVEBACTERIAVancomycinThehalf-lifeofvancomycinincreasessignificantlyinpatientswithrenalinsufficiency.CVVH,CVVHD,andCVVHDFalleffectivelyremovevancomycin.avancomycinloadingdoseof15–20mg/kgiswarranted.Vancom

6、ycinmaintenancedosingforpatientsreceivingCVVHvariesfrom500mgq24hto1500mgq48hreceivingCVVHDorCVVHDF,werecommendavancomycinmaintenancedosageof1–1.5gq24h.Monitoringofplasmavancomycinconcentrationsandsubsequentdoseadjustmentsarerecommendedtoachievedesiredtroughconcentrat

7、ions.Atroughconcentrationof5–10mg/Lisadequateforinfectionsinwhichdrugpenetrationisoptimal,suchasskinandsoft-tissueinfectionsoruncomplicatedbacteremia.However,highertroughs(10–15mg/L)areindicatedforinfectionsinwhichpenetrationisdependentonpassivediffusionofdrugintoana

8、vascularpartofthebody,suchasosteomyelitis,endocarditis,ormeningitis.Recentguidelinesalsorecommendhighertroughs(15–20mg/L)inthetreat