Augmented renal clearance and therapeutic monitoring of beta-lactams

作者：Udy Andrew A; De Waele Jan J; Lipman Jeffrey^*

来源：International Journal of Antimicrobial Agents, 2015, 45(4): 331-333.

DOI：10.1016/j.ijantimicag.2014.12.020

• Augmented renal clearance
• beta-Lactam antibiotics
• Therapeutic drug monitoring

Successful application of antibacterial therapy in the critically ill requires an appreciation of the complex interaction between the host, the causative pathogen and the chosen pharmaceutical. A pathophysiological change in the intensive care unit (ICU) patient challenging the 'one dose fits all' concept includes augmented renal clearance (ARC), defined as a creatinine clearance (CLCr) of >= 130 mL/min. Ideally, CLCr values should be obtained by a timed measured collection of urine, with plasma and urine creatinine levels. Increased renal clearance of antibiotics also occurs in the ICU patient and therefore beta-lactam antibiotic exposure in the critically ill could easily lead to trough drug concentrations below therapeutic ranges. One way to document and alter drug levels is via therapeutic drug monitoring (TDM). The interactions of ARC and beta-lactam TDM are further explored in this article in specific reference to a concomitant article in this issue of the journal.

• 出版日期2015-4