title: To increase or decrease dosage of antimicrobials in septic patients during continuous renal replacement therapy: the eternal doubt.
abstract: Critical illness, acute renal failure and continuous renal replacement therapy (CRRT) are associated with changes in pharmacokinetics. Initial antibiotic dose should be based on published volume of distribution and generally be at least the standard dose, as volume of distribution is usually unchanged or increased. Subsequent doses should be based on total clearance. Total clearance varies with the CRRT clearance which mainly depends on effluent flow rate, sieving coefficient/saturation coefficient. As antibiotic clearance by healthy kidneys is usually higher than clearance by CRRT, except for colistin, subsequent doses should generally be lower than given to patients without renal dysfunction. In the future therapeutic drug monitoring, together with sophisticated pharmacokinetic models taking into account the pharmacokinetic variability, may enable more appropriate individualized dosing.
authors.affiliation: Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Wai-Tat
authors.initials: WT
authors.lastname: Wong
authors.affiliation: Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Gordon
authors.initials: G
authors.lastname: Choi
authors.affiliation: Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong. Electronic address: gomersall@cuhk.edu.hk.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Gomersall
authors.affiliation: Academic Discipline of Anaesthesiology & Critical Care, The University of Queensland and Queensland University of Technology, Queensland, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D003091:Colistin / Q000493:pharmacokinetics / Q000627:therapeutic use; D017576:Daptomycin / Q000493:pharmacokinetics / Q000627:therapeutic use; D016903:Drug Monitoring; D006801:Humans; D051437:Renal Insufficiency / Q000378:metabolism; D017582:Renal Replacement Therapy; D018805:Sepsis
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin; D003091:Colistin