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Updated: Feb 5, 2026

Direct Drug Delivery to Kidney via the Renal Artery
Published on: April 17, 2021
Renal Dosing of Antibiotics: Are We Jumping the Gun?
Ryan L Crass1, Keith A Rodvold2, Bruce A Mueller1
1Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor.
Abstract:
Antibiotic renal dose adjustments are determined in patients with stable chronic kidney disease and may not translate to patients in late-phase trials and practice. Ceftolozane/tazobactam, ceftazidime/avibactam, and telavancin all carry precautionary statements for reduced clinical response in patients with baseline creatinine clearance of 30-50 mL/min, potentially due to unnecessary dose reduction in the setting of acute kidney injury (AKI). In this review, we discuss the regulatory landscape for antibiotics eliminated by the kidney and highlight the importance of the first 48 hours of therapy. Using a clinical database, we identified AKI on admission in a substantial proportion of patients with pneumonia (27.1%), intraabdominal (19.5%), urinary tract (20.0%), or skin and skin structure infections (9.7%) that resolved by 48 hours in 57.2% of cases. We suggest that deferred renal dose reduction of wide therapeutic index antibiotics could improve outcomes in patients with infectious diseases.
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