Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Clin Pract. 2022 Jan 31;2022:1867674. doi: 10.1155/2022/1867674. eCollection 2022.
Augmented renal clearance (ARC), which is commonly defined as increased renal clearance above 130 ml/min/1.73 m, is a common phenomenon among critically ill patients. The increased elimination rate of drugs through the kidneys in patients with ARC can increase the risk of treatment failure due to the exposure to subtherapeutic serum concentrations of medications and affect the optimal management of infections, length of hospital stay, and outcomes. The main goal of this review article is to summarize the recommendations for appropriate dosing of antibiotics in patients with ARC.
This article is a narrative review of the articles that evaluated different dosing regimens of antibiotics in patients with ARC. The keywords "Augmented Renal Clearance," "Critically ill patients," "Drug dosing," "Serum concentration," "Beta-lactams," "Meropenem," "Imipenem," "Glycopeptide," "Vancomycin," "Teicoplanin," "Linezolid," "Colistin," "Aminoglycosides," "Amikacin," "Gentamycin," "Fluoroquinolones," "Ciprofloxacin," and "Levofloxacin" were searched in Scopus, Medline, PubMed, and Google Scholar databases, and pediatric, nonhuman, and non-English studies were excluded.
PK properties of antibiotics including lipophilicity or hydrophilicity, protein binding, the volume of distribution, and elimination rate that affect drug concentration should be considered along with PD parameters for drug dosing in critically ill patients with ARC.
This review recommends a dosing protocol for some antibiotics to help the appropriate dosing of antibiotics in ARC and decrease the risk of subtherapeutic exposure that may be observed while receiving conventional dosing regimens in critically ill patients with ARC.
增强的肾清除率（ARC）通常定义为超过 130ml/min/1.73m 的肾脏清除率增加，是危重症患者的常见现象。由于 ARC 患者通过肾脏消除药物的清除率增加，药物的血清浓度可能低于治疗范围，从而增加了治疗失败的风险，并影响了感染的最佳管理、住院时间和预后。本文的主要目的是总结 ARC 患者抗生素适当给药剂量的建议。
本文是对评估 ARC 患者不同抗生素给药方案的文章进行的叙述性综述。使用的关键词有“增强的肾清除率”、“危重症患者”、“药物剂量”、“血清浓度”、“β-内酰胺类”、“美罗培南”、“亚胺培南”、“糖肽类”、“万古霉素”、“替考拉宁”、“利奈唑胺”、“黏菌素”、“氨基糖苷类”、“阿米卡星”、“庆大霉素”、“氟喹诺酮类”、“环丙沙星”和“左氧氟沙星”，在 Scopus、Medline、PubMed 和 Google Scholar 数据库中进行了搜索，并排除了儿科、非人类和非英语研究。
抗生素的 PK 特性，包括脂溶性或亲水性、蛋白结合、分布容积和消除率，这些特性会影响药物浓度，应与 PD 参数一起考虑，以确定 ARC 危重症患者的药物剂量。
本文综述推荐了一些抗生素的给药方案，以帮助 ARC 患者进行适当的抗生素剂量调整，并降低在 ARC 危重症患者接受常规剂量方案时可能观察到的治疗浓度不足的风险。
