Page 55 - GALENIKA MEDICAL JOURNAL

uglavnom noću, prijeko aparata, uz eventualnu kombinaci- kod odraslih. Oralni ciprofloksacin može postići adekvatnu
ju sa jednom dnevnom izmjenom, to je liječenje peritonitisa dozu u peritoneumu kod bolesnika na automatskoj perito-
kod ovih bolesnika malo komplikovanije. Naime, ovim bole- neumskoj dijalizi. Doziranje antibiotika kod bolesnika na au-
snicima se savjetuje prevođenje na kontinuiranu ambulan- tomatskoj peritoneumskoj dijalizi prikazano je u tabeli 6 19-21 .
tnu peritoneumsku dijalizu sa četiri izmjene, što je lakše za Ukoliko bolesnik dobije gljivični peritonitis, savetuje se pre-
liječenje i davanje antibiotika u svaku kesu dijalizata. Ukoli- kidanje liječenja peritoneumskom dijalizom, vađenje perito-
ko ostanu na automatskoj peritoneumskoj dijalizi može im neumskog katetera i prevođenje bolesnika na hemodijalizu.
se dati prva generacija cefalosporina intermitentno u samu Antimikotici se tada daju intravenski.
dnevnu izmjenu, ali je tada koncentracija antibiotika u toku
noći niska. Zato se preporučuje davanje cefalosporina u sva-
ku izmjenu. Vankomicin se može primijeniti intermitentno

Zaključak

Kod bolesnika sa hroničnim oštećenjem bubrega, u terminalnoj fazi hronične bolesti bubrega i na
hemodijalizi i peritoneumskoj dijalizi važno je adekvatno dozirati antibiotike. Nepravilno davanje

ovih lijekova kod bolesnika koji imaju hronično oštećenje bubrega može pogoršati funkciju bubrega
i ubrzati nastupanje terminalne faze hroničnog oštećenje bubrega kada je neophodno započeti
liječenje dijalizama. Kod bolesnika koji su već na dijalizi, može doći do smanjenja rezidualne diureze ili
do komplikacija u vidu ototoksičnosti ili oštećenja centra za ravnotežu. Zato je neophodno ili smanjiti
dozu lijeka ili produžiti dozni interval ili kombinovati oba metoda, da bi se spriječio dolazak bolesnika
do terminalne faze oštećenja bubrega ili da bi se izbjegle druge komplikacije.

Abstract

Chronic kidney diseases cause disruption of kidney function, but also of other organs which affects both the
pharmacodynamics and the pharmacokinetics of many drugs. Prescribing drugs to patients with chronic kidney disease
requires knowledge of changes in absorption, distribution, metabolism and excretion of drugs and their metabolites.
Avoiding nephrotoxic drugs is the most important principle that we must follow in patients with chronic kidney disease.
If administration of nephrotoxic drugs is necessary, regular control of glomerular filtration rate, serum electrolyte
concentration, and serum drug concentration is required if possible. The dosing of drugs in patients with chronic renal
insufficiency is very delicate, both when determining the initial dose and during the maintenance dose, so it is necessary
to adjust the doses for each patient individually, depending on the degree of kidney damage. For most drugs, there are
recommendations from the Agency for Drugs and Medical Devices of the Republic of Serbia on how to correct the dose of
the drug in chronic kidney failure. If such a recommendation does not exist, general rules are used: the maintenance dose
can be adapted to kidney function by reducing the dose, extending the intervals in which the unchanged dose of the drug
is administered, or a combination of these two methods. In patients with chronic kidney damage, the infection accelerates
the progression towards the terminal stage, when it is necessary to apply one of the methods to replace kidney function.
The infection should be treated with appropriate doses of antibiotics and/or antifungals and for a sufficient period of
time. Likewise, in dialysis patients, there are various causes of infections that must also be adequately treated in order not
to compromise the dialysis method or endanger the patient's life. There are recommendations for the use of antibiotics
and antimycotics in these cases, which should be applied and adjusted to the individual patient. In intensive care units, in
hemodynamically unstable patients with sepsis and acute chronic kidney failure, instead of intermittent hemodialysis, the
following methods can be used: Prolonged Intermittent Renal Replacement Therapy (PIRRD) and continuous procedures -
continuous venovenous hemodialysis (CVVHD), continuous venovenous hemofiltration (CVVH) and continuous venovenous

REVIJALNI RADOVI Galenika Medical Journal, 2023; 2(5):47-54. 53