Antibiotic Dosing in Renal Replacement Therapy


  • 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.


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

  • 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

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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