Simplified Aztreonam Dosing in Patients with End-Stage Renal Disease: Results of a Monte Carlo Simulation

Gross, Alan E.; Xu, Hongmei; Zhou, Diansong; Al‐Huniti, Nidal

doi:10.1128/aac.01066-18

Cited by 1 publication

(1 citation statement)

References 16 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Aztreonam also has an evolving role in the treatment of resistant Gramnegative pathogens, such as metallo-β-lactamase (MBL)-producing Enterobacteriaceae [69]. The recommended dosing regimen is 2 g q6-8 h in ICU patients with normal renal function, but the dose should be halved when CrCl is 10-30 mL/min/1.73 m 2 and quartered when CrCl is <10 mL/min/1.73 m 2 [70,71].…”

Section: Monobactammentioning

confidence: 99%

Beta-Lactams Dosing in Critically Ill Patients with Gram-Negative Bacterial Infections: A PK/PD Approach

2021

View full text Add to dashboard Cite

Beta-lactam antibiotics are often the backbone of treatment for Gram-negative infections in the critically ill. Beta-lactams exhibit time-dependent killing, and their efficacy depends on the percentage of dosing interval that the concentration remains above the minimum inhibitory concentration. The Gram-negative resistance rates of pathogens are increasing in the intensive care unit (ICU), and critically ill patients often possess physiology that makes dosing more challenging. The volume of distribution is usually increased, and drug clearance is variable. Augmented renal clearance and hypermetabolic states increase the clearance of beta-lactams, while acute kidney injury reduces the clearance. To overcome the factors affecting ICU patients and decreasing susceptibilities, dosing strategies involving higher doses, and extended or continuous infusions may be required. In this review, we specifically examined pharmacokinetic models in ICU patients, to determine the desired beta-lactam regimens for clinical breakpoints of Enterobacterales and Pseudomonas aeruginosa, as determined by the European Committee on Antimicrobial Susceptibility Testing. The beta-lactams evaluated included penicillins, cephalosporins, carbapenems, and monobactams. We found that when treating less-susceptible pathogens, especially P. aeruginosa, continuous infusions are frequently needed to achieve the desired pharmacokinetic/pharmacodynamic targets. More studies are needed to determine optimal dosing strategies in the novel beta-lactams.

show abstract

Section: Monobactammentioning

confidence: 99%