Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal.
J Crit Care. 2013 Aug;28(4):341-6. doi: 10.1016/j.jcrc.2012.11.018. Epub 2013 Jan 18.
Considerable evidence has shown that adequate antibiotic therapy is of utmost importance in the critically ill septic patient. However, antibiotic concentration may be insufficient early in infection course. We propose the concept of dose modulation, meaning front-line variability of antibiotic dose, according to patient and microorganism characteristics, followed by its reduction after clinical response and patient recovery. Therefore, dose modulation means concentrating the largest weight of antibiotics at the front-end, when the microbial load is higher and the pharmacokinetic changes poses the highest risk of underdosing and nibbling off antibiotic dose, when the sepsis syndrome is improving, guided by pharmacokinetic and pharmacodynamic data.
大量证据表明，在重症感染性休克患者中，充分的抗生素治疗至关重要。然而，在感染早期，抗生素浓度可能不足。我们提出了剂量调整的概念，即根据患者和微生物特征，对一线抗生素剂量进行调整，然后在临床反应和患者康复后减少剂量。因此，剂量调整意味着在微生物负荷较高、药代动力学变化导致剂量不足风险最高的前端集中使用最大剂量的抗生素，然后根据药代动力学和药效学数据，在感染性休克综合征改善时减少剂量。
