Особенности элиминации лекарственных препаратов для интенсивной терапии с помощью экстракорпоральных методов очищения крови при терапии критических состояний

Статья в Elpub

Рецепт. 2019; : 591-598

Особенности элиминации лекарственных препаратов для интенсивной терапии с помощью экстракорпоральных методов очищения крови при терапии критических состояний

Аннотация

Методы экстракорпорального очищения крови (ЭОК) являются важными составляющими комплексных мероприятий, проводимых пациентам в отделениях реанимации и интенсивной терапии, которые эффективно применяются для патогенетического и этиотропного лечения множества критических состояний. В обзоре обобщены и изложены существующие данные об элиминации лекарственных препаратов методами ЭОК. Проанализировано более сорока различных источников за последние 20 лет. Изучались литературные данные, касающиеся таких методов ЭОК, как продленный вено-венозный гемодиализ, гемофильтрация, плазмаферез, гемосорбция на различных сорбентах, а также применение аппарата «искусственная печень». Описаны особенности изменения общей эффективности и концентрации в плазме препаратов таких групп, как противоэпилептические, антибиотики, противогрибковые средства, цитостатики, иммунодепрессанты и др. Наиболее подробно представлены данные об изменении фармакокинетики антибактериальных препаратов, в том числе антибиотиков резерва, как одной из наиболее важных групп препаратов в интенсивной терапии критических состояний. Установлено, что методы ЭОК могут существенно повлиять на эффективность лакосамида, леветирацетама, парацетамола, ванкомицина, колистина, телаванцина, тейкопланина, меропенема, линезолида, амфотерицина B, метронидазола, далтепарина, гентамицина и др. Использование изложенных литературных данных позволит исключить возможные ошибки в применении описанных лекарственных средств у пациентов с необходимостью проведения заместительной почечной терапии, сорбционных и ферезных методов очищения крови. Влияние методов ЭОК на фармакокинетику антибиотиков резерва может сыграть существенную роль в эффективности антимикробной терапии у пациентов с сепсисом и сопутствующим синдромом полиорганной недостаточности.

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Recipe. 2019; : 591-598

Characteristics of Intensive Care Drugs Elimination by Extracorporeal Blood Puriﬁcation Methods During Therapy of Critical Conditions

Yakubtsevich R. , Belyavskii N.

Abstract

Extracorporeal blood puriﬁcation is one of the most important procedures in complex therapy of critical conditions in the intensive care unit. The aim of our study is to collect and represent exciting data on the elimination of therapeutic drugs by extracorporeal blood puriﬁcation methods. More than forty diﬀerent sources over the past twenty years has been analyzed. The literature data about hemodialysis, hemoﬁltration, plasmapheresis, hemosorption, and the use of extracorporeal liver support devices has been studied. The characteristics of changes in the overall eﬃcacy and plasma concentration levels of drugs from various groups such as antiepileptic, antibiotics, antifungal agents, cytotoxic drugs, immunosuppressants, and others has been described. The most detailed data are presented on the changes in the pharmacokinetics of antibacterial drugs, including reserve antibiotics, as one of the most important groups of drugs in the intensive care of critical conditions. We have found that EOC methods can signiﬁcantly aﬀect the eﬃcacy of lacosamide, levetiracetam, paracetamol, vancomycin, colistin, telavancin, teicoplanin, meropenem, linezolid, amphoterocin B, metronidazole, dalteparin, gentamicin, etc. Using of the founded literature data will allow to avoid possible mistakes in prescribing aﬀected drugs to patients with the need for renal replacement therapy, hemadsorption or plasmapheresis. The eﬀect of EOC methods on the pharmacokinetics of reserve antibiotics can play a signiﬁcant role in the eﬀectiveness of antimicrobial therapy in patients with sepsis and the concomitant multiple organ failure.

References