Zusammenfassung
Maßgeblich für die Arzneimitteldosierung ist die glomeruläre Filtrationsrate (GFR) nicht der Kreatininwert. Bei lebensbedrohlichen Erkrankungen darf man die Startdosis nicht vergessen, die zumeist der Normaldosis entspricht. Die Halbwertszeit gibt Auskunft über die Dauer des Dosierungsintervalls. Für konzentrationsabhängig wirkende Antibiotika, wie Daptomycin, Linezolid oder Colistin, ist ein hoher Spitzenspiegel der Zielspiegel. Für zeitabhängig wirkende Antibiotika ist ein hoher Talspiegel der Zielspiegel. Bei Piperacillin, Meropenem und Vancomycin wird deshalb die Dauerinfusion bevorzugt. Mit kontinuierlichen Nierenersatzverfahren entspricht die Gesamtfiltration oft einer GFR von 30–50 ml/min: Viele Antibiotika kann man dann in voller Normaldosis verabreichen. Nach intermittierender Hämodialyse empfiehlt es sich, eine erneute Startdosis zu geben um danach ausreichende Spiegel zu garantieren.
Abstract
Essential for drug dose adjustment is the glomerular filtration rate (GFR) not the serum creatinine level. In acute disease, a loading dose must be given that usually corresponds to the normal dose. The eliminated half-life is used to estimate the administration interval. For anti-infective drugs with a concentration-dependent effect, the target is the high peak such as for daptomycin, linezolide, and colistin. For anti-infective drugs with a time-dependent effect, the target is the high trough such as for piperacillin, meropenem and vancomycin. Such drugs with a time-dependent action should best be administered by infusion not by bolus dosing. With continuous renal replacement therapy (CRRT), the total filtration rate corresponds to a GFR of 30–50 ml/min and many antibiotics will not need a dose reduction on CRRT. After intermittent hemodialysis, a new loading dose should be given to ascertain sufficiently high concentrations in the interval until the next dose or next dialysis.
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F. Keller gibt folgende Interessenskonflikte an: Referentenhonorare von Novartis, TEWA, Astellas, Roche, Alexion, Medice, Hexal, Bayer, Pfizer, MSD, Aspen, Akademie Niere und Beschäftigungsverhältnis mit KfH und Universitätsklinikum Ulm.
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Keller, F. Pharmakotherapie bei Niereninsuffizienz. Med Klin Intensivmed Notfmed 114, 444–451 (2019). https://doi.org/10.1007/s00063-018-0455-5
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DOI: https://doi.org/10.1007/s00063-018-0455-5