Proposal of a Pharmacokinetically Optimized Dosage Regimen of Antibiotics in Patients Receiving Continuous Hemodiafiltration ▿ ‖

The aim of the study was to quantitatively predict the clearance of three antibiotics, amikacin, vancomycin, and teicoplanin, during continuous hemodiafiltration (CHDF) and to propose their optimal dosage in patients receiving CHDF. For this goal, in vitro CHDF experiments with a polyacrylonitrile (PAN) membrane were first performed using these antibiotics, and then the clearances were compared with in vivo CHDF situations determined in 16 critically ill patients. The in vitro CHDF clearances were described as the product of the outflow rate of a drain (Qoutflow) and the drug unbound fraction in artificial plasma, indicating that drug adsorption to the PAN membrane has minor effect on drug clearance in our settings. The observed in vivo clearances also agreed very well with the predicted values, with a product of Qoutflow and plasma unbound fraction, when residual creatinine clearance (CLCR) was taken into account (within a range of 0.67- to 1.5-fold for 15 of 16 patients). Based on these results, a nomogram of the optimized dosages of amikacin, vancomycin, and teicoplanin was proposed, and it was evident that Qoutflow and residual CLCR are major determinants of the dosage and dosing interval for these antibiotics. Although the applicability needs to be confirmed with another type of membrane or higher Qoutflow, our nomogram can help determine the dosage setting in critically ill patients receiving CHDF

バルーン下逆行性経静脈的塞栓術で治療した十二指腸静脈瘤の1例

十二指腸静脈瘤はまれであるが,致死的な出血を来す.近年,種々の治療法が行われている.肝硬変を有する46歳の男性が,重症の貧血のため入院した.血液検査ではヘマトクリット8.9%,血色素量2.3g/dlであった.内視鏡および造影CT検査により十二指腸水平脚に静脈瘤を認めた.第4病日にバルーン下逆行性経静脈的塞栓術を行い,治療に成功した.第4週の造影CT,MRIと内視鏡検査で十二指腸静脈瘤は消失していた.止血している十二指腸静脈瘤では,バルーン下逆行性経静脈的塞栓術が有効であると考えられた.Duodenal varices are a rare and fatal condition. Treatment options for duodenal varices have been more variety in recent years. A 46-year-old man with liver cirrhosis was admitted because of severe anemia. Laboratory findings showed extremely low values for hematocrit (8.9%) and hemoglobin (2.3 g/dl). Upon endoscopic examination and contrast-enhanced computed tomography, duodenal varices were evident on the third portion of the duodenum. On the 4th day, he was successfully treated by balloon-occluded retrograde transvenous obliteration (BRTO). Contrast-enhanced computed tomography, magnetic resonance imaging and endoscopy on the 4th week showed that the varices had diminished. In cases of duodenal varices when hemostasis, we support the use of BRTO

バルーン下逆行性経静脈的塞栓術で治療した十二指腸静脈瘤の1例

十二指腸静脈瘤はまれであるが,致死的な出血を来す.近年,種々の治療法が行われている.肝硬変を有する46歳の男性が,重症の貧血のため入院した.血液検査ではヘマトクリット8.9%,血色素量2.3g/dlであった.内視鏡および造影CT検査により十二指腸水平脚に静脈瘤を認めた.第4病日にバルーン下逆行性経静脈的塞栓術を行い,治療に成功した.第4週の造影CT,MRIと内視鏡検査で十二指腸静脈瘤は消失していた.止血している十二指腸静脈瘤では,バルーン下逆行性経静脈的塞栓術が有効であると考えられた.Duodenal varices are a rare and fatal condition. Treatment options for duodenal varices have been more variety in recent years. A 46-year-old man with liver cirrhosis was admitted because of severe anemia. Laboratory findings showed extremely low values for hematocrit (8.9%) and hemoglobin (2.3 g/dl). Upon endoscopic examination and contrast-enhanced computed tomography, duodenal varices were evident on the third portion of the duodenum. On the 4th day, he was successfully treated by balloon-occluded retrograde transvenous obliteration (BRTO). Contrast-enhanced computed tomography, magnetic resonance imaging and endoscopy on the 4th week showed that the varices had diminished. In cases of duodenal varices when hemostasis, we support the use of BRTO