Antibiotic Dosing in Sustained Low-Efficiency Dialysis in Critically Ill Patients.

Title

Antibiotic Dosing in Sustained Low-Efficiency Dialysis in Critically Ill Patients.

Creator

Sethi Sidharth Kumar; Krishnappa Vinod; Nangethu Nisha; Nemer Paul; Frazee Lawrence A; Raina Rupesh

Publisher

Canadian journal of kidney health and disease

Date

2018
1905-07

Description

Purpose of review: Sustained low-efficiency dialysis (SLED) is increasingly used as a renal replacement modality in critically ill patients with acute kidney injury (AKI) and hemodynamic instability. There is, therefore, a greater need for the understanding of the antibiotic dosage and pharmacokinetics in these patients, to provide them with optimal therapy. Sources of information: PubMed/Medline, Embase, and Google Scholar. Methods: PubMed/Medline, Embase, and Google Scholar databases were searched using a combination of key words: dialysis, end stage renal disease, renal failure, sustained low efficiency dialysis, extended daily dialysis, prolonged intermittent renal replacement therapy (PIRRT), and antibiotic dosing. Studies that investigated antibiotic dosing and pharmacokinetics during SLED/extended daily dialysis/PIRRT were selected for this review. Key findings: Eleven studies met inclusion criteria and selected for data extraction. The data with regard to dialysis specifications, type of antibiotic including dosages, drug clearances, and dosage recommendations are summarized in Table 1. It is a challenge to find therapeutic doses for antibiotics during SLED therapy because, in general, only aminoglycosides and vancomycin can be assayed in clinical laboratories. Limitations: Although current studies on antibiotic dosing in SLED are limited due to diverse and undersized patient populations, antibiotic dosage adjustments for patients receiving SLED discussed here will serve as a valuable guide. Future large-scale research should focus on establishing guidelines for antibiotic dosage in SLED. Implications: Pharmacokinetic principles should be taken into consideration for the appropriate dosing of drugs during SLED, yet it is vital to monitor response to drug to make sure therapeutic goals are achieved. Antibiotic dosing and timing relative to the initiation of SLED may be important to maximize either the time above the minimum inhibitory concentration (MIC) (time-dependent) or the peak to MIC ratio (concentration-dependent), balancing efficacy and toxicity concerns. Critical care physicians should liaise with nephrologists to make decisions regarding appropriate antibiotic dosing in patients undergoing SLED.

Subject

antibiotics; extended daily dialysis; pharmacokinetics; SLED; sustained low-efficiency dialysis

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

2054358118792229–2054358118792229

Volume

5

Citation

Sethi Sidharth Kumar; Krishnappa Vinod; Nangethu Nisha; Nemer Paul; Frazee Lawrence A; Raina Rupesh, “Antibiotic Dosing in Sustained Low-Efficiency Dialysis in Critically Ill Patients.,” NEOMED Bibliography Database, accessed January 24, 2021, https://neomed.omeka.net/items/show/4822.

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