Mei Jian P, Ali-Moghaddam Azadeh, Mueller Bruce A
Int J Clin Pharm. 2016 Feb;38(1):127-34. doi: 10.1007/s11096-015-0214-0.
The use of hybrid renal replacement therapies like sustained low efficiency dialysis (SLED) is increasing in ICUs worldwide. However, pharmacokinetic studies designed to inform therapeutic antibiotic dosing in critically ill patients receiving SLED are limited. SLED operational characteristics vary across institutions. Pharmacists in institutions that utilize SLED are challenged to recommend therapeutic doses for antibiotics.
To characterize pharmacist-recommended antibiotic regimens for SLED.
An electronic survey was sent to pharmacist members of the American College of Clinical Pharmacy in the Nephrology or Critical Care Practice and Research Network. Dosing recommendations for a hypothetical critically ill septic patient were collected for cefepime, ceftaroline, daptomycin, levofloxacin, meropenem, and piperacillin/tazobactam. Main outcome measure Antibiotic regimens for the six antibiotics, their frequency, pharmacist’s experience with renal replacement therapies (RRT), post-graduate training, years of clinical experience, number of staffed beds in their hospital, and RRT employed in their ICUs.
The survey was completed by 69 clinical pharmacists who had 8.5 ± 7.5 (mean ± SD) years of experience. All pharmacists had experience dosing medications for patients receiving RRT. The most frequently recommended regimen for each antibiotic was: cefepime 1000 mg every 24 h, ceftaroline 200 mg every 12 h, daptomycin 6 mg/kg every 24 h, levofloxacin 500 mg every 24 h, meropenem 1000 mg every 12 h, and piperacillin/tazobactam 2250 mg every 8 h. Up to nine distinct regimens were recommended for each antibiotic, and the total daily dose between these regimens ranged by as much as a 12-fold. Neither pharmacist’s experience with SLED, post-graduate training, nor years of clinical experience were significantly associated with particular dosing recommendations for the antibiotics.
Pharmacists working in institutions that utilize SLED make antibiotic dosing recommendations that vary 4–12-fold depending on the drug. Published research does not provide adequate guidance to optimally dose antibiotics in patients receiving SLED. More SLED pharmacokinetic trials, real-time serum concentration monitoring and advanced pharmacokinetic modeling techniques are necessary to ensure therapeutic dosing in patients receiving SLED.
在全球范围内的重症监护病房（ICU）中，持续低效透析（SLED）等混合肾脏替代疗法的使用正在增加。然而，旨在为接受SLED治疗的重症患者确定抗生素治疗剂量提供依据的药代动力学研究有限。不同机构的SLED操作特点各不相同。在使用SLED的机构中，药剂师在推荐抗生素治疗剂量方面面临挑战。
描述药剂师为SLED推荐的抗生素治疗方案。
向美国临床药学院肾脏病学或重症监护实践与研究网络的药剂师成员发送了一份电子调查问卷。收集了针对假设的重症脓毒症患者使用头孢吡肟、头孢洛林、达托霉素、左氧氟沙星、美罗培南和哌拉西林/他唑巴坦的给药建议。主要观察指标六种抗生素的治疗方案、其频率、药剂师在肾脏替代疗法（RRT）方面的经验、研究生培训情况、临床经验年限、所在医院的床位数量以及ICU中采用的RRT。
69名临床药剂师完成了调查，他们的平均经验为8.5±7.5（均值±标准差）年。所有药剂师都有给接受RRT治疗的患者给药的经验。每种抗生素最常推荐的治疗方案为：头孢吡肟每24小时1000毫克，头孢洛林每12小时200毫克，达托霉素每24小时6毫克/千克，左氧氟沙星每24小时500毫克，美罗培南每12小时1000毫克，哌拉西林/他唑巴坦每8小时2250毫克。每种抗生素推荐的不同治疗方案多达九种，这些方案之间的每日总剂量相差高达12倍。药剂师在SLED方面的经验、研究生培训情况以及临床经验年限与抗生素的特定给药建议均无显著关联。
在使用SLED的机构中工作的药剂师给出的抗生素给药建议因药物不同而相差4至12倍。已发表的研究未能为接受SLED治疗的患者优化抗生素剂量提供充分指导。需要更多的SLED药代动力学试验、实时血清浓度监测和先进的药代动力学建模技术，以确保接受SLED治疗的患者获得治疗性给药。
