Augmented renal clearance in the Intensive Care Unit: An illustrative case series

Udy, Andrew A., Putt, Michael T., Shanmugathasan, Sulochana, Roberts, Jason A. and Lipman, Jeffrey (2010) Augmented renal clearance in the Intensive Care Unit: An illustrative case series. International Journal of Antimicrobial Agents, 35 6: 606-608. doi:10.1016/j.ijantimicag.2010.02.013


Author Udy, Andrew A.
Putt, Michael T.
Shanmugathasan, Sulochana
Roberts, Jason A.
Lipman, Jeffrey
Title Augmented renal clearance in the Intensive Care Unit: An illustrative case series
Journal name International Journal of Antimicrobial Agents   Check publisher's open access policy
ISSN 0924-8579
1872-7913
Publication date 2010-06
Sub-type Article (original research)
DOI 10.1016/j.ijantimicag.2010.02.013
Volume 35
Issue 6
Start page 606
End page 608
Total pages 3
Editor A.M. Geddes
Place of publication Amsterdam, Netherlands
Publisher Elsevier Science
Collection year 2011
Language eng
Formatted abstract
The substantial underlying disease burden, in combination with the therapeutic interventions provided, can result in significantly altered end-organ function in the critically ill. These changes can in turn affect key pharmacokinetic (PK) indices for many antibiotics, including drug clearance, promoting potentially subtherapeutic concentrations for lengthy periods of the dosing interval, therapeutic failure or the selection of resistant organisms. This paper presents three instructional cases from our tertiary-level Intensive Care Unit, where established antibiotic dosing regimens failed to achieve predefined PK targets for optimal bacterial killing. Using therapeutic drug monitoring (TDM), significant dose modification was subsequently undertaken. We propose augmented renal clearance as a possible mechanism underlying this phenomenon, particularly in young post-operative, burns or head-injured patients with normal serum creatinine concentrations. TDM, or at least a measured creatinine clearance, should be considered early in this setting to allow the optimisation of antibiotic exposure.
© 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
Keyword Therapeutic drug monitoring
Drug dosing
beta-Lactams
Aminoglycosides
Glycopeptides
Glomerular-filtration-rate
Serum Creatinine
Critically-ill
Burn patients
Blood-flow
Prediction
β-Lactams
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published under "Short communications".

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 02 May 2010, 00:06:20 EST