Burns, Trauma and Critical Care Research Centre, University of Queensland, Queensland, Australia.
Curr Opin Crit Care. 2012 Oct;18(5):460-71. doi: 10.1097/MCC.0b013e32835685ad.
Antibiotic dosing for critically ill patients that is derived from other patient groups is likely to be suboptimal because of significant antibiotic pharmacokinetic changes, particularly in terms of drug volume of distribution and clearance. Organ support techniques including renal replacement therapy (RRT) and extracorporeal membrane oxygenation (ECMO) increase the pharmacokinetic variability. This article reviews the recently published antibiotic pharmacokinetic data associated with burns patients, those receiving continuous RRT (CRRT), sustained low-efficiency dialysis (SLED) and ECMO.
These groups develop increases in volume of distribution that necessitate the use of higher initial doses to rapidly achieve therapeutic antibiotic concentrations. Burns patients have supranormal drug clearances requiring more frequent administration of antibiotics. Patients receiving CRRT or SLED have variable drug clearances related to different equipment and RRT settings at different institutions. ECMO presents a different challenge because there is such a dearth of data with higher than standard doses potentially required, even in the presence of end-organ failure.
In the context of such variable pharmacokinetics, a guideline approach to dosing remains elusive because of insufficient available data and, therefore, use of therapeutic drug monitoring should be considered advantageous where possible.
由于抗生素药代动力学的显著变化，特别是药物分布容积和清除率方面，从其他患者群体中推导出来的用于危重症患者的抗生素剂量可能并不理想。器官支持技术，包括肾脏替代治疗（RRT）和体外膜氧合（ECMO），增加了药代动力学的可变性。本文综述了最近发表的与烧伤患者、接受连续肾脏替代治疗（CRRT）、持续低效透析（SLED）和 ECMO 的患者相关的抗生素药代动力学数据。
这些患者的分布容积增加，需要使用更高的初始剂量来迅速达到治疗性抗生素浓度。烧伤患者的药物清除率高于正常水平，需要更频繁地给予抗生素。接受 CRRT 或 SLED 的患者的药物清除率存在差异，这与不同机构的不同设备和 RRT 设置有关。ECMO 带来了不同的挑战，因为数据非常缺乏，即使存在终末器官衰竭，也可能需要高于标准剂量。
鉴于这种药代动力学的可变性，由于缺乏足够的数据，指南推荐的剂量方法仍然难以捉摸，因此在可能的情况下，应考虑使用治疗药物监测。
