Influence of Renal Replacement Modalities on Amikacin Population Pharmacokinetics in Critically Ill Patients on Continuous Renal Replacement Therapy

Roger, Claire; Wallis, Steven C.; Muller, Laurent; Saïssi, G.; Lipman, Jeffrey; Lefrant, Jean‐Yves; Roberts, Jason A.

doi:10.1128/aac.00828-16

Cited by 32 publications

(58 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ultrafiltration rate: 1,900-3,250 ml/h 1 g q8h (Vossen et al, 2015) Dialysate rate: 2 L/h 1 g q8h (Vossen et al, 2015) Combined flow rate: 1,500-2,800 ml/h 1 g q8h (Vossen et al, 2015) Amikacin Ultrafiltration rate: 30 ml/kg/h 25 mg/kg q48h (Roger et al, 2016b) Exact dose cannot be predicted (Lam and Bauer, 2013) Combined flow rate: 30 ml/kg/h 25 mg/kg q48h (Roger et al,…”

Section: Doripenemmentioning

confidence: 99%

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

Xia

et al. 2020

Front. Pharmacol.

View full text Add to dashboard Cite

Continuous Renal Replacement Therapy (CRRT) is more and more widely used in patients for various indications recent years. It is still intricate for clinicians to decide a suitable empiric antimicrobial dosing for patients receiving CRRT. Inappropriate doses of antimicrobial agents may lead to treatment failure or drug resistance of pathogens. CRRT factors, patient individual conditions and drug pharmacokinetics/pharmacodynamics are the main elements effecting the antimicrobial dosing adjustment. With the development of CRRT techniques, some antimicrobial dosing recommendations in earlier studies were no longer appropriate for clinical use now. Here, we reviewed the literatures involving in new progresses of antimicrobial dosages, and complied the updated empirical dosing strategies based on CRRT modalities and effluent flow rates. The following antimicrobial agents were included for review:

show abstract

Section: Doripenemmentioning

confidence: 99%

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

Xia

et al. 2020

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…As previously explained, CL CR was analyzed only in patients not treated by CRRT. If inclusion of the covariate resulted in a statistically significant improvement in the log-likelihood values (P Ͻ 0.05) and/or improved the goodness-of-fit plots, then it was included (32,33).…”

Section: Methodsmentioning

confidence: 99%

“…Goodness of fit was assessed by linear regression with an observed-predicted plot (individual and population), coefficients of determination (individual and population-weighted residuals [WR] and normalized prediction distribution error [NPDE] as a function of time and population prediction) and log-likelihood values. Using the final covariate model, a visual predictive check (VPC) was performed by simulating 1,000 subjects to assess the predictive performance of the model (32,33).…”

Section: Methodsmentioning

confidence: 99%

“…We aimed to assess the adequacy of dosing in terms of the worst-case scenario as the type of pathogen and MIC data are often not initially available to the clinician prescribing an empirical (i.e., probabilistic) antimicrobial regimen. Supratherapeutic exposure was defined by a trough concentration (C min ) of Ն2.5 mg/liter, in accordance with French recommendations and previously published studies (9,26,33).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Population Pharmacokinetic Study of the Suitability of Standard Dosing Regimens of Amikacin in Critically Ill Patients with Open-Abdomen and Negative-Pressure Wound Therapy

Carrié

Delzor

Roure

et al. 2020

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The aim was to assess the appropriateness of recommended regimens for empirical MIC coverage in critically ill patients with open-abdomen and negative-pressure therapy (OA/NPT). Over a 5-year period, every critically ill patient who received amikacin and who underwent therapeutic drug monitoring (TDM) while being treated by OA/NPT was retrospectively included. A population pharmacokinetic (PK) modeling was performed considering the effect of 10 covariates (age, sex, total body weight [TBW], adapted body weight [ABW], body surface area [BSA], modified sepsis-related organ failure assessment [SOFA] score, vasopressor use, creatinine clearance [CLCR], fluid balance, and amount of fluids collected by the NPT over the sampling day) in patients who underwent continuous renal replacement therapy (CRRT) or did not receive CRRT. Monte Carlo simulations were employed to determine the fractional target attainment (FTA) for the PK/pharmacodynamic [PD] targets (maximum concentration of drug [Cmax]/MIC ratio of ≥8 and a ratio of the area under the concentration-time curve from 0 to 24 h [AUC0–24]/MIC of ≥75). Seventy critically ill patients treated by OA/NPT (contributing 179 concentration values) were included. Amikacin PK concentrations were best described by a two-compartment model with linear elimination and proportional residual error, with CLCR and ABW as significant covariates for volume of distribution (V) and CLCR for CL. The reported V) in non-CRRT and CRRT patients was 35.8 and 40.2 liters, respectively. In Monte Carlo simulations, ABW-adjusted doses between 25 and 35 mg/kg were needed to reach an FTA of >85% for various renal functions. Despite an increased V and a wide interindividual variability, desirable PK/PD targets may be achieved using an ABW-based loading dose of 25 to 30 mg/kg. When less susceptible pathogens are targeted, higher dosing regimens are probably needed in patients with augmented renal clearance (ARC). Further studies are needed to assess the effect of OA/NPT on the PK parameters of antimicrobial agents.

show abstract

“…The drugs of interest included amikacin [8], ciprofloxacin [9] and linezolid [10]. Surprisingly there was no consistent effect of the type of CRRT.…”

mentioning

confidence: 99%

What’s new in pharmacokinetics of antimicrobials in AKI and RRT?

2017

Self Cite

View full text Add to dashboard Cite

Acute kidney injury (AKI) remains a very common occurrence in critically ill patients and is associated with decreased survival in severe sepsis [1]. Effective treatment for these patients is mostly through treatment of the underlying pathology as well as supportive care with renal replacement therapy (RRT). Optimised pharmacotherapy is of heightened importance to ensure maximal outcomes for critically ill patients with AKI receiving RRT, although the pharmacokinetics of many drugs can change dramatically in these patients, making effective dosing a challenge.The purpose of this paper is to describe the new developments in antibiotic dosing and pharmacokinetics in critically ill patients with AKI and receiving RRT.The overwhelming body of recent literature aims to understand how to better dose these compounds in critically ill patients receiving different forms of RRT, with far more data being generated for continuous than for intermittent RRT. Little data is available in AKI without RRT. Very few data on other classes of drugs are available which is largely due to the fact that many have negligible RRT clearance because of high protein binding, hepatic clearance or large volumes of distribution (e.g. most anticonvulsants), have dosing that is titrated to effect (e.g. analgesics and sedatives) or have readily available therapeutic drug monitoring (TDM).Recent pharmacokinetic studies of antibiotics have moved away from a drug-based dosing approach, where each drug has a given dose regardless of type of RRT, to a strategy where the specific drug dose accounts for the modality of RRT (e.g. intermittent, prolonged or continuous convective and/or diffusive RRT) and the associated settings (e.g. blood or ultrafiltration flow rate, filter material and surface area).Most of the studies continue to evaluate only pharmacokinetic endpoints and include small cohorts which limits the generalizability of findings. On the other hand, some comparative studies have been useful to better elucidate the effect of different approaches to RRT, including different modalities (i.e. intermittent and prolonged intermittent RRT and CRRT). It is hoped that the forthcoming SaMpling Antibiotics in Renal Replacement Therapy (SMARRT) study (ACTRN12613000241730), endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG), will address many of these issues. Further to this, use of ex vivo models of RRT are providing suitable doses for drugs to be subsequently tested in clinical pharmacokinetic studies [2]. Such models are very useful as the interaction between changing RRT modalities and settings on drug clearance, as well as potentially significant drug adsorption to the RRT membrane, can be more accurately calculated without the complicating effects of biology.Important knowledge has been generated recently that has aimed to quantify the effect of the dose and type of RRT used. Using a meta-review methodology of published studies, Jamal et al. highlighted the importance of CRRT dose where they found th...

show abstract

Influence of Renal Replacement Modalities on Amikacin Population Pharmacokinetics in Critically Ill Patients on Continuous Renal Replacement Therapy

Cited by 32 publications

References 33 publications

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

Population Pharmacokinetic Study of the Suitability of Standard Dosing Regimens of Amikacin in Critically Ill Patients with Open-Abdomen and Negative-Pressure Wound Therapy

What’s new in pharmacokinetics of antimicrobials in AKI and RRT?

Contact Info

Product

Resources

About