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在血液透析患者中,使用蒙特卡洛模拟的高剂量透析后与每日β-乳酸剂量对比的评估

Andrew J Bauman¹, Olivia G Caiazza², Nerissa Wan³

¹College of Pharmacy, University of Findlay, Findlay, OH, USA.

International journal of clinical pharmacy

|November 26, 2025

概括

对间歇性HD患者来说,高剂量血清透析 (HD) 后的Ceftazidime/avibactam剂量是可行的,但Cefepime和Meropenem可能需要调整剂量. 较高的塞费皮姆剂量会产生神经毒性风险,需要仔细的管理和监测.

科学领域:

药理动力学和药理动力学
腎臟病學 (nephrology) 是一種醫學專業.
传染性疾病传染性疾病

背景情况:

每天静脉注射的抗生素用于间歇性血液透析 (IHD) 患者需要经常访问诊所.
门诊高剂量后HD管理是一种潜在的替代方案,但缺乏支持数据.

研究的目的:

为了评估药理动力学/药理动力学 (PK/PD) 目标的实现和HD后的神经毒性风险,与IHD患者每日服用塞费皮姆,梅罗和塞法齐迪姆/阿维巴克坦的剂量相比.
使用蒙特卡洛模拟 (MCS) 来比较剂量策略.

主要方法:

开发了一种单间药理动力学模型,用于IHD的无尿患者.
采用MCS来评估各种剂量方案实现目标 (PTA) 的概率和神经毒性风险.
PK/PD的目标包括%T>MIC的cefepime,meropenem和ceftazidime,以及%T>1g/mL的avibactam.

主要成果:

每日治疗方案实现了最佳的PTA (≥90%).
后HD cefepime和meropenem在3天的时间间隔中未能维持目标; ceftazidime/avibactam保持了目标,但avibactam略有下降.
较高的塞费皮姆剂量 (HD后和每日) 预测了神经毒性风险升高;美罗和塞夫塔齐迪姆/阿维巴克坦显示的风险微不足道.

结论:

高剂量后HD剂量是可行的ceftazidime/avibactam,但可能不够的cefepime和meropenem超过3天的透析期间.
较高的塞费皮姆剂量与神经毒性风险的增加有关.
确定了针对塞费皮姆,梅罗和塞夫塔齐迪姆/阿维巴克坦的优化剂量方案,实现了PK/PD和安全目标.

关键词:

时间的首席执行官.塞夫塔胺/阿维巴克坦血液透析是血液透析的方法之一.梅罗佩内姆 (Meropenem) 是一种美的成分.蒙特卡洛模拟的蒙特卡洛模拟药理动力学/药理动力学在HD后的剂量.

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