Fry D E
Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque 87131, USA.
Am J Surg. 1996 Dec;172(6A):20S-25S. doi: 10.1016/s0002-9610(96)00346-7.
Antibiotics are the most commonly used drugs in the surgical patient. Pharmacokinetics is the study of processes that result in the delivery of drugs to effector sites. Drug absorption, distribution, biotransformation, and excretion are the critical elements of drug delivery to effector sites. The biologic elimination half-life (t1/2) and the volume of distribution (Vd) are terms used to describe the active processes of pharmacokinetics; t1/2 and Vd are determined for antibiotics by employing healthy volunteers or minimally ill patients. From these data, dosing schedules for each antibiotic are determined. This article reviews the literature on the impact of critical illness and sepsis on antibiotic pharmacokinetics. The data identify that t1/2 may be reduced in the hyperdynamic states of stress and sepsis and that the Vd is expanded. These changes mean that currently accepted dosing regimens of antibiotics in critically ill patients are inadequate. Subtherapeutic antibiotic concentrations in these patients may account for treatment failures and may be of significance in the emergence of bacterial resistance.
抗生素是外科患者最常用的药物。药代动力学是研究导致药物输送到效应部位的过程。药物吸收、分布、生物转化和排泄是药物输送到效应部位的关键要素。生物消除半衰期（t1/2）和分布容积（Vd）是用于描述药代动力学活性过程的术语；抗生素的t1/2和Vd是通过使用健康志愿者或病情较轻的患者来确定的。根据这些数据，确定每种抗生素的给药方案。本文综述了关于危重病和脓毒症对抗生素药代动力学影响的文献。数据表明，在应激和脓毒症的高动力状态下，t1/2可能会缩短，Vd会扩大。这些变化意味着目前危重病患者中抗生素的公认给药方案并不充分。这些患者中抗生素浓度低于治疗水平可能是治疗失败的原因，并且可能在细菌耐药性的出现中具有重要意义。
