Antimicrobial Dosing in Acute Renal Replacement

Drug Dosing in Continuous Renal Replacement Therapy (CRRT)

“…There have been several excellent review articles in this area, particularly in the field of antimicrobial dosing in CRRT, which tabulate relevant clinical trial data [5,[42][43][44]. However, these require constant updating, and often the descriptions of CRRT techniques and pharmacokinetic measurements in the original studies are far from complete, making extrapolations difficult [45].…”

Antimicrobial Pharmacokinetics and Pharmacodynamics

“…Certain anatomic compartments, including bone, cerebrospinal fluid, and abscesses, are penetrated poorly by some antibiotics [10]. Additionally, distribution in any compartment is dictated by multiple factors, including the chemical properties of the drug, the characteristics of the tissues into which it distributes, and the blood flow resulting in various apparent V D throughout a dosing cycle [10].…”

Antibiotic Dosing During Renal Replacement Therapy

“…Extracorporeal clear ance is determined by several factors related to both the drug and the technique used. In postdilu tion mode, clearance equals the effluent flow m ultiplied by the sieving coefficient, generally yielding a m axim um of 3 LI hr or 50m L/m in (8). Meropenem and piperacillin both have a low molecular weight (438 and 540 Da, respectively) and low protein bind ing (2% and 30%, respectively) facilitating extracorporeal clearance, whereas vancomycin has a higher molecular weight (1,449 Da) and protein binding ranging from 24% to 64% with a mean of 41% (6).…”

“…W hether a drug can be eliminated by extracorporeal techniques is determined by its molecu lar weight, protein binding, and volume of distribution (5). Even in SLED, small solute clearances are higher than in convective techniques such as C W H (8,9). Clearance by extracorporeal treat ment is determ ined by the technique used, com position and surface area of the dialyzer membrane, as well as by blood, effluent, and dialysate flow.…”