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Aminoglycoside use in renal failure.
1Department of Nephrology, Bahrain Specialist Hospital, PO Box 10588, Manama, Bahrain.
Indian Journal of Nephrology
|November 13, 2010
Summary
Aminoglycosides are crucial for gram-negative infections but require dose adjustments in renal failure. Higher predialysis doses are recommended for hemodialysis patients to ensure effective treatment.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Aminoglycosides are primary treatments for severe gram-negative infections.
- These drugs are renally excreted, with short half-lives in normal function.
- Renal impairment significantly prolongs aminoglycoside half-lives, necessitating dose modification.
Purpose of the Study:
- To review the use of aminoglycosides in patients with renal failure.
- To discuss dosage adjustments for aminoglycosides in renal impairment.
- To evaluate aminoglycoside dosing strategies in hemodialysis patients.
Main Methods:
- Literature review of aminoglycoside pharmacokinetics and dosing.
- Analysis of drug excretion and half-life in renal failure.
- Comparison of predialysis versus postdialysis dosing in hemodialysis.
Main Results:
- Aminoglycoside half-life extends significantly in anephric patients (30-60 hours).
- Renal failure necessitates dosage reduction or modification.
- Aminoglycoside clearance during hemodialysis is variable and significant.
Conclusions:
- Conventional postdialysis dosing for aminoglycosides in hemodialysis may be suboptimal.
- Higher predialysis doses are proposed to maintain therapeutic aminoglycoside levels.
- Revised dosing strategies are essential for effective aminoglycoside therapy in renal failure.
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