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Updated: Jun 19, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

[Antibiotic use in patients with renal or hepatic failure]

José Ramón Azanza1, Emilio García, Belén Sádaba

  • 1Servicio de Farmacología Clínica, Clínica Universidad de Navarra, Pamplona, España. jrazanza@unav.es

Enfermedades Infecciosas Y Microbiologia Clinica
|October 27, 2009
PubMed

Insights

Antibiotic dosing requires adjustment in renal or hepatic failure. Dosage reduction is needed for kidney impairment, while liver failure necessitates specific antibiotic guidance. Hemodialysis also impacts antibiotic levels, requiring dose timing adjustments.

Area of Science:

  • Pharmacology
  • Nephrology
  • Hepatology

Context:

  • Antibiotic pharmacokinetics are significantly altered in patients with renal or hepatic dysfunction.
  • Dosage adjustments are crucial for antibiotics eliminated renally or metabolized hepatically to ensure efficacy and safety.
  • Renal impairment necessitates dose reduction based on severity, while hepatic failure requires individualized antibiotic assessment.

Purpose:

  • To provide guidance on adjusting antibiotic dosages in patients with renal or hepatic failure.
  • To outline strategies for managing antibiotic therapy during hemodialysis and other extrarenal clearance techniques.

Summary:

  • Renal impairment requires a 30% dose reduction per stage (moderate, severe).
  • Hepatic failure lacks a universal rule; consult specific antibiotic data.
  • Hemodialysis necessitates post-session dosing or supplementary doses for low molecular weight antibiotics with reduced protein binding.

Impact:

  • Optimized antibiotic dosing in organ dysfunction improves patient outcomes.
  • Prevents sub-therapeutic or toxic antibiotic concentrations.
  • Ensures effective antimicrobial therapy in vulnerable patient populations.

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