[The management of antibiotic therapy in critically ill patients with AKI: between underdosing and toxicity]

Area of Science:

• Nephrology
• Pharmacology
• Critical Care Medicine

Background:

• Intensive care unit (ICU) practices, including microbiology and dialysis, complicate antibiotic selection for nephropathic patients.
• Recent research indicates frequent inappropriate antibiotic dosing (underdosing or overdosing) in critically ill patients, leading to suboptimal outcomes.
• The kidneys' role in drug excretion and metabolism makes them susceptible to antibiotic-induced toxicity, while extracorporeal therapies can alter drug elimination.

Purpose of the Study:

• To review recent literature on the appropriateness of antibiotic use in critically ill patients.
• To focus on contributions relevant to nephrology and the unique challenges of antibiotic management in kidney disease.
• To highlight the complexities of nephropharmacology in the context of intensive care.

Main Methods:

• Comprehensive literature review of recent studies.
• Analysis of antibiotic use appropriateness in critically ill patients.
• Focus on nephrological implications and extracorporeal replacement therapy.

Main Results:

• Antibiotic use in nephropathic patients in ICUs presents significant challenges.
• Inappropriate dosing (both low and high) is common, impacting treatment efficacy and safety.
• Kidney function and dialysis modalities critically influence antibiotic pharmacokinetics and pharmacodynamics.

Conclusions:

• Nephropharmacology is a complex, multidisciplinary field requiring careful consideration of antibiotic use in kidney disease.
• Optimizing antibiotic therapy in critically ill nephropathic patients necessitates a tailored approach considering renal function and dialysis.
• Further research is needed to establish evidence-based guidelines for antibiotic management in this vulnerable patient population.