Antibiotic Dosing in Renal Replacement Therapy
OVERVIEW
- there is little published data to guide dosing of antibiotics in RRT and the critically ill.
- therefore we must use first principles and utilize therapeutic drug monitoring if available.
CONSIDERATIONS
Properties of the antibiotic
- size of molecule
- charge
- solubility
Pharmacokinetics of drug
- how much will be dialysed
- Vd
- clearance
- protein binding
Pharmacodynamics of drug
- what concentrations need to be achieved to be effective
- kill characteristics of drug:
– peak dose/concentration dependent (aminoglycosides)
– time above MIC (beta lactams)
– time and concentration dependent (AUC -> quinlones)
Type and settings of RRT
- mode: CVVDH, CVVHF, CVVDHF
- CVVHD: molecular weight, blood flow rate, dialysate flow rate
- CVVHF: ultrafiltrate flow rate
- blood flow rate
- pre vs post filter dilution
Site of infection/tissue penetration ability of drug
Toxicity of high drug levels
Residual or recovery of intrinsic renal function
RRT prescription compliance
Availability of Therapeutic Drug Monitoring
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC