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Antimicrobial Dosing in Specific Populations and Novel Clinical Methodologies: Kidney Function.

Manjunath P Pai1

  • 1Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.

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Summary

Estimating kidney function is crucial for antimicrobial drug dosing. A comprehensive approach is needed to optimize drug therapy and clinical outcomes in patients with impaired kidney function.

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Area of Science:

  • Pharmacology
  • Nephrology
  • Clinical Pharmacy

Background:

  • Kidney function is essential for determining antimicrobial drug dosage and administration frequency.
  • Current practices often rely on estimated kidney function equations using serum creatinine.
  • Regulatory guidance also recommends using estimated kidney function for studies in patients with abnormal kidney function.

Purpose of the Study:

  • To review advancements in kidney function assessment for drug dosing.
  • To highlight challenges and propose a holistic approach for antimicrobial drug dose adjustment in patients with abnormal kidney function.

Main Methods:

  • Review of evolving methods for kidney function assessment, including biomarkers and modeling.
  • Analysis of changes in kidney replacement therapy delivery.
  • Examination of the complexities in antimicrobial drug dose adjustment.

Main Results:

  • Innovations include alternate biomarkers, exogenous markers, probe substrates, and advanced modeling.
  • Significant changes in kidney replacement therapy settings are occurring.
  • Over-reliance on estimated kidney function can lead to underdosing, particularly in acutely ill patients.

Conclusions:

  • Antimicrobial drug dose adjustment in patients with abnormal kidney function is complex and evolving.
  • A holistic approach is necessary to optimize clinical outcomes and avoid underdosing.
  • Future strategies must integrate new technologies and consider diverse patient populations.