title: Antibiotic Dosing in Patients With Acute Kidney Injury: "Enough But Not Too Much".
abstract: Increasing evidence suggests that antibiotic dosing in critically ill patients with acute kidney injury (AKI) often does not achieve pharmacodynamic goals, and the continued high mortality rate due to infectious causes appears to confirm these findings. Although there are compelling reasons why clinicians should use more aggressive antibiotic dosing, particularly in patients receiving aggressive renal replacement therapies, concerns for toxicity associated with higher doses are real. The presence of multisystem organ failure and polypharmacy predispose these patients to drug toxicity. This article examines the pharmacokinetic and pharmacodynamic consequences of critical illness, AKI, and renal replacement therapy and describes potential solutions to help clinicians give "enough but not too much" in these very complicated patients.
authors.affiliation: Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Lewis
authors.affiliation: Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI, USA muellerb@med.umich.edu.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Mueller
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D017582:Renal Replacement Therapy / Q000379:methods*; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: acute kidney injury; antibiotics; pharmacodynamics; pharmacokinetics; renal replacement therapy