Antibiotic dosing in slow extended daily dialysis.
Slow extended daily dialysis (SLEDD) is the newest form of dialysis that is being used increasingly to replace continuous venovenous hemodialysis (CVVHD) for critically ill patients; it is less expensive to administer and has similar safety for patients who are prone to hemodynamic instability. Unfortunately, there are limited data regarding the appropriate dosing of antimicrobial agents for patients undergoing SLEDD. Furthermore, many nonnephrologists are not familiar with the differences between SLEDD, other continuous renal replacement therapies--for example, CVVHD--and routine hemodialysis. Thus, there is potential for inaccurate and, at worst, inadequate dosing of critical antimicrobial agents for this patient population. We review the available pharmacokinetic data on SLEDD and give preliminary recommendations for how to approach dosing in this situation.
Mushatt
David M
DM
Sections of Infectious Diseases, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana 70118, USA. dmushatt@tulane.edu
Mihm
Linda B
LB
Dreisbach
Albert W
AW
Simon
Eric E
EE
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D016638:Critical Illness; D003956:Dialysis / Q000379:methods*; D006801:Humans; D051437:Renal Insufficiency / Q000628:therapy*
D000900:Anti-Bacterial Agents