Hos svårt sjuka patienter kan t.ex. minskad proteinbindning leda till ökat dosbehov jämfört med mindre svårt sjuka patienter behandlade med intermittent hemodialys. Mätning av plasmakoncentrationer föreslås när det är möjligt. För antibiotika som elimineras via dialysfiltret bör administreringen anpassas så att den sker efter dialys. Aminoglykosider kan eventuellt vara ett undantag från denna princip (28) liksom antibiotika som doseras efter bestämning av plasmakoncentration (se fotnot m till tabell 1 i det bifogade dokumentet från RAF). Prov för bestämning av plasmakoncentration bör inte tas inom de första 4-6 h efter dilays eftersom koncentrationerna då stiger pga. ett s.k. reboundfenomen, omfördelning av antibiotika mellan kroppens olika vätske-/vävnadsrum.
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