Dose matters: Dose of antibiotics in the critically ill patient depends on the dose of renal replacement therapy

Reply to Kielstein and Burkhardt

“…We agree with Rybak et al [1,2] that there is apparently no difference in patient outcome associated with continuous infusion, compared with intermittent dosing. Nevertheless, the use of continuous infusion is regarded as a sensible way of administering vancomycin, especially in intensive care units.…”

“…The pharmacokinetic parameter that best describes the efficacy of vancomycin, according to the latest insights into this matter, is a 24-h area under the curve (AUC 0-24 )/minimum inhibitory concentration (MIC) ratio of у400 [2]. This ratio…”

How can we ensure effective antibiotic dosing in critically ill patients receiving different types of renal replacement therapy?

“…higher effluent flow rates), greater drug clearance is expected, requiring higher doses in order to achieve the same exposure observed with the lower RRT intensity. The enhanced removal of compounds like antibiotics has been proposed as one of the reasons for the failure of benefit seen in critically ill patients with septic shock who received higher RRT intensities which had initially been hypothesized to improve clinical outcomes (Joannes-Boyau et al, 2013;Kielstein et al, 2009).…”