Does dose reduction of renally cleared antibiotics in patients with impaired renal function lead to adequate drug exposure? A systematic review

Vroom, Suzanne L. de; Daalen, Frederike V. van; Zieck, Saskia E.; Mathôt, Ron A. A.; Hest, Reinier M. van; Geerlings, Suzanne E.

doi:10.1016/j.cmi.2020.11.032

Cited by 14 publications

(11 citation statements)

References 41 publications

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“…However, these equations are frequently used in daily practice in the ICU [30]. Moreover, although dose adjustment was done based on renal function, a recent study showed that overexposure seems to be more frequent in patients receiving meropenem and impaired renal function [31].…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Pharmacodynamics of Meropenem by Extended or Continuous Infusion in Low Body Weight Critically Ill Patients

et al. 2021

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Background: Pathophysiological changes such as extreme body weights in critically ill patients with severe infections may alter the pharmacokinetics (PK) of antimicrobials, leading to treatment failure or toxicity. There are almost no PK data on meropenem in critically ill patients with low body weight (LwBW) and therefore information is lacking on the most appropriate dosing regimens, especially when administered by extended infusion. Objectives: To assess if the current administered doses of meropenem could lead to supratherapeutic concentrations in LwBW patients and to identify the factors independently associated with overexposure. Methods: A matched case-control 1:1 study of surgical critically ill patients treated with meropenem administered by extended or continuous infusion and undergoing therapeutic drug monitoring was conducted. Cases (patients with LwBW (body mass index (BMI) < 18.5 kg/m2)) were matched with normal body weight controls (NBW) (patients with BMI ≥ 18.5 kg/m2 and ≤30 kg/m2)) by age, gender, baseline renal function and severity status (APACHE II score). A 100% fT > MIC was considered an optimal pharmacokinetic/pharmacodynamic (PK/PD) target and 100% fT > 10 × MIC as supratherapeutic exposure. Results: Thirty-six patients (18 cases and 18 controls) were included (median (range) age, 57.5 (26–75) years; 20 (55.6% male)). Meropenem was administered by 6 h (extended) or 8 h (continuous) infusion at a median (range) daily dose of 5 (1–6) g/day. Similar median meropenem trough plasma concentrations (Cmin,ss), measured pre-dose on day three to four of treatment) were observed in the two groups (19.9 (22.2) mg/L vs 22.4 (25.8) mg/L, p > 0.999). No differences in the proportion of patients with an optimal or a supratherapeutic PKPD target between cases and controls were observed. A baseline estimated glomerular filtration rate (eGFR) < 90 mL/min was the only factor independently associated with a supratherapeutic PK/PD target. Conclusions: LwBW seems not to be a risk factor for achieving a supratherapeutic PK/PD target in critically ill patients receiving meropenem at standard doses by extended or continuous infusion.

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Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Pharmacodynamics of Meropenem by Extended or Continuous Infusion in Low Body Weight Critically Ill Patients

et al. 2021

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“…Another important issue regarding antimicrobial use is the identification of the correct dose of antimicrobials for each patient, depending on the renal function, as, under-dosing of antimicrobials could be associated with therapeutic failure, while, on the other hand, over-dosing could be associated with unnecessary antimicrobial use with associated toxicity. [29][30][31] Preauthorization of restricted antimicrobials as well as prospective audit and feedback are recommended as basic intervention policies regarding antimicrobial stewardship by national guidelines, and they have shown remarkable efficacy. 22 There are no adequate high quality published reports evaluating the effect of the abovementioned interventions in SOT recipients; however, they are among the most common practices in transplant centers.…”

Section: Potential Objectives In Sot Recipientsmentioning

confidence: 99%

“…Furthermore, timely discontinuation of antimicrobial treatment in patients empirically treated for infection when no evidence of infection arises could also aid toward the reduction of unnecessary antimicrobial consumption. Another important issue regarding antimicrobial use is the identification of the correct dose of antimicrobials for each patient, depending on the renal function, as, under‐dosing of antimicrobials could be associated with therapeutic failure, while, on the other hand, over‐dosing could be associated with unnecessary antimicrobial use with associated toxicity 29–31 …”

Section: Potential Objectives In Sot Recipientsmentioning

confidence: 99%

Importance of antimicrobial stewardship in solid organ transplant recipients: An ESCMID perspective

Ioannou,

Karakonstantis,

Schouten

et al. 2022

Transplant Infectious Dis

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Background In the last decades, solid organ transplantation (SOT) has emerged as an important method in the management of chronic kidney, liver, heart, and lung failure. Antimicrobial use has led to a significant reduction of morbidity and mortality due to infectious complications among patients with SOT; however, it can lead to adverse events and drive the development of antimicrobial resistance; thus, antimicrobial stewardship is of extreme importance. Even though there are ongoing efforts of transplant societies to implement principles of antimicrobial stewardship in everyday practice in SOT, there is still a lack of guidelines in this patient population. Aim The aim of this study was to review the status of antimicrobial stewardship in patients with SOT, highlight its importance from the perspective of an ongoing vivid dialogue among ESCMID experts in the field of antimicrobial stewardship, and depict opportunities for future study in the field. Review Antimicrobial stewardship programs are important in order to allow appropriate initiation and termination of antimicrobials in SOT recipients, and also aid in the most appropriate dosing and choosing of the route of administration of antimicrobials. Application of already known antimicrobial stewardship principles and application of currently used biomarkers and newly developed molecular rapid diagnostic testing tools can aid to the rationalization of antimicrobial prescribing and to a more targeted treatment of infections. Finally, physicians caring for SOT recipients should be actively involved in antimicrobial stewardship in order to assure optimization of antimicrobial prescribing and become familiar with the principles of antimicrobial stewardship.

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“…Eine der häufigsten pharmakologischen Interventionen dürfte die Dosisfindung unter der Berücksichtigung eingeschränkter Organfunktionen sein. Erstaunlicherweise ist einem aktuellen systematischen Review nach [17]…”

Section: Pharmakologische Interventionenunclassified

Antibiotic Stewardship (ABS) im Krankenhaus: ein Update

Juzek-Küpper¹,

Lemmen²

2022

Krankenhaushygiene up2date

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Does dose reduction of renally cleared antibiotics in patients with impaired renal function lead to adequate drug exposure? A systematic review

Cited by 14 publications

References 41 publications

Pharmacokinetics and Pharmacodynamics of Meropenem by Extended or Continuous Infusion in Low Body Weight Critically Ill Patients

Pharmacokinetics and Pharmacodynamics of Meropenem by Extended or Continuous Infusion in Low Body Weight Critically Ill Patients

Importance of antimicrobial stewardship in solid organ transplant recipients: An ESCMID perspective

Antibiotic Stewardship (ABS) im Krankenhaus: ein Update

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