To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: The eternal doubt

Wong, Wai-Tat, Choi, Gordon, Gomersall, Charles D. and Lipman, Jeffrey (2015) To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: The eternal doubt. Current Opinion in Pharmacology, 24 68-78. doi:10.1016/j.coph.2015.07.003


Author Wong, Wai-Tat
Choi, Gordon
Gomersall, Charles D.
Lipman, Jeffrey
Title To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: The eternal doubt
Journal name Current Opinion in Pharmacology   Check publisher's open access policy
ISSN 1471-4973
1471-4892
Publication date 2015-10-01
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.coph.2015.07.003
Open Access Status Not yet assessed
Volume 24
Start page 68
End page 78
Total pages 11
Place of publication Oxford, United Kingdom
Publisher Elsevier
Collection year 2016
Language eng
Abstract Critical illness, acute renal failure and continuous renal replacement therapy (CRRT) are associated with changes in pharmacokinetics. Initial antibiotic dose should be based on published volume of distribution and generally be at least the standard dose, as volume of distribution is usually unchanged or increased. Subsequent doses should be based on total clearance. Total clearance varies with the CRRT clearance which mainly depends on effluent flow rate, sieving coefficient/saturation coefficient. As antibiotic clearance by healthy kidneys is usually higher than clearance by CRRT, except for colistin, subsequent doses should generally be lower than given to patients without renal dysfunction. In the future therapeutic drug monitoring, together with sophisticated pharmacokinetic models taking into account the pharmacokinetic variability, may enable more appropriate individualized dosing.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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