Therapeutic considerations in the use of antibiotics in renal insufficiency

Virtually all antibiotics are excreted in part or in total by the kidneys. Therefore in various degrees of renal function impairment, systemic drug accumulation with dose-related toxicity may take place unless a readjustment is made in standard drug dosing principles. Good clinical practice dictates that the physician have some familiarity with the drug dosing changes that are necessary when patients with renal failure require antibiotic therapy. Correlation of the patient's renal function status with the selected antibiotic is the first step, after which drug dosing tables and nomograms serve as an immediate and practical guide to safe and effective therapy. Antibiotic dosing regimens in renal failure should always be monitored by analysis of serum drug levels when available to the clinician, as this is the best confirmation of safe and effective therapy. This review contains detailed metabolic and pharmacokinetic information that may be used as an additional clinical resource for the antibiotic therapy of patients with renal insufficiency.