接受连续性静脉-静脉血液滤过患者左氧氟沙星抗感染方案的优化

目的:对ICU肾衰竭接受连续性静脉-静脉血液滤过(continuous veno-venous haemofiltration,CVVH)治疗患者左氧氟沙星给药方案进行优化。方法:根据左氧氟沙星药效学及药动学参数等实验数据资料,应用蒙特卡洛模拟法计算累积反应分数(CFR),推荐最佳给药方案。结果:ICU肾衰竭接受CVVH治疗的患者,治疗肺炎克雷伯菌和肺炎链球菌感染时左氧氟沙星的最佳方案分别为500 mg qd iv和200 mg qd iv;ICU肾功能正常患者,对肺炎链球菌感染时左氧氟沙星的最佳方案为750 mg qd iv。对于肾衰竭或肾功能正常患者,当感染铜绿假单胞菌和金黄色葡萄球菌时,左氧氟沙星4种静注给药方案(200,300,500,750 mg qd)治疗效果均不佳,建议联合治疗或更换药物。结论:与ICU肾功能正常患者对比,ICU肾衰竭接受CVVH治疗患者使用左氧氟沙星时应根据不同病原菌感染考虑降低给药剂量。

Optimization of dosage regimens for levofloxacin in patients receiving continuous veno-venous hemofiltration

OBJECTIVE To optimize dosage regimens of levofloxacin in patients receiving continuous veno-venous hemofiltration(CVVH). METHODS Pharmacodynamic and pharmacokinetic parameters of levofloxacin were gathered to calculate cumulative fraction of response(CFR) by Monte Carlo simulation(MCS) to recommend optimum dosage regimens. RESULTS The optimum dosage regimens of levofloxacin for patients receiving CVVH against Klebsiella pneumonia and Streptococcus pneumonia was 500 mg qd iv and 200 mg qd iv. The optimum dosage regimens for patients with normal renal functions in ICU against Streptococcus pneumonia was 750 mg qd iv. Combination therapy or alternative drugs should be considered when 4 dosage regimens(200, 300, 500, 750 mg qd) of levofloxacin were all ineffective against Pseudomonas aeruginosa and Staphylococcus aureus. CONCLUSION It is necessary to reduce dose of levofloxacin in patient receiving CVVH according to infections caused by different bacteria comparing with patients with normal renal function in ICU.