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首页> 外文期刊>Case Reports in Critical Care >Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy
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Flucytosine Pharmacokinetics in a Critically Ill Patient Receiving Continuous Renal Replacement Therapy

机译：接受连续性肾脏替代治疗的重症患者的氟胞嘧啶药代动力学

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Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy.Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminatedCryptococcus neoformansinfection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine levels, and flucytosine was ultimately discontinued.Conclusion. Despite conservative flucytosine dosing for a patient receiving CVVH, peak and trough serum flucytosine levels were supratherapeutic (120 μg/mL at 2 hours and 81 μg/mL at 11.5 hours), which increased drug-related adverse effects. The results indicate that this conservative dosing regimen utilizing the patient’s actual body weight was too aggressive. This case report provides insight into flucytosine dosing in CVVH, a topic that has not been investigated previously. Further pharmacokinetic studies of flucytosine dosing in critically ill patients receiving CVVH are needed in order to optimize pharmacokinetic and pharmacodynamic parameters while avoiding toxic flucytosine exposure.
机译：目的。评估持续接受肾脏替代治疗的危重患者中氟胞嘧啶剂量的病例报告。该病例报告概述了一位81岁的男性，该男性因急性肾功能衰竭接受连续静脉血液滤过（CVVH），并接受氟胞嘧啶治疗以治疗新发隐球菌感染。由于患者的特定因素，根据经验将氟胞嘧啶的剂量调整为比间歇性血液透析（iHD）建议低约50％，比CRRT建议低约33％。获得了治疗上的峰值和谷值，并计算了药代动力学参数。该患者可能由于氟胞嘧啶水平升高而出现血小板减少症，最终停用了氟胞嘧啶。尽管接受CVVH的患者接受了保守的氟胞嘧啶剂量，但峰值和谷底血清氟胞嘧啶水平仍是超治疗的（2小时为120μg/ mL，11.5小时为81μg/ mL），这增加了与药物相关的不良反应。结果表明，这种利用患者实际体重的保守给药方案过于激进。该病例报告提供了有关CVVH中氟胞嘧啶剂量的见解，该主题以前未曾研究过。需要对接受CVVH的重症患者进行氟胞嘧啶剂量的进一步药代动力学研究，以优化药代动力学和药效学参数，同时避免毒性氟胞嘧啶暴露。

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