Aminoglycosides in hemodialysis patients: Is the current practice of post dialysis dosing appropriate

O'Shea, Stacey, Duffull, Stephen and Johnson, David W. (2009) Aminoglycosides in hemodialysis patients: Is the current practice of post dialysis dosing appropriate. Seminars in Dialysis, 22 3: 225-230. doi:10.1111/j.1525-139X.2008.00554.x


Author O'Shea, Stacey
Duffull, Stephen
Johnson, David W.
Title Aminoglycosides in hemodialysis patients: Is the current practice of post dialysis dosing appropriate
Journal name Seminars in Dialysis   Check publisher's open access policy
ISSN 0894-0959
Publication date 2009-05
Sub-type Editorial
DOI 10.1111/j.1525-139X.2008.00554.x
Volume 22
Issue 3
Start page 225
End page 230
Total pages 6
Editor Dr Richard a. Sherman
Place of publication United Staes
Publisher Wiley - Blackwell Publishing
Language eng
Subject 1115 Pharmacology and Pharmaceutical Sciences
11 Medical and Health Sciences
CX
Formatted abstract
Aminoglycosides have been widely used in end-stage renal failure patients for the treatment of infections caused by gram-negative bacilli and Staphylococcus aureus. Traditionally, these agents are administered post dialysis to avoid premature dialytic clearance, although no studies have been performed to confirm that this dosing strategy represents the optimal treatment regimen. In recent years, a more complete understanding of the pharmacokinetics-pharmacodynamics of aminoglycosides has led to a global change in clinical practice from multiple to once-daily dosing in patients with normal renal function with the aim of providing intermittent pulses to maximize the peak concentration relative to overall drug exposure. These same considerations strongly support administration of aminoglycosides before, rather than after, hemodialysis. This study will review the key pharmacokinetic/pharmacodynamic considerations in aminoglycoside dosing, the relationship between serum aminoglycoside concentrations and efficacy/toxicity, the influence of renal function and hemodialysis on aminoglycoside pharmacokinetics/pharmacodynamics, and the mounting population pharmacokinetic and clinical study evidence supporting a paradigm shift in aminoglycoside dosing from post dialysis to predialysis.
Keyword Catheter-associated Bacteremia
Dosing
Hemodialysis
Q-Index Code CX

Document type: Journal Article
Sub-type: Editorial
Collection: School of Medicine Publications
 
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Created: Tue, 20 Apr 2010, 12:41:09 EST by Fiona Mactaggart on behalf of School of Medicine