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1、ICU 抗菌药物用药剂量不足风险探讨ICU 临床药师 孙浩 VPA 1.2g/d，3d后，VPA 39.91 更改至1.6g/d，7d后，VPA 19.32（ VAP 达标 浓度 50-100） VAN 1.0g，q12h，2d后，VAN 2.37 更改至1.0g，q8h，8d后，VAN 8.8-11.52（VAN 达标浓度10，甚至更高）临床常用的给药剂量 哌拉西林他唑巴坦 （4.5g/支）临床常用的给药剂量 美罗培南（0.5g/支） However, when a subject is exposed to a standard dose of an antibacterial in da
2、ily practice, the pK/pD ratio achieved may be lower than expected as a consequence of the patients clinical condition and the characteristics of the involved pathogen This may be considered as underdosing, the result of which will be a therapeutic failure. In critically ill patients, there are a num
3、ber of reasons for an inadequate pK/pD ratio of antimicrobials at the site of infection and that should be considered in case of poor clinical outcome or therapeutic failure (table III).1. 给药剂量不足 按照实际体重计算用药剂量（actual bodyweight）氨基糖苷类、糖肽类、两性霉素B、达托霉素 按照标准体重估算给药剂量（standardized bodyweight）内酰胺类、替加环素、棘白菌素、
4、大环内脂、喹诺酮类宜进行剂量调整人群包括1.Overweight2.亲脂性药物 actual bodyweight3.亲水性药物 ideal bodyweight2.感染局部浓度不足原因分析 1.血供减少 2.细胞膜通过/进入障碍 3.分布容积增加/胶体渗透压减低 4.蛋白结合率高的药物分布障碍 5.屏障作用（CNS）3.清除率增加美罗培南比阿培南美罗培南比阿培南With dialysis, without previous liver transplantation/resection,with dialysis, with previous liver transplantation/re
5、sectionwithout dialysis,without previous liver transplantation/resectionwithout dialysis, with previous liver transplantation/resectionConclusion Dialysis increased the CI of linezolid by 3.5 L/h, corresponding to a mean increase of 23%. In patients after liver transplantation/resection, linezolid C
6、I was reduced by 60% relative to patients without prior liver transplantation/resection.No correlation could be established between anidulafungin exposure and disease severity or plasma protein concentrations in this group of critically ill patients. In this population, we observed a lower anidulafu
7、ngin exposure than in the general patient population.In patients infected with a susceptible Candida albicans or glabrata strain with a MIC well below the breakpoint, no problems are to be expected in the case of a lower exposure. However, in patients with less-susceptible Candida albicans or glabrata strains,a lower exposure can be a problem. If theMICis high or unknown,we recommend considering determining the anidulafungin exposure to ensure that the exposure is adequate.
