Principles of antibacterial dosing in continuous renal replacement therapy

Abstract

Appropriate dose calculation requires knowledge of the pharmacokinetic target and the usual minimum inhibitory concentration of the suspected organism in the patient's locality (or if unavailable, the break point for the organism), published pharmacokinetic data (volume of distribution, non-CRRT clearance) on critically ill patients receiving CRRT (which may differ substantially from noncritically ill patients or those without renal failure), the sieving or saturation coefficient of the relevant drug in critically ill patients, the dose and mode of CRRT being used, and the actual dose of CRRT that is delivered. This large number of variables results in considerable inter- and intrapatient heterogeneity in dose requirements. This article provides basic principles and relevant data to guide the clinician in prescribing individualized dosing regimes.

Pharmacokinetics and Pharmacodynamics of Piperacillin-Tazobactam in 42 Patients Treated with Concomitant CRRT

“…Patients with severe infections often have multisystem organ failure requiring renal replacement therapy, and continuous therapies are frequently preferred over intermittent hemodialysis in intensive care patients to avoid the development or exacerbation of hypotension and maximize fluid removal. Current dosing recommendations for piperacillin-tazobactam in patients receiving continuous renal replacement therapy (CRRT) (1,2) originate from either pharmacokinetic estimates or studies with relatively few patients and lower doses of CRRT than are used today (3,4). We designed this multicenter prospective observational study to evaluate the pharmacokinetics and pharmacodynamics of piperacillin-tazobactam in patients receiving CRRT with contemporary dialysis equipment and prescriptions.…”

Adding to the Armamentarium

“…Continuous RRTs (CRRTs) are now used as frequently as IHD in ICUs worldwide (14). Antibiotic dosing in CRRT has been reviewed recently (15)(16)(17)(18). The advantage of antibiotic dosing in CRRT is that drug removal is relatively constant, resulting in relatively predictable drug dosing.…”

Personalisierte Pharmakotherapie beim Intensivpatienten

“…Durch eine kontinuierliche Nierenersatztherapie werden wasserlösliche Arzneimittel stärker eliminiert als lipophile, die eine höhere Plasmaeiweiß-bindung aufweisen [12]. Substanzen mit einem höheren Verteilungsvolumen werden durch eine kontinuierliche Nierenersatztherapie langsamer entfernt [12] …”

“…Substanzen mit einem höheren Verteilungsvolumen werden durch eine kontinuierliche Nierenersatztherapie langsamer entfernt [12] …”