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Updated: Sep 20, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Are Antibiotics Appropriately Dosed in Critically Ill Patients with Augmented Renal Clearance? A Narrative Review
Mohammad Sistanizad1,2, Rezvan Hassanpour1, Elham Pourheidar1
1Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Aims:
Augmented renal clearance (ARC), which is commonly defined as increased renal clearance above 130 ml/min/1.73 m2, is a common phenomenon among critically ill patients. The increased elimination rate of drugs through the kidneys in patients with ARC can increase the risk of treatment failure due to the exposure to subtherapeutic serum concentrations of medications and affect the optimal management of infections, length of hospital stay, and outcomes. The main goal of this review article is to summarize the recommendations for appropriate dosing of antibiotics in patients with ARC.
Methods:
This article is a narrative review of the articles that evaluated different dosing regimens of antibiotics in patients with ARC. The keywords "Augmented Renal Clearance," "Critically ill patients," "Drug dosing," "Serum concentration," "Beta-lactams," "Meropenem," "Imipenem," "Glycopeptide," "Vancomycin," "Teicoplanin," "Linezolid," "Colistin," "Aminoglycosides," "Amikacin," "Gentamycin," "Fluoroquinolones," "Ciprofloxacin," and "Levofloxacin" were searched in Scopus, Medline, PubMed, and Google Scholar databases, and pediatric, nonhuman, and non-English studies were excluded.
Results:
PK properties of antibiotics including lipophilicity or hydrophilicity, protein binding, the volume of distribution, and elimination rate that affect drug concentration should be considered along with PD parameters for drug dosing in critically ill patients with ARC.
Conclusion:
This review recommends a dosing protocol for some antibiotics to help the appropriate dosing of antibiotics in ARC and decrease the risk of subtherapeutic exposure that may be observed while receiving conventional dosing regimens in critically ill patients with ARC.
Insights
Augmented renal clearance (ARC) in critically ill patients can lead to subtherapeutic antibiotic levels and treatment failure. This review provides dosing recommendations to optimize antibiotic therapy in these patients.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Nephrology
Background:
- Augmented renal clearance (ARC), defined as renal clearance >130 mL/min/1.73 m², is prevalent in critically ill patients.
- Elevated drug elimination in ARC can result in subtherapeutic serum concentrations, increasing the risk of treatment failure.
Purpose of the Study:
- To review and summarize dosing recommendations for antibiotics in critically ill patients with ARC.
- To mitigate the risk of subtherapeutic drug exposure and improve patient outcomes.
Main Methods:
- A narrative review of studies evaluating antibiotic dosing regimens in patients with ARC.
- Searched Scopus, Medline, PubMed, and Google Scholar for relevant literature, excluding pediatric, nonhuman, and non-English studies.
Main Results:
- Pharmacokinetic properties (lipophilicity, protein binding, volume of distribution, elimination rate) and pharmacodynamic parameters are crucial for optimizing antibiotic dosing in ARC.
- Consideration of these factors is essential for achieving therapeutic drug concentrations.
Conclusions:
- A dosing protocol for select antibiotics is recommended to ensure appropriate antibiotic dosing in ARC.
- Optimized dosing strategies can decrease the incidence of subtherapeutic antibiotic exposure in critically ill patients with ARC.
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