Heintz Brett H, Matzke Gary R, Dager William E
Department of Pharmacy Practice, College of Pharmacy, Touro University, 1310 Johnson Lane, Mare Island, Vallejo, CA 94592, USA.
Pharmacotherapy. 2009 May;29(5):562-77. doi: 10.1592/phco.29.5.562.
Infectious diseases and impaired renal function often occur in critically ill patients, and delaying the start of appropriate empiric antimicrobial therapy or starting inappropriate therapy has been associated with poor outcomes. Our primary objective was to critically review and discuss the influence of chronic kidney disease (CKD) and acute kidney injury (AKI) on the clinical pharmacokinetic and pharmacodynamic properties of antimicrobial agents. The effect of continuous renal replacement therapies (CRRTs) and intermittent hemodialysis (IHD) on drug disposition in these two populations was also evaluated. Finally, proposed dosing strategies for selected antimicrobials in critically ill adult patients as well as those receiving CRRT or IHD have been compiled. We conducted a PubMed search (January 1980-March 2008) to identify all English-language literature published in which dosing recommendations were proposed for antimicrobials commonly used in critically ill patients, including those receiving CRRT or IHD. All pertinent reviews, selected studies, and associated references were evaluated to ensure their relevance. Forty antimicrobial, antifungal, and antiviral agents commonly used in critically ill patients were included for review. Dosage recommendations were synthesized from the 42 reviewed articles and peer-reviewed, evidence-based clinical drug databases to generate initial guidance for the determination of antimicrobial dosing strategies for critically ill adults. Because of the evolving process of critical illness, whether in patients with AKI or in those with CKD, prospective adaptation of these initial dosing recommendations to meet the needs of each individual patient will often rely on prospectively collected clinical and laboratory data.
重症患者常并发感染性疾病及肾功能损害，延迟开始适当的经验性抗菌治疗或开始不恰当的治疗与不良预后相关。我们的主要目的是严格审查和讨论慢性肾脏病（CKD）和急性肾损伤（AKI）对抗菌药物临床药代动力学和药效学特性的影响。还评估了持续肾脏替代疗法（CRRT）和间歇性血液透析（IHD）对这两类人群药物处置的影响。最后，汇编了针对重症成年患者以及接受CRRT或IHD治疗的患者的特定抗菌药物给药策略。我们进行了一次PubMed检索（1980年1月至2008年3月），以识别所有发表的英文文献，其中针对重症患者常用的抗菌药物（包括接受CRRT或IHD治疗的患者）提出了给药建议。对所有相关综述、选定研究及相关参考文献进行评估以确保其相关性。纳入40种重症患者常用的抗菌、抗真菌和抗病毒药物进行综述。从42篇综述文章及经过同行评审的、基于证据的临床药物数据库中综合剂量建议，以生成确定重症成年患者抗菌给药策略的初始指南。由于危重病的演变过程，无论是AKI患者还是CKD患者，前瞻性地调整这些初始给药建议以满足每个患者的需求通常将依赖于前瞻性收集的临床和实验室数据。
