Keller F
Sektion Nephrologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Med Klin Intensivmed Notfmed. 2019 Jun;114(5):444-451. doi: 10.1007/s00063-018-0455-5. Epub 2018 Jul 6.
Essential for drug dose adjustment is the glomerular filtration rate (GFR) not the serum creatinine level. In acute disease, a loading dose must be given that usually corresponds to the normal dose. The eliminated half-life is used to estimate the administration interval. For anti-infective drugs with a concentration-dependent effect, the target is the high peak such as for daptomycin, linezolide, and colistin. For anti-infective drugs with a time-dependent effect, the target is the high trough such as for piperacillin, meropenem and vancomycin. Such drugs with a time-dependent action should best be administered by infusion not by bolus dosing. With continuous renal replacement therapy (CRRT), the total filtration rate corresponds to a GFR of 30-50 ml/min and many antibiotics will not need a dose reduction on CRRT. After intermittent hemodialysis, a new loading dose should be given to ascertain sufficiently high concentrations in the interval until the next dose or next dialysis.
药物剂量调整的关键是肾小球滤过率（GFR）而非血清肌酐水平。在急性疾病中，必须给予负荷剂量，通常相当于正常剂量。消除半衰期用于估计给药间隔。对于具有浓度依赖性效应的抗感染药物，目标是达到较高的峰值，如达托霉素、利奈唑胺和多粘菌素。对于具有时间依赖性效应的抗感染药物，目标是达到较高的谷值，如哌拉西林、美罗培南和万古霉素。这类具有时间依赖性作用的药物最好通过静脉输注给药，而不是大剂量推注给药。在持续肾脏替代治疗（CRRT）中，总滤过率相当于30 - 50毫升/分钟的GFR，许多抗生素在CRRT时无需减少剂量。在间歇性血液透析后，应给予新的负荷剂量，以确保在下一次给药或下次透析前的间隔期内有足够高的血药浓度。
