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Renal Dosing of Antibiotics: Are We Jumping the Gun?

Abstract Antibiotic renal dose adjustments are determined in patients with stable chronic kidney disease and may not translate to patients in late-phase trials and practice. Ceftolozane/tazobactam, ceftazidime/avibactam, and telavancin all carry precautionary statements for reduced clinical response...

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Bibliographic Details
Published in:Clinical infectious diseases 2019-04, Vol.68 (9), p.1596-1602
Main Authors: Crass, Ryan L, Rodvold, Keith A, Mueller, Bruce A, Pai, Manjunath P
Format: Article
Language:English
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Summary:Abstract Antibiotic renal dose adjustments are determined in patients with stable chronic kidney disease and may not translate to patients in late-phase trials and practice. Ceftolozane/tazobactam, ceftazidime/avibactam, and telavancin all carry precautionary statements for reduced clinical response in patients with baseline creatinine clearance of 30–50 mL/min, potentially due to unnecessary dose reduction in the setting of acute kidney injury (AKI). In this review, we discuss the regulatory landscape for antibiotics eliminated by the kidney and highlight the importance of the first 48 hours of therapy. Using a clinical database, we identified AKI on admission in a substantial proportion of patients with pneumonia (27.1%), intraabdominal (19.5%), urinary tract (20.0%), or skin and skin structure infections (9.7%) that resolved by 48 hours in 57.2% of cases. We suggest that deferred renal dose reduction of wide therapeutic index antibiotics could improve outcomes in patients with infectious diseases. Renal dose adjustments are determined in healthy individuals with chronic kidney disease. Empirical antibiotic dose reductions for renal impairment in trials and practice may frequently be premature due to a high prevalence of transient acute kidney injury in infected populations.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciy790