Importance of high creatinine clearance for antibacterial treatment in sepsis

Udy, Andrew and Lipman, Jeffrey (2012). Importance of high creatinine clearance for antibacterial treatment in sepsis. In Jordi Rello, Jeffrey Lipman and Thiago Lisboa (Ed.), Sepsis management: PIRO and MODS (pp. 171-197) Berlin, Germany: Springer.

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Author Udy, Andrew
Lipman, Jeffrey
Title of chapter Importance of high creatinine clearance for antibacterial treatment in sepsis
Title of book Sepsis management: PIRO and MODS
Place of Publication Berlin, Germany
Publisher Springer
Publication Year 2012
Sub-type Research book chapter (original research)
ISBN 9783642035197
Editor Jordi Rello
Jeffrey Lipman
Thiago Lisboa
Chapter number 12
Start page 171
End page 197
Total pages 27
Total chapters 14
Collection year 2013
Language eng
Abstract/Summary Despite significant advances in organ support systems, and an improved understanding of the cellular and humoral mechanisms driving sepsis, there is still an unacceptably high in-hospital mortality rate associated with this syndrome. A key component to improving outcomes is the application of early antibacterial therapy, in sufficient dose and spectrum. This relies on an understanding of the relevant pharmacological properties of the chosen agent, in addition to the alterations in drug handling that are unique to the critically ill. In particular, the host response, in addition to the application of resuscitation fluids and vasoactive agents, can significantly alter renal drug elimination in this setting. A phenomenon termed augmented renal clearance, or ARC, is being increasingly recognised in subsets of critically ill patients. While plasma creatinine concentrations and other formulae estimating glomerular filtration lack sensitivity in identifying ARC, a measured creatinine clearance is a feasible and easily repeatable measure that can assist the clinician in identifying those at risk of sub-optimal drug exposure. Importantly, this should be routinely considered by the prescriber, in order to improve the chances of therapeutic success and reduce the opportunity for the selection of drug-resistant strains.
Q-Index Code B1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Book Chapter
Collections: Official 2013 Collection
School of Medicine Publications
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Created: Tue, 13 Mar 2012, 17:45:53 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH