Antibiotics with physiological saline or glucose with, is there a difference?

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Most of them are treated with normal saline, but some also use glucose, because most of the antibiotics are decomposed in acid environment,

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Most of them are treated with normal saline, but some also use glucose, because most of the antibiotics are decomposed in acid environment, which leads to the failure of drugs and even the increase of sensitization.

A: with sugar or salt according to the patient's specific situation and decide.

1: is determined according to the primary disease and complications of patients: (1) if the patient has hypertension, coronary heart disease, and heart function is not good, should reduce salt intake, to reduce the burden on the heart. (2) if the patient has diabetes, but the heart and kidney function is acceptable, the brine can be used, but with sugar can add insulin against regulation. (3). If the patient is poor kidney function, to reduce the intake of sodium and water, reduce the sodium water storage slip.

2: according to the results of the patient's test. (1) such as electrolyte results. To see if there is hyponatremia, then given saline, and then use sugar. (2) according to myocardial enzymes and other evaluation of cardiac function, to determine the choice of salt sugar

3: solution with some drugs soluble in sugar or salt, its efficacy will be better, it should be based on the drug instructions selected Sugar Salt

4: such as patients with shock, should be given to the salt water to supplement the blood volume and then given the sugar supplement

5: salt water is mainly used for the regulation of electrolytes and sugar is mainly used as a source of energy

In short, the choice should be careful, especially in the Department of respiration, many elderly patients, there are different degrees of cardiac function is not good, diabetes, in the selection of salt to be careful when considering the use of sugar to add insulin. Two: the selection of solvent is mainly from the aspects of antibiotic stability

1: the selection of solvent is mainly from the stability considerations of antibiotics. In the preparation of glucose in the production process need to add hydrochloric acid, the solution PH is about 3, while the physiological saline slightly higher, generally from 4 to 5. Beta lactam in near neutral (PH=6 ~ 7) stable solution, acid or alkaline solution are susceptible to beta lactam ring open loop, loss of antibacterial activity, we should do the salt solvent.

Macrolide antibacterial efficacy in alkaline condition than in acidic condition can be increased 10 times (a report), the selection of salt as a solvent, adding sodium bicarbonate or increase of pH in solvent.

2 the amount of solvent used to control the general minimum specifications. For the short half-life of drugs, such as penicillin, I have seen in clinical pediatric 500ml soluble sugar solution, lost more than 2 hours, in front of the drug metabolism, haven't finished, did not reach the effective concentration. Now most of the use of 100ml+ antibiotics, perhaps the treatment habits, so high efficiency.

Why. Antibiotics are not static push to static point? The reason is because the first pharmacokinetic (compartmental model, apparent distribution and so on), two is because the oil and water solution (oil) suspension for intravenous injection (no antibiotic for water suspension), because can cause dangerous vascular embolism it is clearly pointed out. In the 11 edition of new medicine.

2 brine or syrup with antibiotics and drug problems: in fact this is itself about the physicochemical properties, usually cephalosporins, penicillins antibiotics are relatively stable in the pH value of saline, intravenous drip can in 12 hours outside with a good, but in this kind of glucose macromolecular substances, antibiotics complexation stability decreased.

The synthesis of antibiotics such as metronidazole, Kuinuo ketones due to specific molecular structure, 5% glucose solution was more stable than saline shape, for a detailed explanation of this problem can ask pharmaceutical plate comrades.

About 3 of the solvent quantity problem why 100, not 250? Actually this is habit, there is no absolute requirement, but for those patients who need to limit water input (cirrhosis, heart failure), and the need to quickly put the drug infusion to increase the blood concentration, should use the 100ml liquid compatibility. 4: advocate the use of saline, mainly from antibiotic stability.

Penicillin as an example, they are in near neutral (PH=6 ~ 7) stable solution, acidic or alkaline solution to accelerate decomposition, the best application with the injection of water or isotonic solution of penicillin Sodium Chloride Injection. Soluble glucose solution (PH=3.5 ~ 5.5) can have a certain degree of decomposition. Penicillins decompose rapidly in alkaline solutions. Therefore, it is strictly prohibited to alkaline solution (sodium bicarbonate, aminophylline) and its compatibility.

(Reference: Chen Xinqian Kim for soup light editor. New Pharmacology (Fifteenth Edition) people's Health Publishing House P49) according to the principle of drug instructions specified requirements with liquid preparation, general import drug instructions in more detail, some comrades can search!

Quinolones, such as levofloxacin, especially pefloxacin, should be used with sugar. Pefloxacin can not see the chloride ion, otherwise it will precipitate.

To ampicillin with saline can not use glucose. Specific analysis of specific issues

For patients with pulmonary encephalopathy (type 2 respiratory failure), best use of saline with antibiotics, because of the use of glucose will increase carbon dioxide retention, exacerbation of pulmonary encephalopathy. But some antibiotics only with sugar, such as the majority of macrolides.

4: such as patients with shock, should be given to the salt water to supplement the blood volume and then given the sugar supplement

I don't think it can be used in shock. Because the shock reduced insulin secretion, which is prone to use of hyperglycemia with glucose and saline for sodium and chloride content were significantly higher than normal intercellular fluid, renal function is affected by the shock will hinder the excretion of sodium and chloride by hyperchloraemia, so it can not be used. In the treatment of expansion, it is best to use a balanced salt solution and hypertonic saline solution.

From the effect of antibiotics, cephalosporins, we use brine, fluoroquinolones with sugar, penicillin with salt, macrolide use sugar. I still think more authoritative instructions

Class quinolones with syrup, macrolides are sugar, other especially cephalosporins and penicillins with salt effect than good syrup. But to take into account whether the patient had diabetes, electrolyte is disorder, a lot of problems, and the amount of liquid into the patient's heart function can not be generalized, metaphysics.

Out of clinical soon, some of the details of the use of antibiotics from time to time to worry about their own:

1 on the use of antibiotics: usually intravenous drip, but when to consider using intravenous injection? Whether the so-called severe infection before use?

2 antibiotic dispensing: my superior doctors always said antibiotics are generally used with saline solution, if 5% glucose will reduce the effect of preparation. (of course, in addition to macrolide antibiotics are generally prepared with sugar addition). Do not know where he saw this conclusion, do not know if there is no reason. But I was edited by Professor He Quanying "respiratory disease diagnosis and treatment guidelines for the treatment of P66 pneumonia" antibiotic dose just said "solvent 250ml+ drugs, intravenous drip, and did not emphasize the use of saline?!

3 antibiotics and prepared brine or syrup amount problem: now my department use of antibiotics mostly use 100ml+ antibiotics. Some doctors say it can improve the concentration of the drug. At first glance, it seems reasonable, but it is only in vitro when the concentration of 100ml is higher than 250ml, but into the body, in the face of 4-5L's blood, seems to be negligible. So in Professor He Quanying's "respiratory disease diagnosis and treatment guidelines" in the treatment of pneumonia did not emphasize 100ml, but also more 250ML. Moreover, infectious diseases are generally associated with fever, need to supplement the liquid, generally more than 1000ml, so it seems that there is no need to emphasize the importance of 100ml ah.

These are some of the personal problems encountered in the clinic, although there are their own views, but do not know right or wrong, ask you!

1 the application of antibiotics, I have not encountered intravenous injection, intravenous drip can solve the problem, to push it? General intravenous drugs most short half-life, fast play pharmacological effects, like general antibiotics, no half-life is so short, if you can give too much liquid, less can, do not need intravenous (50-100ml) 2 on antibiotic prepared brine or syrup amount problem: this problem has troubled me for a long time, I have asked the leadership, he also did not say the specific reasons, also checked some information and drug instructions, did not see a clear explanation (may retrieve overall), personal understanding of both the saline or sugar, is used as a liquid to dilute or dissolved drug,

To explain their reasons (may be too far fetched):

Salt water allocation may be a habit;

It may be better to simulate the physiological environment of the human body with saline;

In addition, if patients strictly limit the intake of Na, also can only use sugar

Clinically, with sugar and salt with the antibiotics, the patient infusion after found no significant difference between the 3 doses in brine: actually not too restrictive, now clinical treatment liquid mainly according to the actual situation of the patient, if the patient has a restriction on the amount of liquid brine, so it should be less, if the patient had no significant amount of liquid limit, but also need to add liquid volume, then you can give some people more choice; habits about 100-250

However, intravenous injection must be slow, I see in the clinical use of other high - age doctors using intravenous injection of 10-20ml are generally with the liquid, the specific should be pushed for how long? I downloaded some of the courseware used in DXY about first aid drugs such as amiodarone and cedilanid and lidocaine "and other drugs, are generally recommended more than 10-20min.

Asked the ward nurses push the speed of note, they said the general 10~15 minutes after the push, and sometimes push note, the patient will be pain, may be pushed on half an hour. However, at such a rate, there was no adverse reaction!

The problem with the liquid, but also do not know whether his source is correct, here to give you a look:

Glucose Injection should not be used as the solvent of drugs:

Furosemide crystallization

Bumetanide crystallization

PH< 4 when phenytoin cannot be completely dissolved;

The acetyl coenzyme A, the intermediate metabolite of iodine fixing glucose, provides acetyl groups for the synthesis of acetylcholine and increases the symptoms of organophosphate poisoning

Heparin in pH< 6 of the solution quickly failed

Trastuzumab protein coagulation

Etoposide is not stable, can form fine precipitation

Precipitation of hydroxycamptothecin

Ammonia production

Compatible with the presence of and vitamin B12.

Tegafur combined with acidic drugs.

Do not use acid infusion of nedaplatin and pH=5 amino acid infusion following rehydration electrolyte and 5% glucose infusion of glucose or sodium chloride infusion.

It is easy to produce precipitation

Doxorubicin dissolved or diluted with water or Sodium Chloride Solution. Compatibility of daunorubicin with acid or alkaline solution.

Pantoprazole injection can be diluted with Sodium Chloride Injection or a special solvent and diluted with solvents or other prohibited drug dissolution.

Itraconazole is prohibited diluted by 5% Glucose Injection or Ringer's solution

It is not recommended to dilute the drug with glucose solution in the treatment of anti human lymphocyte immunoglobulin. Glucose is produced by hydrochloric acid, and it is acidic.

Rocephin Ceftriaxone Sodium for Injection Roche products

[usage]...... Intravenous injection of 0.25 grams or 0.5 grams of melt into the injection of sterile water in the injection of 5 ml, 1 grams of water into the intravenous infusion of 10 ml, injection time of not less than 2 ~ 4 minutes.......

This is a short time limit

I found the product description of foreign companies is comfortable. China was too horrible to look at people who are interested can go and see more imported products specifications, there will be a harvest. Ha-ha

For example, you need to use 5%G.S 250ML dissolved fleroxacin, saline.

Because of the addition of salt water, there will be white turbid suspension

That's enough to fear

Each medication and ceftriaxone sodium and calcium in an effect if there is doubt we must read the instructions, I remember 500mg 500ml with azithromycin intravenous drip of water, 2 hours, welcome the exhaustive. There are many differences between the static push of antibiotics and the strong heart medicine, but the strong heart medicine should be pushed slowly because of the fear of an accident, and it should be matched with 50% sugar,

Is it possible that macrolide antibiotics such as macrolides and antimicrobial agents are not compatible with fungicides? What is the theoretical basis? One of the fungicides is not only cephalosporins, penicillins, or in addition to the big ring and Lin can be outside the

The use of fungicides and antibacterial agents has been affirmed, the relevant information can be found

I see the use of antibiotics in the newborn 0-3 days are sugar 5-10ml drops, but the book is also available on the newborn 0-3 days 1-2mmol/kg NA, I do not know why do not use physiological saline.

My understanding is the newborn sodium metabolism is not perfect, the sodium salt shoulds not be used for a long time

In addition, the sugar is maintained on newborn blood glucose regulation, neonatal antibiotic use less saline as solvent and after birth 3 days without sodium supplement. We usually added to adjust the sodium according to the electrolyte.

Neonatal transfusion tension requirements can not be too high, so most of the sugar with sugar or salt according to the patient's specific situation and decide. I think the following should be considered

A: according to the primary disease and complications of patients and 1. If the patient has hypertension, coronary heart disease, and heart function is not good, should reduce salt intake, to reduce the burden on the heart. 2 but if the patient has diabetes heart and kidney function is acceptable, the brine can be used, but with sugar can add insulin against 3. If the patient is poor kidney function, to reduce the intake of sodium and water, reduce the sodium water storage slip.

Two: according to the results of the test of the patient. 2, such as electrolyte results. See if there is hyponatremia, then give saline, and then use sugar. According to the myocardial enzymes and other evaluation of cardiac function, to determine the choice of salt sugar. 1

Three: liquid with some drugs soluble in sugar or salt its efficacy will be better, it should be selected according to the drug instructions Sugar Salt

Four: if the patient shock, should be given to the salt water to supplement the blood volume and then to the sugar supplement

Five: salt water is mainly used for the regulation of electrolytes and sugar as the main choice of energy to think of this

In short, the choice should be careful, especially in the Department of respiration, many elderly patients, there are different degrees of cardiac function is not good, diabetes, in the selection of salt to be careful, when considering whether to add sugar to add insulin

Pharmacopoeia of the supporting books: "notes on clinical medication" chemical drugs and biological products volume (05 Pharmacopoeia). Pharmacopoeia of the State Food and drug administration, authoritative and detailed. Also seems to have a proprietary Chinese medicine volume, but I did not search.

Can be found on the internet. Note, however, that there is a list of what other people have written about "clinical medication," which is also popular on the web. I've never paid attention to antibiotics solvent, did not think there are so many knowledge inside, see you speak about the real benefit, the problem of small sum up solvent:

Glucose solution PH is about 3.5, while the physiological saline slightly higher, generally about 5.5.

1 beta lactam in near neutral (PH=6 ~ 7) stable solution, acid or alkaline solution are easy to lose beta lactam antimicrobial activity, we should do the salt solvent.

2 macrolide antibacterial efficacy in alkaline condition than in acidic condition can be enhanced by 10 times, the proposed election of salt as a solvent.

3 synthetic antibiotics such as metronidazole, Kuinuo ketones due to specific molecular structure, 5% glucose solution was more stable than saline shape, so it is recommended to use sugar as a solvent.

We are also commonly used in the emergency clinic on these categories, of course, the clinical or specific analysis of specific issues, such as low sodium or diabetes patients, choose to distinguish the pros and cons!

There is a question to ask you comrades:

According to the white blood cell classification level and how to choose antibiotics?

Respiratory system: the total number of white blood cells high, neutral classification is also high, which to choose?

The total number of white blood cells is high, neutral classification is not high, which to choose?

White blood cell count is not high, neutral classification is very high, which to choose?

Gastrointestinal and urinary system: the total number of white blood cells high, neutral classification is also high, which to choose?

The total number of white blood cells is high, neutral classification is not high, which to choose?

White blood cell count is not high, neutral classification is very high, which to choose?

According to me in the Department of respiration these days are generally not based on the total number of white blood cells and neutral height to choose antibiotics. It is based on the community or hospital acquired empirical medication:

1 young adults and without underlying diseases in patients with community-acquired pneumonia, common macrolides and penicillins (money or patients not previously been sick of rural patients with drug resistance, too) generation of cephalosporins and quinolones. General students on the use of cefazolin or pull, look at the scope of chest X-ray inflammation, white blood cells in young people with inflammation can react, so the general neutral and white blood cells are simultaneously elevated. Severe cough, sputum, white blood cells are not high school with azithromycin 0.5. Older age with levofloxacin 0.4

2 elderly people with underlying disease requiring hospitalization or community-acquired pneumonia, two or three generation cephalosporins, B lactam / enzyme inhibitor and quinolones, sometimes associated with macrolide or aminoglycoside. [cefoperazone and sulbactam sodium combined with azithromycin or Jiadingka levofloxacin, sometimes Jiadingka, sometimes according to the patient's past history of allergy use]

Acquired pneumonia commonly used two or three generation cephalosporins 3 hospital, B lactam / enzyme inhibitor, quinolones or carbapenems. [with levofloxacin, cefoperazone sulbactam or moxifloxacin]

Severe community-acquired pneumonia: use of macrolides combined with three generation cephalosporins, or a combination of broad-spectrum lactam / B enzyme inhibitor, carbapenem; B lactam allergy with quinolone combined with aminoglycosides. [the general white blood cells if not very high, neutral would be greater than 85%, single moxlfloxacin]

Acquired United anti Pseudomonas with quinolone or aminoglycoside B lactam / any kind of enzyme inhibitor, carbapenem in the hospital, when necessary, combined with vancomycin. [times, imipenem, beauty is equal, sometimes some patients with high fever and antibiotics in other families have changed a few rounds with a month plus antifungal, the patient often white blood cells and neutral are normal, or high white blood cell, neutral and relatively high, must strike out] macrolide antibacterial efficacy in alkaline condition than in acidic condition can be enhanced by 10 times, the proposed election of salt as a solvent

Sugar is a liquid, zero tension it will lead to low permeability of the tissue fluid?

If the application of antibacterial drugs as a solvent only when the liquid amount does not affect the overall.

In addition, in the preparation of glucose solution in order to sterilization, the pH value is low, the activation of the coagulation system in the input process, so that the body is in a state of high coagulation, for patients with a tendency to use coagulation should pay attention to.

Penicillin has epitopes, no immunogenicity, but its degradation products of penicilloic acid or penicillenic acid, and in vivo protein covalent binding, can induce specific IgE antibody, the mast cell and basophil sensitization. Penicillin in alkalescent can form penicillenic acid, so the use of penicillin should be prepared before using, the use should not be placed after two hours, the saline volume should not be too much, especially in children, drop speed slow, long time of infusion.

Macrolides with salt dissolution and I do not know whether the actual operation is not as if erythromycin was dissolved in saline or crystallization habit so the clinical remember I have a manual published in 2005 by the sugar drug drugs used on a sugar, is the State Drug Supervision Bureau, up to more than 1 thousand pages, contains the pharmacology and drug instructions, especially drug chemical name and all the commercial name and form is introduced, and the manual of the foreign consumption, should be the content of Qi Quanqie's authority! Price 200 yuan. Le Xin's instructions: soluble in 5%G - S or 5%G - N - S in the intravenous drip, also belong to the B lactam, but not available dissolved in physiological saline, why?

In addition, I do not know how to "isotonic" liquid understanding? I have the impression that 5%GS and saline in vitro, and plasma osmotic pressure equal to the body, and after 5%GS metabolism without osmotic pressure, plasma osmotic pressure and physiological saline is close, so these two kinds of liquid in isotonic saline should be. Department of Pediatrics, the use of various tension liquids (the so-called "tension", and osmotic pressure should be the same), the G-S isn't tension. However, we are here doctors and nurses are called 5%G S isotonic, physiological saline is not isotonic? Sugar is not tension because it will enter the body metabolism when I am reading, we do the experiment, put some penicillin drugs according to the clinical use of the concentration of dissolved in 5%GS, NS, 10%GS, sometimes dissolved in 5%GNS or compound NS, then after a period of time measure the concentration of the drug, to see how much drug degradation. From the experimental results, the drug is relatively stable in 5%GS, NS, and the degradation of 10%GS or other solvents are more. Such experimental conditions is not high, this is also very easy to express, do people more, but have a common problem, the relatively rough, generally do not consider the degradation of the drug is what, when concentration of degradation products will produce greater than the number of adverse effects on the human body, and the influence of temperature on the drug stability etc.. For the doctor, as long as according to the specific circumstances of patients, the drug solvent suggests, it should be no problem. Solvent instructions on the marked, generally is proved through experiments, in which drug stable solvent, can be assured use, if did not indicate the specific solvent, there are two possibilities, one is a drug is relatively stable, the solvent can be selected, the second possibility is that people do not the stability test of the drugs in the medium

2 antibiotic dispensing: my superior doctors always said antibiotics are generally used with saline solution, if 5% glucose will reduce the effect of preparation. (of course, in addition to macrolide antibiotics are generally prepared with sugar addition). Do not know where he saw this conclusion, do not know if there is no reason. But I was edited by Professor He Quanying "respiratory disease diagnosis and treatment guidelines for the treatment of P66 pneumonia" antibiotic dose just said "solvent 250ml+ drugs, intravenous drip, and did not emphasize the use of saline?!

On this issue, the park has been discussed, for example:

Why do most of the antibiotics mix with salt instead of sugar? Advocate the use of saline, mainly from the stability of antibiotics.

Penicillin as an example, they are in near neutral (PH=6 ~ 7) stable solution, acidic or alkaline solution to accelerate decomposition, the best application with the injection of water or isotonic solution of penicillin Sodium Chloride Injection. Soluble glucose solution (PH=3.5 ~ 5.5) can have a certain degree of decomposition. Penicillins decompose rapidly in alkaline solutions. Therefore, it is strictly prohibited to alkaline solution (sodium bicarbonate, aminophylline) and its compatibility.

We recommend a Book < 2005 MCDEX clinical drug reference > by Sichuan MEDICOM software research and Development Co., by the State Food and Drug Administration producer, up to 1502 pages, priced at 198 yuan. The information in the book I have full authority in the use of MCDEX, 2004, feeling very good, get a lot of information not elsewhere.

Our topic can be extended to drug compatibility. I have asthma patients in clinic, if diluted with sugar aminophylline, can you add insulin,

Diabetic patients with intravenous 5%GNS500ml, really great influence on blood sugar, if it is, in some cases very difficult ah, such as sugar + macrolides could add insulin? Sodium Chloride Injection should not be used as the solvent of drugs

Amphotericin B, liposomal amphotericin B pH < 4.25, otherwise the formation of precipitation

Pefloxacin mesylate precipitate. Pefloxacin mesylate pH3.5~4.5, physiological saline pH4.5~7.0, the compatibility of the pH value changes, pefloxacin mesylate will form a free pefloxacin, solubility in water is reduced, resulting in crystallization. Therefore not compatible.

Lactic acid precipitation and erythromycin oxaliplatin (including chloride chloride solution with different concentration) or other drugs.

Sodium chloride can degrade the drug.

The solution compatibility of amsacrine and chlorine ions, otherwise easy to produce precipitation.

Sodium Chloride Injection is not diluted with sodium phosphate.

The solution of fleroxacin and sodium chloride or chlorine ions are incompatible. Fleroxacin Injection is the use of both acidic and basic structure of fleroxacin in groups, and the amino acid soluble salt made, in an electrolyte solution for the same ion effect and the solubility decreases, resulting in the formation of particles and precipitate condensation in a short period of time.

Trovafloxacin may not use the Sodium Chloride Injection 0.9% dilution of this medicine, may form a kind of ALA trovafloxacin hydrochloride and available precipitation, 5% glucose solution, 0.2%, 0.45% Sodium Chloride Injection to dilute the drug.

When using diluent, amiodarone can only use 5% glucose solution.

Norepinephrine should be diluted with 5% Glucose Injection or Glucose and Sodium Chloride Injection,, and should not be diluted with Sodium Chloride Injection.

Polyene phosphatidylcholine is strictly prohibited by dilution with electrolyte solution.

Avoid the compatibility with inorganic salts (such as sodium chloride, potassium chloride, etc.) in order to avoid the crystallization of mannitol.

Corticotrophin not with neutral and alkaline injection, such as sodium chloride, sodium glutamate, aminophylline, in order to avoid haze. (acute gout attack, the drug 40-80U diluted in saline 250-500ml intravenous drip.)

Prasterone sulfate can not be dissolved in physiological saline, can produce turbid. Talentview a bottle containing 0.5 grams of imipenem, ulinastatin 0.5. The effective components were imipenem.

2 antibiotic dispensing: my superior doctors always said antibiotics are generally used with saline solution, if 5% glucose will reduce the effect of preparation. (of course, in addition to macrolide antibiotics are generally prepared with sugar addition). Do not know where he saw this conclusion, do not know if there is no reason. But I was edited by Professor He Quanying "respiratory disease diagnosis and treatment guidelines for the treatment of P66 pneumonia" antibiotic dose just said "solvent 250ml+ drugs, intravenous drip, and did not emphasize the use of saline?! On this issue, the park has been discussed, for example:

Why do most of the antibiotics mix with salt instead of sugar?

Advocate the use of saline, mainly from the stability of antibiotics.

Penicillin as an example, they are in near neutral (PH=6 ~ 7) stable solution, acidic or alkaline solution to accelerate decomposition, the best application with the injection of water or isotonic solution of penicillin Sodium Chloride Injection. Soluble glucose solution (PH=3.5 ~ 5.5) can have a certain degree of decomposition. Penicillins decompose rapidly in alkaline solutions. Therefore, it is strictly prohibited to alkaline solution (sodium bicarbonate, aminophylline) and its compatibility.

Professor Wang Aixia, Professor: comparison of static, 100ml, 500ml, or 100ml area under the curve of efficacy, it is recommended that beta lactam with 100ml solution

In my room for salt intake in many cases is limited, it often needs to be replaced in the antibiotic saline water, and for those who have no special limit of antibiotics in the replacement did not observed the difference of curative effect, do not know whether there is a more direct evaluation index in observation of curative effect on;

Secondly, for the time dependent antibiotics to extend the delivery time is advocated, direct static push is not conducive to maintaining blood concentration is greater than the minimum inhibitory concentration of time, if patients need liquid limit, we tend to be infused with micro pump, with fewer solvents, but time will last for 2 hours, I do not know you in how to do this.

Erythromycin was dissolved in the sugar, and the salt was not precipitated. Interested can look at the current specification of erythromycin. I tried first, the top students can put forward the problem seems to be common, but many clinical doctors and often others, without thinking. We must have this questioning spirit, the spirit of seeking truth, it can continue to progress, in clinical work, let those who are silent smatter backseat driver.

Here, I just want to say something about the dosage of antibiotics. In my opinion, it is beneficial to use a small amount of liquid in a given concentration range. Reason: with a small amount of liquid medicine into the body can quickly to reduce the drug dissolution, due to oxidation and reduction. Can also reduce the amount of liquid used for a long time to give the liver more clearance to reduce the concentration of drug in vivo. In short, with a small amount of liquid, you can quickly enter the body of the drug, the drug can quickly reach the highest concentration of the drug to achieve antibacterial effect. The antibacterial effect of the drug is closely related to the concentration of the drug.

I have some objection to this sentence:

1 "penicillin is a drug that needs a long period of time," he said". For such drugs, because of the stability of the drug to extend the infusion time has not been widely accepted. General 100ml solution, 30min drop.

2 in foreign countries, a lot of antibacterial drugs to do skin test, and our quality who can keep the transfusion pump long time, resistance will not change.

3. Start infusion of penicillin... Can quickly reach the loading dose, then control the speed of infusion "sentence is wrong, because the drug concentration dependent, such as quinolones and aminoglycosides, can give a high dose and time dependent blood drug concentration was higher than MIC as long as possible so, multipleadministrations. The clinical significance of PK/PD to the rational use of antibiotics

The biological activity of the drug and its therapeutic effects depend on the concentration and duration of the drug. A certain dose of antibiotic concentrations achieved in vivo and to maintain the time, related to the pharmacokinetics (PK) process. The treatment effect of antibiotics, and drug concentration and duration, is also related to the pharmacodynamics (PD) content. So, the research of PK/PD on the reasonable application of antibiotics, it has important clinical significance in reducing antibiotic resistance.

At present, the measure of antibiotic antibacterial activity and treatment effect of general, is the determination of minimum inhibitory concentration (MIC) in vitro and can kill bacteria of the lowest concentration (MBC), which is an important parameter in evaluating resistance. But MIC is only from the concentration of antibiotics reflect the antibacterial activity, and no factors including its intensity and time. The pharmacodynamics of drug concentration and action time and antibacterial activity to be integrated, is a timely and correct choice of route of administration, dosage, the best time interval and the appropriate course of treatment, the clinical curative effect of antibiotics and avoid the resistance prediction very useful parameters.

Antibiotic concentration dependent and divided into two types of time dependent, so in the formulation of dosage regimen according to the PK/PD parameter, is also quite different. The concentration dependent antibiotics, the higher the concentration of sterilization is stronger, quinolones and aminoglycosides, amphotericin B and metronidazole. The pharmacodynamic parameters are: the area of 24 hours of drug concentration time curve (AUC) /MIC, AUIC> 125-250 is not only fast, and can effectively kill bacteria and inhibit resistant strains, the clinical efficiency of up to > 90%, it should be high dose 1 times daily dosing (immunocompetent patients for AUIC> from 25 to 30, immunosuppressed patients require AUIC> 100). And the ratio of > (Cmax) to /MIC (8-12). Such as aminoglycosides for 1 times a day, 1-2 times per day is appropriate for quinolones. It is based on the principle that the aminoglycoside drugs are changed from two times a day to one dose per day. Research shows that if the quinolones AUIC> 100, even if the bacteria is not clear, the drug sensitivity rate to remain at 90% or above; if AUIC< 100, are drug resistant bacteria will eventually increased day by day, almost all bacterial resistance; animal model of infection also shows that in 30, the mortality rate AUIC< > 50% when AUIC<, 100; when the animal model of infection almost no death.

Time dependent antibiotics (non concentration dependent), most varieties including penicillins, cephalosporins and macrolides. The Cmax is not important, but the drug concentration above MIC is more important to predict the bactericidal power. Time dependent antibiotic requirements of serum drug concentration is greater than the minimum inhibitory concentration (T> MIC), its duration should exceed eyedroping interval 40%-50%. As a clinical study on the treatment of sinusitis and otitis media, either sensitive or intermediate or resistant bacteria, when beta lactam drugs T> MIC to 40%-50%, the antibacterial activity reached the maximum on the clearance of bacteria, not only speed up the time, and the removal of a significant increase in the number of. In addition, time dependent antibiotics, in the usual dose, serum drug concentration reached 4-5 times MIC, the bactericidal effect is saturated, then increase the dosage in general can not improve the efficacy. Such as ceftazidime, respectively, given 1g and 2G, 3 times a day, the latter serum drug peak concentration increased exponentially, but the efficacy did not increase, the reason is T> MIC ratio did not increase. This kind of antibiotics has little or no effect after antibiotic, maintain its half-life time depends on the serum concentration of drug. Such as beta lactam antibiotics in the duration of infection drug concentration more than MIC or T> MIC is 50%-60% when the sterilization rate is highest, reaching the maximum efficacy, and carbapenem antibiotics, T> MIC 40% can achieve the best effect, the existence of such subtle differences, differences in protein affinity the combination with antibiotics and penicillin bacteria. The percentage of time interval for different strains was different. The best effect of cephalosporin antibiotics for T> MIC 60%-70%, penicillin was 50%. At present, the dosage of penicillin will be increased to 1000-2000 units per day to reduce the frequency of administration, which is wrong. Because the half-life of penicillin is less than 1 hours, it is recommended to use once every 4-6 hours. The prolongation of the dosing interval, not up to T>, and the requirement of MIC and duration over the dosing interval 40%-50%. So, time dependent antibiotics requires multiple daily dosing, or continuous infusion, in order to maintain the MIC in the interval 50%-60%. The experiment shows that penicillin and cephalosporins for treatment of pneumococcal infection animal, when the blood concentration of T> MIC is not more than 20% of the dosing interval, the mortality rate was 100%, as to 40%-50% or longer, the bacterial clearance rate of 90%-100%, the animal survived. But it should be noted that the drug concentration of such antibiotics reached MIC more than 4 times, even if the increase in dosage, the effect will not increase the number of.

1, discuss the amount of solvent is not much sense, the key lies in a single application time. Because the 30ml solvent can dissolve completely as long as, if the application of micro - pump for a few hours, there is no problem; 100ml release 20 minutes in liquid drops is no problem.

Requirements of different drugs on a single application is not the same, such as listening to the recent meropenem in a speech contest, their results are compared with the single application time of 1 hours, 2 hours, 3 hours for the best effect, with xueyaoshi comrades PK/PD theory. Another example for the epidemic of such patients, our department is requested in the first time iv160 million units (adult), and then ivdrip, concrete analysis of specific situations.

Just don't violate the legal effect according to the manual instructions, the basis of all is the strongest, is stronger than that of Pharmacopoeia, textbooks, expert opinion, violation of instructions would lose a lawsuit

The ideal state of the antibiotic administration scheme: to give a single dose of intravenous injection, so that the peak plasma concentration, and then to the static point to maintain stable plasma concentration. However, the risk of antibiotics is too high, prone to adverse reactions and strong stimulation of the injection site, so more harm than good, or not so good.

I am a clinical pharmacy, from a pharmaceutical point of view:

1 antibacterial drugs generally do not advocate intravenous injection, the injection may be too fast to bring high blood drug concentration prone to adverse reactions. Only in a number of primary hospital patient financial constraints, in order to save costs common.

2 selection of solvent mainly from the stability considerations of antibiotics. In the preparation of glucose in the production process need to add hydrochloric acid, the solution PH is about 3, while the physiological saline slightly higher, generally from 4 to 5. Beta lactam in near neutral (PH=6 ~ 7) stable solution, acid or alkaline solution are susceptible to beta lactam ring open loop, loss of antibacterial activity, we should do the salt solvent.

Macrolide antibacterial efficacy in alkaline condition than in acidic condition can be increased 10 times (a report), the selection of salt as a solvent, adding sodium bicarbonate or increase of pH in solvent.

3 the amount of solvent used to control the general minimum specifications. For the short half-life of drugs, such as penicillin, I have seen in clinical pediatric 500ml soluble sugar solution, lost more than 2 hours, in front of the drug metabolism, haven't finished, did not reach the effective concentration. Now most of the use of 100ml+ antibiotics, perhaps the treatment habits, so high efficiency.

In the year of hospital management in the inspection of the record table to check the situation of antibiotics in hospitalized patients (Ministry of Health), the relevant terms there is reasonable selection of solvent of this one, we are also in accordance with these theories to find.

Penicillin is a drug that needs a long time. It belongs to the time dependence of antibacterial drugs, the antibacterial effect by penicillin concentration higher than the length of time the MIC's decision, so the first infusion can quickly reach the loading dose, then control the speed of infusion, the blood concentration is higher than MIC as long as possible. In foreign countries, and even the use of infusion pump for a long time to maintain the method. Time dependent antibiotics such as penicillin, beta lactam, carbapenem, etc.. According to PK/PD, these drugs in addition to prolonged infusion time, but also shorten the dosing interval, using Q8H or q6h. "Macrolide antibiotics antibacterial efficacy in alkaline condition than in acidic condition can be increased 10 times (a report), the selection of salt as a solvent, adding sodium bicarbonate or increase of pH in solvent."

Effects of antibiotics resistance mainly occurs in the infected organism, namely the use of alkaline solvent and high pH value of the body and how much?

I think that what kind of solvent focus which is antibiotic stability, I do not know if my understanding is correct?: time dependent sterilization is weak and moderate sustained effect of antimicrobial agents, beta lactams, erythromycin and other older generation of macrolides, itraconazole, PK/PD parameter is T > MIC for reference;

Another type: time dependent sterilization with a strong sustained effect of antimicrobial agents, such as azithromycin, a new generation of macrolides, tetracycline, vancomycin, fluconazole, etc., PK/PD parameters are AUC/MIC as a reference.

And again: is the concentration dependent bactericidal and antibacterial drugs has strong persistent effect, to fluoroquinolones, aminoglycosides, nystatin, amphotericin B, PK/PD parameters with AUC/MIC or Cmax/MIC as a reference. In the clinic, antibiotics (I mean cephalosporins) intravenous drip, intravenous injection, and saline syrup configuration, with 100ml, I have used 250ML.

About 1 problems: a lot of intravenous antibiotic medication in manual way, which can be referred to intramuscular injection, intravenous injection or intravenous drip, I met in clinical intravenous (slow) patients did not have adverse reactions. However, intravenous injection must be slow, high blood concentration in the unit time, prone to adverse reactions. The first time when I saw the intravenous injection, and also Shanfeng the same doubts, but the professor explained that control the amount of fluid, like why some antibiotics with 100ml, some with 250ml dilution, such as oliguria patients.

About 2 sugar configuration problem: front comrades have mentioned, is the stability of solvent pH on antibiotic effect. Antibiotics are relatively stable in salt water, not easy to break down. But in clinic, some patients still met with syrup with antibiotics, such as the need to limit the liquid input, but also need to supplement the energy of patients, although also know that sugar will affect the results, but in order to take into account, or to do. In fact, although these problems my heart seems to be the answer, but as Shanfeng said, the textbooks do not explicitly mentioned, so in clinical use, but it is not the best model, should be individualized, can make nothing of it! Drug interval time to consider many aspects, including half life, azithromycin half-life of about 41 hours, you can maintain the concentration of the body for a long time > MIC, but vancomycin half-life of about 3 ~ 9h, normal renal function.

 

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