Drug administration in intermittent renal replacement therapy

Schetz, Miet

doi:10.1007/978-94-011-5482-6_121

Cited by 1 publication

(3 citation statements)

References 146 publications

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“…Drugs like ceftriaxone have limited removal while other drugs such as ampicillin or ceftazidime have clearance rates close to that of aminoglycosides. Clinicians should refer to tables of S values to help optimize prescribing practice with these agents in patients receiving CRRT 73,74 .…”

Section: β-Lactam Antibioticsmentioning

confidence: 99%

“…RENAL REPLACEMENT THERAPY AND ANTIMICROBIALS 73,74,[105][106][107] The serum levels of all antimicrobials are affected by the use of RRT, whether in the form of intermittent haemodialysis (IHD) or continuous haemofiltration (CRRT). If IHD is applied, several antibiotics are effectively removed and require repeat dosing after the IHD session 74 .…”

Section: Ciprofloxacin (As Representative Of the Fluoroquinolones)mentioning

confidence: 99%

“…Vancomycin is not removed at all if standard cellulose or low-flux biosynthetic membranes are used. However, if high-flux biosynthetic membranes are used and especially if some convective clearance is applied (intermittent haemodiafiltration or intermittent haemofiltration), then vancomycin clearance can be significant and adjusted re-dosing may be necessary 73 . Therefore, if working in a unit where such intermittent therapy is used, the intensive care physician needs to understand these issues and become familiar with the technical characteristics of the IHD applied in that institution.…”

Section: Ciprofloxacin (As Representative Of the Fluoroquinolones)mentioning

confidence: 99%

See 2 more Smart Citations

Pharmacological Principles of Antibiotic Prescription in the Critically Ill

Pinder¹,

Bellomo

Lipman³

2002

Anaesth Intensive Care

112

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The goal of antimicrobial prescription is to achieve effective drug concentrations. Standard antimicrobial dosing regimens are based on research performed often decades ago and for the most part with patients who were not critically ill. More recent insights into antibiotic activity (e.g. the importance of high peak/MIC ratios for aminoglycosides and time above MIC for β-lactam antibiotics), drug pharmacokinetics (e.g. increased volume of distribution and altered clearances) and the pathogenesis of sepsis (e.g. third space losses and altered creatinine clearances) have made re-evaluation of dosing regimens necessary for the critically ill.The inflammatory response associated with sepsis results in a rapid decrease in serum albumin levels, large fluid shifts and third space losses, initially with a high cardiac output. In turn these changes result in increased creatinine clearance and increased renal drug clearance. Unless these effects are offset by ensuing renal and/or hepatic impairment, with subsequent drug accumulation, antibiotic levels may be too low for optimal efficacy. The institution of continuous renal replacement therapy separately affects antibiotic clearances, and therefore dosing, even further.This article reviews relevant literature and offers principles for more effective and appropriate antibiotic dosing in the critically ill, based on the pharmacokinetic and pharmacodynamic principles of the main antibiotic groups (aminoglyosides, glycopeptides, β-lactams, carbapenems and quinolones) and knowledge of the pathophysiology of the inflammatory response syndrome. Finally it also provides some guidance on the basic principles of drug prescription for patients receiving continuous renal replacement therapy. FIGURE 2: Creatinine clearance vs 4th generation cephalosporin clearance ( • ) combination of cefepime (x) and cefpirome (data points -from references 9 and 10). Creatinine clearance (ml/min) Drug clearance (ml/min)

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Section: β-Lactam Antibioticsmentioning

confidence: 99%