Antibiotic dosing in patients with renal insufficiency or receiving dialysis

Many patients are admitted to the hospital with renal insufficiency or renal insufficiency develops during their hospital stay. Many of these patients have bacterial infections requiring antimicrobial therapy. Antibiotic dosing in patients with varying degrees of renal insufficiency or hepatic failure is a therapeutic challenge to the clinician. The physician must be aware of the pharmacokinetics of the antibiotic in renal insufficiency as well as with intact renal function. Most antibiotics are eliminated via either hepatic or renal mechanisms, and the clinician should use this knowledge to select an antibiotic with the proper spectrum for the patient. This article presents practical guidelines for patients with hepatic insufficiency or various degrees of renal failure as well as for patients receiving peritoneal dialysis or hemodialysis. The guidelines presented provide the clinician with an approach that is easy to use and remember for determining the appropriate dose and dosing interval in patients with impaired hepatic or renal dysfunction.