de Lastours V
Service de médecine interne, hôpital Beaujon, 100, avenue du Général-Leclerc, 92110 Clichy, France; IAME, UMR-1137, université Paris-Diderot, Inserm, 16, rue Henri-Huchard, 75018 Paris, France.
Rev Med Interne. 2018 Mar;39(3):171-177. doi: 10.1016/j.revmed.2017.06.009. Epub 2017 Jul 8.
While we are confronted with the major increase in antibiotic resistance, the preservation of existing antibiotics has become an absolute necessity both to achieve therapeutic success and to limit the risks of the emergence of resistance. The optimization of antibiotic use and dosages must have a threefold objective: guarantee antibacterial efficacy, limit toxicities and limit emergence of resistant strains. However, with the increase in the number of multipathological patients, particularly those with renal or hepatic impairment, the increase in the number of patients with extreme weights and the use of antibiotics with narrower therapeutic margins, the adaptation of antibiotic dosages is becoming increasingly important. By reminding some principles of pharmacokinetics and pharmacodynamics of antibiotics (PK/PD), the necessary objectives for clinical effectiveness of most antibiotic classes are reviewed and several examples of situations where dosage adjustments are necessary will be given. In particular, adjustment of antibiotic dosages in obese patients will be discussed. Adaptation is not limited to the adaptation of the total daily dose. The PK/PD parameters also tell us that the mode of administration (intermittent versus continuous, number of injections per day, etc.) is also an essential point to consider. By taking examples concerning some molecules, infections and difficult clinical situations, we review situations in which dosage adjustments appear necessary.
在我们面临抗生素耐药性大幅增加的情况下，保存现有抗生素已成为实现治疗成功以及限制耐药性出现风险的绝对必要条件。抗生素使用和剂量的优化必须有三个目标：保证抗菌疗效、限制毒性以及限制耐药菌株的出现。然而，随着多病理患者数量的增加，尤其是那些有肾或肝损伤的患者、极端体重患者数量的增加以及治疗窗较窄的抗生素的使用，抗生素剂量的调整变得越来越重要。通过回顾抗生素药代动力学和药效学（PK/PD）的一些原则，对大多数抗生素类别的临床有效性的必要目标进行了综述，并将给出一些需要进行剂量调整的情况的实例。特别是，将讨论肥胖患者抗生素剂量的调整。调整不仅限于每日总剂量的调整。PK/PD参数还告诉我们，给药方式（间歇给药与持续给药、每天注射次数等）也是一个需要考虑的要点。通过列举一些分子、感染和困难临床情况的实例，我们回顾了似乎需要进行剂量调整的情况。
