colistin guideline, International Consensus Guidelines for the Polymyxins, renal dosing, 콜리스틴 가이드라인 (2)

이전 포스팅과 겹치는 내용이긴 하지만 다시 한 번 짚고 넘어가도록 하자!

 

gimi-drug.tistory.com/5

colistin ? CMS? 너란 녀석 이름이 참 많구나

 

성분명(1)	colistimethate	polymyxin E
성분명(2)	colistin sodium methanesulfonate [CMS]	colistin
활성형 여부	inactive form (prodrug)	active form
배설	renal clearance	non renal clearance

국내 제형은 모두 CMS로, prodrug 형태로만 투여된다.

 

 

 

가이드라인의 목차 (Clinical Questions and Recommendations)

 

 

Susceptibility and Pharmacokinetics/Pharmacodynamic

1. How Should Susceptibility Be Tested, and WhatAre the Minimum Inhibitory Concentration Break-points for the Polymyxins to Guide Therapy?

2. Is There a Recommended PK/PD TherapeuticTarget for Maximization of Efficacy for Colistinand Polymyxin B?

Polymyxin Pharmacokinetic

3. Should I Preferentially Use One Polymyxin Over the Other?

Colistin Intravenous Dosing

4. For  CMS,  What  Is  the  Relationship  Between Different Dosing Units in the Literature?

5. Do  I  Need  to  Administer  an  Intravenous  Loading Dose When I Initiate Therapy with CMS?

6. What  Should  My  Initial  Daily  Maintenance Dose  of  CMS  Be  in  Patients  with  Normal  Renal Function?

7. Do  I  Need  to  Adjust  the  Daily  Maintenance Dose of CMS If the Patient Has Renal Impairment?

8. Does Renal Replacement Therapy Have Implications  for  Selection  of  Intravenous  CMS  Dosage Regimens?

 

Polymyxin B Intravenous Dosing

9. Do I Need to Administer an Intravenous Loading Dose When I Initiate Therapy with Polymyxin B?

10. What Is the Recommended Initial Daily Maintenance Dose for Polymyxin B in Patients with Normal Renal Function?

11. Do I Need to Adjust the Daily Polymyxin B Maintenance Dose If the Patient Has Renal Impairment?

12. Does Renal Replacement Therapy Have Implications for Selection of Intravenous Polymyxin B Dosage Regimens?

13. Is There a Role for Therapeutic Drug Monitoring of Colistin or Polymyxin B?

14. What Strategies Can Be Used to Decrease the Incidence of Acute Kidney Injury in Patients Receiving Colistin or Polymyxin B Therapy?

15.  If My Patient Develops AKI While on Colistin or Polymyxin B, Should I Decrease the Dose?

Polymyxin Combinations

16.  Should Monotherapy or Combination Therapy for Polymyxin B or Colistin Be Used to Treat Patients with CRE Infections?

17. Should Monotherapy or Combination Therapy for Polymyxin B or Colistin Be Used to Treat Patients with CRAB?

18. Should Monotherapy or Combination Therapy for Polymyxin B or Colistin Be Used to Treat Patients with CRPA?

19. Should Inhaled Polymyxins Be Administered to Patients with HAP/VAP, and If So, Which Agent Is Preferred?

Intrathecal and Intraventricular Administration of Polymyxins

20.  Should Intraventricular or Intrathecal Administration of Polymyxins Be Considered in Meningitis or Ventriculitis?

 

 

reference : 

(1) Tsuji, Brian T., et al. "International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)." Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 39.1 (2019): 10-39.