Impact of extrarenal clearance therapies on antimicrobial plasma concentrations in the Intensive Care Unit
DOI:
https://doi.org/10.30445/rear.v13i12.992Keywords:
acute kidney injury, antimicrobials, continuous renal replacement therapy, extracorporeal clearanceAbstract
A careful management of antimicrobials is essential in the critically ill with acute kidney injury, especially if renal replacement therapy is required. Acute kidney injury may lead per se to clinically significant modifications of drugs’ pharmacokinetic parameters, and the need for renal replacement therapy represents a further variable that should be considered to avoid inappropriate antimicrobial therapy. In many cases, the extracorporeal removal of antimicrobials can be relevant, with a consistent risk of underdosing-related treatment failure and/or potential onset of bacterial resistance.
In this clinical scenario, the knowledge of the pharmacokinetic and pharmacodynamic properties of different antimicrobial classes is essential to adapt the doses and/or dosage ranges.
The purpose of this review is to present an updated summary of the current evidence for this phenomenon and to guide possible drug adjustment.
For the preparation of this document, a non-systematic review of articles indexed in MEDLINE (PubMed) from the last fifteen years has been carried out, updated in December 2019, using the keywords “critically ill”, “acute kidney injury”, “antimicrobials”, “continuous renal replacement therapy” and “extracorporeal clearance”.
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