The influence of acute kidney injury on antimicrobial dosing in critically ill patients: Are dose reductions always necessary?

Blot,Stijn, Lipman, Jeffrey, Roberts, Darren M. and Roberts, Jason A (2014) The influence of acute kidney injury on antimicrobial dosing in critically ill patients: Are dose reductions always necessary?. Diagnostic Microbiology and Infectious Disease, 79 1: 77-84. doi:10.1016/j.diagmicrobio.2014.01.015

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Author Blot,Stijn
Lipman, Jeffrey
Roberts, Darren M.
Roberts, Jason A
Title The influence of acute kidney injury on antimicrobial dosing in critically ill patients: Are dose reductions always necessary?
Journal name Diagnostic Microbiology and Infectious Disease   Check publisher's open access policy
ISSN 1879-0070
0732-8893
Publication date 2014-05-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.diagmicrobio.2014.01.015
Volume 79
Issue 1
Start page 77
End page 84
Total pages 8
Place of publication Philadelphia United States
Publisher Elsevier Inc.
Language eng
Abstract Optimal dosing of antimicrobial therapy is pivotal to increase the likelihood of survival in critically ill patients with sepsis. Drug exposure that maximizes bacterial killing, minimizes the development of antimicrobial resistance, and avoids concentration-related toxicities should be considered the target of therapy. However, antimicrobial dosing is problematic as pathophysiological factors inherent to sepsis that alter may result in reduced concentrations. Alternatively, sepsis may evolve to multiple-organ dysfunction including acute kidney injury (AKI). In this case, decreased clearance of renally cleared drugs is possible, which may lead to increased concentrations that may cause drug toxicities. Consequently, when dosing antibiotics in septic patients with AKI, one should consider factors that may lead to underdosing and overdosing. Drug-specific pharmacokinetic and pharmacodynamic data may be helpful to guide dosing in these circumstances. Yet, because of the high interpatient variability in pharmacokinetics of antibiotics during sepsis, this issue remains a significant challenge.
Keyword Antibiotic
ICU
Pharmacodynamics
Pharmacokinetics
Renal failure
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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