Bryan C S, Stone W J
Ann Intern Med. 1975 Feb;82(2):189-95. doi: 10.7326/0003-4819-82-2-189.
Impairment of penicillin G excretion in renal failure may result in life-threatening, dose-related toxicity. We report a method for achieving a desired mean serum penicillin G concentration in patients with renal failure, with minimal risk of both undertreatment and drug toxicity. The method is based on the linear relation between the total plasma clearance of penicillin G (Cpen) and the endogenous creatinine clearance. The daily maintenance dose of penicillin G (units) is defined by the product, Cpen (ml/min) times desired mean serum penicillin G concentration (mug/ml) times 2300. Application of this method to patients with various degrees of renal impairment by either constant-rate infusion or intermittent infusion gave serum penicillin G concentrations within the desired range in all but 1 of 15 instances. On the basis of these observations, practical guidelines for "comparably massive" penicillin G therapy are suggested.
肾衰竭时青霉素G排泄受损可能导致危及生命的剂量相关毒性。我们报告一种方法，可使肾衰竭患者达到期望的平均血清青霉素G浓度，同时将治疗不足和药物毒性的风险降至最低。该方法基于青霉素G的总血浆清除率（Cpen）与内生肌酐清除率之间的线性关系。青霉素G的每日维持剂量（单位）由Cpen（毫升/分钟）乘以期望的平均血清青霉素G浓度（微克/毫升）再乘以2300得出。通过恒速输注或间歇输注将该方法应用于不同程度肾功能损害的患者，15例中除1例外，其余患者的血清青霉素G浓度均在期望范围内。基于这些观察结果，提出了“相当大量”青霉素G治疗的实用指南。
