了解重症患者的抗微生物药物动力学,以优化抗微生物治疗:一个叙事性审查
Claire Roger1,2
1Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Nîmes, France.
在败血症中优化抗菌剂量对患者的生存至关重要. 本综述详细介绍了当治疗药物监测不可用时,如何在重症患者中调整抗生素剂量.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
背景情况:
- 有效的败血症治疗需要及时的抗微生物药物管理和精确的剂量,以达到治疗药物度在感染部位.
- 治疗药物监测 (TDM) 建议用于优化抗微生物剂量,但并非在所有重症监护病房 (ICU) 或所有抗微生物药物中普遍可用.
- 在没有TDM的情况下,临床医生必须考虑患者的病情,病原体,器官功能障碍和药物特性,以便明智地做出剂量决定.
研究的目的:
- 描述危急病患者的病理生理变化,影响抗微生物剂量.
- 为在没有TDM的重症患者中优化抗微生物治疗提供实际建议.
主要方法:
- 重症患者的病理生理学变化的审查.
- 在危急疾病中影响抗微生物药理学因素的分析.
- 对个性化剂量策略的实用建议的综合.
主要成果:
- 危急病患者表现出显著的药物动力学变异性,需要个性化抗菌剂剂量.
- 病理生理学变化会影响药物分布,新陈代谢和排泄,改变所需剂量.
- 器官功能障碍和体外疗法等因素显著影响抗微生物药理动力学.
结论:
- 在重症患者中,个性化抗微生物剂量是必不可少的,特别是当TDM无法使用时.
- 了解患者特异性的病理生理变化是优化抗菌药物治疗的关键.
- 实际指导可以帮助临床医生做出明智的剂量决定,以改善败血症的结果.
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