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Prescription of Antimicrobial Agents in Patients Undergoing Continuous Renal Replacement Therapy

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Infectious Diseases in Critical Care

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Abstract

The prescription of antibiotics to critically ill patients is an extremely common intervention. Early and appropriate antimicrobial administration has been repeatedly shown to improve mortality in septic patients [1–7]. However, whilst the choice of drug class will normally be influenced by numerous factors such as the likely organism, the current unit flora, and the patient’s comorbidities, the dose prescribed will usually be a standard one, perhaps modified by an estimated glomerular filtration rate (GFR) or a suggested “dialysis dose”. Yet, in the critically ill, a host of factors may influence the therapeutic level of prescribed antibiotics. These include increased volumes of distribution, changes in protein binding and increased extrarenal and renal losses all of which may contribute to lower than predicted drug levels when the usual patient dosage regimens are used [8]. The problem becomes more complex when renal failure supervenes. The addition of renal replacement therapy, restoration of renal function during recovery and alterations in volume of distribution may all lead to lowered tissue levels of antibiotics, with the potential to increase morbidity and mortality through inadequate antibiotic activity [9, 10].

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Authors and Affiliations

  1. Intensive Care Services, Hawke’s Bay Hospital, Hastings, New Zealand

    R. Freebairn MB, ChB

  2. Department of Intensive Care Medicine, Ned Hanlon Building, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Brisbane, 4029, Queensland, Australia

    J. Cohen BSc, MRCP

  3. Department of Intensive Care Medicine, 3rd Floor Ned Hanlon Building, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Brisbane, 4029, Queensland, Australia

    J. Lipman MD

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  1. R. Freebairn MB, ChB
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  2. J. Cohen BSc, MRCP
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Editor information

Editors and Affiliations

  1. Critical Care Department, Joan XXIII University Hospital, Carrer Mallafré Guasch, 4, E-43007, Tarragona, Spain

    Jordi Rello MD, PhD  & Alejandro Rodríguez MD, PhD  & 

  2. Medical Intensive Care Unit, Washington University School of Medicine, Barnes-Jewish Hospital, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO, 63110-1093, USA

    Marin Kollef MD (Professor of Medicine and Director) (Professor of Medicine and Director)

  3. Intensive Care Department, Joan XXIII University Hospital, Carrer Mallafré Guasch, 4, E-43007, Tarragona, Spain

    Emili Díaz MD

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Freebairn, R., Cohen, J., Lipman, J. (2007). Prescription of Antimicrobial Agents in Patients Undergoing Continuous Renal Replacement Therapy. In: Rello, J., Kollef, M., Díaz, E., Rodríguez, A. (eds) Infectious Diseases in Critical Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-34406-3_13

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