Pôle Pharmacie & Pôle Urgences-Réanimation-Anesthésie, Centre Hospitalier de Valenciennes, Valenciennes, France.
Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pharmacie, Pierre-Bénite.
Ther Drug Monit. 2022 Feb 1;44(1):86-102. doi: 10.1097/FTD.0000000000000941.
Antibiotics are frequently used in patients receiving intermittent or continuous renal replacement therapy (RRT). Continuous renal replacement may alter the pharmacokinetics (PK) and the ability to achieve PK/pharmacodynamic (PD) targets. Therapeutic drug monitoring (TDM) could help evaluate drug exposure and guide antibiotic dosage adjustment. The present review describes recent TDM data on antibiotic exposure and PK/PD target attainment (TA) in patients receiving intermittent or continuous RRT, proposing practical guidelines for performing TDM.
Studies on antibiotic TDM performed in patients receiving intermittent or continuous RRT published between 2000 and 2020 were searched and assessed. The authors focused on studies that reported data on PK/PD TA. TDM recommendations were based on clinically relevant PK/PD relationships and previously published guidelines.
In total, 2383 reports were retrieved. After excluding nonrelevant publications, 139 articles were selected. Overall, 107 studies reported PK/PD TA for 24 agents. Data were available for various intermittent and continuous RRT techniques. The study design, TDM practice, and definition of PK/PD targets were inconsistent across studies. Drug exposure and TA rates were highly variable. TDM seems to be necessary to control drug exposure in patients receiving intermittent and continuous RRT techniques, especially for antibiotics with narrow therapeutic margins and in critically ill patients. Practical recommendations can provide insights on relevant PK/PD targets, sampling, and timing of TDM for various antibiotic classes.
Highly variable antibiotic exposure and TA have been reported in patients receiving intermittent or continuous RRT. TDM for aminoglycosides, beta-lactams, glycopeptides, linezolid, and colistin is recommended in patients receiving RRT and suggested for daptomycin, fluoroquinolones, and tigecycline in critically ill patients on RRT.
抗生素经常用于接受间歇性或连续性肾脏替代治疗（RRT）的患者。连续性肾脏替代可能会改变药代动力学（PK）和达到 PK/药效学（PD）目标的能力。治疗药物监测（TDM）可以帮助评估药物暴露情况并指导抗生素剂量调整。本综述描述了最近在接受间歇性或连续性 RRT 的患者中进行的抗生素 TDM 数据，以及 PK/PD 目标获得（TA）情况，提出了进行 TDM 的实用指南。
检索了 2000 年至 2020 年期间发表的关于接受间歇性或连续性 RRT 的患者进行抗生素 TDM 的研究，并对其进行了评估。作者重点关注了报告 PK/PD TA 数据的研究。TDM 建议基于临床相关的 PK/PD 关系和以前发表的指南。
共检索到 2383 份报告。排除不相关的出版物后，选择了 139 篇文章。总体而言，107 项研究报告了 24 种药物的 PK/PD TA。数据可用于各种间歇性和连续性 RRT 技术。研究设计、TDM 实践和 PK/PD 目标的定义在研究之间不一致。药物暴露和 TA 率差异很大。TDM 似乎对于控制接受间歇性和连续性 RRT 技术的患者的药物暴露是必要的，特别是对于治疗窗狭窄的抗生素和危重症患者。实用建议可以提供有关各种抗生素类别相关 PK/PD 目标、采样和 TDM 时间的见解。
接受间歇性或连续性 RRT 的患者的抗生素暴露和 TA 存在很大差异。建议对接受 RRT 的患者进行氨基糖苷类、β-内酰胺类、糖肽类、利奈唑胺和黏菌素的 TDM，并建议对接受 RRT 的危重症患者进行达托霉素、氟喹诺酮类和替加环素的 TDM。
