Antimicrobial pharmacokinetics in pediatric patients on kidney replacement therapy: a comprehensive narrative review

Area of Science:

• Pharmacology
• Nephrology
• Pediatrics

Background:

• Patients on dialysis often require antimicrobial therapy, particularly for sepsis.
• Altered pharmacokinetics (PK) in dialysis patients necessitate antimicrobial dose adjustments, as established in adult studies.
• Existing pediatric studies on antimicrobial PK during kidney replacement therapy (KRT) are limited, leading to reliance on extrapolated adult data.

Purpose of the Study:

• To review existing literature on antimicrobial PK in pediatric patients undergoing dialysis.
• To identify knowledge gaps in pediatric antimicrobial dosing for patients on KRT.
• To guide future research priorities in this vulnerable population.

Main Methods:

• A comprehensive literature review was performed.
• Searched for original studies evaluating antimicrobial PK in pediatric patients on hemodialysis, peritoneal dialysis, or continuous KRT.
• Synthesized findings to describe current knowledge and identify research needs.

Main Results:

• Identified 56 original studies on the PK of twelve different antimicrobials in pediatric dialysis patients.
• Demonstrated a significant under-study of antimicrobial PK in pediatric patients on dialysis.
• Highlighted the reliance on adult data for pediatric dosing recommendations.

Conclusions:

• Antimicrobial PK in pediatric patients on dialysis is an understudied area.
• This population is at high risk for infections and drug toxicity.
• Future research should prioritize commonly used antimicrobials and those with known toxicity risks at higher concentrations.