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Review
. 2022 Jan 31:2022:1867674.
doi: 10.1155/2022/1867674. eCollection 2022.

Are Antibiotics Appropriately Dosed in Critically Ill Patients with Augmented Renal Clearance? A Narrative Review

Mohammad Sistanizad  1   2 , Rezvan Hassanpour  1 , Elham Pourheidar  1
Affiliations
Review

Are Antibiotics Appropriately Dosed in Critically Ill Patients with Augmented Renal Clearance? A Narrative Review

Mohammad Sistanizad et al. Int J Clin Pract. .

Abstract

Aims: Augmented renal clearance (ARC), which is commonly defined as increased renal clearance above 130 ml/min/1.73 m2, is a common phenomenon among critically ill patients. The increased elimination rate of drugs through the kidneys in patients with ARC can increase the risk of treatment failure due to the exposure to subtherapeutic serum concentrations of medications and affect the optimal management of infections, length of hospital stay, and outcomes. The main goal of this review article is to summarize the recommendations for appropriate dosing of antibiotics in patients with ARC.

Methods: This article is a narrative review of the articles that evaluated different dosing regimens of antibiotics in patients with ARC. The keywords "Augmented Renal Clearance," "Critically ill patients," "Drug dosing," "Serum concentration," "Beta-lactams," "Meropenem," "Imipenem," "Glycopeptide," "Vancomycin," "Teicoplanin," "Linezolid," "Colistin," "Aminoglycosides," "Amikacin," "Gentamycin," "Fluoroquinolones," "Ciprofloxacin," and "Levofloxacin" were searched in Scopus, Medline, PubMed, and Google Scholar databases, and pediatric, nonhuman, and non-English studies were excluded.

Results: PK properties of antibiotics including lipophilicity or hydrophilicity, protein binding, the volume of distribution, and elimination rate that affect drug concentration should be considered along with PD parameters for drug dosing in critically ill patients with ARC.

Conclusion: This review recommends a dosing protocol for some antibiotics to help the appropriate dosing of antibiotics in ARC and decrease the risk of subtherapeutic exposure that may be observed while receiving conventional dosing regimens in critically ill patients with ARC.

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Conflict of interest statement

The authors declare no conflicts of interest for the research, authorship, and/or publication of this article.

References

    1. Carlier M., Carrette S., Roberts J. A., et al. Meropenem and piperacillin/tazobactam prescribing in critically ill patients: does augmented renal clearance affect pharmacokinetic/pharmacodynamic target attainment when extended infusions are used? Critical Care . 2013;17(3):p. R84. doi: 10.1186/cc12705. - DOI - PMC - PubMed
    1. Hites M., Taccone F. S., Wolff F., et al. Broad-spectrum β-lactams in obese non-critically ill patients. Nutrition and Diabetes . 2014;4(6):p. e119. doi: 10.1038/nutd.2014.15. - DOI - PMC - PubMed
    1. Abdulla A., Ewoldt T. M. J., Hunfeld N. G. M., et al. The effect of therapeutic drug monitoring of beta-lactam and fluoroquinolones on clinical outcome in critically ill patients: the DOLPHIN trial protocol of a multi-centre randomised controlled trial. BMC Infectious Diseases . 2020;20:57–59. doi: 10.1186/s12879-020-4781-x. - DOI - PMC - PubMed
    1. Bilbao-Meseguer I., Rodríguez-Gascón A., Barrasa H., Isla A., Solinís M. Á. Augmented renal clearance in critically ill patients: a systematic review. Clinical Pharmacokinetics . 2018;57(9):1107–1121. doi: 10.1007/s40262-018-0636-7. - DOI - PubMed
    1. Sime F. B., Udy A. A., Roberts J. A. Augmented renal clearance in critically ill patients: etiology, definition and implications for beta-lactam dose optimization. Current Opinion in Pharmacology . 2015;24:1–6. doi: 10.1016/j.coph.2015.06.002. - DOI - PubMed