脓毒症休克伴急性肾损伤新生儿抗菌药物剂量调整的个体化治疗实践

Individualized Treatment Practice of Antimicrobial Drugs Dosage Adjustment in a Neonate with Septic Shock and Acute Kidney Injury

以1例脓毒症休克合并急性肾损伤新生儿为例,探讨临床药师在危重症患儿抗菌药物剂量调整中发挥的作用。临床药师综合分析了抗菌药物在脓毒症休克患儿体内药动学的改变及连续性肾脏替代治疗对抗菌药物清除作用的影响,协助医生上调美罗培南剂量至140 mg q12h,并延长其输注时间至4 h,同时监测万古霉素血药浓度并两次给出剂量调整建议。该患儿转归良好,未发生药品相关的严重不良反应。面对危重症新生儿抗感染治疗的挑战,临床药师发挥专长,开展治疗药物监测,给予个体化用药建议,可保障药物治疗的有效性及安全性。

To explore the role of clinical pharmacists in the dose adjustment of antibacterial drugs in a critically ill neonate with septic shock and acute kidney injury.By analyzing the pharmacokinetics changes in children with sepsis shock and the effect of continuous renal replacement therapy(CRRT)on the clearance of antibacterial drugs comprehensively,the clinical pharmacist assisted physicians in dosage adjustment.The dosage of meropenem was increased to 140 mg q12 h,and the infusion time was extended to 4 hours.Under the guidance of therapeutic drug monitoring,the clinical pharmacist gave dose adjustment recommendations for vancomycin twice.The conditions of the neonate was stable and improved without serious adverse drug reactions.Facing the challenge of anti-infective treatment of critically ill neonates,clinical pharmacists should carry out therapeutic drug monitoring and give individualized suggestions,which can ensure the effectiveness and safety of medication.