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Determination of antibiotic dosage adjustments in patients with renal impairment: elements for success

Nimish Patel1, Marc H Scheetz, George L Drusano

  • 1Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA.

The Journal of Antimicrobial Chemotherapy
|August 26, 2010
PubMed

Insights

This review presents a new method for antibiotic dosing in patients with kidney disease, focusing on effectiveness and safety. It uses extended-infusion piperacillin/tazobactam to optimize drug levels and minimize risks.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Traditional antibiotic dosing for renal impairment aims for similar drug concentrations.
  • This historical approach overlooks the crucial link between antibiotic exposure and therapeutic effect.
  • Optimizing antibiotic dosing requires balancing efficacy, toxicity, and resistance development.

Purpose of the Study:

  • To review a modern methodology for antibiotic dosage adjustments in renal impairment.
  • To highlight a new approach that integrates exposure-effect relationships.
  • To illustrate this methodology using extended-infusion piperacillin/tazobactam.

Main Methods:

  • Review of contemporary pharmacokinetic/pharmacodynamic (PK/PD) principles.
  • Analysis of a proposed renal dosing scheme.
  • Application of the methodology to extended-infusion piperacillin/tazobactam.

Main Results:

  • The reviewed methodology provides an optimal framework for renal dose selection.
  • It balances the probability of target attainment with risks of toxicity and resistance.
  • Extended-infusion piperacillin/tazobactam serves as a practical example for implementation.

Conclusions:

  • A contemporary methodology offers improved antibiotic dosing strategies for patients with renal impairment.
  • This approach enhances therapeutic success by considering exposure-effect relationships.
  • Optimal dosing schemes are essential for managing patients with kidney disease and preventing antimicrobial resistance.

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