Augmented renal clearance: Unraveling the mystery of elevated antibiotic clearance

Udy, Andrew, Roberts, Jason and Lipman, Jeffrey (2010). Augmented renal clearance: Unraveling the mystery of elevated antibiotic clearance. In J.-L. Vincent (Ed.), Yearbook of Intensive Care and Emergency Medicine 2010 (pp. 495-506) Brussels, Belgium: Springer Verlag. doi:10.1007/978-3-642-10286-8

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Author Udy, Andrew
Roberts, Jason
Lipman, Jeffrey
Title of chapter Augmented renal clearance: Unraveling the mystery of elevated antibiotic clearance
Title of book Yearbook of Intensive Care and Emergency Medicine 2010
Place of Publication Brussels, Belgium
Publisher Springer Verlag
Publication Year 2010
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/978-3-642-10286-8
Open Access Status
Series Yearbook of Intensive Care and Emergency Medicine
ISBN 9783642102851
978364210286
ISSN 1942-5381
Editor J.-L. Vincent
Volume number 2010
Chapter number 15
Start page 495
End page 506
Total pages 12
Total chapters 19
Collection year 2011
Language eng
Formatted Abstract/Summary
The prescription of pharmaceuticals in the critically ill represents a significant challenge, largely due to the scarcity of knowledge concerning the pharmacokinetic implications of the underlying disease state. Dynamic changes in organ function can be remarkable in this population, driven by both the primary pathophysiological disturbance, and as a consequence of therapy provided. Vascular tone, capillary permeability, fluid status, cardiac output, and major organ blood flow can be significantly altered, with substantial follow-on effects on the volume of distribution and clearance of many agents.

Augmented renal clearance refers to the enhanced renal elimination of circulating solute and is being increasingly described in subsets of critically ill patients. Defining and recognizing this process, however, in terms of routinely available measures of renal function is problematic, as there are many controversies on how best to estimate or measure glomerular filtration, let alone what is considered as the upper limit of normal.

From a pharmacokinetic point of view, augmented renal clearance can significantly elevate the elimination of renally cleared antibiotics, resulting in potentially sub-therapeutic dosing, treatment failure, or the selection of resistant microorganisms. Notably, this is rarely considered in clinical practice, and as such doses are infrequently revised.
© Springer-Verlag
Q-Index Code B1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Book Chapter
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Mon, 21 Mar 2011, 20:11:03 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH