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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Antibiotic dosing in critically ill patients receiving CRRT: underdosing is overprevalent
Susan J Lewis1, Bruce A Mueller
1Department of Clinical Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan.
Seminars in Dialysis
|September 11, 2014
Summary
Antibiotic underdosing is common in continuous renal replacement therapy (CRRT), leading to treatment failure and increased mortality. Clinicians should aggressively dose antibiotics in critically ill patients receiving CRRT to achieve therapeutic targets.
Area of Science:
- Pharmacology
- Nephrology
- Critical Care Medicine
Background:
- Published dosing algorithms for continuous renal replacement therapy (CRRT) often lead to antibiotic underdosing.
- Inadequate antibiotic therapy is a significant risk factor for mortality in critically ill patients, particularly those with acute kidney injury (AKI).
Discussion:
- Underdosing results from factors like improved hepatic function in AKI patients, patient variability, delayed pharmacodynamic target achievement, and CRRT intensity.
- Clinicians may overemphasize antibiotic toxicity risks, neglecting the benefits of rapid therapeutic concentrations in CRRT patients.
Key Insights:
- Current CRRT antibiotic dosing strategies frequently fail to achieve pharmacodynamic targets.
- Aggressive antibiotic dosing is crucial for improving outcomes in critically ill patients undergoing CRRT.
Outlook:
- Further research is needed to refine antibiotic dosing guidelines for CRRT patients.
- Optimized dosing strategies can mitigate risks associated with underdosing and improve patient survival.
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