在接受新的创新性替代疗法的重症患者中,抗生素剂量建议
Susan J Lewis1,2, Bruce A Mueller3
1Department of Pharmacy Practice, College of Pharmacy, University of Findlay, 1000 N. Main Street, 45840, Findlay, OH, USA. slewis@findlay.edu.
BMC nephrology
|February 27, 2024
概括
新的替代疗法 (KRT) 影响抗生素剂量. 这项研究确定了KRT重症患者的最佳β-乳酸剂量,同时考虑毒性风险,确保有效性.
科学领域:
- 药理动力学和药理动力学
- 关键护理神经病学 关键护理神经病学
- 抗生素剂量优化 抗生素剂量优化
背景情况:
- 像Tablo这样的创新置换疗法 (KRT) 系统为急性损伤提供了灵活的治疗选择.
- 与传统方法相比,KRT中的废水速率,持续时间和频率的变化可能会改变抗生素清除率.
- 优化抗生素剂量对于接受KRT的重症患者至关重要,以确保治疗疗效并最大限度地降低毒性.
研究的目的:
- 在接受各种KRT疗程的重症患者中开发和评估beta-lactam抗生素的最佳抗生素剂量.
- 用蒙特卡洛模拟来确定不同剂量策略的目标实现概率 (PTA) 和毒性概率.
- 在各种KRT场景中,在治疗一周内达到至少90%PTA的抗生素剂量.
主要方法:
- 利用已发表的体重和药理动力学数据来预测对塞费皮姆,塞夫塔齐迪姆,伊米佩内姆,梅罗佩内姆和皮佩拉西林/塔扎巴克坦的药物暴露.
- 采用蒙特卡洛模拟 (MCS) 来评估PTA和各种剂量方案的毒性概率.
- 定义的疗效目标是标准的自由β-乳酸血度时间超过最小抑制度 (40-60%fT>MIC和40-60%fT>4xMIC).
主要成果:
- 在所有模拟的KRT方案中,MCS确定了特定的β-乳剂量,在所有模拟的KRT方案中达到约90%的PTA.
- KRT特征显著影响了所需的抗生素剂量策略.
- 针对高疗效的某些cefepime和piperacillin/tazobactam疗法有风险超过毒性值.
结论:
- 新型KRT系统的适应性需要量身定制的β-乳糖抗生素剂量策略.
- 可以设计出符合治疗目标的抗生素剂量,在高级KRT患者中是可行的.
- 需要进一步的临床研究来验证这些模拟剂量建议.
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