{"id":16995,"date":"2019-04-15T05:15:31","date_gmt":"2019-04-14T21:15:31","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=16995"},"modified":"2019-06-02T06:37:41","modified_gmt":"2019-06-01T22:37:41","slug":"%e6%b3%95%e5%9b%bd%e8%8d%af%e7%90%86%e4%b8%8e%e6%b2%bb%e7%96%97%e5%ad%a6%e4%bc%9a%e5%8f%8a%e6%b3%95%e5%9b%bd%e9%ba%bb%e9%86%89%e4%b8%8e%e9%87%8d%e7%97%87%e5%8c%bb%e5%ad%a6%e4%bc%9a%e4%b8%b4%e5%ba%8a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=16995","title":{"rendered":"[\u6cd5\u56fd\u836f\u7406\u4e0e\u6cbb\u7597\u5b66\u4f1a\u53ca\u6cd5\u56fd\u9ebb\u9189\u4e0e\u91cd\u75c7\u533b\u5b66\u4f1a\u4e34\u5e8a\u6307\u5357]\uff1a\u4f18\u5316\u5371\u91cd\u75c5\u60a3\u8005\u7684beta\u5185\u9170\u80fa\u6cbb\u7597"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Optimization of the treatment with beta-lactam antibiotics in critically ill patients\u2014guidelines from the French Society of Pharmacology and Therapeutics (Soci\u00e9t\u00e9 Fran\u00e7aise de Pharmacologie et Th\u00e9rapeutique\u2014SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Soci\u00e9t\u00e9 Fran\u00e7aise d\u2019Anesth\u00e9sie et R\u00e9animation\u2014SFAR)<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Guilhaumou&nbsp;et al. Critical Care&nbsp;(2019) 23:104<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">https:\/\/doi.org\/10.1186\/s13054-019-2378-9<\/h3>\n\n\n\n<h2 class=\"wp-block-heading\">Guidelines \u6307\u5357<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">First area. Pharmacokinetic variability of beta-lactam antibiotics<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">\u7b2c\u4e00\u90e8\u5206\uff1abeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u7684\u836f\u4ee3\u52a8\u529b\u5b66\u53d8\u5316<br \/><\/h2>\n\n\n\n<p><strong>R1.1. We suggest considering systematically and daily the many sources of pharmacokinetic variability when prescribing beta-lactam antibiotics to critical care patients.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5371\u91cd\u75c5\u60a3\u8005\u4f7f\u7528beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u65f6\uff0c\u5e94\u6bcf\u5929\u7cfb\u7edf\u8003\u8651\u5bfc\u81f4\u836f\u4ee3\u52a8\u529b\u5b66\u53d8\u5316\u7684\u56e0\u7d20<\/p>\n\n\n\n<p>Optional recommendation\u2014strong agreement<\/p>\n\n\n\n<p><strong>R1.2.1. We suggest determining the glomerular filtration rate by calculating creatinine clearance with the formula U x V\/P at the onset of treatment with beta-lactam antibiotics, and every time the clinical condition and\/or renal function of the patient significantly changes.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5728\u5f00\u59cbbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6cbb\u7597\u65f6\uff0c\u4ee5\u53ca\u4e34\u5e8a\u60c5\u51b5\u548c\uff08\u6216\uff09\u80be\u529f\u80fd\u663e\u8457\u6539\u53d8\u65f6\uff0c\u6839\u636e\u516c\u5f0fU x V\/P\u8ba1\u7b97\u808c\u9150\u6e05\u9664\u7387\u4ee5\u786e\u5b9a\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\u3002<\/p>\n\n\n\n<p><strong>R1.2.2. We suggest determining the glomerular filtration rate by calculating creatinine clearance with the formula U x V\/P every time beta-lactam concentration is measured in order to help in interpreting the result. <\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u6bcf\u6b21\u6d4b\u5b9abeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6d53\u5ea6\u65f6\uff0c\u5e94\u6839\u636e\u516c\u5f0fU x V\/P\u8ba1\u7b97\u808c\u9150\u6e05\u9664\u7387\u4ee5\u786e\u5b9a\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff0c\u4ee5\u5e2e\u52a9\u7ed3\u679c\u89e3\u8bfb\u3002<\/p>\n\n\n\n<p>Optional recommendation\u2014strong agreement<\/p>\n\n\n\n<p><strong>R1.3.1. We suggest measuring albumin (or at least plasma proteins) at least once at the onset of treatment with beta-lactam antibiotics in order to guide the prescription.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5f00\u59cbbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6cbb\u7597\u65f6\uff0c\u5e94\u5f53\u81f3\u5c11\u6d4b\u5b9a\u4e00\u6b21\u767d\u86cb\u767d\uff08\u6216\u81f3\u5c11\u8840\u6d46\u603b\u86cb\u767d\uff09\u6c34\u5e73\uff0c\u4ee5\u6307\u5bfc\u6297\u751f\u7d20\u5904\u65b9\u3002<\/p>\n\n\n\n<p><strong>R1.3.2. We suggest measuring albumin (or at least plasma proteins) when performing beta-lactam TDM in order to help in interpreting the result.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5f53\u8fdb\u884cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6cbb\u7597\u836f\u7269\u76d1\u6d4b(TDM)\u65f6\uff0c\u5e94\u6d4b\u5b9a\u767d\u86cb\u767d\uff08\u6216\u81f3\u5c11\u8840\u6d46\u603b\u86cb\u767d\uff09\u6c34\u5e73\uff0c\u4ee5\u5e2e\u52a9\u7ed3\u679c\u89e3\u8bfb\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><em>Second area.<\/em>&nbsp;Pharmacokinetic-pharmacodynamic relationship of beta-lactam antibiotics<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">\u7b2c\u4e8c\u90e8\u5206\uff1abeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u7684\u836f\u4ee3\u52a8\u529b\u5b66\u4e0e\u836f\u6548\u5b66\u7684\u5173\u7cfb<\/h2>\n\n\n\n<p><strong>R2.1. We suggest considering the percentage of the dosing interval during which the free plasma concentration of beta-lactams is above a multiple (\u201ck\u201d) of the minimum inhibitory concentration (MIC) of the causative bacteria (%fT\u2009&gt;\u2009k\u00d7 MIC) as the therapeutic target for treatment with beta-lactam antibiotics.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5c06\u7ed9\u836f\u95f4\u9694\u4e2d\u6e38\u79bbbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8840\u6d46\u6d53\u5ea6\u8d85\u8fc7\u81f4\u75c5\u83ccMIC\u7684k\u500d\u7684\u65f6\u95f4\u6bd4\u4f8b(%fT &gt; k x MIC)\u4f5c\u4e3abeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6cbb\u7597\u76ee\u6807\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R2.2. We suggest targeting a free plasma beta-lactam concentration between four and eight times the MIC of the causative bacteria for 100% of the dosing interval (fT\u2009\u2265\u20094\u20138 x MIC\u2009=\u2009100%) to maximize bacteriological and clinical response in critical care patients.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5c06100%\u7684\u7ed9\u836f\u95f4\u9694\u7ef4\u6301\u6e38\u79bbbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8840\u6d46\u6d53\u5ea6\u4e3a\u81f4\u75c5\u83ccMIC\u76844-8\u500d\uff0c\u4ee5\u4fdd\u8bc1\u5371\u91cd\u75c5\u60a3\u8005\u7ec6\u83cc\u5b66\u53ca\u4e34\u5e8a\u53cd\u5e94\u6700\u4f73\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R2.3. For beta-lactam antibiotics without validated toxicity threshold concentration, we suggest that it is useless, and even dangerous, to exceed plasma free concentrations of beta-lactam antibiotics above eight times the MIC (i.e., %fT\u2009&gt;\u20098\u00d7 MIC).<\/strong> \u5bf9\u4e8e\u6ca1\u6709\u6bd2\u6027\u4e34\u754c\u503c\u7684beta\u5185\u9170\u80fa\u6297\u751f\u7d20\uff0c\u6211\u4eec\u5efa\u8bae\uff0c\u5c06beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6e38\u79bb\u8840\u6d46\u6d53\u5ea6\u7ef4\u6301\u5728MIC\u76848\u500d\u4ee5\u4e0a(%fT &gt; 8 x MIC)\u5e76\u65e0\u7528\u5904\uff0c\u751a\u81f3\u6709\u5bb3\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><em>Third area.<\/em>&nbsp;Administration of beta-lactam antibiotics<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">\u7b2c\u4e09\u90e8\u5206\uff1abeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u7684\u4f7f\u7528<\/h2>\n\n\n\n<p><strong>R3.1. Pending the result of therapeutic drug monitoring (TDM), we suggest that a higher daily dose of beta-lactam antibiotics than that administered in patients outside the ICU should be administered at the onset of treatment, especially in the most critically ill patients and in those with preserved renal function.<\/strong> \u672a\u5f97\u5230\u6cbb\u7597\u836f\u7269\u76d1\u6d4b(TDM)\u7ed3\u679c\u65f6\uff0c\u6211\u4eec\u5efa\u8bae\uff0cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6cbb\u7597\u521d\u59cb\u65f6\uff0c\u6bcf\u65e5\u4f7f\u7528\u8f83\u9ad8\u5242\u91cf\uff08\u9ad8\u4e8e\u975eICU\u60a3\u8005\uff09\uff0c\u5c24\u5176\u662f\u75c5\u60c5\u6700\u4e3a\u5371\u91cd\u7684\u60a3\u8005\u53ca\u80be\u529f\u80fd\u4fdd\u7559\u7684\u60a3\u8005\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R3.2. We suggest administering beta-lactam antibiotics by prolonged or continuous infusions for infections due to bacteria with high MIC in order to increase the probability of achieving the PK-PD targets.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5bf9\u4e8e\u9ad8MIC\u7ec6\u83cc\u5f15\u8d77\u7684\u611f\u67d3\uff0c\u5e94\u5ef6\u957fbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8f93\u6ce8\u65f6\u95f4\u6216\u6301\u7eed\u8f93\u6ce8\uff0c\u4ee5\u589e\u52a0\u8fbe\u5230PK-PD\u76ee\u6807\u7684\u51e0\u7387\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R3.3. We suggest administering beta-lactam antibiotics by prolonged or continuous infusions in critical care patients with septic shock and\/or a high severity score in order to improve the clinical cure rate.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5bf9\u4e8e\u611f\u67d3\u6027\u4f11\u514b\u548c\uff08\u6216\uff09\u75c5\u60c5\u5371\u91cd\u60a3\u8005\uff0c\u5e94\u5ef6\u957fbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8f93\u6ce8\u65f6\u95f4\u6216\u6301\u7eed\u8f93\u6ce8\uff0c\u4ee5\u6539\u5584\u4e34\u5e8a\u6cbb\u6108\u7387\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R3.4. We suggest administering beta-lactam antibiotics by prolonged or continuous infusions in critically ill patients suffering from lower respiratory tract infections in order to improve the clinical cure rate.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5bf9\u4e8e\u4e0b\u547c\u5438\u9053\u611f\u67d3\u7684\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u5e94\u5ef6\u957fbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8f93\u6ce8\u65f6\u95f4\u6216\u6301\u7eed\u8f93\u6ce8\uff0c\u4ee5\u6539\u8fdb\u4e34\u5e8a\u6cbb\u6108\u7387\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R3.5. We suggest administering beta-lactam antibiotics by prolonged or continuous infusions in critically ill patients suffering from infections due to non-fermenting Gram-negative bacilli in order to improve the clinical cure rate.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5bf9\u4e8e\u975e\u53d1\u9175\u9769\u5170\u9634\u6027\u83cc\u611f\u67d3\u7684\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u5e94\u5ef6\u957fbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8f93\u6ce8\u65f6\u95f4\u6216\u6301\u7eed\u8f93\u6ce8\uff0c\u4ee5\u6539\u8fdb\u4e34\u5e8a\u6cbb\u6108\u7387\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R3.6. We suggest administering an intravenous loading dose before starting the continuous or prolonged infusion at the onset of treatment with beta-lactam antibiotics, in order to achieve a concentration within the PK-PD targets as quickly as possible. <\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5f00\u59cbbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6cbb\u7597\u65f6\uff0c\u5728\u6301\u7eed\u8f93\u6ce8\u6216\u5ef6\u957f\u8f93\u6ce8\u65f6\u95f4\u524d\uff0c\u5e94\u7ed9\u4e88\u9759\u8109\u8d1f\u8377\u5242\u91cf\uff0c\u4ee5\u5c3d\u5feb\u4f7f\u8840\u836f\u6d53\u5ea6\u8fbe\u5230PK-PD\u76ee\u6807\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><em>Fourth area.<\/em>&nbsp;Therapeutic drug monitoring of beta-lactam antibiotics<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">\u7b2c\u56db\u90e8\u5206\uff1abeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6cbb\u7597\u836f\u7269\u76d1\u6d4b<\/h2>\n\n\n\n<p><strong>R4.1. We suggest performing therapeutic drug monitoring in ICU patients with expected beta-lactam PK variability and\/or in patients with clinical signs potentially related to beta-lactams toxicity.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5bf9\u9884\u8ba1beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u836f\u4ee3\u52a8\u529b\u5b66\u53d8\u5316\u8f83\u5927\u7684ICU\u60a3\u8005\u548c\uff08\u6216\uff09\u4e34\u5e8a\u8868\u73b0\u53ef\u80fd\u4e0ebeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6bd2\u6027\u76f8\u5173\u7684\u60a3\u8005\uff0c\u5e94\u5f53\u8fdb\u884c\u6cbb\u7597\u836f\u7269\u76d1\u6d4b\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R4.2. We suggest performing therapeutic drug monitoring (TDM) of beta-lactam antibiotics in critical care patients undergoing renal replacement therapy.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5bf9\u4e8e\u63a5\u53d7\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u7684\u5371\u91cd\u75c5\u60a3\u8005\u8fdb\u884cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u7684\u6cbb\u7597\u836f\u7269\u76d1\u6d4b(TDM)\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R4.3. We suggest performing beta-lactam TDM by dosing plasma trough concentration in case of intermittent administration and plasma steady-state concentration in case of continuous administration.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5bf9\u4e8e\u95f4\u65ad\u4f7f\u7528beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u60a3\u8005\u76d1\u6d4b\u836f\u7269\u8c37\u6d53\u5ea6\uff0c\u5bf9\u4e8e\u6301\u7eed\u7528\u836f\u60a3\u8005\u76d1\u6d4b\u7a33\u6001\u6d53\u5ea6\u3002<\/p>\n\n\n\n<p><strong>R4.4. We suggest performing beta-lactam TDM 24 to 48&nbsp;h after the onset of treatment; after any change in dosage; and in the event of a significant change in the patient\u2019s clinical condition.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5728\u6cbb\u7597\u5f00\u59cb\u540e24-48\u5c0f\u65f6\uff0c\u6539\u53d8\u5242\u91cf\u540e\uff0c\u4ee5\u53ca\u60a3\u8005\u4e34\u5e8a\u60c5\u51b5\u663e\u8457\u53d8\u5316\u65f6\uff0c\u5e94\u5f53\u8fdb\u884cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20TDM\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R4.5. In case of central nervous system infection, we suggest performing beta-lactam TDM, if possible, on blood and cerebrospinal fluid samples collected concomitantly.<\/strong> \u5bf9\u4e8e\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\u611f\u67d3\u60a3\u8005\uff0c\u6211\u4eec\u5efa\u8bae\uff0c\u5982\u6709\u53ef\u80fd\uff0c\u5e94\u540c\u65f6\u91c7\u96c6\u8840\u548c\u8111\u810a\u6db2\u6807\u672c\uff0c\u8fdb\u884cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u7684TDM<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R4.6.1. We suggest performing beta-lactam TDM according to a validated chromatographic method.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u6839\u636e\u7ecf\u8fc7\u9a8c\u8bc1\u7684\u8272\u8c31\u6cd5\u8fdb\u884cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20TDM\u3002<\/p>\n\n\n\n<p><strong>R4.6.2. We suggest that beta-lactam TDM results should be available to clinicians as soon as possible in order to have a real impact on ICU patient\u2019s management.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5e94\u5f53\u5c3d\u53ef\u80fd\u5411\u4e34\u5e8a\u533b\u751f\u63d0\u4f9bbeta\u5185\u9170\u80fa\u6297\u751f\u7d20TDM\u7ed3\u679c\uff0c\u4ee5\u771f\u6b63\u5f71\u54cdICU\u60a3\u8005\u7684\u6cbb\u7597\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R4.7. We suggest considering as therapeutic targets the plasma concentrations presented in<\/strong><em>&nbsp;<\/em><strong>Table<\/strong><em>&nbsp;<a href=\"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-019-2378-9#Tab2\">&nbsp;<strong>2<\/strong>&nbsp;<\/a><\/em><em>.<\/em> \u6211\u4eec\u5efa\u8bae\u4ee5\u8868\u4e2d\u8840\u6d46\u6d53\u5ea6\u4f5c\u4e3a\u6cbb\u7597\u76ee\u6807\u3002<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/csccm.org.cn\/wp-content\/uploads\/2019\/04\/\u56fe\u7247-1.png\" alt=\"\" class=\"wp-image-17003\"\/><\/figure>\n\n\n\n<p><strong>R4.8.1. In case of non-achievement of the target beta-lactam plasma concentration, we suggest in first line:<\/strong> \u82e5\u672a\u80fd\u8fbe\u5230beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u76ee\u6807\u8840\u836f\u6d53\u5ea6\uff0c\u6211\u4eec\u5efa\u8bae<\/p>\n\n\n\n<ul><li><strong>Either increasing the frequency of administration (i.e., further fractionate the dose) or switching to continuous administration, while maintaining the same daily dose;<\/strong> \u6216\u8005\u589e\u52a0\u7ed9\u836f\u9891\u7387\uff08\u5373\u8fdb\u4e00\u6b65\u5206\u89e3\u6bcf\u65e5\u603b\u5242\u91cf\uff09\uff0c\u6216\u6539\u4e3a\u6301\u7eed\u8f93\u6ce8\uff08\u7ef4\u6301\u6bcf\u65e5\u603b\u5242\u91cf\u4e0d\u53d8\uff09<\/li><\/ul>\n\n\n\n<ul><li><strong>Or increasing the unit dose administered discontinuously by 25 to 50% while maintaining the same frequency of administration.<\/strong> \u6216\u7ef4\u6301\u7528\u836f\u9891\u7387\u4e0d\u53d8\u7684\u60c5\u51b5\u4e0b\uff0c\u5c06\u95f4\u65ad\u7ed9\u836f\u5242\u91cf\u589e\u52a025%\u523050%\u3002<\/li><\/ul>\n\n\n\n<p><strong>R4.8.2. In the case of persistence of below-target beta-lactam plasma concentration despite one of the previous measures, we suggest switching to prolonged or continuous administration in combination with an increase of the beta-lactam daily dose.<\/strong> \u82e5\u91c7\u53d6\u4e0a\u8ff0\u63aa\u65bd\u540e\uff0cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8840\u836f\u6d53\u5ea6\u4ecd\u6301\u7eed\u4f4e\u4e8e\u6cbb\u7597\u76ee\u6807\u65f6\uff0c\u6211\u4eec\u5efa\u8bae\u6539\u4e3a\u5ef6\u957f\u8f93\u6ce8\u65f6\u95f4\u6216\u6301\u7eed\u8f93\u6ce8\uff0c\u4e14\u589e\u52a0beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6bcf\u65e5\u5242\u91cf\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n\n\n\n<p><strong>R4.9.1. In case of supra-therapeutic plasma beta-lactam concentration, we suggest in first line:<\/strong> \u5f53beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8840\u836f\u6d53\u5ea6\u8d85\u8fc7\u6cbb\u7597\u76ee\u6807\u65f6\uff0c\u6211\u4eec\u5efa\u8bae\uff1a<\/p>\n\n\n\n<ul><li><strong>Either reducing the daily dose in the case of continuous administration;<\/strong> \u5728\u6301\u7eed\u8f93\u6ce8\u65f6\u51cf\u5c11\u6bcf\u65e5\u5242\u91cf<\/li><\/ul>\n\n\n\n<ul><li><strong>Or decreasing the unit dose administered discontinuously by 25 to 50% while maintaining the same frequency of administration.<\/strong> \u7ef4\u6301\u6bcf\u65e5\u7528\u836f\u9891\u7387\u4e0d\u53d8\u7684\u60c5\u51b5\u4e0b\uff0c\u5c06\u95f4\u65ad\u7528\u836f\u5242\u91cf\u51cf\u5c1125%\u81f350%<\/li><\/ul>\n\n\n\n<p><strong>R4.9.2. In case of extremely high concentration and\/or signs of toxicity consistent with beta-lactam overdose, we suggest stopping the administration and further resuming the treatment after having checked the decrease in beta-lactam concentration; then conducted under strict TDM.<\/strong> \u5982\u679cbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8840\u836f\u6d53\u5ea6\u6781\u9ad8\u548c\uff08\u6216\uff09\u51fa\u73b0beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u836f\u7269\u8fc7\u91cf\u7684\u4f53\u5f81\u65f6\uff0c\u6211\u4eec\u5efa\u8bae\u7ec8\u6b62\u836f\u7269\u8f93\u6ce8\uff0c\u5f53\u68c0\u6d4bbeta\u5185\u9170\u80fa\u6297\u751f\u7d20\u6d53\u5ea6\u964d\u4f4e\u540e\u518d\u6062\u590d\u7528\u836f\uff1b\u6b64\u540e\u8fdb\u884c\u4e25\u683c\u7684TDM\u3002<\/p>\n\n\n\n<p><strong>R4.9.3. We suggest performing renal replacement therapy if acute renal failure is, at least partially, responsible for symptomatic beta-lactam overdose.<\/strong> \u6211\u4eec\u5efa\u8bae\uff0c\u5f53\u6025\u6027\u80be\u529f\u80fd\u8870\u7aed\u81f3\u5c11\u90e8\u5206\u5bfc\u81f4beta\u5185\u9170\u80fa\u6297\u751f\u7d20\u8fc7\u91cf\u7684\u4e34\u5e8a\u75c7\u72b6\u65f6\uff0c\u5e94\u8fdb\u884c\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u3002<\/p>\n\n\n\n<p><em>Optional recommendation<\/em>\u2014<em>strong agreement<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Optimization of the treatment with beta-lactam antibiot [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[25],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16995"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16995"}],"version-history":[{"count":5,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16995\/revisions"}],"predecessor-version":[{"id":17004,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16995\/revisions\/17004"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16995"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16995"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16995"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}