Dosificación de antibióticos antipseudomónicos en pacientes con disfunción renal aguda sometidos a técnicas continuas de depuración extrarenal

Martín, Esther Carcelero San; Muner, Dolors Soy

doi:10.1016/j.medin.2012.02.012

Cited by 2 publications

(1 citation statement)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For this purpose, two of the most frequently prescribed beta-lactams for nosocomial infections (meropenem and piperacillin) and a highly protein-bound antibiotic usually prescribed for community-acquired infections (ceftriaxone) were chosen for a thorough review. A systematic review of all available data on beta-lactam antibiotic pharmacokinetics in critically ill patients with CRRT was beyond the scope of this article, as this has been done elsewhere [7-9]. …”

Section: Introductionmentioning

confidence: 99%

Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy

et al. 2014

View full text Add to dashboard Cite

Although early and appropriate antibiotic therapy remains the most important intervention for successful treatment of septic shock, data guiding optimization of beta-lactam prescription in critically ill patients prescribed with continuous renal replacement therapy (CRRT) are still limited. Being small hydrophilic molecules, beta-lactams are likely to be cleared by CRRT to a significant extent. As a result, additional variability may be introduced to the per se variable antibiotic concentrations in critically ill patients. This article aims to describe the current clinical scenario for beta-lactam dosing in critically ill patients with septic shock and CRRT, to highlight the sources of variability among the different studies that reduce extrapolation to clinical practice, and to identify the opportunities for future research and improvement in this field. Three frequently prescribed beta-lactams (meropenem, piperacillin and ceftriaxone) were chosen for review. Our findings showed that present dosing recommendations are based on studies with drawbacks limiting their applicability in the clinical setting. In general, current antibiotic dosing regimens for CRRT follow a one-size-fits-all fashion despite emerging clinical data suggesting that drug clearance is partially dependent on CRRT modality and intensity. Moreover, some studies pool data from heterogeneous populations with CRRT that may exhibit different pharmacokinetics (for example, admission diagnoses different to septic shock, such as trauma), which also limit their extrapolation to critically ill patients with septic shock. Finally, there is still no consensus regarding the %T>MIC (percentage of dosing interval when concentration of the antibiotic is above the minimum inhibitory concentration of the pathogen) value that should be chosen as the pharmacodynamic target for antibiotic therapy in patients with septic shock and CRRT. For empirically optimized dosing, during the first day a loading dose is required to compensate the increased volume of distribution, regardless of impaired organ function. An additional loading dose may be required when CRRT is initiated due to steady-state equilibrium breakage driven by clearance variation. From day 2, dosing must be adjusted to CRRT settings and residual renal function. Therapeutic drug monitoring of beta-lactams may be regarded as a useful tool to daily individualize dosing and to ensure optimal antibiotic exposure.

show abstract

Section: Introductionmentioning

confidence: 99%

Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy

et al. 2014

View full text Add to dashboard Cite

show abstract

Antimicrobial use in hospitalized patients with renal dysfunction: A multiprofessional approach

Bacelar

Silva

Júnior

et al. 2021

RSD

View full text Add to dashboard Cite

Introduction: The monitoring of nephrotoxic antimicrobial use and the identification of probable problems related to their use in patients with renal risk factors is of the utmost importance, mainly regarding the safety and protection of patients' health. The present study aimed to analyze the use of restricted-use antimicrobials in hospitalized patients with renal dysfunction. Methods: This is a cross-sectional retrospective study carried out from January to March 2015, which included the following variables: age, gender, comorbidities, type of kidney disease, hospitalization unit, and antimicrobial sused, classified according to the ATC (Anatomical Therapeutic Chemical) methodology. Results and Discussion: records of renal dysfunction were found in 113 monitored patients, most of which were males, with CKD, and aged between 60 and 89 years. The most commonly prescribed restricted-use antimicrobials were from the broad-spectrum penicillin group. Conclusions: Safety in pharmacotherapy may be decisive in the clinical outcome of renal patients, so the multiprofessional contribution plays an important role in maintaining a favorable clinical condition.

show abstract

Dosificación de antibióticos antipseudomónicos en pacientes con disfunción renal aguda sometidos a técnicas continuas de depuración extrarenal

Cited by 2 publications

References 49 publications

Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy

Beta-lactam dosing in critically ill patients with septic shock and continuous renal replacement therapy

Antimicrobial use in hospitalized patients with renal dysfunction: A multiprofessional approach

Contact Info

Product

Resources

About