Reply to Kielstein and Burkhardt

Pharmacokinetics and pharmacodynamics of antibiotics in critically ill acute kidney injury patients

“…In clinical practice, the most commonly used guideline is the "Sanford Guide to Antimicrobial Therapy" (Gilbert et al 2014), which includes CRRT and IHD, and recommends that the dosage of an antimicrobial with ED to be estimated as with CRRT. However, Mushatt et al (2009) recommend that, for antibiotics administered every 24 h, a supplementary dose should be considered immediately after ED or alternatively, the prescribed daily dose should be given after ED. For drugs administered every 12 h, a dose should be done after ED session and the other after 12 h. Another suggestion is that drugs such as vancomycin and gentamicin, for which serum levels can be measured, should be assessed immediately after ED to determine the need for a further dose after dialysis (Mushatt et al 2009).…”

“…However, Mushatt et al (2009) recommend that, for antibiotics administered every 24 h, a supplementary dose should be considered immediately after ED or alternatively, the prescribed daily dose should be given after ED. For drugs administered every 12 h, a dose should be done after ED session and the other after 12 h. Another suggestion is that drugs such as vancomycin and gentamicin, for which serum levels can be measured, should be assessed immediately after ED to determine the need for a further dose after dialysis (Mushatt et al 2009). Table 1 shows the pharmacodynamic characteristics (PD) and pharmacokinetic (PK) of the main antibiotics used in clinical practice in intensive care, although the recommended doses have been extrapolated from studies not conducted with the critical AKI population and acute renal support.…”