Antibiotic dosing during sustained low-efficiency dialysis: Special considerations in adult critically ill patients*

Abstract

The potential for significant drug removal during an 8-hr-or-longer sustained low-efficiency dialysis session is evident by the limited number of studies available. Because significant amounts of drug may be removed by sustained low-efficiency dialysis combined with altered pharmacokinetic variables in critically ill patients, the risk for suboptimal drug concentrations and pharmacodynamics must be considered. Appropriate dose and calculation of dosing intervals is essential to provide adequate antibiotic therapy in these patients. It is recommended that institutions who utilize sustained low-efficiency dialysis establish dosing guidelines for all pharmacists and physicians to follow to provide consistent delivery of antibiotics at adequate concentrations.

Vancomycin removal during low-flux and high-flux extended daily hemodialysis in critically ill septic patients

“…Critically ill patients are often haemodynamically unstable. They demonstrate alterations in drug pharmacokinetics due to multiorgan dysfunction and acute changes in volume state 20 . A substantial number of hemodialysis patients have residual renal function which may influence vancomycin clearance.…”

Drug Dosing in Continuous Renal Replacement Therapy (CRRT)

“…There are multiple variants of hybrid RRT and very few pharmacokinetic studies have been published to aid drug dosing in patients undergoing hybrid RRT or extended dialysis, although recently these reports have become more numerous [58][59][60].…”

Pharmacogenomics Dictate Pharmacokinetics: Polymorphisms in Drug-Metabolizing Enzymes and Drug-Transporters

“…However, lipophilic compounds or non-ionized species are reabsorbed dependent on the pH and pKa of the drug which dictates the elimination rate and is measured in patients via creatinine clearance rates (CCR) (Kooman JP. 2009;Bogard KN, 2011;Fesler P, 2011), a parameter which will be emphasized later in this chapter in relation to drug-transporter expression in the liver and the kidney.…”