Shi A-Xi, Qu Qiang, Zhuang Hai-Hui, Teng Xin-Qi, Xu Wei-Xin, Liu Yi-Ping, Xiao Yi-Wen, Qu Jian
Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China.
Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou, China.
Front Pharmacol. 2023 Jul 26;14:1137975. doi: 10.3389/fphar.2023.1137975. eCollection 2023.
Augmented renal clearance (ARC) is a state of enhanced renal function commonly observed in 30%-65% of critically ill patients despite normal serum creatinine levels. Using unadjusted standard dosing regimens of renally eliminated drugs in ARC patients often leads to subtherapeutic concentrations, poor clinical outcomes, and the emergence of multidrug-resistant bacteria. We summarized pharmaceutical, pharmacokinetic, and pharmacodynamic research on the definition, underlying mechanisms, and risk factors of ARC to guide individualized dosing of antibiotics and various strategies for optimizing outcomes. We searched for articles between 2010 and 2022 in the MEDLINE database about ARC patients and antibiotics and further provided individualized antibiotic dosage regimens for patients with ARC. 25 antibiotic dosage regimens for patients with ARC and various strategies for optimization of outcomes, such as extended infusion time, continuous infusion, increased dosage, and combination regimens, were summarized according to previous research. ARC patients, especially critically ill patients, need to make individualized adjustments to antibiotics, including dose, frequency, and method of administration. Further comprehensive research is required to determine ARC staging, expand the range of recommended antibiotics, and establish individualized dosing guidelines for ARC patients.
肾脏清除率增加（ARC）是一种肾功能增强的状态，尽管血清肌酐水平正常，但在30%-65%的重症患者中普遍观察到。在ARC患者中使用未经调整的肾排泄药物标准给药方案通常会导致治疗浓度不足、临床结果不佳以及多重耐药菌的出现。我们总结了关于ARC的定义、潜在机制和危险因素的药学、药代动力学和药效学研究，以指导抗生素的个体化给药以及优化治疗结果的各种策略。我们在MEDLINE数据库中搜索了2010年至2022年间关于ARC患者和抗生素的文章，并进一步为ARC患者提供了个体化的抗生素给药方案。根据先前的研究，总结了25种ARC患者的抗生素给药方案以及各种优化治疗结果的策略，如延长输注时间、持续输注、增加剂量和联合用药方案。ARC患者，尤其是重症患者，需要对抗生素进行个体化调整，包括剂量、频率和给药方法。需要进一步进行全面研究，以确定ARC分期，扩大推荐抗生素的范围，并为ARC患者建立个体化给药指南。
