To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: the eternal doubt

Wong, Wai Tat, Choi, Gordon, Gomersall, Charles D, & Lipman, Jeffrey (2015) To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: the eternal doubt. Current Opinion in Pharmacology, 24, pp. 68-78.

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Critical illness, acute renal failure and continuous renal replacement therapy (CRRT) are associated with changes in pharmacokinetics. Initial antibiotic dose should be based on published volume of distribution and generally be at least the standard dose, as volume of distribution is usually unchanged or increased. Subsequent doses should be based on total clearance. Total clearance varies with the CRRT clearance which mainly depends on effluent flow rate, sieving coefficient/saturation coefficient. As antibiotic clearance by healthy kidneys is usually higher than clearance by CRRT, except for colistin, subsequent doses should generally be lower than given to patients without renal dysfunction. In the future therapeutic drug monitoring, together with sophisticated pharmacokinetic models taking into account the pharmacokinetic variability, may enable more appropriate individualized dosing.

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ID Code: 86587
Item Type: Journal Article
Refereed: Yes
DOI: 10.1016/j.coph.2015.07.003
ISSN: 1471-4892
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Schools > School of Nursing
Deposited On: 16 Aug 2015 23:57
Last Modified: 17 May 2016 02:20

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