Xu Wei-Xin, Qu Qiang, Teng Xin-Qi, Zhuang Hai-Hui, Liu Si-Fan, Wang Ying, Qu Jian
Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China.
Institute of Clinical Pharmacy, Central South University, No.139 Middle Renmin Road, Changsha, 410011, People's Republic of China.
Eur J Pediatr. 2024 Jan;183(1):51-60. doi: 10.1007/s00431-023-05272-x. Epub 2023 Oct 20.
The effect of renal functional status on drug metabolism is a crucial consideration for clinicians when determining the appropriate dosage of medications to administer. In critically ill patients, there is often a significant increase in renal function, which leads to enhanced drug metabolism and potentially inadequate drug exposure. This phenomenon, known as augmented renal clearance (ARC), is commonly observed in pediatric critical care settings. The findings of the current study underscore the significant impact of ARC on the pharmacokinetics and pharmacodynamics of antimicrobial drugs in critically ill pediatric patients. Moreover, the study reveals a negative correlation between increased creatinine clearance and blood concentrations of antimicrobial drugs. The article provides a comprehensive review of ARC screening in pediatric patients, including its definition, risk factors, and clinical outcomes. Furthermore, it summarizes the dosages and dosing regimens of commonly used antibacterial and antiviral drugs for pediatric patients with ARC, and recommendations are made for dose and infusion considerations and the role of therapeutic drug monitoring.
ARC impacts antimicrobial drugs in pediatric patients.
• ARC is inextricably linked to the failure of antimicrobial therapy, recurrence of infection, and subtherapeutic concentrations of drugs.
• This study provides an updated overview of the influence of ARC on medication use and clinical outcomes in pediatric patients. • In this context, there are several recommendations for using antibiotics in pediatric patients with ARC: 1) increase the dose administered; 2) prolonged or continuous infusion administration; 3) use of TDM; and 4) use alternative drugs that do not undergo renal elimination.
肾功能状态对药物代谢的影响是临床医生在确定给药合适剂量时的关键考虑因素。在危重症患者中，肾功能通常会显著增强，这会导致药物代谢加快，进而可能使药物暴露不足。这种现象被称为肾清除率增加（ARC），在儿科重症监护环境中很常见。当前研究结果强调了ARC对危重症儿科患者抗菌药物药代动力学和药效学的重大影响。此外，该研究揭示了肌酐清除率增加与抗菌药物血药浓度之间呈负相关。本文全面综述了儿科患者ARC的筛查，包括其定义、危险因素和临床结局。此外，还总结了ARC儿科患者常用抗菌和抗病毒药物的剂量及给药方案，并针对剂量和输注注意事项以及治疗药物监测的作用提出了建议。
ARC影响儿科患者的抗菌药物。
• ARC与抗菌治疗失败、感染复发和药物亚治疗浓度密切相关。
• 本研究提供了ARC对儿科患者用药及临床结局影响的最新概述。• 在这种情况下，对于ARC儿科患者使用抗生素有以下几点建议：1）增加给药剂量；2）延长或持续输注给药；3）使用治疗药物监测；4）使用不经过肾脏消除的替代药物。
