TY  - CHAP
T1  - Antibiotic therapy in patients with renal impairment
T2  - Urogenital Infections and Inflammations
AU  - Keller, Frieder
ED  - Naber, Kurt G.
AD  - Frieder Keller, University Hospital Ulm, Department Internal Medicine 1, Nephrology, Ulm, Germany, E-mail: frieder.keller@uni-ulm.de
N2  - Every second drug needs dose adjustment to kidney function. The Cockcroft and Gault formula gives an estimate of the individual kidney function whereas the CKD-EPI and other formulas state only the standardized GFR. Pharmacokinetics should be considered to avoid accumulation and toxic drug effects. Pharmacodynamics should be considered to avoid sub therapeutic under dosage. High peak concentrations are the target for antibiotics with a concentration-dependent action (gentamicin, amikacin, levofloxacin, ciprofloxicin, daptomycin, linezolid, colistin and most anti-fungal drugs). High trough concentrations are the target for antibiotics with  time-dependent action (ampicillin, piperacillin, cefazolin, ceftazidime, meropenem, clarithromycin, doxycycline, vancomycin and all anti-viral drugs). From such pharmacokinetic and pharmacodynamic principles the following recommendations might be derived for the adjustment of antimicrobial drugs to the kidney function. Start anti-infective treatment within 1 hour. Use a loading dose (Dstart) – at least the normal or even a higher bolus dose. If the GFR is above 60 ml/min no dose adjustment is needed. Dose adjustment (D) should follow not before day 3 of the antibiotic therapy. If the estimated half-life is less than the normal administration interval no dose reduction should be made, but use at maximum the half-maximum standard dose. After hemodialysis a supplementary dose should be given to replace the removed fraction. During continuous renal replacement therapy usually a normal or near normal dose might be advisable. In the most critical patients, the continuous infusion of anti-infective drugs might allow for higher and more efficacious dosing without an increased risk of toxicity (meropenem, piperacillin, oxacillin, vancomycin, acyclovir).
PY  - 2018
DA  - 2018/01/22
DO  - 10.5680/lhuii000008
LA  - en
UR  - https://dx.doi.org/10.5680/lhuii000008
L2  - https://dx.doi.org/10.5680/lhuii000008
PB  - German Medical Science GMS Publishing House
CY  - Duesseldorf
ER  -