在有或没有连续脏替代疗法的重症患者中优化氏素剂量方案
Taniya Charoensareerat1, Phongphak Bunrit1, Sasina Phanpoka1
1Faculty of Pharmacy, Siam University, Bangkok, Thailand.
Journal of critical care
|November 7, 2024
概括
为患有耐药细菌的重症患者,包括接受连续脏替代疗法 (CRRT) 的患者,确定了最佳的芽素剂量. 对于Klebsiella pneumoniae和Pseudomonas aeruginosa,已确定了特定的治疗方案,但不是Escherichia coli.
科学领域:
- 药理学 药理学是指药理学的学科.
- 传染性疾病 传染性疾病
- 临界护理医学 临界护理医学
背景情况:
- 格拉姆阴性细菌的耐药性在重症监护机构构成重大威胁.
- 优化抗生素剂量对于有效治疗至关重要,特别是在脏替代疗法 (CRRT) 持续治疗患者等生理变化的患者中.
- 斯福米是一种有价值的抗生素,用于治疗多药耐药的格拉姆阴性感染.
研究的目的:
- 在重症患者中为耐药格拉姆阴性细菌定义最佳的氏胺剂量方案.
- 评估CRRT对氏素的药理动力学和所需剂量调整的影响.
- 对于关键病原体,实现目标达到的高概率 (>90%) .
主要方法:
- 为患有或没有CRRT的重症患者开发药理动力学模型.
- 蒙特卡洛模拟用于预测福斯福米辛暴露 (AUC/MIC比率).
- 基于特定的MIC值,为Klebsiella pneumoniae (KP),Pseudomonas aeruginosa (PA) 和Escherichia coli (EC) 定义了药理学目标.
主要成果:
- 对于KP感染 (MIC 64 mg/L),最佳方案是每8小时6g (危急病) 和每12小时8g (CRRT).
- 对于PA感染,每6小时服用6g (重症患者) 和每8小时服用7g (CRRT) 的疗法实现了目标.
- 没有一个测试的疗法实现了90%的概率实现针对MIC>32 mg/L的EC感染的目标.
结论:
- 在重症患者中,对于高MIC感染 (64 mg/L),推的每日菌素剂量范围为18-24g.
- 对于接受CRRT的患者,剂量调整是必要的.
- 这些模拟剂量方案的临床验证是必不可少的.
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