Are Antibiotics Appropriately Dosed in Critically Ill Patients with Augmented Renal Clearance? A Narrative Review

Abstract

Aims. Augmented renal clearance (ARC), which is commonly defined as increased renal clearance above 130 ml/min/1.73 m2, is a common phenomenon among critically ill patients. The increased elimination rate of drugs through the kidneys in patients with ARC can increase the risk of treatment failure due to the exposure to subtherapeutic serum concentrations of medications and affect the optimal management of infections, length of hospital stay, and outcomes. The main goal of this review article is to summarize the recommendations for appropriate dosing of antibiotics in patients with ARC. Methods. This article is a narrative review of the articles that evaluated different dosing regimens of antibiotics in patients with ARC. The keywords “Augmented Renal Clearance,” “Critically ill patients,” “Drug dosing,” “Serum concentration,” “Beta-lactams,” “Meropenem,” “Imipenem,” “Glycopeptide,” “Vancomycin,” “Teicoplanin,” “Linezolid,” “Colistin,” “Aminoglycosides,” “Amikacin,” “Gentamycin,” “Fluoroquinolones,” “Ciprofloxacin,” and “Levofloxacin” were searched in Scopus, Medline, PubMed, and Google Scholar databases, and pediatric, nonhuman, and non-English studies were excluded. Results. PK properties of antibiotics including lipophilicity or hydrophilicity, protein binding, the volume of distribution, and elimination rate that affect drug concentration should be considered along with PD parameters for drug dosing in critically ill patients with ARC. Conclusion. This review recommends a dosing protocol for some antibiotics to help the appropriate dosing of antibiotics in ARC and decrease the risk of subtherapeutic exposure that may be observed while receiving conventional dosing regimens in critically ill patients with ARC.

Dosing Regimen for Cefotaxime Should Be Adapted to the Stage of Renal Dysfunction in Critically Ill Adult Patients—A Retrospective Study

“…However, only 25% of previously underdosed patients reached the target range at the second cefotaxime monitoring with 8 g, implying that higher doses could also be considered. As delaying the first appropriate antibiotic administration has been associated with increased in-hospital mortality [18], this strategy should improve optimal treatment of infections and, therefore, length of hospital stay and treatment outcomes [19].…”

Effects of refined nursing interventions in the operating room on surgical‐site wound infection in patients with lung cancer: A meta‐analysis

“…Nursing management in the operating room is a key link in the whole process of surgery, which significantly affects patients' postoperative recovery 12 . Surgical‐site wound infections can worsen the condition, thereby prolonging hospitalisation and increasing the financial, physical and psychological burden on patients 45 . Reducing the rate of nosocomial infections in patients undergoing surgery has become a priority in hospital management, especially in patients undergoing thoracic surgery.…”

“… 12 Surgical‐site wound infections can worsen the condition, thereby prolonging hospitalisation and increasing the financial, physical and psychological burden on patients. 45 Reducing the rate of nosocomial infections in patients undergoing surgery has become a priority in hospital management, especially in patients undergoing thoracic surgery. Therefore, there is a need for an in‐depth study of interventions to prevent nosocomial infections, particularly inpatients undergoing lung cancer surgery.…”