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How to treat chronic renal failure complicated with urinary tract infection?

2017-11-08 17:31

Patients with renal failure are easily complicated with infection, such as urinary tract infection, should be treated immediately, sensitive antibiotics for possible pathogens, and support therapy to enhance the disease resistance of the body.

How to treat chronic renal failure complicated with urinary tract infection?

Urinary tract infection in patients with chronic renal failure, the treatment is great difficulty, reasons are as follows: ①chronic renal failure renal atrophy, blood flow is poor, the drug is not easy to reach the effective concentration to obtain effective antibiotic concentration without causing poisoning is difficult in blood and urine; ②effective antibacterial concentrations the medicine in the kidney to slowly to reach, so prone to bacteria resistance;③the infection is usually in the hospital the main pathogenic bacteria were resistant strains; ④the bilateral renal damage is not equal, antibacterial drugs in different concentration on both sides of the kidney, the concentration of antibacterial drugs on the side of poor renal function is low, cannot play a role.

Because the kidney is the main way of excretion of many antibiotics, chronic renal failure caused by delayed excretion of drugs, accumulation, increased renal toxicity, therefore, when the safe and effective use of antibiotics in patients with chronic renal failure complicated with urinary tract infection, should be based on the drug sensitivity of antibiotics, the main metabolic process, and excretion pathway of the kidney toxicity, combined with the patient's creatinine the clearance rate, and whether the patient for dialysis treatment, comprehensive analysis, to determine the type of antibiotic administration route, method and dose.

Most of the antibiotics used to treat urinary tract infections are renal excretion. Therefore, the key problem of antibiotic use is dose adjustment. The first dose is the same as the general dose to ensure the concentration of effective drugs in the blood. Since then, the use of maintenance volume, so that the blood concentration exceeds the minimum inhibitory concentration, blood concentration monitoring is ideal, but not yet universal, there are two methods to calculate the amount of maintenance:

The reduction method: medication interval unchanged, and second times after each drug reduction. It can be calculated by formula: the normal dose of each dose is 1/Scr (mg/dl) or the normal dose of the drug every time is Ccr/100.

Extended interval method, that is, dose per dose is not reduced, but the interval is prolonged. The formula can be used to calculate the interval of medication (mg/dl) = the interval of drug use in normal subjects. Scr. In the two method, the decrement method is better, while the extended interval method is difficult to estimate the maintenance of blood drug concentration, and the patients with severe infection will affect the curative effect. Dialysis patients, such as those who can be cleared by dialysis, need to add a dose after dialysis.


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