Dosierung von Antiinfektiva bei Nierenversagen und Nierenersatztherapie in der Intensivmedizin

Empfehlungen der Sektionen Niere der DGIIN, ÖGIAIN und DIVI

Dose adjustment of anti-infective drugs in patients with renal failure and renal replacement therapy in intensive care medicine

Recommendations from the renal section of the DGIIN, ÖGIAIN and DIVI

Zusammenfassung

Hintergrund

Viele Antiinfektiva erfordern bei kritisch kranken Patienten mit akuter Nierenschädigung (AKI) und Nierenersatztherapie eine Dosisanpassung, um adäquate therapeutische Konzentrationen zu erreichen.

Ziel der Arbeit

Es sollen grundlegende pharmakokinetische und pharmakodynamische Prinzipien der Dosisanpassung von Arzneimitteln dargestellt und praktische Empfehlungen zur Dosierung von Antiinfektiva auf der Intensivstation geben werden.

Material und Methoden

Die Empfehlungen zur Dosierung von ausgewählten Antiinfektiva wurden basierend auf einer Zusammenschau der Angaben in Fachinformationen, publizierten Studien und Empfehlungen, pharmakokinetischen und pharmakodynamischen Erwägungen sowie Erfahrungen und Expertenmeinungen der Autoren erstellt.

Ergebnisse

Von 37 Antiinfektiva (31 Antibiotika, 2 Virostatika, 4 Antimykotika) ist bei 8 eine Dosierung unabhängig von der Nierenfunktion möglich. Bei 29 Antiinfektiva war eine konkrete Dosierungsempfehlung für intermittierende Hämodialyse und bei 24 Antiinfektiva für kontinuierliche Hämofiltration möglich.

Diskussion

Anhand aktueller Datenlage werden hier für die wichtigsten Antiinfektiva Empfehlungen zur Dosierung bei Patienten mit AKI und Nierenersatztherapie gegeben.

Abstract

Background

Many anti-infective drugs require dose adjustments in critically ill patients with acute kidney injury (AKI) and renal replacement therapy, in order to achieve adequate therapeutic drug concentrations.

Objectives

The fundamental pharmacokinetic and pharmacodynamic principles of drug dose adjustment are presented. Recommendations on anti-infective drug dosage in intensive care are provided.

Materials and methods

We established dose recommendations of selected anti-infective drugs based on information in the summary of product characteristics, published studies and recommendations, pharmacokinetic and pharmacodynamic considerations, and the experience and expert opinion of the authors.

Results

Out of a total of 37 anti-infective drugs (31 antibiotics, 2 antivirals, 4 antifungals) 8 can be administered independent of renal function. For 29 anti-infective drugs, a specific recommendation on drug dosage could be made in case of intermittent hemodialysis and for 24 anti-infective drugs in case of continuous hemo(dia)filtration.

Conclusions

Recommendations on dosing of important anti-infective drugs in critically ill patients with AKI and renal replacement therapy are provided.

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Correspondence to Prof.(apl.) Dr. D. Czock.

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Interessenkonflikt

D. Czock, D. Kindgen-Milles, S. John, M. Schmitz, A. Jörres, M. Oppert, und C. Willam geben an, dass kein Interessenkonflikt besteht. M. Joannidis erhielt Vortrags‑/Konsulentenhonorare von den Firmen Baxter Healthcare Corp, CSL Behring, Fresenius und Astute Medical sowie Forschungsunterstützung von der Firma Fresenius. J. T. Kielstein erhielt Vortragshonorare von den Firmen Fresenius Medical Care, Baxter und Terumo BCT sowie Forschungsunterstützung von der Firma ExThera Medical. V. Schwenger erhielt Vortragshonorare von den Firmen Fresenius Medical Care und Baxter. A. Zarbock erhielt finanzielle Unterstützung von den Firmen Astute Medical und Fresenius.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Joannidis, Innsbruck

S. John, Nürnberg

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Czock, D., Schwenger, V., Kindgen-Milles, D. et al. Dosierung von Antiinfektiva bei Nierenversagen und Nierenersatztherapie in der Intensivmedizin. Med Klin Intensivmed Notfmed 113, 384–392 (2018). https://doi.org/10.1007/s00063-018-0416-z

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Schlüsselwörter

  • Akutes Nierenversagen
  • Nierenersatztherapie
  • Antibiotika
  • Pharmakodynamik
  • Pharmakokinetik

Keywords

  • Acute kidney injury
  • Renal replacement therapy
  • Antibiotics
  • Pharmacodynamics
  • Pharmacokinetics