| 特集名 | 透析患者の薬物の処方とモニタリング | |
|---|---|---|
| 題名 | 抗生物質・抗菌薬のTDM | |
| 発刊年月 | 1999年 11月 | |
| 著者 | 田中 寛 | 大野記念病院泌尿器科 |
| 【 要旨 】 | 透析患者の感染症は治療が遅延すると重篤化しやすく，早期より抗生物質・抗菌薬を投与することが多い．原因菌の予測，その菌に対する耐性頻度が低い，感染臓器・部位に移行しやすいなどの選考基準で薬剤を選択せざるをえない． 血液透析患者の場合，透析中に血液回路より薬剤の投与が可能である．また，透析性のある薬剤の血中濃度は透析中と非透析時のそれぞれで測定し，透析量，体重によっても大きな差が生じるため，各血液浄化法のtherapetic drug monitoring (TDM) が必要である．残存腎機能のある場合には腎保護を考慮し，副作用の予防のためにもTDMが有用である． 血中濃度のシミュレーションには透析中，非透析時の臨床薬理学的パラメーターを使用し，その実証も必要である．薬剤，患者，透析情報で投与計画が示されるシステムの開発が待たれる． |
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| Theme | Prescription of Therapeutics and Monitoring for the Dialysis Patients | |
|---|---|---|
| Title | TDM of antibiotics | |
| Author | Hiroshi Tanaka | Department of Urology, Ohno Memorial Hospital |
| [ Summary ] | Hemodialysis patients may easily become infected. Earlier chemotherapy is recommended for these patients, because their conditions will become more serious when treatment for infection is delayed. A drug, which has a low possibility for promoting resistant bacteria, and which easily shifts its focus to the infected organ or location of infection, should be selected for patients with the possibility of contracting infectious bacteria diseases. Intravenous infusion is possible for hemodialysis patients, through the blood line. Serum concentrations of dialyzable drugs must be monitored during and after hemodialysis treatment. Serum concentrations are changed according to hemodialysis dosage and patient body weight. TDM is necessary during various types of blood purification. When weekly serum concentrations of drugs are simulated, the pharmacokinetic parameters, both during and without hemodialysis treatment must be used. Results should be checked by actually monitoring serum concentrations. Residual renal functioning should be protected, and the side effects of the antibiotics must be prevented through TDM. Systems, which can show medication planning for antibiotics, using the simulation of pharmacokinetics, are expected to be developed in the near future, when the information about the drugs, the patients, and hemodialysis treatment is given. |
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